If you want to meet Dr. Denis Mukwege, you wake up before the sun and ride to the outskirts of Bukavu, dodging sewage gullies and potholes on the dirt road leading to a gated entrance.

Once inside, the first thing you hear at Panzi Hospital in the Democratic Republic of the Congo is a chorus of women, their songs filling the morning air, announcing that chapel has begun.

“Climb the mountains,” the women sing in Swahili. “Call Jesus, and he will act.”

Mukwege founded Panzi 26 years ago after serving as medical director at a mission hospital that was destroyed by rebels fighting the Congolese army. The ob-gyn built the new hospital to help mothers deliver babies more safely. But his first patient was a woman who had been raped. Many more rape survivors followed. The doctor realized his calling had shifted.

At sunup on this day, with rebel forces again closing in, the women sing of faith and hope. They are among the most recent casualties in what is arguably the deadliest armed conflict since World War II. The violence is centered in Congo’s eastern provinces, near the Rwandan border. Panzi sits on the outskirts of Bukavu, a city of more than 1 million people and the provincial capital of South Kivu.

After nearly an hour of music, a local pastor shares a message on the “fear nots” from Isaiah 41, weaving between French and Swahili. He concludes, “Don’t be afraid. No one has the last word in your life but God. Walk with God.”

For more than 30 years, war has ravaged South Kivu’s population. Outside forces, including Rwanda and Uganda, support rebel groups in a pitched battle that’s mostly about monopolizing Congo’s trove of raw minerals essential to technology.

China controls much of the mining and trade, and the United States has pledged millions toward a new export corridor from eastern Africa to the Atlantic Ocean. The AI-fueled thirst for new chip technology runs on cobalt—and the world’s top producer of cobalt is Congo.

Other conflicts get more headlines, but the war here has strong ties to US and global interests, if measured only in smartphones. Yet many in the developed world know little about this conflict that’s caused more than 5 million deaths and untold atrocities—including widespread sexual violence. Now, Mukwege is on high alert as the region seems poised for another horrific spiral.

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On a recent visit to Panzi Hospital, 185 of its 450 patients were receiving treatment for sexual violence. Over the years, Panzi’s doctors and nurses have treated more than 70,000 women for injuries resulting from rape.

“Bonjour, maman,” Mukwege says, smiling and pausing to chat with a mother as she’s helped along the sidewalk.

The doctor won the Nobel Peace Prize in 2018 for his work at the hospital and for bringing global attention to the brutality in Congo. The doctor, who turned 70 this year, is in surgery two days a week and works closely with a team of 50 doctors and more than 100 nurses.

Mukwege was born here in Bukavu, a hilly city hugging the shore of Lake Kivu, just south of the equator. His father was the city’s first Congolese Protestant pastor, and Mukwege is a pastor at his parish church. The third of nine children, he nearly died at birth after a neighbor cut his umbilical cord with a dirty knife. Mukwege has spent his life improving medical care for Congo’s women and children.

He has long worked in the shadow of war. In 1996, Mukwege was the medical director of Lemera Hospital when it came under attack from Congolese rebels and the Rwandan army at the start of the First Congo War. He had left the hospital, 50 miles south of Bukavu, to pick up supplies and returned to discover the rebels had executed three nurses and killed 30 patients in their beds. The soldiers looted the hospital, which had been built by the Swedish Pentecostal mission in the 1950s and run by missionary doctors who’d mentored Mukwege until he took over in 1991. War left the hospital in ruins.

When he started planning a new hospital to improve maternal care, he secured land in the Panzi neighborhood from his Pentecostal denomination. When the first patient arrived in 1999, she was not a mother in labor but a woman who had been shot

and raped by five men. In the first three months of operations, 45 women arrived with injuries from rape. “There was no time to think about, let alone celebrate, the official opening of the hospital,” Mukwege recalled in his 2021 book, The Power of Women: A Doctor’s Journey of Hope and Healing.

Mukwege initially handed off surgeries to a more experienced Finnish doctor. Over time and against Mukwege’s will, he became an expert at caring for survivors of rape. He learned how to surgically repair bladders, genitals, rectums, and other organs damaged not only by male penetration but also by wooden stakes, guns, or other objects. He learned how to treat fistulas—tears between the vagina, bladder, and rectum that won’t heal and lead to crippling pain and leakage, often leaving women ostracized and alone. He learned how to save organs after women were shot in the pelvic area. And he became an expert at identifying the geographical regions where women were attacked just by looking at their wounds. Militias in one area held women to flames, in another area shot them, and in others used bayonets in what appeared to be ritualistic rapes.

Mukwege recalled the horror of those earlier years in his 2018 Nobel lecture. He described an 18-month-old child coming to Panzi Hospital by ambulance after being raped. Mukwege found the nurses sobbing when he arrived. He told the dignitaries assembled in Oslo, “We prayed in silence, ‘My God, tell us what we are seeing isn’t true.’”

The Nobel prize brought the doctor global fame, but his deep local roots make him a beloved figure in Bukavu, where his image appears on buses and billboards. At the hospital, he stands out in a white scrub coat and pants, a head taller than most patients.

The women call him “Papa” and stop to share their troubles with him. On this day, his schedule includes patient consultations, surgery, and meeting with the ambassadors from Germany and Sweden.

Mukwege and Panzi Hospital continue to draw international attention to sexual violence. These horrors spread during prolonged conflicts, and not only in Africa. Rape and sexual torture were prominent features of the October 7, 2023, attacks by Hamas on Israel. Russian soldiers in Ukraine’s Kherson region sexually assaulted women ranging from 19 to 83 years old, according to a UN inquiry.

Over the past decade, human rights monitors have documented scores of rape cases committed by M23 rebels, who now control most of eastern Congo, as well as by Congolese army soldiers. One UN report stated that rape is “a daily reality from which Congolese women gained no respite.”

Rape as a feature of conquest is an ancient evil. Instances are recorded in the Book of Genesis and are outlawed in the Book of Deuteronomy, with provisions to protect female victims (Deut. 22:22–29).

Survivors of rape can also experience a sort of living death that plagues them for years after the initial crimes are committed. The physical trauma is often followed by stigma that isolates survivors from husbands, families, and communities. It may make childbirth impossible or impossibly painful. And when soldiers aren’t punished, sexual violence becomes an epidemic.

The M23 rebels who are committing many of these crimes are part of a Tutsi-led movement backed by Rwanda. They have been advancing this year, battling Congolese forces while leaving thousands dead and more than half a million displaced.

The rebels captured Bukavu in February. In the following weeks, the hospital remained operational, treating injuries and gunshot wounds and delivering 110 babies—a sign of life continuing.

Living under persistent threat isn’t sustainable, Mukwege says. And he isn’t afraid to confront the devastating truth: The powerful entities that plunder the country’s natural resources are to blame for this epidemic of rape. A Belgian surveyor in the late 1800s called this region “a geological scandal” because it’s so rich in prized minerals like cobalt, gold, diamonds, and tin.

Bukavu is 1,000 miles from the capital, Kinshasa, and many of its outlying areas are unreachable by road. That, plus lush geography, allows illicit mineral trades to flourish. Accomplices include neighboring countries and the bottomless global appetite for technology.

Congo’s cobalt and other minerals are essential to powering electric cars, mobile phones, and laptop computers. When sourced directly from Congo, they’re labeled “conflict minerals” subject to disclosure (in the US, tech companies must file with the Securities and Exchange Commission). But most of these minerals are exported via Rwanda to China, the leading consumer of cobalt. The Chinese own mines in Congo outright, and M23 rebels control key areas surrounding the mines.

China—and US-based tech companies relying on Chinese factories—skirts the conflict minerals label by using Rwanda as a transit point for smuggled minerals from Congo. Much of Rwanda’s gold, its largest listed export, also is smuggled from Congo.

Rwandan forces under now-president Paul Kagame entered Congo after the 1994 Rwandan genocide to rout Hutu génocidaires who sought to escape justice. But Rwanda has stayed for the lucrative trade, with about 4,000 Rwandan troops supporting M23 rebels in the latest offensive.

“Congo is, almost literally, a gold mine for Rwandan businesses,” writes Jason Stearns, senior fellow and founder of the Congo Research Group. “Such profiteering is made possible by the M23, which keeps Congo’s state too weak to stop the theft.”

War in Congo has become a racket, says Mukwege, “a kind of mafia organization at the international level. Our resources make others rich, while people here can be killed at any time. They can die of starving. We have cities that don’t have water, without law and security. It’s not something done by hazard; it’s done to put people in a situation where they have no choice.”

Mukwege ran for president in 2023 and lost. After making a name for himself advancing what he calls holistic care, he now wants to promote holistic justice. He wants to see rapists and their supporters brought to trial. And he wants to believe the world will take notice.

All these things weigh on Mukwege as he sits down in his office after chapel, flanked by a Bible and a model of the female reproductive organs. “You can feel the responsibility here. It never goes away. If you keep silent, if you don’t talk for them and support them, you become complicit in what is going on. And things are not improving.”

Last year, Mukwege traveled to Silicon Valley to meet with leaders of US tech companies. He says he asked them, “Why do you prefer to get minerals you need from armed groups who are raping and killing people?”

Mukwege’s not interested in boycotting technology. He says it’s about cleaning up supply lines and clearing out foreign-backed militias. He wants those down the supply chain to comprehend the connection between consumerism and what his patients endure.

“We can build bridges, find opportunities for peace, and get minerals and mining clean. Now, it is a dirty business,” he says. “We have to find new leverage to push our politicians.” Mukwege pounds the desk as he talks, frustrated that he sees the problem up close every day and it never becomes less than a horror, while for the rest of the world it’s normalized.

In 2018, he shared the Nobel Peace Prize with Nadia Murad, the Yazidi activist who survived sex slavery at the hands of ISIS captors in Iraq. The award signified new recognition of the problem of sexual violence, he thought.  Instead, “nothing changed, and you have the impression that on the international level, no one cares.” Seven years later, he wonders if the world order has simply grown comfortable with elevating money over humanity. But Mukwege says Christians have a responsibility to care because “this is a thing that destroys families, that destroys churches.”

“I know that God is God, and God is there even if you are going through terrible things. But how can I talk here about the church while women can be raped at any time and not protected?”

Rape survivors at the hospital—who should be focusing on their recovery—face daily fears of violence from M23. As the fighting reached Bukavu earlier this year, the hospital faced “devastating” new violence, it said in a statement, with numbers of sexual violence cases tripling some days. Built as a 125-bed facility, the hospital is often filled far beyond its capacity. Construction is underway on an ambitious project to expand the campus to a regional medical center and teaching hospital.

Alongside caring for rape survivors, Panzi is a referral hospital with general surgery, an emergency wing, HIV treatment clinics, and a busy maternity ward. The hospital delivers about 3,000 healthy babies a year—and achieves a 99 percent live birth rate in a country with one of the worst infant mortality rates in the world.

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Panzi is often the only hope for the region’s rape survivors. “Mukwege is the only surgeon within thousands of miles who has the ability to offer treatment,” said Dr. Deborah Rhodes, a leading breast cancer specialist from the US who has trained doctors at Panzi. Too often, she said, “there is nowhere else to go. Patients sometimes walk 5, 10, 15 days to get to the hospital.”

Mukwege has learned that he and his team may not solve the problem of rape, but they can give the survivors hope—and reasons to live.  The staff’s own endurance is tested repeatedly by the prevalence of young patients. In recent months, Mukwege and other doctors treated an eight-year-old rape survivor and one who was just six months old. The infant was raped while her mother was hanging laundry. The mother heard her screams and found her daughter wrapped in bloodied blankets. Doctors at Panzi had to give the baby anesthesia to examine her. Dr. Neema Rukunghu, Panzi’s deputy medical director, was on call that day.

The baby’s parents were “deeply traumatized,” Rukunghu says. Panzi is providing therapy and counseling for them. Doctors worked with police, who identified the perpetrator, a soldier who’d just left the Congolese army. In every case possible, Panzi provides DNA sampling and other evidence. In this case and many others, Rukunghu says, the suspect has disappeared.

Can a child so young recover? “For now, yes, she has healed well,” says Rukunghu, who is herself a mother with young children. “But she is very young, and with this kind of surgery… When she’s a teenager, will she get periods normally? What will we tell her about what happened? And how will that affect her psychologically? These are the things we don’t know. What we do know is that in each case the trauma goes on.”

Some survivors recuperate alongside other patients in the hospital’s general wards, as a way to avoid further stigma. Still, a dedicated wing for those needing special care is usually full, and sometimes women must sleep two to a bed.  Large windows, covered in sheer curtains woven with delicate flowers, suffuse this long room with light. Most of the women in the 40 beds are receiving care or sleeping. A whiteboard by the nurse’s station lists patients. Two are 14 years old and three are 16. One of the girls has a fever; she’s bleeding and anemic. She’s also pregnant.

This teen is one of a growing number of second-generation rape survivors, Rukunghu explains. The girl’s mother waits outside the entrance to the ward. Rukunghu remembers treating her as well, and she speaks with her softly.

About a third of Panzi’s sexual assault survivors are under legal age—18 years old in Congo. Yet girls under 18 make up three-quarters of the pregnancy cases at Panzi that are due to rape. Inside, one of the teen rape survivors rises slowly from her bed to greet Rukunghu, or “Doctor Nene.” She smiles, wearing a dress patterned with bright blue and green flowers.

“She came here with a very large wound, and she was totally traumatized,” Rukunghu says. A month after she had surgery, “It’s amazing now to see her in a dress, to see her laugh.”

Besides surgery and wound care, patients receive post-exposure prophylaxis, which is medication to prevent transmission of HIV and other sexually transmitted infections.

The hospital campus adjoins facilities run by the Panzi Foundation, which provides psychosocial counseling, legal help, skills training and crafts, a school and daycare, and halfway houses for patients who cannot return home.  Long-term patients are assigned a maman chérie—a female volunteer who provides companionship and safe physical touch, an important step toward healing from sexual trauma. Outdoors, these volunteers work with women at picnic tables under a covered patio, weaving baskets and watching movies after lunch. Those in recovery have meals here too. Common areas and communal activities, Rukunghu says, are key to the recovery process.

When Rhodes first learned about the prevalence of sexual violence in Congo and about Panzi’s work, she was employed at Mayo Clinic. She and a team of three surgeons and an operating room nurse from Mayo took vacation time to travel there, bringing new equipment to support surgeons like Rukunghu. “I would not say my work was changed by my time at Panzi,” Rhodes said. “I would say my life was changed. Everyone who went would say that.”

Rhodes worked alongside Mukwege from dawn until as late as midnight, “and what they are able to accomplish with basically no running water, it’s just extraordinary,” she said. “It’s a test of extreme innovation, adaptation, and dedication.”

Rhodes came away realizing, she said, that Mukwege was certainly one of the great surgeons in the world. But very few surgeons have made the sacrifice he’s made to provide services that would be completely unavailable without him.

What keeps Mukwege going, he’s quick to say, are his faith and his patients. “I can tell you that the women of Congo are very strong,” he says. “I can’t imagine how they can go through these terrible things and still every morning stand up and say, ‘I want to go on and take care of my family. I want their future even if mine seems over.’”

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The workday doesn’t end for Mukwege so much as shift. In late afternoon he changes into a dark business suit, white shirt, and street shoes to attend a worship service at his Pentecostal church across town. He does this most weekdays and is there on Sundays when he is not traveling, aides and visitors like Rhodes confirm.

On this Wednesday evening, Mukwege spoke to a congregation of about 500 people. He read Scripture and led prayers that included speaking in tongues. He remained on the dais throughout three hours of worship, joined in singing, and introduced a visiting Belgian pastor who gave the sermon that night. Afterward, the doctor greeted friends before returning to the hospital compound in the dark. He was one of several doctors on call for overnight emergencies.

Mukwege and his wife, Madeleine, moved from their home across the city to live inside Panzi’s gated compound after the doctor escaped an assassination attempt in 2012. Armed men waited for his arrival outside his home while others held two of his daughters inside at gunpoint. They pulled him from the car and appeared ready to shoot him when his longtime bodyguard came from behind the house to stop them. They shot and killed the bodyguard instead, and he collapsed on Mukwege, who says he then passed out. He woke covered in blood, thinking it was his own. The gunmen, perhaps believing they’d killed the doctor, had freed his daughters and taken off.

Mukwege has made other enemies too. Denouncing both Rwandan and Congolese leaders, he’s received multiple death threats. Yet each time these messages or plots become public, his Congolese neighbors turn out in the streets to support him.

After all these years fighting on behalf of survivors of sexual violence, the doctor has not lost his sense of horror or need for prayer. Even on a casual walk across the hospital campus, he pauses in conversation to eye the gates, wary of rebels and army soldiers closing in.

Late in the day, his voice cracks and fades as he talks. “When people call or knock on our door to say, ‘We have an emergency,’ and you see it is a baby,” he says, “you don’t have any idea [how it is possible] she can be raped, all her bowels outside. All you can say is, ‘Lord, help me.’ It is unbelievable. Why can this happen?” The next minute, his face softens and his eyes turn bright, because tomorrow is another day. “When I arrive in the mornings and the women are saying, ‘Hello, Papa,’ they want to come with their problems and issues. It’s a blessing for me.”

He implores the global church to pray and to act. And he vows to keep fighting the evil that has overrun his homeland and filled his hospital with patients. “To lose hope? Then I just finish and leave. I’m not ready to do that. I know this country and the people here. … We have people who believe in God, who believe that things can change.” 

Mindy Belz is a freelance writer.