The difficulties facing American Indian women who have been raped are myriad, and include a shortage of sexual assault kits at Indian Health Service hospitals, where there is also a lack of access to birth control and sexually transmitted disease testing. There are also too few nurses trained to perform rape examinations, which are generally necessary to bring cases to trial.
Women say the tribal police often discourage them from reporting sexual assaults, and Indian Health Service hospitals complain they lack cameras to document injuries.
Police and prosecutors, overwhelmed by the crime that buffets most reservations, acknowledge that they are often able to offer only tepid responses to what tribal leaders say has become a crisis.
Reasons for the high rate of sexual assaults among American Indians are poorly understood, but explanations include a breakdown in the family structure, a lack of discussion about sexual violence and alcohol abuse.
Rape, according to Indian women, has been distressingly common for generations, and they say tribal officials and the federal and state authorities have done little to help halt it, leading to its being significantly underreported.
In the Navajo Nation, which encompasses parts of Arizona, New Mexico and Utah, 329 rape cases were reported in 2007 among a population of about 180,000. Five years later, there have been only 17 arrests. Womenâ€™s advocates on the reservation say only about 10 percent of sexual assaults are reported.
The young woman who was raped in Emmonak, now 22, asked that her name not be used because she fears retaliation from her attacker, whom she still sees in the village. She said she knew of five other women he had raped, though she is the only one who reported the crime.
Nationwide, an arrest is made in just 13 percent of the sexual assaults reported by American Indian women, according to the Justice Department, compared with 35 percent for black women and 32 percent for whites.
In South Dakota, Indians make up 10 percent of the population, but account for 40 percent of the victims of sexual assault. Alaska Natives are 15 percent of that stateâ€™s population, but constitute 61 percent of its victims of sexual assault.