medica mondialeSpecial issueContents• A new beginning in Kosovo – medica mondiale in Gjakova• Medica Zenica – continued involvement for seven years• medica mondiale Tirana: “I was the most persecuted of the persecuted “• Violence against women and international law• Asylum: from a victim of war to a deportee• How can trauma be addressed in women?• PR work and fundraising• Financial overview 1999

War is always violence against women

The events in spring last year, when the cold calculated madnessof the Milosevic regime broke over the Kosovon Albanians, killingmany people or forcing them to join the exodus, stirred us to ac-tion too. Simply lamenting the situation of Kosovor women andexpressing our solidarity to them in e-mails was no longerenough, as for years we had been receiving repeated reports ofsexualised violence under the system of ethnic apartheid. The suf-fering of the refugees, and what we knew about the violence in-flicted on women when such crises escalate, meant that we had tooffer the survivors tangible support. Unfortunately this apocalypse had to unfold before wemoved closer to Kosovo. Simply engaging in discussions justifying NATO’s intervention interms of international law seemed to us to be a luxury that could ill be afforded. We took thehelplessness that we felt on seeing the TV images and translated it into action, beginning tosupport refugee women in the camps in Tirana. When our clients returned to their destroyedhomeland in the immediate wake of the KFOR soldiers, we went with them. Since then wehave been establishing a women's therapy centre in Gjakova.

This was possible as financial backing was quickly forthcoming from those supporting usthrough donations and from the German Federal Ministry for Economic Co-operation headedby Heidemarie Wieczorek-Zeul. But we have no illusions – this work there will be needed formany years to come. As we believe the projects should become autonomous, take a long-term approach and be sustainable – local women will be taking responsibility in the futurefor the content and running of the work – we need to find the right pace for overall consoli-dation of this one-year-old project. This also involves constantly reviewing our goals andadapting the content of the project to changes where necessary. This is particularly true if wewish to respond to the traumatisation that war has caused for our staff from Kosovo.

Sustainable public support – just a demand or a reality?

In this context we will see to what extent state support, which is already being called intoquestion, reflects the need for a sustainable approach. Violence against women also servedto justify military intervention – now at least a fraction of the funds that were made avail-able for that intervention must be earmarked for psycho-social intervention.

It has long been clear that German deportation policy was set to turn into a debacle for Bos-nian and Kosovor refugees. They have had to return to face chaos in terms of infrastructureand no prospects for the future, without having had the peace and quiet needed to processat least part of their traumas. Germany could have afforded them an opportunity to heal thepsychological wounds suffered through human rights violations – through therapy, em-ployment or social contacts. Yet now deportation has once again ripped open the fragile scartissue forming over these wounds. In the words of an old woman, it was like being expelledall over again.

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This debacle also affects everyone living in Germany. A country that deals so inhumanelywith the survivors of genocide will also show no mercy within its own borders towards thosewho do not fit in, who are alien, incorrect. Violence is not the exclusive prerogative of theBalkans.

As a group specifically supporting women and girls, we are familiar with the feeling of beingrapidly excluded as a disruptive, unwanted element. However, the values and dignity of so-ciety as a whole always suffer when certain groups are marginalised.

This magazine brings together an overview of our most recent activities. We hope that thiswill interest you and would like to thank you for all your donations and for the various otherforms of support. At the same time, we have to call for your continued support and solidarity– for the survivors, who want to rebuild a new life in dignity, both in Germany and in theirhomeland.

Dr Monika HauserDirector

6 questions on medica mondiale

1. How did medica mondiale come into being?Through the commitment of Cologne gynaecologist Monika Hauser. In 1992, when she heardabout the systematic wartime rapes of Bosnian women, she decided to offer help on the spotas a doctor. She contacted various aid organisations but they showed little interest in her de-sire to focus specifically on women and girls. She therefore set up the women's therapy cen-tre, "Medica Zenica", in central Bosnia in spring 1993. The characteristic feature of the or-ganisation was its blend of (mobile out-patient and in-patient) gynaecological care, togetherwith psycho-social support/therapy, which is still a unique mix.

2. What does medica mondiale do now?We continue to finance "Medica Zenica", which now has 70 exclusively Bosnian staff and isrun independently of the Cologne office.

Since 1999, we have been working with women and girls in Gjakova/Kosovo through themedica mondiale Kosovo therapy centre. In the medica mondiale Tirana health and counsel-ling centre we support Albanian women, many of whom suffered violence and torture fordecades under the Hoxha regime. In Germany we call for a right to remain for women trau-matised by war. We also provide information on the structure of sexualised violence in warthrough publications, press reports, presentations, guest lecturer posts etc. Last but not least,we actively lobby nationally and internationally to promote the interests of women and girlstraumatised by war.

___________________________________________________________________________________________CreditsPublished by:medica mondiale e.V.Hülchrather Straße 450670 Cologne/GermanyTel: + 49 221 93 18 98 0Fax: +49 221 93 18 98 1info@medicamondiale.orgwww.medicamondiale.org

Account for donationsmedica mondiale e.VSparkasse BonnBank code 380 500 00Account number: 45 000 163

Editors (legally responsible for con-tent)Isabella Stock, Dr Monika Hauser

Photos:Christel Becker-Rau, Cologne,medica mondiale

Layout: Barbara Treumann, Co-logne

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3. Who works with medica mondiale?On the spot: doctors, nurses, midwives, psychologists... - in a nutshell, specialists from vari-ous spheres who are deployed on the basis of their qualifications and receive further trainingfrom us. Medica Zenica has 70 staff members and medica mondiale Kosovo has 35, whilst ateam of 8 is working in Tirana. There are currently 11 staff members working in the Cologneoffice. This is the nerve-centre from which we co-ordinate our projects abroad, collect dona-tions, lobby, liase with the press and do PR work, whilst also dealing with a broad range ofadministrative tasks.

4. Why does medica mondiale work only with girls and women?In addition to all the other kinds of suffering caused by war, it is still women and girls whosuffer additional gender-specific torture: sexualised violence. The traumata generated bythis are extremely severe. However, women generally do not receive support tailored to theirparticular situation, nor long-term psycho-social back-up and therapy.

5. How does medica mondiale finance its work?Mainly through donations. Since 1999 we have also received support from the German gov-ernment though the Agency for Technical Co-operation (GTZ), although this is initially onlyfor a limited period. Our key challenge is how to secure the long-term financing we need forour projects.

6. How can I support medica mondiale's work?You'll find a number of ideas on p. 15f of this magazine.

A new start in Kosovo

In summer 1999, just after the war in Kosovo had ended, Kosovor refugees returned to theirhomeland from the countries nearby that had offered them refuge. That meant that we alsomoved our work with Kosovor women from Albania to Kosovo. We were looking for a suit-able location for our project and decided to opt for Gjakova, a small town in the south-westthat had been more or less destroyed. Many reports of the most serious human rights viola-tions had filtered out from here. In addition to countless other acts of violence, women andgirls in Gjakova had also been subject to sexualised wartime violence. The "medica mon-diale Kosovo" project was one of the first aid organisations to start work in this region.

We rented an initial house for the project and Kosovor women were taken on as psycho-social counsellors and medical staff. In August the counsellors began to make home visits,thus starting to establish contact with traumatised women.

In parallel a training programme began with specialists from Germany and Bosnia-Herzegovina. Having succeeded in moving the mobile out-patient unit from Albania toGjakova in September, our team, lead by gynaecologist Dr. Kornelia Schönfeld, started pro-viding primary gynaecological care in the villages in the region and began to develop an in-patient unit in Gjakova.

Gisela Endel and Margrit Spindeler, who had previously established the project for refugeewomen in Albania, took charge of the psycho-social sphere and overall coordination.

Gynaecological fieldworkVisiting clients continues to be an important part of work inGjakova.

“I discuss everything that I do as a doctor with the patient,every examination, even every time I touch them. I onlystart conversations when the patient is clothed. Here any-thing intimate is taboo, so I have to be very careful.”

(Dr. Kornelia Schönfeld, gynaecologist with medica mon-diale Kosovo)

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Returning to the scene of the terrorThe women told us about what had happened when they were expelled and about theirflight. Most of them had witnessed human rights violations. Many of their male relatives hadbeen killed or carried off to Serbian prisons, where they are still detained.

However, at that time none of the women talked directly about sexualised violence. The sig-nals were clear and the indications quite unambiguous, but not one of the women was ableto talk about it. We were to learn that sexualised violence against women is extremely tabooin Kosovo, reflecting highly patriarchal social structures.

Stabilising the women's psy-chological state and developingstrategies with them for copingwith everyday life - two key as-pects of the work done bycounsellors.

The women from Gjakovahad returned to the scene ofthe terror, where in the firstinstance they had to re-establish their lives. In this

phase we therefore concentrated on stabilising the women's psychological state and devel-oping strategies with them for coping with daily life.

With the onset of the bitter winter cold in Kosovo, we began to focus more on providing hu-manitarian aid. We organised wood for fuel, ovens and warm clothing, and distributed food.

Domestic violence

From November on we were also faced with another manifestation of violence againstwomen. KFOR and UNHCR brought women who had survived severe domestic violence to us.We gave them a safe place to stay and provided health care for the women, along with psy-chological and legal assistance. We set up the "Women's Refuge Initiative" together with lo-cal women's organisations.

In December Annette Lyth, a Swedish lawyer, began to expand our work on documentationand legal aid. However we have put this project on ice for a while, as the women were not yetable to talk about the sexual violence they had experienced, and focussed subsequently onlegal advice and socio-political support.

In the medium term we will focus on consolidating our psycho-social work and developingthe inter-disciplinary advice centre. This will involve further training of Kosovor team mem-bers in trauma and psychosomatic disorders, as well as more training in project manage-ment and PR work.

Excerpt from an evaluation report by astaff member of the "Agency for TechnicalCooperation" (GTZ):

"They (the staff of medica mondialeKosovo, ed.) work very closely together inconfined spaces and some of the topicsthey deal with in this context cause realstrain and easily lead to exhaustion.

Nonetheless visitors find an atmosphere ofincredible harmony, which gives thewomen strength to overcome conflicts andenormous tenacity in doing their work. Iwould be so bold as to say that a group ofmen would be unable to work togetherunder such conditions. The women de-serve great respect for this achievement."

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Medica Zenica:Continued involvement for seven years

280 women are taking part in training coursesin 2000. Finishing the courses helps boost self-esteem and plays an important part in helpingtraumatised women to recuperate.

Medica Zenica 1999:61 women and 39 children lived in the Medicacentre49 children attended our crèche7,898 clients received medical treatment1,876 women visited the out-patient unit

24 hairdressers, 20 seamstresses, 17 upholster-ers and 8 machine knitters completed coursesin the training centre.

Much of the work done by our therapy centre in central Bosnia involved assistance to Koso-vor women and children, in parallel to our ongoing support to women from Bosnia-Herzegovina. Medica Zenica began an action programme for refugees from Kosovo andprovided medical and psychological assistance through the mobile gynaecological clinic andsupport team, particularly in the Rakovica and Lipa refugee camps. Some Kosovor womenand children were housed in the therapy centre.

"We were worried each and every time that offenders came to Zenica in search of their wivesand children. We were concerned about the woman in question and about all the women liv-ing in the centre. We were very concerned when one of the women threatened to commit sui-cide, or when young women left the house and didn't come back for 24 hours."

"We were furious when the culprits came to the centre drunk and violent time after time, whenfamily members refused support for the clients and blocked the healing process. We were furi-ous when other institutions showed no interest in doing work that fell very much within theirremit."

Mariana Senjak, psychologist at Medica Zenica

Furthermore, as a qualified advice centre, Medica Zenica became increasingly important inthe city and the region. A growing number of women visited the out-patient unit in Zenica.Women who had heard about Zenica through the SOS telephone hotline or through informa-tion campaigns asked us for support. The police, social workers, the hospital and the orphan-age referred survivors of rape and other forms of violence to Medica Zenica.

In 1999 Medica's gynaecologists, GP and internist treated a total of 4,522 women. The mobileout-patient clinic, "Martha" treated 972 women.

Sexual education and information on contraception and pregnancy are also important ele-ments in our work.

New training centre

The official inauguration of the new training centre for Bosnian refugee women in early Maywas a real milestone last year. Women will be trained as hairdressers, seamstresses and up-holsterers in the newly equipped and well-appointed rooms. Up to the end of 1999, 69women took part in officially recognised courses. In 1999 seven young women successfullycompleted their vocational training here. They also lived in the Medica centre while trainingand received extensive back-up from the Medica team.

This year Medica enabled 280 women to take part in four-month training courses. Not all ofthose who complete their training will find a job in Bosnia's ravaged economy, but success-fully completing their training increases the women's self-esteem and self-confidence, whichis vital to the healing process.

Broad interest in the "Infoteka" study

In 1999 the documentation and information centre focused on violence against women inthe post-war period. The "Infoteka" published a study on the extent of violence againstwomen in Zenica. The publication attracted a great deal of attention in central Bosnia. Wewere pleased to see a number of TV and radio reports on this taboo topic.

Together with Medica's psychologists,the "Infoteka" staff ran informationand awareness seminars on violenceagainst women. These were attendedby staff from the police force, the judi-ciary and various social institutions.This gave rise to a more pro-womenprotocol for procedures in cases ofrape and other forms of violence noti-fied to the authorities, which was develofice and Medica. A female psychologist ments from victims.

We are also co-operating increasingly wsuch as "Women Against Violence" and effect regionally in providing a better bato maintain the existing network of Serbvia during the Kosovo crisis.

Medica staff are also increasingly consulagainst women. This has included invitaexample in Vienna, and to run training c

Medica Zenica's work demonstrates clevision of a global network. The Bosniatraining courses for their Albanian Gjakova/Kosovo on counselling traumati

When we began to provide assistance towe also met a lot of Albanian women livisevere physical and psychological damagcivil wars, misogynist traditions and thunder Enver Hoxha's regime. That is whynia with medica mondiale Tirana.

Vera Kuca Dema is one of our clients.

"I was the

Vera Kuca munist regworst kindsand the tratheless one"Persecutedthis alliancthat "womeof the Nati1994.

Medica Zenica publications - "Infoteka 1999":• Study on violence against women in Zenica (in

English)• National NGO report on Women's Human

Rights in BiH (in English)• Manual for support teams working with survi-

vors of violence (in Bosnian)All of these publications are available through us.

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ped jointly by the police, the public prosecutor's of-is now always present when the police take state-

ith regional and international women's networks,"Women in conflict zones". This had had a positivesis to combat nationalism and thus made it possibleian and Kosovor female activists in former Yugosla-

ted in the international arena as experts on violencetions to our psychologists to attend conferences, forourses in Italy and Albania.

arly that medica mondiale has moved closer to ourn psychologists from Medica Zenica hold regularand Kosovor colleagues in Tirana/Albania andsed clients.

Kosovor women in Albanian refugee camps in 1999,ng in unbearable circumstances. They suffered frome due to the periods of unrest in the country, akin toe consequences of years of imprisonment suffered we are actively seeking to assist women from Alba-

most persecuted of the persecuted"

Dema* is one of the victims of Enver Hoxha's Com-ime. Now 67, she has experienced decades of the of torture and violence ever since she was thirteen,uma she suffered still affects her. Yet she is none- of the most active women in the Albanian NGO Women". In 1991 she was one of the initiators of

e of Albanian women, as she "had always known"n are stronger than men". She has been a member

onal Council Assembly of Persecuted Women since

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Ms. Dema, why do you call yourself the most persecuted of persecuted women?Vera Dema: Because I lived an infernal life for 45 years. My family was one of the first to beexpelled from their home. Because when I was thirteen I was held in custody for eightmonths and spent two years in prison and lived through many years of imprisonment andhumiliation after that.

Why?Because of class struggle. My father had studied at the Academy of Vienna as an officer. Hewas imprisoned in Italy and returned to Albania in 1942. He was involved in setting up theindependent Albanian government. He fled abroad, as he had studied Communism in somedetail and was all too aware of his "advantages". That sealed our fate for more than 30 yearsup until the present day, as even relatives twice removed were imprisoned in place of familymembers.

And what happened to the rest of the family then?After two dreadful years in prison we were moved to the labour camp in Tepelena. That iswhere I spent my lost youth. My only shoes were sandals made from old tyres, I was forced tofetch wood and was kicked and beaten when I couldn't keep going any longer. They didwhatever they wanted with us.

Could you tell us more about that period?My mother had kidney disease, which meant she had to go to the toilet frequently. But as weweren't allowed to leave our room at night she urinated into a cup and hid it under the lug-gage. The next morning the guard checking found it and punished my mother in public fortwo days: She was suspended above the entrance to the camp with her hands above her headfor two days and two nights. It was the middle of January. It broke my heart to see her likethat, growing weaker hour by hour. She later died in a detention camp. That caused memuch more suffering than my lost youth.

You took part in the medica mondiale meeting in Tirana along with other women from theAssociation of Persecuted Women. Did you feel some sense of relief?I was very pleased, as I'd never experienced anything like it. I felt as if I were part of one bigfamily. I need these meetings, as they give me calm and strength. This centre can really helpus.

What did you like best?The warm affectionate way of dealing with each other, the interest and kindness of thewomen. I've never felt better anywhere.As I couldn't enjoy my youth, I want to sing and be happy now, to regain the time I lost - be-cause now I am free.

The interview by a member of medica mondiale Tirana was published in the newspaper "IN-TERVISTA" 02/21/2000, Tirana, Albania.

*Ms. Dema asked that her real name be used.

The therapy centre in Tirana is a contact point for traumatised women and for women fromthe slums. We work with Albanian staff, who give the women psycho-social support and gy-naecological care, modelling the approach on that of our therapy centres in Bosnia andKosovo. We provide additional psychological training to doctors, nurses and social workers,as well as offering training focusing specifically on women for qualified health care workers.

Violence against women and international law

Violence during wars is always (also) violence against women.How and whether this violence is condemned and punished bysociety is decisive for the victims. For a community expressessolidarity with survivors of violence by punishing perpetrators ofsuch violence. It excludes those who have committed violenceand welcomes the survivors back into a world from which their

Violence againstwomen in wars hap-pens around the globe,as our map shows.There is widespreadknowledge of this vio-lence. Yet again andagain it proves to bedifficult to establish ajuridical basis that willensure that survivorssee justice.

traumatic experience had violently removed them and which they felt that they were nolonger part of.

However, women are often denied even the slightest gesture of welcome if they are raped.The criminal trial becomes a renewed torture, there is often no recognition of the injusticecommitted and often it is the victims who are excluded, not the culprits.

Sexualised and targeted wartime violence against women has only begun to be prosecutedunder international criminal law since the two ad-hoc tribunals on former Yugoslavia andRwanda. From the outset, medica mondiale saw a need to become involved in this process,precisely because such criminal prosecution can have both negative and positive conse-quences for women who appear as witnesses. This also includes providing competent adviceand support to women who wish to act as witnesses for the prosecution. Our co-operationwith the tribunal in The Hague was and is linked to our criticism of the way in which survi-vors are once again subjected to a situation in which they have no control whatsoever andno-one is there specifically to represent their interests.

The International Criminal Tribunal

In negotiations on the inter-national Criminal Tribunalwe are also seeking to ensurethat sexualised wartimeviolence is prosecuted to itsfullest extent and that thewitnesses are not reduced toliving pieces of evidence.That is why in 1999 medicamondiale staff have at-tended various internationalexpert conferences ad-dressing sexualised violenceand humanitarian interna-tional law, and have also givenpapers at these meetings.

In summer 1998 the statutefor an International CriminalTribunal on genocide, crimesagainst humanity and war crimtent work of the "Women's Caulawyers, convinced participantsgender-specific violence than evseveral follow-up conferences aute, and will also address the decedural rules for the trial, inclutendency among the internatiocompletely remove those provispreventing this, medica mondiabeen directly involved in activeNovember 1999.

Asylum: from a victim of

Lobbying both nationally and inwar is an important part of ourour long experience working inagainst deportations of Bosniafounded factual grounds to p

Counsel for the defence: You say you had five packs of thecontraceptive pill when you came to Celebici in April 1992.From your doctor?Witness: Yes, I've been taking it for a long time.Counsel for the defence: Well, at the end of March you be-came pregnant. Would it surprise you to hear that your doc-tor says that he did not prescribe the pill for you then?Witness: I didn't have enough so that for a while I had nottaken the pill and so I got pregnant. At the beginning ofApril I had an abortion performed by my doctor. Then Ibought five boxes of the contraceptive pill at the chemist'sand began to take it again.

From the end of May to the end of August 1992 GrozdanaC. was detained in the Celibici camp in Bosnia-Herzegovina. She was repeatedly raped during this pe-riod. Five years later she is a witness for the prosecutionat the International Tribunal in The Hague. She identifiesthe defendant as the rapist and gives a detailed accountof what happened. " I think that I was simply separatedfrom my body then. They kill you psychologically andphysically", she stated in court.

Again and again the counsel for the defence focuses onwhere the contraceptive pills came from. This is all com-pletely immaterial to the crime of rape. The defence is ofcourse well aware of that too. They are trying to do just

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one thing: to embroil the witness in contradictions andthus undermine her credibility. But their questions areabout very intimate parts of the witness' life, which she isnow compelled to reveal in public. Neither the prosecu-tion nor the three judges intervene.

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s was adopted in Rome. During the negotiations the persis-s for Gender Studies", an international alliance of feminist

o include a more comprehensive definition of the crime ofr before in international criminal law. By the end of 2000, to devise specific provisions to implement the Rome Stat-nitions of the various crimes covered and the details of pro-ing rules on evidence. It is becoming clear that there is a

al delegations to seek in this process to undermine or evenns of the statute most positive for women. With a view to, along with the "Women's Caucus for Gender Studies" hasobbying during the official negotiations in New York since

ar to a deportee.

ernationally in defence of women and girls traumatised byork. We are often asked to help in individual cases, due to

Bosnia-Herzegovina, and particularly since our campaign women from Germany in 1997. We aim to provide well-vent deportations of severely traumatised women from

Germany. On the whole we have obtained good results: we have repeatedly managed topersuade the judges involved to change their minds - often at the last minute.

Internationalsympathy forrefugees inwartime oftenquickly turnsinto rejection,which ulti-mately leads todeportation.

A case fromMülheim ander Ruhrclearly illus-trates thehair-raisinggap between the reality of life for a survivor and the bureaucratic approach of the Germanauthorities: Ms. X, 39, three children, only submitted her own application for asylum after sixyears in Germany, as she had believed that her husband's application was enough for both ofthem. The numerous war crimes she witnessed during military occupation of her home vil-lage and the violence she experienced whilst fleeing had triggered a severe case of post-traumatic stress disorder. She had been treated for years with psycho-pharmaceuticals dueto constant panic attacks.

Harsh reality versus bureaucracy

Her condition worsened when she was threatened with deportation; she repeatedly col-lapsed and became increasingly suicidal. The judge dealing with the case rejected her appli-cation. His main argument: "the addition of further claims means that the witness is notcredible". What this means is that in the course of the (initial) hearing with the FederalAgency for Recognition of Refugees, the woman had scarcely mentioned the violence she hadsuffered and her resulting illness. She did not mention these issues until she was threatenedwith deportation.

Cases like this demonstrate how important it is to inform decision-makers and help to makethem more aware of the relevant issues. The very phenomenon of an apparent inability tospeak out, which the judge saw as grounds for deportation, is one of the main symptoms oftraumatisation, particularly in women who have experienced sexualised violence. Refugeewomen, who were given a lot of sympathy internationally as victims in the immediate af-termath of the war, have again and again seen this sympathy wane relatively rapidly andchange into rejection in the countries that offered them refuge. They suddenly find them-selves once again in the role of the deportee - no matter what scars the consequences of thewar have etched on their souls, they are supposed to return to the place in which they expe-rienced the violence. For here they are just a nuisance.

For years we have been demanding that the right for women traumatised by war to remainin Germany be enshrined in the constitution. Political resistance from various quarters willhave to be overcome as we move closer to this goal. We will only one day achieve this objec-tive if we persist in our lobbying and information campaigns.

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There are no facilities in Bosnia and Kosovo of-fering long-term trauma treatment for womenexcept for our therapy centres. Deporting atraumatised woman amounts to a renewedtraumatisation, and is thus profoundly inhu-mane.

You can rebuild houses fairly quickly - the burdened psy-ches of traumatised individuals need time and care togradually recover.

How to address trauma in women

Wt

Ttsdmt

RrafeiHcawc

Traumatic reactions occur in caseswhere it makes no sense to do any-thing. If it is impossible to resist orflee, then human self-protectionmechanisms are overloaded andcollapse into a state of chaos. (….)Traumatic experiences eliminatethe social network that generallygives people a sense of meaning, ofbeing in control and belonging to asystem of relationships.

(Judith L. Herman: Die Narben derGewalt (Trauma and Recovery),Munich 1994)

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hat is a "trauma"? How can it be "treated" in therapy and what approach do we take inherapy?

his relatively new topic has been experiencing a real boom recently in the world of psycho-herapy and development aid. Many approaches focus simply on therapy in the narrowense of the term and tend above all to treat the symptoms. It is very rare to find an inter-isciplinary approach focussing specifically on women and looking at the longer term.edica mondiale is working on fine-tuning the way in which we support women and girls

raumatised by war in crisis zones.

apes are always found in wars and similar conflicts. Responses to women who have beenaped from their own society after the war and in countries where they take refuge is gener-lly characterised by others not knowing how to react, although pronounced rejection is alsorequently observed. To date, medica mondiale is the only organisation in Germany with solidxperience in gender-specific and interdisciplinary treatment of trauma in a crisis area. This

s based on many years of work with women and girls traumatised by war in Bosnia-erzegovina and in Kosovo. We are keen to share our experience with others and often re-

eive enquiries about training with us, both from individuals and from the staff of Germannd international NGO's. At the same time, we are always breaking new ground in our workith the women concerned in crisis areas and the staff in the projects constantly face new

hallenges.

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The trauma of rape

For a number of reasons, the trauma of rape should be clearly distinguished from othertraumatic experiences - such as natural catastrophes, accidents or other "man-made disas-ters". Women and girls around the world are confronted with sexualised violence day in andday out. Rape is generally a social taboo and causes profound shame in women who havebeen raped. Society often concentrates in such cases on the insult to the men symbolised byrape and women are assumed to share the guilt for what has happened, and are despised,hated and rejected. Rape is not recognised as an act of violence.

As they are aware of all this, it is often not possible for women and girls who have been rapedto ever talk openly about their experiences and in most countries there is nowhere they canreally feel safe. That means that they do not have a basis for starting to take the first stepstowards coming to terms with their traumatic experience.

As a result, physical and mental wounds are often not identified or treated, which meansthat the women frequently suffer the consequences of such injuries throughout their lives.

"The victims can only begin to heal when there is recognition of the truth of what has hap-pened to them", says American psychiatrist Judith L. Herman. However, for the reasons men-tioned above, most women have so far not had a chance to heal.

Our approach

We do not view the women and girls as helpless victims but stress the courage and strengththat have helped them to survive the wounds they suffered during wartime.

Our basic assumption is that the women's individual, collective and culture-specific re-sources are of vital importance in overcoming the trauma. We can therefore pick up on theseresources and use them in providing professional support. Our work with traumatised Bos-nian women and girls has demonstrated the validity of this approach, and has shown howimportant it is to link gynaecological, psycho-social and psychotherapeutic support.

After taking a careful look at the situation facing the girls in question immediately after thewar and in the post-war period, we found that we needed more elements in our model. Anetwork bringing together various complementary disciplines is needed to help and supporttraumatised women and girls. That is particularly true as most of the survivors - whetherthey are in Bosnia-Herzegovina, in Kosovo or in exile - had to live in very inhumane condi-tions in the period after the traumatic event.

Indeed, these women experienced the exact opposite of humane treatment: the insensitiveand often misogynist attitude taken by politicians, the media and medical institutions oftencaused them new wounds - in addition to those inflicted by their immediate social environ-ment. In Germany too hospitals, health authorities and private doctors have little expertisein dealing with such cases, which, together with the constant fear of deportation, often mas-sively increases the risk of retraumatisation. The effects of retraumatisation can be muchmore serious than the impact of the original trauma. Furthermore, the suffering of thewomen was often unthinkingly put on display, in an attempt to wield more political influ-ence or to boost audience figures with "sex and crime" stories.

We view it as our responsibility as an international human rights organisation to supportsurvivors of the most severe violations of human rights in overcoming the injuries they havesuffered, and to persistently and forcefully do all we can on every level to ensure that thesesurvivors are not retraumatised. Our approach therefore highlights precisely these issues.

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From an interdisciplinary to a multi-disciplinary strategy

That is why we have broadened our initial approach toinclude legal, political and intercultural aspects, whichwill play a growing role in our on-the-spot activities.

In tandem with targeted evaluation of our work in ex-isting projects, we will be increasingly involved in ex-changing know-how with international women's projectsand organisations. Regular discussions with women whoare experts in various disciplines offer a good platformfor this type of exchange.

In the medium-term we plan to contribute to setting upprojects in other crisis areas by drawing up a manualcomprising country-specific and culture-specific stan-dards for work with women and girls traumatised bywar. In this context we are also planning to develop arange of further training schemes for qualified staff in-terested in working in this field.

PR and fundraising

In conversation with Andrea Fischer, German Health Min-ister (first from left) during "top 99" in Dusseldorf: fromleft to right Lisa Renkhof-Schleich (on the board of medicamondiale), Anna Biermann (management).

A small stand with a big impact: we managed toconsiderably increase public interest in our workthanks to our presence at the women's trade fair"top 99" in Dusseldorf.

The war in Bosnia-Herzegovina attracted more public interest and stirred more emotions inGermany than any conflict since. Or at least that was the case until Milosevic expelled anentire people and NATO began to bomb Serbia in Spring 1999.

The eyes of the whole world were fixed on Kosovo - and on the fate of the women there.Shortly after Easter 1999 we were inundated with enquiries from the press. And fortunatelythis filtered through into extensive media coverage of the topic of sexualised violence in warand reports on our work. By autumn 1999, we had given 186 interviews, been involved inmaking 18 TV reports and had produced 36 contributions to various publications, over andabove our own publications. Our staff members attended five international conferences andseven German conferences and made presentations in 27 German cities in the course of re-gional events. Providing background material to academics, journalists and studentsrounded off this side of our work.

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Our stand at the women's trade fair, "top 99", put us in touch with a whole host women in-terested in our work and keen to support it.

Famous women were also of enormous assistance to us in our PR work over the past year: forexample TV-presenter Bettina Böttinger, who moderated a discussion with Monika Hauserduring "top 99" and put our case in an advert in a women's magazine. Or Ilona Christen, whogave us her support in a meeting with the press to launch the mobile out-patient unit inKosovo and collected a considerable sum in donations. Nor should we forget support frompoliticians, first and foremost German Federal Minister Heidemarie Wieczorek-Zeul. We oweher our thanks for support from the Ministry for Economic Cooperation and Development,which she heads. Journalists also played an essential role, and pushed for their editors to en-courage readers to send donations to us. Their steadfast reporting has meant (and continuesto mean) that the concerns of women traumatised by war have not vanished amidst theflood of news stories.

In addition to support from famous faces, politicians and other public figures, we also relyvery much on support from private individuals and active groups of supporters. Many peoplewere shocked by events during the war in Kosovo, and this was expressed in a wave of veryspontaneous and generous donations for women and girls traumatised by the war in Kosovo.In addition to many individual donations, supporter groups also organised a number of verycreative fundraising events. These showed very clearly that giving, solidarity, imaginationand fun really can go hand-in-hand. There were a number of benefits for medica mondiale -including theatrical and cabaret performances, concerts, art projects and garage sales. Col-lections were also organised in companies and amongst private individuals at various cele-brations and festivities. We received a great deal of support from Catholic and Protestantcongregations, politicians, women's initiatives, schools, playgroups - but the list would be toolong to print here if we were to mention everyone individually.

Thank you to everyone for your generous support, which has made it possible for usto help women and girls in Kosovo and Albania too.

Financial Overview 1999

Expenditure 1999

General administrative costs 10% (=246,210 DM)

Medica Zenica30% (=769,973 DM)

Interdisciplinary trauma treatment concept 2% (=56,004 DM)

medica mondiale Kosova 36% (=910.560 DM)

medica mondiale Tirana 8% (=195.409 DM)

Public relations14% (=350,237 DM)

Total revenues 1999

Donations, contributions from associate members and allocation of fines82% (=5,459,651 DM)

Contributions from the federal government (Federal Ministry for Economic Co-operation and Development, Foreign Office, German Agency for Technical Co-operation 12% (=819,650 DM)

Other contributions5% (=309,965 DM)

Interest and other revenue1% (=94,103 DM)

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Donations and contributionsIn 1999 donations, contributions from associate members and allocation of fines (under aGerman system whereby some of the revenue from administrative fines is allocated to chari-ties) increased to 5, 459,651 German Marks from the previous year's sum of 971, 264 Marks.People were remarkably willing to make donations to fund our work with Kosovor womenand girls. However, the pronounced drop in donations for the Medica Zenica women's ther-apy centre continued.

Our political and practical experience in Bosnia, together with the German government's in-creased emphasis on women's issues, meant that for the first time we received substantialshort-term public funding for the medica mondiale Kosovo project initiated in April 1999.This funding is currently granted for a limited period, expiring at the end of 2000. In 1999 wereceived contributions from this source to the tune of 1,129,615 Marks.

Project financingIn 1999 we made 1,931,618 Marks available to support projects. This represents an increaseof 268 per cent against the previous year, and is mainly due to the launch of the medicamondiale Kosovo and medica mondiale Tirana projects, together with the project on a con-cept for interdisciplinary trauma treatment. Aggregate expenditure in 1999 amounted to2,528,101 Marks.

Press and public relations work/ securing donationsPress and public relations work is also an essential part of what we do. The general publicand the media are kept constantly supplied with political, comprehensive information aboutthe specific situation of women and girls in war and crisis zones, the consequences of thecrimes committed against them and about our projects.

We have extended our work in securing donations with a view to ensuring long-term sup-port for our projects. A total of 350,273 Marks was spent for both areas. This sum includespublication of a donor magazine, medica-journal.

Administrative costsPolitical and practical developments, along with the greater volume of work in project anddonation management, meant that we had to extend our headquarters in Cologne. We spent246,210 Marks on running the office.

Reserves for projectsOur concept envisages long-term medical, psycho-social and legal assistance. Support frompublic funds is currently only available for a very limited time period, which means that thedonations we receive serve to ensure we can finance our projects abroad in the medium-term. Planned expenditure in this area is around 2,8 million Marks in 2000.

How you can help

Although the war is over, the trauma suffered by women and girls due to the violence theyhave experienced is far from over. But it's only with your support that we'll be able to helpthem in the long-term, and be there for our clients for as long as they need us.

There are many different ways in which you can support our work:

Individual donations:If possible please use our pre-printed payment slip and indicate your full address.

Regular donationsDonations by standing order or direct debit are a good way to support traumatised womenand girls in war and crisis zones, because:• You help us to reduce administrative costs. That means more money is directly available

to support women and girls.

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• We need continuing commitment to achieve our goal of long-term support to helpwomen come to terms with their trauma. Support from those who make regular dona-tions to our work is of the essence in making this possible.

• And last but not least this mode of payment is the most straightforward and convenientfor you too.

Parties and anniversariesBirthdays, anniversaries, weddings and club parties: there are always good reasons to cele-brate. Ask your guests to make a donation to medica mondiale instead of buying a present.Just write to us or give us a ring if you want to help us in this way. Then we can keep an eyeon the donations coming in and give a hand with the thank-you letters.

Flowers and wreathesOne alternative to flowers and wreathes for funerals is to ask for a donation to medica mon-diale, which is often just what the deceased would have wanted. Please contact us so thatwe can allocate the donations correctly when writing thank-you letters and sending confir-mation of donations received.

The small change schemeThe small change scheme involves deciding to do donate the small change on wage and sal-ary payments. Sums between 1 and 99 pfennigs are collected in joint accounts, and are thentransferred to medica mondiale once a month or once a year, indicating on the transfer slipthat this is part of the "small change scheme". All staff members, the works council or staffcouncil and your employer must agree to take part in this scheme. Please call us if you stillhave questions!

BenefitsWhether it is a concert, a reading or a play, a benefit is always a good opportunity to presentmedica mondiale's work and collect donations.

Garage salesOld books, home baking, home-made liquors… hold a garage sale in support of medica mon-diale, either on your own or with friends. That also gives you a chance to tell people aboutour work.

Sport and funYou can create a special event day to do something together to help women and girls in warand crisis zones, by running, swimming or cycling to support medica mondiale. Participantscollect sponsorship per metre or kilometre from parents, relatives, friends or firms. Themoney is then donated to medica mondiale. Ask us for help if you have any questions whilstgetting things organised!

Donations instead of giftsHow about a change from pens and bottles of champagne? Give your business partnerssomething different; make a donation for women and girls in war and crisis zones instead ofthe usual gifts for your customers. For example, you can inform your business partners aboutthis with special slips to put in your greetings cards.

InformationIt's very important to us that a lot of people hear about our work. We would be delighted toprovide you with information for events and information stands, or to pass on to yourfriends and acquaintances.

ImaginationThese are just a few examples of ways in which you can support our work. Perhaps you havesome more great ideas - let your imagination run loose. We would be delighted to hear fromyou.

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Questions?If you have any questions or would like more information, we'd be happy to help. You canwrite to us, or contact us at + 49 221 93 18 98 24 or at info@medicamondiale.org. Visit ourwebsite at www.medicamondiale.org!

Confirmation of donationIf you need a receipt, i.e. for your tax return, we would be pleased to send you one on request.

CHARTERmedica mondiale is an organisation run by women for women.

medica mondiale sees itself as a feminist organisation.

medica mondiale developed from co-operation between medica Cologne and Medica Zenica,a project against violence towards women in Bosnia-Herzegovina in the context of war.

medica mondiale supports and promotes women and girls in war and crisis zones, whosephysical, psychological, social and political integrity has been violated, irrespective of theirpolitical, ethnic and religious background. This violation may have been inflicted by society,by family members or as a result of war. The aim is to strengthen women's capacity to healthemselves, to support and demand their right to shape their lives freely and independently.

medica mondiale provides emergency and long-term aid to traumatised women and girls inwar and crisis zones through:� projects providing medical and psycho-social care� projects to promote public preventive health care schemes� initial and further training projects and job creation schemes� projects to improve nutrition, housing and legal status� projects to inform the general public about the situation of these women and girls, and to highlight the reasons for and the background to violence against women� projects to create places where women can be autonomous

medica mondiale seeks to secure a sound basis for these projects in the long-term withinautonomous women's structures and social infrastructure.

medica mondiale promotes information campaigns and documentation of the diverse formsof violence against women and the global nature of this phenomenon. In doing this medicamondiale puts a particular emphasis on working with national and international women'sorganisations and human rights groups, as well as with other NGOs and government bodies.

medica mondiale opposes all kinds of nationalism and fundamentalism, participates in es-tablishing democratic structures and in national and international reconciliation processes.

medica mondiale sees itself as part of the international women's movement and works topromote recognition of women's rights as human rights with a view to fostering non-hierarchical gender relations.