[Skip to Content]
Sign In
Individual Sign In
Create an Account
Institutional Sign In
OpenAthens Shibboleth
[Skip to Content Landing]
Letter From Monrovia
February 25, 1998

Violence Against Women During the Liberian Civil Conflict

Author Affiliations

From Women's Rights International, Laramie, Wyo, and the School of Public Health, Boston University, Boston, Mass (Dr Swiss); the Department of Psychology, University of Wyoming, Laramie (Dr Jennings); and the Women's Health and Development Program, Mother Patern College of Health Sciences, Don Bosco Polytechnic, Monrovia, Liberia (Ms Aryee, Brown, Jappah-Samukai, Kamara, Schaack, and Turay-Kanneh).

 

Edited by Annette Flanagin, RN, MA, Associate Senior Editor.

JAMA. 1998;279(8):625-629. doi:10.1001/jama.279.8.625
Context.—

Context.— Civilians were often the casualties of fighting during the recent Liberian civil conflict. Liberian health care workers played a crucial role in documenting violence against women by soliders and fighters during the war.

Objective.— To document women's experiences of violence, including rape and sexual coercion, from a soldier or fighter during 5 years of the Liberian civil war from 1989 through 1994.

Design.— Interview and survey.

Setting.— High schools, markets, displaced persons camps, and urban communities in Monrovia, Liberia, in 1994.

Participants.— A random sample of 205 women and girls between the ages of 15 and 70 years (88% participation rate).

Results.— One hundred (49%) of 205 participants reported experiencing at least 1 act of physical or sexual violence by a soldier or fighter. Survey participants reported being beaten, tied up, or detained in a room under armed guard (17%); strip-searched 1 or more times (32%); and raped, subjected to attempted rape, or sexually coerced (15%). Women who were accused of belonging to a particular ethnic group or fighting faction or who were forced to cook for a soldier or fighter were at increased risk for physical and sexual violence. Of the 106 women and girls accused of belonging to an ethnic group or faction, 65 (61%) reported that they were beaten, locked up, strip-searched, or subjected to attempted rape, compared with 27 (27%) of the 99 women who were not accused (P≤.02, .07, .001, and .06, respectively). Women and girls who were forced to cook for a soldier or fighter were more likely to report experiencing rape, attempted rape, or sexual coercion than those who were not forced to cook (55% vs 10%; P≤.001, .06, and .001, respectively). Young women (those younger than 25 years) were more likely than women 25 years or older to report experiencing attempted rape and sexual coercion (18% vs 4%, P=.02 and .04, respectively).

Conclusions.— This collaborative research allowed Liberian women to document wartime violence against women in their own communities and to develop a unique program to address violence against women in Liberia.

DOCUMENTING RAPE, which is difficult in peacetime,1 is even more challenging during war. Members of the international medical community can share their skills in conducting research to help strengthen a local community's ability to document rape during war.2 Using this collaborative approach, the community members who lived through the experiences themselves define the issues, conduct the research, and keep the data.

In this article, we report some of the results of a survey conducted in Monrovia, Liberia, by a collaborative team of Liberian health care workers and a US physician. The purpose of the survey was to document women's reproductive health needs and their experiences of violence, including rape and sexual coercion, from a soldier or fighter during the first 5 years of the Liberian civil war. The data on reproductive health are not included in this article.

BACKGROUND

The Liberian civil conflict began in December 1989 when the National Patriotic Front of Liberia, led by Charles Taylor, crossed into Liberia from the Ivory Coast to overthrow the government of Samuel Doe (Figure 1). Ethnic tensions that had increased under Doe's rule fueled the fighting. Ten months after the war began, Doe was dead, a regional peacekeeping force was in Monrovia, and the National Patriotic Front of Liberia had been pushed out of Monrovia. During the war, there were 7 different fighting groups, including the former government's Armed Forces of Liberia. Monrovia, under the relative protection of a peacekeeping force after August 1990, was, nevertheless, under attack from July to November 1990, October 1992, and April 1996. In July 1997, Charles Taylor was elected president, ending more than 7 years of civil conflict.3

Image description not available.
Liberia and its neighboring countries in West Africa.

Nearly half of Liberia's 2.5 million people were forced to flee their homes at least once during the civil conflict,4 giving Liberia the largest percentage of refugees and internally displaced people of any country in the world. Liberians who fled to Monrovia lived in and traveled through parts of the country that were under the control of 1 or more factions before they reached Monrovia and the relative protection of a West African peacekeeping force.

In 1994, when this survey was conducted, more than 500000 people were living in Monrovia. The survey sample included 205 women and girls between the ages of 15 and 70 years selected from 4 settings: high schools, markets, displaced persons camps, and urban communities in Monrovia. We are releasing the data at this time because the July 1997 elections in Liberia ended the civil conflict.3

METHODS
Survey Design

The Liberian members of the research team represented 5 ethnic groups and 3 religious backgrounds, and they spoke 9 ethnic languages among them. The team began their work by defining violence against women, a subject that was not openly discussed in Liberia before the war. The team chose wartime violence against women by soldiers or fighters as the subject of their survey because the public nature of the violence against women during the war made it possible for many Liberians to begin to speak openly about it.

Before developing the survey, the team met in small groups with more than 100 women and girls in Monrovia to learn what they had experienced during the war. The team selected discussion group sites that would reflect the experiences of women from different age groups, religions, levels of education, economic status, and rural or urban communities. The discussion groups were held at high schools, churches, mosques, markets, and displaced persons camps. Contrary to cultural tradition, women in the discussion groups were willing to speak about the sexual violence they had experienced during the civil war.

The survey was written in Liberian English in the words used by Liberian women themselves. Because the team learned from the discussion groups that there was no commonly understood word for rape, they developed survey items using words referring to forced sex that were more commonly understood to mean rape. Attempted rape by a soldier or fighter was defined as an attempt to force sex using physical force. In the discussion groups, women had reported experiencing several types of sexually coercive relationships that they were forced into because of the war. Sexual coercion was defined as being forced into a sexual relationship with a soldier or fighter because of wartime conditions to feed oneself or one's family, to get shelter or clothing, or for protection and safety. Soldiers were defined as armed combatants serving the former government's Armed Forces of Liberia; fighters were defined as armed combatant members of any of the warring factions.

The validity of the survey items was established by interviewing a sample of 8 women between ages 18 and 60 years. For each item referring to rape and sexual coercion, the woman was asked to describe what the item meant. The team also tried to ensure that the interview did not violate any cultural traditions that would prevent them from obtaining accurate data. For example, each of the team members knew that it was inappropriate for a younger woman, even a woman in her 50s, to ask an older woman any questions about sex. The interviewers preceded each question about sex with the traditional phrase denoting respect, "Excuse me, Ma." At the end of the interview, the interviewer asked the woman whether any of the survey questions had been inappropriate. After validating the survey items, the team pretested the survey with 14 women living in a displaced persons camp and 12 women living in a community. The pretest sites were not included in the final sampling plan.

Sampling Techniques

The team selected 9 different survey sites to maximize representation: 3 high schools (government, private nondenominational, and private religious); 2 markets where the women marketeers would have crossed into different regions of the country to buy goods and encountered different fighting factions; 2 displaced persons camps that received women from different regions of the country; and 2 urban communities (1 that was densely populated, ethnically diverse, impoverished, and tended to receive displaced women and 1 that was less densely populated, homogeneous, affluent, highly educated, and from which women tended to be displaced). The minimum age for interviewees was 15 years. Girls who were 15 years old at the time of the interview would have been 10 years old when the war began.

Because word of the survey and its contents would quickly spread within a community, it was important to complete the entire sample of a given site in 1 day to ensure that the interviewee had not had previous exposure to the survey's content. The general sampling plan at each site consisted of 3 steps: (1) determine the size of the sampling population, (2) compute the sampling interval by dividing the population size by the number of surveys the team could complete in 1 day (n=24), and (3) select a member of the population at each sampling interval. In the high schools, individual girls were selected. In the markets, the sampling unit was a market table. In the displaced persons camps and the urban communities, the sampling unit was a household.

The team derived a sampling plan for the high schools by obtaining, from the teachers, the number of girls in attendance that day in grades 9 through 12. The sampling was done publicly so that everyone knew that the girls had not been selected because of any particular wartime experience, thereby preventing any stigma that might have been attached to being selected to participate in a survey about sexual violence.

The market sites were the only locations where a number of women refused to participate. The 6 interviewers received 25 refusals (38%) from 65 women they approached in the markets. The large number of refusals was most likely due to problems with the sampling strategy at the markets. At the first market site, the entire team visited the market as a group and counted the tables together. Some of the market women became concerned that the information they gave on the survey would have a negative effect on the amount of relief food they received.

This problem was corrected at the second market site where only 1 team member visited the market and drew a detailed map of the location and number of tables. The sampling interval was computed and specific tables were randomly selected from this map. Because lotteries were common in Liberia before the war, the team made colorful "lucky tickets" for the tables that had been randomly selected. After introducing herself to a marketeer, the team member placed the ticket on the table, saying, "lucky ticket," and invited the woman to participate in the survey.

Another problem with the sampling strategy in the markets was that when an interviewer received a refusal at a market table, she would then approach the next table to the right. Twenty-two of the 25 refusals were from 3 series of tables right next to each other. Because the market tables are in a crowded open space, the women who refused would have been aware that the woman at the table before her had refused as well.

Participation rates at the other settings were remarkably high. The 6 interviewers approached 167 women in the high schools, displaced persons camps, and urban communities, and they received only 2 refusals (1%). Overall, the total participation rate in the survey was 88% (205 of 232).

Sampling in the communities and in the displaced persons camps was facilitated by the availability of food distribution census data. The civil war isolated Monrovia from the rest of the country and created a situation where everyone in the city, as well as in the displaced persons camps, was forced to rely on food relief. Every household structure, therefore, was marked for food distribution. The team was able to obtain the household data from the nongovernmental organizations distributing food. As is common in situations where food relief is provided, the census data on the total number of people in each household were inflated. The data on the number and location of heads of households, however, were accurate. Once the sampling interval was computed from the household data, the team selected a starting household at random using the last 2 digits of the serial number on a Liberian $5 bill chosen at random.

Interview Procedure

The interviews were conducted in the best available private spaces. Each interview began with an explanation of the purpose of the survey and a request for verbal informed consent to participate in the survey. The participants were told that the purpose of the survey was to find out "what women went through during the war . . . to prepare training materials for health workers that will help them provide better care to women because they are aware of what women have gone through." The team did not offer any financial or other incentive to the participants.

The informed consent procedure was conducted verbally to ensure confidentiality. Confidentiality of the survey data was protected in several ways. None of the participants' names were asked for or written down, all surveys were numbered and accounted for in the field and in the office, and a special deadbolt lock was made for the filing cabinet where the surveys were stored.

The survey was structured with the questions about rape and sexual coercion appearing near the end of the survey, after the interviewer had the opportunity to establish rapport with the participant. The interview concluded with a set of open-ended questions that were not submitted for statistical analysis. These questions served as an immediate cross-check for the interviewer, and provided an opportunity for the participant to discuss her reaction to the survey.

Data Analysis

At the end of each day, the team members proofread each survey for accuracy, clarity, and completion. After all 205 surveys had been completed, the responses for each survey were transferred onto a coding sheet that was used for double-entering data into statistical analysis programs on a computer.5,6 Descriptive analyses were performed to assess the prevalence of physical and sexual violence and coercion among the women in this survey. A χ2goodness-of-fit test was used to analyze differences between groups, using a liberal α criterion level of .10.

RESULTS

Of the 205 women and girls surveyed, 100 (49%) reported experiencing at least 1 act of physical or sexual violence from a soldier or fighter during the years 1989 through 1994 (Table 1). Thirty-four (17%) of those surveyed reported being beaten, tied up, or locked up (detained in a room under armed guard) by soldiers or fighters. Sixty-six (32%) reported that they had been strip-searched 1 or more times. Thirty-one (15%) reported that they had been raped, subjected to attempted rape, or sexually coerced by soldiers or fighters. In addition, 87 (42%) reported witnessing a soldier or fighter kill or rape someone else.

Table 1.—Number of Women Reporting Physical and Sexual Violence and Coercion
Table 1.—Number of Women Reporting Physical and Sexual Violence and Coercion
Image description not available.

Twenty-nine (14%) women reported experiencing more than 1 type of violent act. The data reported here represent the number of women reporting each type of violent act.

Women and girls who were accused of belonging to a particular ethnic group or fighting faction (n=106) were at greater risk for physical and sexual violence than those who were not accused (n=99) (Table 2). Of the 106 women and girls accused of belonging to an ethnic group or faction, 65 (61%) reported that they were beaten, locked up, strip-searched, or subjected to attempted rape, compared with 27 (27%) of the 99 women who were not accused (P≤.02, .07, .001, and .06, respectively). In addition, 23 (22%) of the women accused of belonging to an ethnic group or faction experienced more than 1 violent act, compared with 6 (6%) of the women who were not accused (P=.003).

Table 2.—Number of Women Reporting Physical and Sexual Violence and Coercion, by Whether She Was Accused of Belonging to a Particular Ethnic Group or Fighting Faction
Table 2.—Number of Women Reporting Physical and Sexual Violence and Coercion, by Whether She Was Accused of Belonging to a Particular Ethnic Group or Fighting Faction
Image description not available.

Women younger than 25 years at the time of the survey (n=105) were more likely than adult women aged 25 years or older (n=100) to report having experienced attempted rape and sexual coercion by soldiers or fighters (Table 3). Nineteen (18%) of those younger than 25 years reported experiencing attempted rape or sexual coercion, compared with 4 (4%) of adult women (P=.02 and .04, respectively). Adult women, however, were more likely than young women to be tied up or strip-searched. Forty-eight (48%) of adult women reported being tied up or strip-searched, compared with 21 (20%) of the young women (P=.10 and .001, respectively).

Table 3.—Number of Women Reporting Physical and Sexual Violence and Coercion, by Age Group
Table 3.—Number of Women Reporting Physical and Sexual Violence and Coercion, by Age Group
Image description not available.

Women and girls who were forced to cook for a soldier or fighter (n=22) were at a greater risk for sexual violence and coercion than those who were not forced to cook (n=183)(Table 4). Twelve (55%) of the 22 women and girls who were forced to cook for a soldier or fighter reported experiencing rape, attempted rape, or sexual coercion, compared with 19 (10%) of the 183 women and girls who were not forced to cook (P≤.001, .06, and .001, respectively). Eighteen (82%) of the 22 women who were forced to cook reported that they had been locked in a room under armed guard or strip-searched, compared with 69 (38%) of the 183 women and girls who had not been forced to cook (P=.05 and .02, respectively).

Table 4.—Number of Women Reporting Physical and Sexual Violence and Coercion, by Whether She Was Forced to Cook for a Soldier or Fighter
Table 4.—Number of Women Reporting Physical and Sexual Violence and Coercion, by Whether She Was Forced to Cook for a Soldier or Fighter
Image description not available.
COMMENT

During the first 5 years of the recent Liberian civil conflict, nearly half the women and girls in this survey reported being subjected to at least 1 act of physical or sexual violence by soldiers or fighters. Being accused of belonging to a particular ethnic group or fighting faction was a significant risk factor for physical violence and attempted rape. Young women (those who were younger than 20 years when the war began) and women of any age who were forced to cook for a soldier or fighter were particularly at risk for sexual violence. Women who were aged 20 years or older when the war began were at greater risk for being tied up or strip-searched.

In the beginning of the Liberian civil conflict, the government army and fighting factions were divided primarily along ethnic lines. It was common for civilians, when confronted by a soldier or fighter, to be forced to identify their ethnic group by speaking their ethnic language. In our survey, those women who were confronted by a soldier or fighter and accused of belonging to an enemy ethnic group or fighting faction were more likely to experience violence. Our sample did not include significant numbers from the 4 main ethnic groups involved in the early fighting. Although we do not have the data that would tell us whether women of those ethnic groups were at greater risk than other ethnic groups, we did find that violence against women crossed all the 15 ethnic groups in our sample.

During the civil conflict in Liberia, when women crossed checkpoints or when fighters took control of a village, some women were forced to cook for a soldier or fighter. The results of the survey showed that, as reported in the small group discussions by the Liberian women, being forced to cook for a soldier or fighter was associated with being subjected to his control in a variety of ways including sexual violence.

Limitations

Rape is underreported in peacetime, and, when using survey-based interviews, it is difficult to get full disclosure of rape.1 In addition to the possibility that rape by combatants was underreported in this survey, the prevalence of sexual violence reported does not reflect all incidents of sexual violence experienced by women during the war. The survey asked about sexual violence only by soldiers or fighters, not by civilians.

The sample of women and girls who participated in this survey was not representative of the entire country of Liberia. After August 1990, Monrovia was under the relative protection of a West African peacekeeping force. The participants in our survey who stayed in Monrovia throughout the war were exposed to fighting within Monrovia for about 7 months during 1990 and 1992. Rural areas outside Monrovia were fought over and controlled by a number of different factions during the war. The prevalence of rape and sexual coercion by a soldier or fighter in rural areas may have been higher than what we found in our survey of women and girls in Monrovia.

While these considerations address the possibility that the prevalence of rape by soldiers or fighters during the Liberian conflict may have been higher than reported in our survey, it is important to recognize the scale of sexual violence this study documents in Monrovia during the first 5 years of the civil conflict.

Conducting Research in a War-Torn Environment

Documenting violence against women in a country in the midst of war presented many challenges. Protecting the personal safety of the research team members and survey participants was a challenge because both random and targeted acts of violence were a genuine risk. Protecting the confidentiality of the data was crucial for preventing the possibility of retaliatory violence, but was made more difficult because heavy munitions and looting made typically reliable physical security devices (eg, walls, locked doors, steel deadbolt locks) practically useless. The logistics of survey design and sampling were complicated by the unpredictable nature of war. In addition, the team worked under a military curfew that limited their working hours and made travel difficult and sometimes risky.

The team took precautions to ensure that interviewing a woman did not put her at a greater risk for harm than she already experienced in her daily life. The participants' safety was somewhat protected by the fact that the main topic of the survey was women's health. In addition, although the public random selection process may seem contradictory to protecting the participant's anonymity, it protected participants from the perception that they were being chosen to report a specific experience. The interviewers purposely did not ask for identities of fighting factions or details of when and where the violent events occurred.

Precautions were also taken to protect the safety of the Liberian members of the team. They were provided some measure of protection because as health care workers they were respected by members of the community. In addition, team members were careful to keep a low profile particularly because they crossed checkpoints in the course of their work. They traveled inconspicuously in an old station wagon and were able to prevent any of the surveys from being confiscated at checkpoints.

Ensuring that the survey data remained with the local research team was difficult. For example, in 1996 a rocket-propelled grenade came through the wall of the team's office in Monrovia. No one was in the office at the time. The hole in the wall, however, was large enough to admit soldiers or fighters who looted everything in the office, including breaking the deadbolt lock on the filing cabinet. Although all of the team's equipment was stolen, the surveys were merely strewn on the floor of the office as it was ransacked. The team was later able to collect the surveys and move them to a safer location.

CONCLUSION

The collaboration between Liberian health care workers and US researchers to document violence against women served several goals. First, it legitimized discussions about violence against women by putting it under the domain of health.

Second, the survey project was a consciousness-raising tool for the Liberian team members. As they wrote, tested, and conducted the survey, their own understanding of violence against women broadened to include acts that some had not previously considered violations of their rights (eg, domestic violence). In addition, the Liberian team members report that the survey has given them confidence to work toward social change.

Third, this collaborative research led to the development of a unique program using role-playing and storytelling to address violence against women in Liberia. Rural traditional birth attendants have used these stories to help organize women in their communities to stop violence against women. In addition, after analyzing the results of their survey, the team members created stories that will be used to communicate the survey results to rural women who cannot read.

Fourth, the survey allowed Liberian women to document wartime violence against women in their own communities. To help focus attention on violence against women in situations of armed conflict at the international level, the United Nations Special Rapporteur on Violence Against Women will present the Liberian survey results to the United Nations Commission on Human Rights, in her 1998 report.7

References
1.
Koss MP. Detecting the scope of rape: a review of prevalence research methods.  J Interpersonal Violence.1993;8:198-222.
2.
Swiss S, Giller JE. Rape as a crime of war: a medical perspective.  JAMA.1993;270:612-615.
3.
 Liberia: Emerging From the Destruction.  New York, NY: Human Rights Watch/Africa; 1997.
4.
 West Africa-Displaced Persons.  Washington, DC: Office of US Foreign Disaster Assistance, Agency for International Development; March 14, 1991. Situation Report No. 17.
5.
 Epi Info [computer program]. Version 6. Atlanta, Ga: Centers for Disease Control and Prevention; 1994.
6.
 SPSS [computer software]. Version 6.1. Chicago, Ill: SPSS Inc; 1995.
7.
 Report of the Special Rapporteur on Violence Against Women, Its Causes and Consequences.  Geneva, Switzerland: United Nations Commission on Human Rights (in press); United Nations document E/CN.4/1998/54.
×