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.
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,
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
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.
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
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
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.
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
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.
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
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.
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.
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).
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).
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).
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.
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.
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
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.
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
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
Swiss S, Jennings PJ, Aryee GV, Brown GH, Jappah-Samukai RM, Kamara MS, Schaack RDH, Turay-Kanneh RS. Violence Against Women During the Liberian Civil Conflict. JAMA. 1998;279(8):625-629. doi:10.1001/jama.279.8.625