FREETOWN, Sierra Leone

IN a rape treatment center here, I met a 3-year-old patient named Jessica, who was cuddling a teddy bear.

Jessica had seemed sick and was losing weight, but she wouldn’t say what was wrong. Her mother took her to a clinic, and a doctor ferreted out the truth. She had been raped and was infected with gonorrhea.

As I stood in the rape center corridor, reeling from the encounter with Jessica, a 4-year-old girl was brought in for treatment. She, too, turned out to have been infected with a sexually transmitted disease in the course of a rape. Also in the center that day were a 10-year-old and a 12-year-old, along with older girls.

Sexual violence is a public health crisis in much of the world, and women and girls ages 15 to 44 are more likely to be maimed or killed by men than by malaria, cancer, war or traffic accidents combined, according to a 2005 study. Such violence remains a significant problem in the United States, but it’s particularly prevalent in countries like Sierra Leone, Liberia or Congo that have endured civil war. The pattern is that after peace arrives, men stop shooting each other but continue to rape women and girls at staggering rates — and often at staggeringly young ages.