Deep inside the sprawling HEAL Africa Hospital complex in the Eastern Congolese city of Goma is a small ward where women recover from injuries they suffered during complicated births and violent sexual attacks. When I entered, I first saw Muwakeso, a fragile-looking elderly woman sitting on a chair next to a bed. It took me a moment to realize that she wasn’t the patient, but rather her 3-year-old granddaughter Sakina, who was curled up into a tiny mound under a hospital sheet on the bed.

Sakina was heavily sedated to numb the pain after the second of three major surgeries she underwent to reconstruct parts of her lower body following a horrific attack about a year ago. Muwakeso recalls five men in civilian clothes approaching her house and beating her. Before she lost consciousness she heard Sakina screaming. The young girl was raped, but Muwaseko doesn’t know by how many men, and Sakina is unable to say.

The men were never caught.

The attack happened in Mweso, a village in Eastern Congo and a hotbed of militia activity in a war that started almost two decades ago and employed several armies and dozens of armed groups. They are fighting for niche causes, ranging from the ideological to the ethnic and the purely criminal — and often a mix of all three.

They act with impunity, many committing unspeakable acts of violence against civilians. They have redefined what is “normal” in war. And violence against women, but also against girls, boys, and men is now common, even among civilians.

Sri Mulyani talking to Muwakeso. Dr Paluku, fourth from left, performed the surgery on Sakina. © Cherry Stoltenberg/HEAL Africa

In Eastern Congo and elsewhere violence against civilians isn’t just an outcome of war. It also fuels conflict. It harms individuals, weakens the social fabric, breaks up communities and introduces behavior into societies that makes peacebuilding more difficult. Most people in the area are too young to remember times without war and violence. Few trust that the status quo will change soon.

While often more prevalent in conflict, violence against women is in fact a global phenomenon rooted in social norms and attitudes. More than one in three women around the world have experienced an attack, the vast majority committed by their husbands or boyfriends.

In the Great Lakes area, gender-based and sexual violence has reached catastrophic levels. Any effort to bring peace to the area will have to deal with the causes and consequences of this violence. This means treating the physical and psychological wounds, supporting reintegration of survivors who often are rejected by their communities after the attacks, and enabling them to build a livelihood to support themselves and their children.

This is why addressing sexual and gender-based violence is an integral part of theGreat Lakes Initiative, a joint United Nations/World Bank effort that was launched in 2013 to promote peace in the region through better health and education services, more cross-border trade, and access to energy. The initiative is supporting HEAL Africa, whose doctors, nurses and other staff treated over 5,100 rape cases in 2014 and which also promotes women’s economic empowerment as part of their mandate to heal survivors.

On the Rwandan side of the border, where gender-based violence remains a severe problem in spite of the strong government commitment to promote gender equality, the initiative is helping the government set up 17 one-stop centers, where women find free medical, psychological, and legal support after surviving sexual violence.

And in Burundi, the initiative backs three hospitals to assist women, including through youth-friendly services.

Following the 2013 regional agreement, peace in Eastern Congo has been fragile at best. World Bank research tells us that violence does not stop when war ends. In fact, it often increases in the absence of functioning institutions. We can witness this in the Great Lakes region, where political progress has been slow, making it difficult to improve livelihoods and bring lasting peace to the region. It will require our best efforts to prevent a collapse of the process.

In two months, Sakina will have her final surgery. Physically, she should be okay, but she will remain vulnerable. Muwakeso, her grandmother, struggles to walk after the attack, making it hard for her to look after a child.

Sakina is the only girl in the small recovery room. Fourteen other women are sharing 11 beds. Double occupancy is normal. The room is quiet and peaceful, with two trained nurses looking after the patients, who can stay here as long as the hospital can afford it. But the need always outstrips HEAL Africa’s capacity. Right now, 150 more women are waiting for surgery, about half of them with injuries they suffered during a rape.

The real names of “Sakina” and “Muwakeso” have been changed to protect their identity.