Misery The Armed Zone
The armed conflict that swept eastern Ukraine in 2014 and is still ongoing displaced close to a million people, who fled the fighting. Among those left behind, trapped in the war zone, were those too frail, too sick, or too poor to flee. Many spent months hiding from shelling in dark, damp basements, with little food and practically no medical aid as explosions shook the world outside.
Misery The Armed Zone
When experiencing armed conflicts and forced migration, women face significant challenges related to changed living conditions and are exposed to health-related consequences. Consistently, women are targets of severe structural and personal violence, while lacking access to even the most basic healthcare services. Despite facing considerable hardships, these women display extraordinary resilience and endurance by finding strength through social support and internal resources. Synthesized qualitative research illustrates that women value social support, including peer support, which is a promising intervention that needs to be evaluated in future experimental studies.
Violence against women is an extensive global public crisis permeating socio-demographic variables and transcending national borders . Displaced women and women living in the aftermath of an armed conflict are at an increased risk of experiencing physical, mental, and sexual violence [6,7,8,9,10,11,12]. When exposed to armed conflicts and/or forced migration, women suffer a wide range of severe short- and long-term health-related physical and psychological consequences. Repeatedly and uniformly, studies show a high risk of mental health burdens among refugee women, including symptoms of posttraumatic stress and depression [13,14,15,16,17]. Refugees also show a high prevalence of various serious non-communicable and communicable diseases, including diabetes, hypertension, and HIV [17,18,19,20]. Obstetric complications are also common, with higher rates of maternal and neonatal morbidity among forced migrants compared with non-migrant populations [17, 21,22,23,24]. Further complicating their health-related situation, reports suggest that women refugees experience unmet health needs and suffer structural inequalities in access to healthcare services , including reproductive health services [23, 25, 26]. Taken together, research indicates a situation where refugee women experience significant health-related consequences and mental health burdens when exposed to armed conflict, torture and/or forced migration.
While the hardships experienced by women were evident, some reports also describe positive effects of being exposed to armed conflict and/or forced migration. Gaining expanded responsibilities within the family was described, leading to empowerment, greater independence, and a capacity to challenge traditional gender roles [46, 48, 52, 62]. Another positive effect was strengthened relationships with family members and others in similar positions [47, 48, 54].
Having to migrate through illegal or legal routes and to live in displacement involved significant psychological distress, fears, and uncertainties [43, 45,46,47,48, 56, 59]. Women were reminded of the significant dangers to their lives when witnessing the death of others  and they needed to take responsibility for others (including children) during migration, leading to significant psychological distress [45, 51]. Being exposed to armed conflict and being forced to migrate involved a loss of identity, difficulties accepting their new identity, challenges when trying to adjust to the new context, and feeling grief or emptiness when missing or longing for their previous life [43,44,45,46, 52, 56]. Women living in refugee camps perceived the camps as unsafe and inhospitable with poor living conditions, associated with suffering [42, 43, 45, 55, 59] including anxiety, psychological distress, and fears [56, 59], intensified when the camp was close to armed conflicts .
During armed conflicts and forced migration, women and their daughters were at high risk of being subjected to sexual violence, including coercion, repeated rapes, and sexual harassment [39,40,41, 44, 46, 53, 55, 57,58,59, 61]. Soldiers and civilians used rape to humiliate and spread fear [40, 58, 59]. Pregnant women were considered particularly exposed to the risk of being raped . As a strategy to reduce the risk of being subjected to sexual violence, women were isolated from the outside world by others such as their husbands or decided to isolate themselves from public spaces and regular activities [38, 39, 42, 55, 61]. When exposed to sexual violence, women encountered a culture of silence, stigma and social exclusion [39, 40, 42, 44, 46, 55, 58]. They also had limited opportunities for induced abortion and legal support .
An important finding is the numerous interpersonal and intrapersonal resources women utilized to find strength and endure the hardships they experienced. Having social support contributed to enhanced resilience, while a lack of social support contributed to psychological distress and social exclusion. Previous studies suggest that social support can have a protective effect in war and may improve mental health in refugees [71,72,73]. Some studies have also shown promising results of group-based psychosocial interventions [74,75,76]. According to our findings, women engaged in social support that involved emotional, informational, and instrumental support. Interestingly, women utilized peer support, meaning they provided and received support from women in similar situations as themselves. Indeed, peer support interventions among refugee women have been suggested as relevant and effective interventions, potentially resulting in reduced social exclusion and mental health burdens . Besides social support, women also drew strength from faith and religion to endure the hardships they encounter during armed conflicts and forced migration. In line with these findings, studies have illustrated that religion is utilized by many refugees to facilitate coping with psychological distress [73, 78, 79]. Taken together, our review portrays the individual potential positive effects that social support and faith can have for refugees. Clinicians supporting these women should assess their individual resilience-building resources and explore how women can be empowered, including social support and faith. Our findings also highlight the need for more experimental clinical research aiming to enhance resilience and promote mental health among these women through social support and internal resources.
When experiencing armed conflicts and forced migration, women face significant challenges related to changed living conditions, gender-based violence, and health-related consequences. Consistently, women are targets of severe structural and personal violence, while lacking access to even the most basic healthcare services. Societal changes are needed to improve the protection and rights of women in these settings. Despite facing considerable trauma, these women display considerable resilience and endurance by finding strength through social support and internal resources. Synthesized qualitative research illustrates that women value social support, including peer support. Peer support is a promising intervention that needs to be evaluated in future experimental studies.
The North and South Kivu provinces are the epicenter of this disaster. Base of the biggest rebel faction (RCD Goma), disputed home of the Banyamulenge and other Tutsi in Congo, the provinces are the point of convergence of armed groups (Maï Maï, Interahamwe, Burundian rebels, Banyamulenge militias, RCD soldiers, Rwandan, Ugandan and Burundian soldiers). In South-Kivu, the Maï Maï, Interahamwe and FDD form a variety of alliances de facto supporting Kabila, fighting the Tutsi ethnic group, furthering their own cause against the regional regimes or committing acts of banditism. The lives of the Banyamulenge are being threatened or they risk to be expelled from the Congolese community. The RCD rebels have not been able to gain the acceptance of the population. The sheer number of actors and complex motivations, the barbarism and multitude of human rights violations and the constant exaction on the civilians by all sides have made this area a true mosaic of misery.
Over the past months, attacks on relief workers have sharply increased. Most organizations have given up these Territories or stopped their movements and the population is abandoned. Apart regular field visits from donors (USAID, ECHO), FAO and OCHA and a recent trip by UNHCR, no UN agency has been physically present in Uvira there since August 1998. Recently, only IMC, ICRC and Action against Hunger-USA had regular international staff presence. In June, a large part of their activities were suspended due to an ambush on an IMC vehicle. ACF-USA has just initiated a major dissemination campaign to help all the armed groups understand the principles and life-saving importance of humanitarian aid. At the same time, it demands unobstructed access to all those in need. ACF-USA intends to deploy again soon.
The "official" frontline separating Kabila and his international allies from the various rebels and their backers has remained fairly stable until the former unleashed a new offensive in July-August 2000. Behind rebel lines, the Kivu Provinces are the stage of a second front or rather a mosaic of different spin-offs and surrogates of the larger conflict. In south-Kivu, the Maï Maï, FDD, ex-FAR and Interahamwe converge in various changing alliances. It is usually unclear how they are structured and their motivation is blurred, from ethnic hatred and self-protection to political interest, financial gain and pure banditism. The RCD, Burundian and Rwandan forces each occupy the towns and villages in the Ruzizi Plains, along the Uvira-Bukavu road and south of Uvira upto Baraka parallel to the Lake Tanganyika shoreline. The road itself, the Ubwari peninsula, the Middle Plateaux and the edges of the High Plateaux are open game area for the Maï Maï, FDD and Interahamwe. In annex 1, the characteristics of these various armed groups are presented.