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Introspections   |    
If I Deliver the Baby Now
Linda Piwowarczyk, M.D., M.P.H.
Am J Psychiatry 2009;166:760-761. doi:10.1176/appi.ajp.2009.09030388
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“If I deliver the baby now, I want to give it to you to take to America.”

These were the words of a very pregnant woman from Darfur whom I interviewed on a recent mission to a refugee camp in Chad.

What would propel a woman to give up her own flesh and blood, which she nurtured in her own body the past 9 months? It did not seem to matter that I had only known her for a few minutes. Was it desperation or was it love?

Twenty thousand Darfurians live in this camp in eastern Chad near the Sudanese border. Many have been there for 4 or 5 years. The sun beats down, it is the sub-Sahara. Not a cloud is in the sky to offer a few minutes of relief. Dry riverbeds look like long, vacant beaches. Long pieces of clothing protect people from the hot sun. Sure-footed donkeys carry containers of water, wood, grass, things for or from the market—while convoys trying to avoid any bandits on the road go barreling past.

Bartering is the exchange of goods without the transfer of money. Is it a true exchange when someone has bundles of cloth to offer and you are selling your food to buy milk that is scarce, or that rare tiny piece of meat when the food you get is not really enough to live on or so monotonous that one’s stomach cries out for relief? If programs were in place so you could earn a living, you would not have to trade the food that you subsisted on for simple household needs or something to replace the rags your children wear. They say it is not an emergency anymore. Who did they ask anyways? Phrases like “moving to a nonacute phase” are somehow meaningless when one dwelling after the next is filled with people suffering from hunger. Does it matter that it is not severe?

Practices of benign deterrence suggest that it is better not to operate the camp so as to become a magnet attracting the poor, the hungry, the sick, the destitute. At the same time, there is something drastically wrong when a woman has to go 30–40 km away from a camp looking for firewood, only to fall prey to soldiers or villagers who lie in wait to beat or rape or both. When there is no recourse because she walked “unfortunately” just too far away from the camp outskirts to obtain any chance of getting justice. Or when all sexual violence is viewed as consensual…even by those entrusted to protect the population.

How do you understand profound levels of sadness covered over by bright saffron African robes? Somehow the DSM falls short of encapsulating extreme levels of suffering—where words only approximate hardship that defies description.

Individuals want to be self-sufficient. As one woman said, “We are very strong. We want to work.” Many yearn for their fruit trees and vegetables. “If it were safe to go home, I would leave at this moment.”

But what does that mean when your home village has been burned to the ground, your herds long killed or looted, your food stores burned or stolen, and your groundwater contaminated in a part of the world where water is a commodity?

The pregnant woman told me the following:

In the early morning at 5 a.m., both the Sudanese army and the Janjaweed surrounded the village with cars. They then came into the village on horses and camels. They wore green—the official wear of the Sudanese military government. They were armed with guns. People were sleeping and did not know what was happening. They started shooting people and killing them. I did not understand what they were saying. I saw two men killed. There were many others. I was afraid to go and look. My family escaped to another village. One of my male relatives helped bring my grandmother, mother, and myself. I hid with my mother and children. They burned the village and took all the animals. It was 2003....

My mother died at the border from being mad.... She could not get treatment. My grandmother is at the frontier doing some work....

I went outside of the [refugee] camp for firewood. A man found me. I was about 30 km from the camp because there was no firewood nearer. I was with four other women. He was a villager in simple clothes. We started to run, and he grabbed my arm. He put his knife to the ground, ripped my clothing, and raped me. I tried to fight but I did not have the power....

She just had one simple wish: to go home and live in safety in her country. How often we take so much for granted—water, shelter, basic food, freedom. Yes, she does have symptoms of depression and PTSD. But more than that, her life is at the disposal of the humanitarian community, the Chadians, and countries of goodwill. Moreover, of 240,000 refugees in Chad (http://www.unhcr.org), each has a unique story of persecution and fight for survival.

“If I deliver the baby now, I want to give it to you to take to America.” I think it is love and desperation.

The author was a participant in a project led by Physicians for Human Rights, working with the Harvard Humanitarian Initiative, to gather information about the long-term physical and psychological impacts of rape on Darfuri women. A team of four researchers spent 3 weeks in the field interviewing women and the humanitarian care providers. Address correspondence and reprint requests to Dr. Piwowarczyk, Boston Center for Refugee Health and Human Rights, Boston Medical Center, Dowling 7, One Boston Medical Center Place, Boston, MA 02118; piwo@bu.edu (e-mail). Introspection accepted for publication March 2009 (doi: 10.1176/appi.ajp.2009.09030388).

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