The author Philip Gourevitch once wrote: “Oh Congo, what a wreck. It hurts to look and listen. It hurts to turn away.” Exploited and misruled for much of its modern history, this country has spent more than a decade in a state of semi-permanent civil war. 5.4m people have died, mostly from disease and starvation, and Congo’s abundant mineral resources bring nothing but the worst kind of exploitation.  Directed in 2006 by Lisa F Jackson, and shown recently at the RSM’s global health film club, “The Greatest Silence: Rape in the Congo” concerns a further tragic facet of this conflict: the systematic rape of Congolese women. “Rape” is actually a rather mild term for the violations suffered. Many of the women subsequently require surgery for fistulas, having been deliberately mutilated and 30% will be HIV positive. This gender violence is not a consequence of the war, but a key mechanism in its execution: both as a demonstration of power and a form of social control. Raped women are likely to be abandoned by their partners and ostracised by their communities; children born as a result of rapes carry their own stigma. Jackson has a connection with this subject that no one would wish on themselves: she was gang-raped herself in 1976, an experience she shares with the women she interviews.

Filming takes place in South Kivu province, 3572 sq km with a population of 141000. It is part of the “red zone” and has known incessant fighting during the conflict. Healthcare services are often poorly equipped and serving the area are 27 health centres and a Panzi hospital. The gynaecologist there, Denis Mukwege, works eighteen hour days repairing severely damaged genitalia. Some of the women may also be doubly incontinent and require multiple operations.

During and after the screening, this question is with me: who are the men who commit these acts, and how can they act in this way? I refuse to believe that Congolese people are any different to any of the rest of us, but some of their number act in ways that are cruel and barbaric beyond expression. In the film, and with rather more disregard for her personal safety than I can muster, Jackson ventures into the bush and meets some of them. From behind scarves and dark glasses they admit their crimes, but otherwise give little away.

Perhaps their casually brandished weaponry reveals more. During the post screening discussion one of the panellists explains that many of the soldiers will have joined the militia in their early teens. Initiations whereby they will have killed their families and raped their own mothers are not uncommon. With a weak central government, Congo is unable to protect its citizens and the brutalisation of its people stretches back several centuries. This is a thoughtful and powerful film, and I hope that someday the Congolese will be able to make films of their own.

Stephen Ginn is the BMJ editorial registrar.