The Red Line Initiative: a joint call to draw a red line to end conflict-related sexual violence

Together, the International Federation of Gynecology and Obstetrics (FIGO) and the Dr. Denis Mukwege Foundation have published a joint editorial in the International Journal of Gynecology and Obstetrics (IJGO).¹ Authored by Dr Denis Mukwege and Dr Jeanne Conry, the article calls on health professionals to speak out and join the campaign to end the use of sexual violence as a weapon of war.

FIGO and the Mukwege Foundation recognise that decades of work have been put into efforts seeking to end conflict-related sexual violence (CRSV) and that a great deal of important progress has been made.² Despite these efforts, CRSV continues to be widespread and systematic in many conflicts: it causes horrific devastation to survivors, their families and communities and harm lasting over generations. From the Democratic Republic of Congo, Colombia, Nepal, Libya, Iraq, Myanmar and Ethiopia to Ukraine, the unavoidable reality is that CRSV continues to be accepted by too many as an unfortunate, but unpreventable, part of armed conflict. It is time to create a movement to demand change, and to build and sustain the moral imperative on states to act.

Creating focused action

The Mukwege Foundation has been hard at work translating Dr Mukwege’s call to draw a red line against CRSV into a concrete agenda to change the current unacceptable status quo. The Red Line Initiative was born from these efforts.³

The Red Line Initiative aims to create focused action needed to address this systemic problem and to establish a clear legal framework for strong and timely action by. It has three core aims:

• Evoke a clear moral rejection and outcry against the use of CRSV in all its forms, including as a method of warfare.
• Strengthen and clarify the legal obligations on states to prohibit the use of sexual violence in conflict, prevent and punish it, as well as to repair the harms it causes.
• Build political will to ensure a more robust and timely response by states in line with their international obligations.

The Red Line Initiative is rooted in the belief that CRSV represents a violation of our shared humanity that must be prioritised as a wholly unacceptable tactic that has no place in modern warfare.

Effecting change as health care professionals

The responsibility of health professionals – who confront the scourge of CRSV – must go beyond repairing the consequences of these heinous crimes on the bodies of women and girls. Therefore, FIGO and the Mukwege Foundation are calling for bold and new thinking to finally put an end to the wholly unacceptable use of sexual violence as a weapon of war.

The plea is borne out of a deep frustration with the decades-long failure of the international community to realise its commitments to put an end to the use of CRSV and the continued horrific devastation and damage that CRSV causes to survivors and society as a whole.

The importance of addressing this issue comprehensively cannot be overstated. CRSV destroys family ties, communities and social norms. It inflicts harm over generations – for example through HIV transmission, the rejection of children born of rape, and collective psychological trauma.^4,5,6 In some conflicts, 90% of the rapes are gang rapes, often in public or in front of family members, and the use of objects or weapons to rape is routine, resulting in injuries that are rarely seen outside the context of conflict.^7,8

Drawing a red line: our call to action

It is time to evoke the international outcry that conflict-related sexual violence deserves and to mobilise the global community to act.

As health care professionals, obstetricians and gynaecologists see first-hand the severe and often lifelong negative health consequences caused by wartime sexual violence.

Together, FIGO and the Mukwege Foundation call on members of the public health community – particularly obstetricians and gynaecologists – to come together in this fight. The voice of OBGYNs is needed, alongside those of survivors.⁹ The expertise of OBGYNs is needed. Together, it will be possible to achieve concrete, meaningful change so that war is no longer waged through the use of sexual violence.

Read the full article in the International Journal of Gynecology and Obstetrics to find out more about the Red Line Initiative and to answer the call to action.

Sign FIGO and the Mukwege Foundation's statement calling to draw a red line to end conflict-related sexual violence

---

References

1. Mukwege, D. and Conry, J.A. (2023), A call to action: Drawing a red line to end conflict-related sexual violence. Int J Gynecol Obstet. https://doi.org/10.1002/ijgo.14963

2. UN Security Council, Security Council resolution 1820 (2008), 19 June 2008, S/RES/1820 (2008). https://www.refworld.org/docid/485bbca72.html. Accessed March 5, 2023.

3. The Red Line Initiative: www.endcrsv.org  

4. Gingerich T, Leaning J. The use of rape as a weapon of war in the conflict in Darfur, Sudan. Harvard School of Public Health; 2004.

5. Corish M, Djeddah C, Usher-Patel M. Reproductive Health during Conflict and Displacement: A Guide for Programme Managers‘, p. 113. WHO; 2000.

6. Bartels S, VanRooyen M, Leaning J, Scott J, Kelly J. Now The World Is Without Me: An Investigation Of Sexual Violence In Eastern Democratic Republic of Congo. Oxfam international; 2010.

7. Hagen K, Yohani S. The nature and psychosocial consequences of war rape for individuals and communities. International Journal of Psychological Studies. 2010;2(2):14–25.

8. Mukengere Mukwege D, Nangini C. Rape with extreme violence: The new pathology in South Kivu, Democratic Republic of Congo. PLoS Medicine. 2009;6(12): 1-5.

9. SEMA Call to Action: www.endcrsv.org/call-to-action

Signatories

The following organisations have confirmed their support for the Red Line Initiative and this statement.

Africa Platform for Social Protection

American College of Obstetricians and Gynecologists

Asia and Oceania Federation of Obstetrics and Gynecology

Asociación de Ginecología de El Salvador

Asociación de Ginecología y Obstetricia de Guatemala

Associação Moçambicana de Ginecologistas e Obstetras

Associação Portuguesa de Diagnóstico Pré Natal

Association of Obstetricians and Gynecologists of Uganda

Austrian Society of Obstetrics and Gynecology

Baqai medical university

Belgian Association of Neonatologists  (=BVN = Belg Vereniging Neonatologie = GBN = Groupement Belge de Néonatologie)

Chilean Society of Obstetrics and Gynecology

Collège National des Gynécologues et Obstétriciens Français

Universidad de Cartagena, Cartagena, Colombia

Deutsche Gesellschaft für Gynäkologie und Geburtshilfe

Emirates Medical Association UAE

Estonian Gynecologists' Society

ETHIOPIAN SOCIETY OF OBSTETRICIANS AND GYNECOLOGISTS

European Board and College of Obstetrics and Gynaecology

European Network of Trainees in Obstetrics and Gynaecology

Federación Colombiana de Obstetricia y Ginecología

Federação das Sociedades Portuguesas de Obstetrícia e Ginecologia

Federacion Argentina de sociedades de Obstetricia y Ginecologia

Federación Ecuatoriana de Sociedades de Ginecología y Obstetricia

Federación Mexicana de Colegios de Obstetricia y Ginecología

Federation of Obstetrics and Gynecological Societies of India

Hellenic Society of Obstetrics and Gynecology

Hospital Gea Gonzalez

Institute of Obstetricians & Gynaecologists, Royal College of Physicians of Ireland

Japan Society of Obstetrics and Gynecology

Kenya Obstetrical and Gynaecological Society

KIT Royal Tropical Institute

Korean Society of Obstetrics and Gynecology

Latvian Association of Gynaecologists ans Obstetricians

Lithuanian Society of Obstetricians and Gynecologists

Maple Grove Gynecological Centre

Medicare Cardiac and General Hospital

Mothercare Gynae Clinic

Obstetrical & Gynaecological Society of Hong Kong

Obstetrical and Gynecological Society of Malaysia

Nairobi Hospital

Pakistan Medical Association Karachi

Panhellenic Society of Trainees in Obstetrics and Gynecology

Reproductive and Maternal Health Consortium Kenya

Royal College of Obstetricians and Gynaecologists

Royal College of Physicians in Ireland

Share-Net International

SOCIEDAD DE GINECOLOGIA Y OBSTETRICIA DE HONDURAS

SOCIEDAD PERUANA DE OBSTETRICIA Y GINECOLOGIA

Sociedade Portuguesa de Contraceção

Sociedade Portuguesa de Medicina da Reprodução

Società Itaiana di Ginecologia e Ostetricia (SIGO)

Société Africaine de Gynécologie-Obstétrique (SAGO)

Société Royale Marocaine de Gynécologie Obstétrique

Societé Portuguese Gynécologie

Society Of Gynaecologists and Obstetricians of Pakistan

Society of Obstetricians and Gynecologists of Canada

Sociedad Nicaragüense de Ginecología y Obstetricia

Sonya Clarissa Munoz Madrigal

South African Society of Obstetricians and Gynaecologists

South Asian Federation of Obstetrics and Gynaecology

Swedish Society of Obstetrics and Gynecology

Taiwan Association of Obstetrics and Gynecology

The European Society of Contraception and Reproductive Health

The Nairobi Hospital

The Obstetrical and Gynaecological Society of Hong Kong

VVOG, Vlaamse Vereniging voor Obstetrie en Gynaecologie

Wellbeing of Women

World Association of Trainees in Obstetrics and Gynecology

Youth Health Organization

Zambia Association of Gynaecologists and Obstetricians