Mukwege can't say for certain if the attacks are on the increase. In general, the hospital estimates it sees just 10 per cent of all sexual violence victims, but certain patterns are developing. Attackers are now identifiable by their manner of attack: one group, after raping the woman or girl, inserts the barrel of a gun into her vagina and shoots, thus destroying her vagina, bladder, rectum and causing massive blood loss. Some force males at gunpoint to rape mothers or sisters, often in front of the whole community. A large percentage of the attackers are HIV-positive and knowingly try to infect their victims.