السلام عليكم

1. السلام عليكم Rape in War Time:What We Really Know about the Situation in Syria? Dr: Dipl.-Psych. Jamal Khalil Sobeh Neurological Rehabilitation Clinic (NRK-Aachen) International Workshop at Hamburg University/KlimaCampus, 16-17 September 2013

2. Outlines Introduction Rape in War Time: Atrocities under research Syrian Revolution: Unspoken Atrocities Posttraumatic Stress: When Rape leaves its Scars! Occlusion

3. Introduction • The Story of a “nightmare”! • Rape: “as old as war itself”! • What is a Wartime Rape? • Why it´s important to deal with?

4. [ 1 ] Rape in War Time: Atrocities under research

5. History of Atrocities: Korea • More than 200.000 cases • By Japanese armies • Individual and mass pare

6. Europe under Nazi-Occupation • More than 2 Mill. Under German Control • Mostly in East Europe • Army Forces and SS-Units • Also in Concentration Camps

7. Germany under Occupation • more than 250.000 women and children! • mostly by “Red Armies”! • Trans-generation Trauma • The silent, old victims!

8. African Ware and Conflicts • Liberia, Sierra Leon, Rwanda, Sudan • In Rwanda (1994): more than 20.000 • By all groups of conflicts • Individual and mass pare

9. El Salvador under Suppression • More than 20.000 cases • Mostly by FMLN • As an effective Torture

10. Nightmare of Bosnia-Herzogvenia “Keep the good ones over there. Enjoy them“ Ratko Mladic • Between 25.000 and 50.000 Cases • By Bosnia Serp Army and Militias • Rape as an effective “War-Strategy“ • “Open Injury“

11. Syria: Unspoken Stories • Unspoken Atrocities • On-going “Drama” • On-going “Trauma”

12. What is a Wartime Rape? In General: • Involves the penetration of the mouth, vagina or anus by any object or bodily part • Is forced or non-consensual • Physical act of rape which perpetrated by an armed group during wartime

13. Misconceptions about Rape in War Time 1 Ubiquitous in War! 2 An African Problem! A Problem of Ethnis War! 3 More Common Among Rebel Groups than State Militaries 4

14. Misconceptions about Rape in War Time 5 Perpetrators Always Men! 6 Given Opportunity, Men Will Rape! Always Perpertrators by Combatants! 7 Victims Always Female! 8

15. Misconceptions about Rape in War Time Incidene Increasing, Decreasing, Steady! 9 Rape at High Prevalence a Strategy of War! 10 (Cohen et al., 2013; Wood, 2003; McKlevey, 2007)

16. [ 2 ] Syrian Revolution: Unspoken Atrocities

17. Syria was “stable” and “immune” to revolt! Interview with Wall Street Journal 31.01.2011

18. Syria: Republic of Fear and Shadows • Al-Assad Family from Founder to Inheritor • The Presented, who can sending E-mails! • Propaganda without borders! • The first Lady: A Rose in a dissert!

19. The hard way to freedom: • Children as “Spark” of revolution! • The Crackdown of Walls of Fear • Friday Demonstrations • Old wine in new battle: Brutality and War as a Policy! • From peaceful to armed Revolution

20. Recourses • Amnesty International • Human Rights Wach • UN-Reports • Journalist`s Reports‏ • NGOs (e.g. Save The Children) • The Syrian Network of Human Rights, and other Syrian • Activists on the Ground • Personal Contact, Friends and Observer

21. Sexual Violence and Rape The hard way to freedom: • Early reports in the first 6 months • Unknown number of cases!: (600 to 6000!) • Sexualisation of the conflict • Difficulties in Documentation • A Socio-Cultural Taboo

22. Systematic Review! Type of Conflict • Internal Conflict, with sectarian aspects • No sharp religious divides

23. Systematic Review! Characteristics of armed groups that perpetrate rape • Intelligence Forces • Shabeeha: Informal Militia • Syrian Armed Forces • Clear command Structure • No evidence for order • High level of “toleration” by commandants

24. Systematic Review! Motivation of perpetrating rape • Brutalization of the population • A tool of Torture • Sectarian Cleaning! (evidence from Homs!) Characteristics of the Rapists • Not so clear • Members of security and Intelligence forces (more than 95%) • No evidence for committing by Rebels (less than 1%)

25. Systematic Review! Characteristics of the raped Individuals • Mostly Muslim Sunni! • Activists and relatives of activists • Woman and Children (more than 90%), Men (Cases unknown!) Characteristics of the rape • Mostly in Detention Centres, and at homes! • Mostly witnessed by other detainees • High level of Brutality

26. [ 3 ] Posttraumatic Stress: When Rape leaves its Scars!

27. The Traumatic Event: Just imagine (presentation a shot Video)

28. Means of Trauma • Emotional or psychological injury, resulting from an extremely stressful or life-threatening situation • “normal” response to “abnormal” Situation!

29. Traumatic Events • Natural Disasters • Car accidents • Armed Conflicts and Wars • Terrorism • Domestic Violence • Torture • Rape

30. Features of Traumatic Event • Sudden or unexpected • The shocking nature of such events • Death or threat to life or bodily integrity Feeling of

31. Types of Traumatic Event Trauma Typ-I Trauma Typ-II • Natural disasters • Unitary • Short term Effect • Human-made Disasters • Multiple • Long-term Effect

32. Rape as a Special Form of Traumas • Its not a merely “unwanted” Sex • High Risk for developing PTSD • Long-term consequences • Gender-oriented Crime

33. Trauma and Mental Disorders Post Traumatic Stress Disorder PTSD Traumatic Event

34. Clinical Symptoms of PTSD Ca. 5-10 % will develop Symptoms of PTSD after traumatic events More than 80% of Rape victims Intrusive or Re-experience Symptoms Persistent Avoidance Persistent Arousal Dissoziation!

35. Problems usually come Together! • Comorbidity in more than 87% • Major Depression (70%)‏ • Anxiety Disorder (50-70%)‏ • Sleep Disturbances (60%)‏ • Somatoform Disorders (35%)‏ • Addiction and Abuse (40%)‏ • Others (25%)

36. Risk Factors of PTSD

37. Rape as a Social Impact • Dishonoured to the whole family • Social Stigma • Lose of social support • From “Personal” to “Social”!

38. Neuropsychology of Trauma Neuropsychology studies the structure and function of the brain related to specific psychological processes and behaviours (Attention – memory – perception – language – personality - & motor functions) ‏ (Sturm & Zimmermann, 2001; Posner & Raichle, 2004; Petermann et al., 2006)‏

39. Neuropsychology of Trauma Regions of interest Amygdala (Emotional Memory)‏ Thalamus (centre of information)‏ Prefrontal cortenx (Cognitive Control & Appraisal)‏ Hyppocampos (Learing and declarative Menory)‏ HPA-Axis Hypothalamic-Pituitary-Adrenal Brain Stem (Regulation of Arousal & Attenion)‏

40. Fight or Flight Stress Response in Threat and Danger Dissoziation

41. The Traumatic Memory Implistic Memory Amygdala, automatic, emotional Explistic Memory Hippocampus: integrated, realistic Rape as a Trauma: Automatic, implicit storage in the Amygdala without explicit processing in Hippocampus Types of Memory (Bering, 2006; Grawe, 2004; Engels, 2002; Nyberg, 2005; Vasterling, 2002; Pitman et al., 2006)‏

42. Hypo-Activity in prefrontal Cortex • Inhibition of Processing in Hippocampus PTSD an multiple Dysfunktionen No control on Flashbacks or “Triggers”, No Integration of the event (Bering, 2006; Grawe, 2004; Engels, 2002; Nyberg, 2005; Vasterling, 2002; Pitman et al., 2006)‏

43. Neuropsychological Impact Disorder of Attention Functions Memory Problems

44. [ 4 ] Conclusion • Syria is not an “Exception”! • What Can be done? • Hope is the last who die!

45. Phan Thi Kim Phuc

46. الأمل ليس بالقناعة بأن عملا ما سيفضي إلى نتيجة إيجابية، بل هو ذلك الإعتقاد بأن القيام بهذا العمل له معنىً بحد ذاته، بغض النظر عن النتائج التي سيفضي إليها فاتسلاف هافل Hoffnung ist nicht die Überzeugung dass etwas gut ausgeht, sondern die Gewissheit, dass etwas Sinn hat, egal wie es ausgeht. Vaclav Havel

47. شكراً جزيلاً لِحُسْنِ انتباهكم Thank you for your attention Danke für Ihre Aufmerksamkeit