DRC: MSF warns of new surge of attacks on civilians in Ituri

The latest escalation began on June 27 in Djangui, Djugu territory, where nine people – including women and children – were killed during an attack on a displacement site. On July 31, the village of Katsu was targeted, leaving more people wounded and displaced. More recently, over 40 people were massacred inside a church in Komanda, and Bunia, the provincial capital, was also attacked.

In a context where access to healthcare is already extremely limited, the majority of victims are not getting medical care despite serious physical and psychological consequences.

Adèle,* a mother of seven in her forties, was shot in the arm as she tried to take cover during the July 31 attack on Katsu.

“We woke to the sound of gunfire. Everyone was running for their lives. That’s when the attackers started shooting at people. There were no fighters – this was a senseless attack,” she said.

Civilians trapped in recurring cycles of violence

Caught between recurring clashes, intercommunal tensions, and the proliferation of armed groups, civilians in Ituri continue to pay the heaviest price. In its March 2025 report Risking their lives to survive, MSF highlighted that women and children accounted for nearly one third of victims of violence treated in its facilities.

“What is happening in Ituri is unacceptable. Civilians are victims of atrocities committed by armed groups daily. MSF calls on all state and non-state actors to spare civilians. Protecting the population from these atrocities is critically urgent,” said Asiyat Magomedova, MSF Head of Mission in the region.

Jean-Bosco,* from the village of Tsotso, fled an armed attack on August 2.

“I heard gunfire from across the river before running into armed men. They accused me of hiding a weapon in my home. I told them I was just a civilian. Some wanted to spare me, others insisted I should be killed. I raised my arm to shield my head, and that’s when they struck me twice with a machete on my wrist and fingers,” he said.

Only a fraction get lifesaving care

At the MSF-supported Salama Clinic in Bunia, corridors are still crowded. Stretchers are carried in one after another by staff or from the few ambulances available. Open fractures, gunshot wounds, shrapnel injuries – each patient bears the brutal marks of conflict.

Yet most never make it to the clinic. Since January, 250 patients have been treated for severe conflict-related injuries – 105 of them between July and August alone. Teams have already performed 934 surgeries for gunshot and blade-related trauma, with many patients requiring multiple operations to survive.

“In the past three months, admissions have nearly doubled. We’ve had to switch to emergency mode and set up tents for extra beds. But the reality is, most of the wounded never reach us,” said Asiyat Magomedova.

Beyond wounds: invisible scars

Patients at Salama Hospital come from areas such as Drodro, Nizi, Lopa, Fataki, and Komanda, where treatment for severe injuries is almost non-existent. MSF supports 15 health zones with ambulance referrals and mobile kits to stabilize patients.

Beyond their physical wounds, survivors carry invisible scars: the fear of tomorrow, anxiety, trauma, silent tears, vacant stares. Each outbreak of violence deepens psychological wounds.

The renewed violence is also driving mass displacement and compounding already immense humanitarian needs. More than 1.56 million people are currently displaced in Ituri, according to provincial authorities, nearly half of them in Djugu territory, with high concentrations in Drodro and Angumu health zones. Between mid-July and mid-August alone, over 82,800 people fled fresh attacks in Djugu and Irumu, according to OCHA.

“Every day, the humanitarian space is shrinking: with roads closed, activities suspended, insecurity everywhere. Behind these barriers, the needs for medical care, nutrition, clean water, protection, and psychosocial support continue to grow for thousands of displaced families. Protecting civilians and ensuring access to healthcare are legal obligations in times of conflict. Authorities and armed groups must urgently act to end abuses and guarantee safe, unhindered humanitarian access,” said Asiyat Magomedova.

*Names have been changed to protect identities.

Background: Risking their lives to survive

The province of Ituri has been shaken by decades of violence, notably with the Second Congo War starting in 1998. Following a lull that began in 2007, the province has experienced a resurgence of violence since 2017, when armed attacks and violations of international humanitarian law (IHL) resulted in death, deep trauma, mass displacement of populations, and growing humanitarian needs.

In 2024, around 1.36 million people – 18% of the province’s population – are displaced due to violence.1 The protracted nature of these displacements, along with other crises affecting the DRC and neighbouring countries, is leading donors to withdraw their funding, even though the needs are still vast. The crisis in Ituri is not new, but it is still a crisis, with urgent needs that must be addressed. For populations affected and displaced by the violence, it is a matter of survival.

In this context, MSF is a key humanitarian actor in Ituri. It provides medical and humanitarian assistance in the health zones of Drodro, Angumu, and Bunia. The report Risking their lives to survive is based on medical data, testimonies gathered in the field, and information shared by other humanitarian actors. It highlights the physical and psychological consequences of the violence on civilians, the obstacles to accessing healthcare, and the unmet humanitarian needs.

1. Presentation of the Population Movement Commission (CMP) of Ituri, November 4, 2024.