German NGO Medica Mondiale and local Kosovo NGO Medica Gjakova, which works with survivors of sexual abuse from the Kosovo war, published a report on Thursday highlighting that most wartime rape survivors in Kosovo are still suffering serious psychological and physical consequences.

Titled “I am not guilty for what happened to me”, the report includes data from a questionnaire which 200 survivors responded to and also 20 interviews.

“The research found that 73 per cent of participants in the study qualify as suffering from Complex PTSD. An additional 13 per cent meet all the criteria for a PTSD diagnosis,” the report concluded.

It added that despite high levels of PTSD, respondents said the work of Medica Gjakova with survivors had helped to alleviate their difficulties.

Complex Post Traumatic Stress Disorder, CPTSD, C-PTSD or cPTSD, is a mental health condition that can develop from prolonged or repetitive trauma. Post Traumatic Stress Disorder, PTSD, is a mental health disorder that can develop when a person experiences one traumatic event.

“Nearly all of the study participants (95.5%) meet the criteria for clinical depression,” the report noted. while 59 participants reported suicidal ideation within the past week and 101 reported self-harm ideation since the war, 142 thought life was not worth living.

“The vast majority (96%) of the participants reported high levels of anxiety, and 57% (114) reported (self-)medication with sedatives,” it said.

The report quotes an anonymous Kosovo Albanian woman as saying: “I am never calm because when I go out I see that [the scene of trauma] and I remember everything, I feel very tired.”

Another woman, from the Roma, Ashkali, or Egyptian community, said that “wherever I went out I was scared. If somebody came to the door, I would think they were coming again, that fear remained.”

The study also says “a clear relationship was found between sexualised violence and sexual dysfunction among the survivors. About two-thirds of respondents (100) said they have problems during intercourse, while roughly one third (45 participants) said they do not, with 55 participants declining to answer.”

“Six out of the nine male survivors said they have problems during sexual intercourse”, it added.

An anonymous Kosovo Albanian man is quoted as saying his abuser “hit me on the head, he hit me on my body and he threw me on the concrete pavement nearby… Not only did he rape me, he beat me on my head and my neck… I can never get it out of my mind… I begged them twice, three times, especially the one holding an automatic rifle, to kill me, but in vain”.

Around 45 per cent of respondents claimed they knew other survivors who did not speak out about their abuse mainly because of the fear of bringing shame to their family.

More positively, “a vast majority (79%) of participants reported high levels of resilience; 64% said that despite the pain they have experienced some form of growth,” the report reads. It noted “a coexistence of strength and growth on the one hand, and suffering on the other”.

The consequences of the abuse have also caused generational trauma, with around 67 per cent of respondents claiming it has affected their families completely and around 29.4 per cent claiming it has affected their family to some extent; 48 per cent claim it has affected their children.

“Only 11.5% explicitly responded that they do not think that their experience affects their children,” the report said.

A Kosovo Albanian woman is cited as saying: “I passed the fear on to the children – the dark rooms, the unknown streets, I was always afraid something might happen.”

Survivors advise other survivors not to deal with the experience on their own, with some encouraging them “to speak up” in safe and confidential environments in order to avoid “victim-blaming”.

“Many participants explicitly recommend contacting Medica Gjakova and other support organisations, some saying that this helps with forming new friendships and developing a sense of belonging,” the report says.

It adds that “participants demand understanding and acknowledgement of survivors and their experiences – from society more in general and Kosovar society in particular. This includes empathic comprehension of their suffering and pain, as well as demanding that survivors are treated with respect by those in their immediate environments as well as their fellow citizens in general”.

The report recommends the institutional strengthening of services for survivors of wartime sexual assault to overcome stigmatization; development of new services, especially psycho-social support and outreach strategies, especially for male survivors and survivors from Serbian, Roma, Ashkali, and Egyptian communities.

It also recommends interventions to change patriarchal norms and gender roles; improved access to reparations, including the amendment of the 2014 Law on the Status and the Rights of the Martyrs, Invalids, Veterans, Members of Kosovo Liberation Army, Sexual Violence Victims of the War, Civilian Victims and their Families, to reflect the findings of the study and needs of the survivors.

The report further recommends the removal of time limits to apply for the official status of wartime rape victim, which confers certain state benefits, considering that some survivors might not apply because they fear certain family members, or do not want to “shame” them.

It urges the authorities to “amend the timeframe for war-related incidents of sexualised violence covered by the law to encompass the whole period of conflict. The current temporal limitation discriminates between survivors and disproportionately withholds survivors from ethnic minorities from exercising their rights. The suggestion is to adopt the timeframe stipulated in the Law on Missing Persons, which ranges from 1 January 1998 to 31 December 2000”.

It is estimated there are around 20,000 survivors of wartime rape in Kosovo.