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Rough Cut: South Africa: An Everyday Crime
Interview With Dr. Sebastian Van As
Cape Town trauma surgeon Dr. Sebastian Van As talks about the social ills behind South Africa's high rape statistics and what it will take to properly addresss the problem.

Dr. Sebastian Van As is a trauma surgeon and head of the trauma unit at the Children's Red Cross Hospital in Cape Town, the only trauma center of its kind for children in South Africa. Originally from the Netherlands, Van As has documented thousands of rape cases through the Red Cross Hospital. Here, he talks with FRONTLINE/World's Elena Ghanotakis about what's behind the high number of rape cases in South Africa and, in his view, what measures should be taken to counter the problem.

Dr. Sebastian Van As

Dr. Sebastian Van As

Elena Ghanotakis: How much of a problem is child rape in South Africa?
Dr. Sebastian Van As: Child rape is a tremendous problem in South Africa. From all the sexual offenses reported to the police -- about 60,000 on an annual basis -- almost half are child abuse cases. That is sexual abuse of children under the age of 18, so it is really a massive problem.

Who are the main perpetrators of these crimes?
Contrary to the stereotype -- that it's some stranger or evil man who jumps over the wall and runs into your house and rapes your children -- the reality is very different. About 90 percent are sexually abused by people they know. If we analyze this group further, we'll see that it consists of three different people: Family members, family friends and neighbors. It is nearly always someone the child knows very well. Often the children are groomed to be abused. The child isn't suddenly picked out of his house and taken to a place where he is sexually abused. There is a relationship between the perpetrator and the child.

Have you encountered the "virgin rape" myth and can you explain what this is?
There has been tremendous publicity surrounding the virgin rape myth -- even [Swiss psychoanalyst] Carl Jung described it as an archetype. If you've got a sexually transmitted disease, you must have sexual contact either with very young people who haven't had sex yet or with very elderly people who don't have sex anymore. It's been described being practiced in the Middle Ages. People were having sexual contact with young children to get rid of syphilis, for instance. In South Africa, it is often blamed as the main cause of child rape, but I very strongly disagree with that. Fifteen years ago, when there was no HIV, we had similar numbers of children being raped, so it is not something that is caused by the AIDS pandemic. The majority of children are raped by people in their family or in their community. [These predators] are not strangers sick with HIV and trying to get better. [At the hospital,] we have seen more than 1,000 cases of children sexually abused. In none of these cases was the motive of the perpetrator to get rid of HIV.

What are the conviction rates for rape in South Africa?
For murder and sexual abuse and rape in this country, the conviction rate is extremely low. For children, it is on the order of 7 percent. It's a shockingly low number. It means that 93 percent of the people committing child rape and child sexual abuse are free.

Implicit in all this is that rape is extremely difficult to prove in court. To successfully prosecute, you [need] an objective report of what happened, and it is extremely difficult to get that. Recently, there was a trial against the vice president of this country [Jacob Zuma] in which a 30-year-old woman claimed she was raped by him. The case went to court and attracted a lot of publicity, but the vice president was not prosecuted because [the rape] couldn't be proven. This court case demonstrated how complex it is to really find out what happened. This is a case of an adult woman, who was completely logical and reasonable, and there was great difficulty in demonstrating that there was rape. Can you imagine how that would work for a child who is 4 or 5 years old, who still has magic thinking? It is extremely difficult. How do you prove that the child really was raped?

What should be done to address this situation?
We must look at the causes of why people rape. What terrible things happened in these peoples' lives that they end up taking babies and raping them? There is a very strong correlation between perpetrators and victims. Several studies indicate that up to 97 percent of perpetrators were child abuse victims themselves. And the same accounts for physical abuse. In other words, if you grow up in an environment where you are properly nurtured, where people care for you, you have good values and norms, you are extremely unlikely to become a child batterer or a child rapist. However, if you grew up in an environment where your father came home drunk, beat your mother and slept with your sisters and neighbor, you see all that. You are very prone to a similar behavior.

Can you guide me through the process of what happens when a baby or a child comes to Children's Red Cross after they've been raped?
We have lots of junior doctors we are training here in hospital, and when they are faced with a baby or a small child who has been raped, it can be very traumatic. The doctor can start crying while he is examining the child or become agitated and cross because he suspects that the parents were not taking care of the child and were involved in the abuse. Of course, if the doctor gets angry or agitated in any way, the child is not able to recognize that this anger or frustration is not focused toward him. For a child to have been raped and then see a doctor saying, "Oh my God, what's happening?" is a disaster. It reinforces to the child the thought that something terrible has happened to him.

It's important to be very sympathetic to the child. Nearly always if a child has been acutely raped, it will be painful [for him during an] examination. We prefer to give a general anesthetic to the child and then examine them under anesthesia for two reasons. First to make sure that the baby doesn't [experience] pain. (If there are tears, either around the vagina or the rectum, it is extremely painful to look there under local.) The other thing is that the child will not remember anything because the child just goes to sleep and when he wakes up, it is all done.

How do you feel doing this kind of work and dealing with children who are raped?
How I feel is a difficult one. Sometimes you get the idea that you are trying to sail against the wind, because there's a continuous cycle. Whatever you do -- and we try to focus on prevention -- the more awareness you create in society, the more people you [help]. There has definitely been an increase in the numbers we see treated here, but I do not necessarily think that is a reflection that things are getting worse. Awareness has been raised. You have to create awareness in order to attack [the problem]. Twenty years ago in South Africa, no one was talking about child rape. We had a conference a few years ago and there was a lady speaking about sexual harassment. Thirty years ago, sexual harassment didn't exist here. It did not mean that there were not bosses sexually abusing their secretaries, but in that time, the language and the thought process were not developed yet. We have developed the terminology of sexual harassment. Now, everybody knows what it is and what it means and that it is not part of normal life -- that you can do something about it.

Do you see the same pattern in the physical abuse of children?
Physical abuse was only described about 50 years ago for the first time, after the Second World War. Before that, the medical profession was in denial. It was a taboo. It has only been in the past 15 to 20 years that people have started writing about it quite a lot.

In South Africa, we know there has been tremendous sexual abuse in the past. But it wasn't the number one problem. People were worried about the political situation, about threatening civil war and leaving the country, so [their] activities and energy levels were directed at completely different areas. Now that we're more than 10 years into democracy, we have started to recognize a whole lot of other social injustices.