By Aryn Baker | Photographs by Lynsey Addario for TIME

First they shot her husband.

Then the soldiers killed her two sons, ages 5 and 7. When the uniformed men yanked her daughter from her hands next, Mary didn’t think it could get any worse.

Mary and her family were members of the Nuer tribe in South Sudan, caught up in a vicious power struggle between the new country’s President Salva Kiir, a member of the Dinka tribe, and his Vice President, Riek Machar, a Nuer. Their war, fought largely along ethnic lines, has turned the northern part of the country into a wasteland. At least 50,000 people have been killed, according to the U.N., nearly 4 million face famine, and another 2.2 million have fled their homes, recounting tales of civilian slaughter, gratuitous torture and even forced cannibalism. Mary and her family were among the tens of thousands of civilians seeking refuge at a U.N. peacekeeping base in the northern city of Bentiu when they ran into Kiir’s forces on the road in June 2014.

The 27-year-old recounts what occurred next distantly, as if she were explaining something that happened to someone else. The soldiers told Mary that they considered the Nuers in the camps to be rebels, and that they killed her sons because they couldn’t risk letting them grow up to be fighters. “We don’t kill the women and the girls,” the soldiers told Mary. “They said they would only rape us. As if rape were different than death,” says Mary, speaking in a safe house in neighboring Uganda run by Make Way Partners, an American Christian organization that provides housing, medical care and schooling for South Sudanese orphans and victims of human trafficking. After the soldiers killed her husband and sons, five of them held her down and forced her to watch as three others raped her 10-year-old daughter. Her name was Nyalaat. When the men were done, Mary says, “I couldn’t even see my little girl anymore. I could only see blood.” Then the men took turns with Mary. Nyalaat died a few hours later. “I wanted to die too.”

Lynsey Addario—Getty Images Reportage for TIME

Instead, Mary made it to a U.N. camp for civilians displaced by war. The conflict raged on, and soldiers—she’s not even sure from which army—were able to slip in to the camp through gaps in the fence and rape whichever women they could catch. “It happened to all of us: little girls, grandmothers. They didn’t care.” The rules were simple, says Mary, who asked that her full name not be used. “If you calm down when they are raping you, they won’t beat you. But if you resist, they will beat you, even so much to use the gun in you.”

Photographer Lynsey Addadario and reporter Aryn Baker discuss the difficulties of reporting on rape.

Rape in war is as old as war itself. But the intimate nature of sexual assault means that the horrors often go undocumented, sanitized out of history books and glossed over in news accounts that focus on casualties and refugee numbers. Yet that mass rape is so common in wartime only makes it more corrosive. It spreads disease. Its stigma destroys families and breaks down society. It leaves unwanted children who serve as constant reminders of the worst day of their mother’s life. “Rape is a weapon even more powerful than a bomb or a bullet,” says Jeanna Mukuninwa, a 28-year-old woman from Shabunda, in the Democratic Republic of Congo. “At least with a bullet, you die. But if you have been raped, you appear to the community like someone who is cursed. After rape, no one will talk to you; no man will see you. It’s a living death.”

Mukuninwa knows. In 2004, at the end of Congo’s own factional war, soldiers attacked her village. They tortured and killed the men. Then they stripped the women, including Mukuninwa, and staked their arms and legs to the ground, and left them to be used by any passing soldiers. Mukuninwa doesn’t know how many men raped her during captivity, but she remembers that they used sticks and rifle barrels as well. She was 16 years old. When the women passed out from the pain, soldiers revived them with buckets of water.

The U.N. reports that 200,000 Congolese women and children have been raped during Congo’s long-simmering conflict. Estimates for South Sudan are in the thousands. Both numbers are likely too low, says Pablo Castillo-Diaz, a specialist on sexual violence in conflict for U.N. Women, the U.N. agency tasked with issues of women’s equality, protection and empowerment. “Rape is one of the most underreported war crimes that there are. Women, if they survive the attack, rarely tell anyone else. We only hear of the most brutal incidences or the public ones that the whole community sees.”

But that’s begun to change. Rape may be a common war tactic, but it was only prosecuted as a crime against humanity in 1998, by the International Criminal Tribunal for the former Yugoslavia, following the discovery of the rape camps used by Serb soldiers during the Bosnian war. At the same time, Rwandan officials were also charged with rape as a war crime during that country’s 1994 genocidal conflict. Widespread media coverage of both trials drew international condemnation. Talking about rape in war became less taboo.

Most recently, harrowing revelations about ISIS’s sale of Yezidi women as sexual slaves in Iraq and Syria, and Boko Haram’s abduction of hundreds of schoolgirls for forced marriages in Nigeria, have pushed survivors and activists to demand a real global response to a war crime with consequences so enduring it all but precludes peace. “The raping of women, the holding of women as chattel and slaves is utterly horrific, but it isn’t new. It’s just an escalation and amplification of what has been going on for many years,” says Eve Ensler, the American playwright and activist. “Anytime people are talking about this, it’s a good thing. But what hasn’t happened is that we haven’t ended the violence. That is the next step.”

The next step is being taken in Congo of all places, a country whose grim ­history—it has been dubbed both “the rape capital of the world” and “the world’s worst place to be a woman” by high-ranking U.N. officials—has made it an accidental lab for some of the most progressive work on rape recovery. Bukavu, in South Kivu, and Goma, in North Kivu, the areas of eastern Congo most devastated by the war, are home to ambitious international and local programs dedicated to turning rape victims into rape survivors. Their experiences could help women around the world. “It would be a good thing,” says Mukuninwa, “that our suffering here in Congo might be able to help other women somewhere else turn their pain into power, as we are starting to do here.” First, she says, silence must end. As long as rape remains hidden and shameful, recovery is impossible.

As a gynecologist and the medical coordinator for Panzi Hospital’s center for survivors of sexual violence in Bukavu, Dr. Neema Rukunghu knows better than anyone else the physical damage wrought by rape. She has stitched up the tears, and she has retrieved inserted objects. She has repaired flesh seared by the heat of a bullet fired inside a vagina that by some miracle, or curse, didn’t kill but crippled for life. Her work is vital. Women with fistulas—tears between the vagina, the anus, the bladder and the bowel—from rape cannot retain their urine or feces. No matter how often they clean, they smell. They are shunned by their communities and are even unwelcome in church. For many women, fistula surgery is the only route to a new chance at life.

But Rukunghu says that the invisible wounds from rape are far more ­devastating—and far harder to repair. “Just imagine a husband who is forced to watch his wife be raped, or his daughter. There are things that stay in your head for life.” The work she does at Panzi, she says, seems insignificant compared with the scale of that psychic trauma. “In these surgeries, we repair damage, but I never get real closure. Are we truly healing her? Are her problems over? I can’t ever say with certainty that I have fixed anyone.”

On average Panzi treats 1,300 to 1,900 women a year, even though Congo’s war officially ended a decade ago. When Rukunghu first started, seven years ago, she saw young and ­middle-aged women. Now she is even treating toddlers. In late 2015 she attended to a 3-month-old baby girl who had been abducted from her parents’ house and returned a day later, ravaged and near dead. It’s unlikely that she will ever be able to potty-train, or walk, or have a child of her own.

Mukuninwa spent a total of seven years at Panzi Hospital. At first it was for the treatments, then because she had nowhere else to go. Physically she was strong, but she couldn’t stand to be touched and spent most of her days alone. In 2007, Ensler visited Bukavu at the invitation of Panzi’s founding doctor and gynecologist, Denis Mukwege. There she met local women’s-rights activist Christine Schuler-Deschryver, who worked with Mukwege and wanted to help rape survivors regain their lives after surgery. Together, they canvassed patients for ideas. Mukuninwa was one of the most outspoken. “I couldn’t say I wanted therapy, because I didn’t know what it was,” she says. Instead, Mukuninwa asked for schooling. She wanted a safe place to live among supportive peers, where women could learn their rights and where their voices mattered.

In 2011, Schuler-Deschryver and Ensler opened City of Joy, a six-month residential program for rape survivors that combines group therapy with literacy classes, leadership training, self-defense courses and lessons in human-rights law. Ninety women attend each semester. The focus is on empowerment, says Ensler. “City of Joy is not a refuge. It is a center for transformation. We are literally saying that the violence which was done to you, through a process of love, healing therapy and education, can be turned into a motor that makes you a leader.”

The therapy, says Mukuninwa, lets women understand that the rape was not their fault. The life skills and leadership training gain them confidence, and the nurturing atmosphere enables them to build support networks that last long after the program finishes. Graduates are expected to establish women’s support groups when they go home and become leaders in their community. “People think that, after being raped, you are just a victim,” says Mukuninwa. “What City of Joy taught me is that life goes on after rape. Rape is not the end. It is not a fixed identity.”

Lynsey Addario—Getty Images Reportage for TIME

After spending a year at the displaced-persons camp in South Sudan, Mary decided last April to leave for the capital of Juba. By this time she was pregnant and could only guess at which of the six different men that had raped her at the camp might be the father. It was too late to take the herbs that some of the other women in the camp used to rid themselves of unwanted pregnancies, and a medical abortion would have been impossible to obtain. Instead, Mary planned to poison the baby as soon as it was born and throw it in the garbage, a curse from God that she would return to God. “I had nothing. No family, no income. I was thinking, ‘How will I be able to take care of a child that reminds me, every time I look at its face, of what happened to me in the camp?’”

In the end, Mary kept the baby, now a burbling 8-month-old, after a friend convinced her that she would find support. Still, Mary struggles with the trauma of her daughter’s conception. She cannot bring herself to say, out loud, that she loves the child, but her tender caresses and softly sung lullabies make it clear that she does.

Unwanted pregnancies like Mary’s are one of the most painful problems resulting from conflict-related rape. Not only are the women stigmatized, but so too are their children. In eastern Congo alone, as many as 50,000 children were born of rape over the past two decades. In many countries in Africa and the Middle East, they are not eligible for national IDs without a father’s name on the birth certificate, which prevents them from going to school or receiving government assistance. Growing up, they are ostracized as the sons and daughters of loathed enemies and often face discrimination. Yet there are few ways for the victims of rape to abort their pregnancies even if they want to. The U.S.’s Helms Amendment, enacted in 1973, prevents American assistance funds from going to programs that also provide abortions. Since most international humanitarian medical organizations rely in some part on U.S. funding, they are reluctant to take the risk, even if they believe there is a need.

In July a consortium of 56 international human-rights, legal, medical and religious groups from 22 countries petitioned President Barack Obama to issue an Executive Order affirming the rights of female war-rape victims to comprehensive medical care, including abortion, under the Geneva Conventions. So far, Obama has not officially responded. “We think in terms of making an actual difference in women’s lives, the ability to obtain an abortion in the case of ­conflict-related sexual violence would have the biggest impact,” says Diaz of U.N. Women. Still, the notion of aborting a pregnancy is so taboo in the Christian communities of Congo and South Sudan that it’s not clear how many women would avail themselves of the services even if they did exist.

Not all women see their children conceived in rape as burdens. Ayak was 17 when she lost her family to a rebel attack on her village near Bentiu, in South Sudan. She was raped while fleeing, alone, for the camp, and like Mary, she was raped repeatedly while she was there. One of her rapists gave her HIV, and now she is pregnant. Make Way Partners, the American Christian organization that helped Mary, also brought Ayak to Uganda for treatment.

Speaking in a halting English she picked up as a child in a Kenyan refugee camp, Ayak says that her unborn child is the only family she is likely to ever have. In South Sudan, having HIV would make her a social pariah. “I want a family, I want a husband. But the doctors say there is no cure for my disease. No one will ever marry me.” She cradles her pregnant belly with both hands and smiles sadly as she envisions a lonely future. “This baby will be my friend. He will keep me company.”

Husbands usually have a harder time accepting children born of rape. When Fabien Mwira found that his wife Judith Niraneza had conceived a child through rape after a 2007 attack on his village of Mugunga, near Goma, he abandoned her. A year later, after pressure from his family, he returned, but he hated the child. When Niraneza asked for money to feed the little girl or buy her clothes, he would beat his wife, telling her to go ask the child’s father.

Men, says Mwira, often feel emasculated and guilty when their wives are raped, and don’t know how to reassert their role in the family—except through violence. “We men don’t have fistulas that need to be repaired, but we have a trauma that needs healing,” he says. “And it is just as important for bringing peace to our communities that we be healed as it is for the women to be healed.”

Mwira was part of a 2012 pilot program for male partners of rape survivors developed by a psychologist in tandem with Promundo, a U.S.-based NGO that focuses on domestic violence. The program, called Living Peace, targets men who have been flagged as particularly violent or who have abandoned their wives. Over a 15-week series of guided group therapy sessions, the men are taught that rape is not their wives’ fault and that it is no reflection of their inability to provide for and protect their families. They also learn how to be better husbands and fathers. “I was so ashamed,” says Mwira. “I thought I was the only one whose wife had been raped. But when I understood that others had the same problems as me, I started to understand that it wasn’t her fault. And by then I started to come closer to her bit by bit.”

After an initial pilot program that started with 300 men in 2012, Promundo is set to bring the therapy program to 9,000 more men and their wives by 2019. “Yes, it’s important to focus on the victims of sexual violence, and even on the children born of sexual violence,” says Benoit Ruratotoye, Living Peace’s Goma-based founding psychologist. “But to complete the circle, to really help this society change, we need to involve the author of this violence: men.”

Lynsey Addario—Getty Images Reportage for TIME

Rape in war largely begins, and ends, with men. In Congo, as around the world, Ruratotoye blames a masculine culture rooted in violence that has historically devalued women. Though groups like ISIS and Boko Haram justify wartime rape through twisted interpretations of religious doctrine, at the base is an entrenched belief in the superiority of men. To stop rape, says Ruratotoye, that kind of thinking needs to change. “We have to develop a positive masculinity. One that isn’t based on violence, that promotes the rights of all.” It starts, he says, with boys. “If they are not taught human rights, respect for women, equality, these children will grow into young men who think they are better than women, and they will grow into men who rape women, who will use violence to get their way. They will become violent men.”

Education alone isn’t enough to stop rape in war, says Rukunghu, the fistula surgeon at Panzi Hospital. That requires society as a whole to condemn it and the government to act. So far, the Congolese government has convicted 135 soldiers on rape charges since the end of the war, and says that the decline in registered cases of rape in former conflict zones, from 15,000 in 2013 to 10,882 in 2014, is due in part to increased prosecution. But the numbers are still unacceptably high, says Rukunghu, largely because it took more than a decade to react. If other countries are to learn anything from Congo’s experience, she says, it is to address the issue immediately, before wartime rape infects all of society. “When I see these [child] rapes in the community, it makes me think that they are doing it because those who did it before, during the war, were never punished,” says Rukunghu. “Instead it was banalized, and so it was like we accepted that rape is something that can happen.” A man may believe that sex with a virgin girl, even one as young as 3 months old, may bring him wealth or cure disease, she says, “but that is not why he does it. He does it because he knows that there is no prison waiting for him, no death penalty. He knows he can get away with it.

No countries need these efforts more than Syria and Iraq, where ISIS has openly codified a system of sexual slavery so repugnant that the world has reacted with outrage rarely seen in other incidences of wartime rape. In August 2014, ISIS attacked the northern Iraqi region of Sinjar, taking thousands of women and children from the Yezidi religious minority as slaves. ISIS’s department of war spoils set prices based on age, and, in a document dated Jan. 29, 2015, but discovered only at the beginning of 2016, its committee for religious rulings detailed the conditions under which a slave could be used for sex. They are horrendous. “I did not want to kill myself—but I wanted them to kill me,” says Nadia Murad Basee Taha, a young Yezidi woman who was held as a sex slave by ISIS in Iraq for a few months before managing to escape

If Congo’s experiences with rape in conflict can help victims around the world with recovery, then the global reaction to ISIS’s use of sexual slavery should serve as a template for more effective prosecution. “We have a history of impunity for sexual war crimes that goes back to the beginnings of war,” says Ensler. “When you don’t have accountability, you can basically say you have licensed that kind of sexual brutality forever.”

To put an end to rape in war, rather than merely healing it, requires that ISIS’s actions be treated as a war crime, point blank, and not just a “second-class crime that happens to second-class citizens,” according to Zainab Bangura, the U.N.’s special representative on sexual violence in conflict. Rape in war, she notes, is not inevitable. Rather it is a reflection of the subordinate status of women in society. Wartime rape will stop when the status of women changes, and the shame lands on the perpetrators, not the victims.