Sitting on a stone step, surrounded by wounded patients – bandaged women resting on the grass, children with dressings on various parts of their bodies playing with white blown-up rubber gloves, and men hobbling around the hospital gardens on home-made crutches – all I could think was that MSF really does bring the most extraordinarily dark aspects of humanity together with the lightest. Light reflected by humanity, compassion and bearing witness – simply being there by someone’s side.

And this witnessing is part of MSF’s charter, our principle of témoignage – to act as a witness and speak out, either in private or in public, about what we are seeing, in the hope of raising awareness and alleviating suffering. I have learnt that sometimes this is an unimaginable challenge, as we often have to negotiate our presence in a place with the very people we are speaking out against. And sometimes we are the only ones who have been there to see what is actually happening with our own impartial and neutral eyes.

But the spirit of speaking out is in MSF’s blood. And, in Tari, a lot of blood is shed. A lot. Not from armed conflict, or an epidemic, or a natural disaster. But from violence: widespread family and sexual violence, as well as general violence. Even the local dogs get caught up in the violence.

 This is Bambi. He had two of his legs ‘chopped’ and is now cared for under the loving wing of the international staff team at the hospital.

This is Bambi. He had two of his legs ‘chopped’ and is now cared for under the loving wing of the international staff team at the hospital.

And within this highly violent existence, two sections of the population suffer extortionately: women and children. They face “shockingly high levels of family and sexual violence, with rates of abuse estimated to be some of the highest in the world outside a conflict zone.

Within these hospital grounds in Tari, MSF set up a Family Support Centre, the only place where survivors can come to get free and confidential medical treatment after experiencing family and sexual violence. Over the few days I was there, we saw women arriving after being heavily beaten by their husbands, those about to give birth; one woman had been ‘chopped’ with a bush knife in the back of her head and on both hands as she tried to defend herself. ‘Chopped’ is a medical term in this region, and means being cut with a giant bush knife or machete. 

Other women and girls had been chopped: a 16-year-old chopped in the back of her head by her brother because she came home half an hour later than normal; others had missing fingers or chopped wounds all over their bodies, made by relatives or husbands; another had marks from beatings with a hot iron rod; and another was physically attacked by her stepsister.

Rape survivors came too: one as young as 13 and another suspected case of a five-year-old. The team offer mental health support and psychological first aid to these woman, as well as vital medical treatment. The team “speak out” in hushed and comforting voices, by simply saying; “Rape is rape”, “Physical abuse is illegal”, “Sexual abuse is illegal” and “We will help you”.

Erina Piawe is the triage nurse at the centre. She told me, “If this didn’t exist… the women would be in darkness; they wouldn’t know about the services being offered. They don’t know what rape is, or what violence is – they think it’s normal because they faced this with their parents or the community. That’s why violence is just continuously going on like this. But through the work we are doing here, we’ll see if there are some changes.”

The local women who run the centre with support from MSF also put themselves at risk to help these survivors. For they themselves have received threats from people in Tari for challenging the accepted normal occurrence of family and sexual violence. They know that speaking out takes courage. They endure it as part of their daily life.