MSF DRC: Harmful, restrictive measures obstruct care for sexual violence survivors

Survivors of sexual violence in consultation at the CCLK health centre in Goma. At this facility in the heart of the city of Goma, capital of North Kivu in the east of the DRC, MSF provides a comprehensive service for survivors: curative and preventive consultations, medical abortions, prevention of unwanted pregnancies, psychosocial support, health protection and promotion.

Since the beginning of 2026, the authorities overseeing health services in North Kivu have introduced or proposed measures for healthcare workers, health facilities, and humanitarian organisations that raise serious concerns about medical confidentiality, medical ethics, victim and survivor protection, and access to healthcare. ​

These measures include pressuring health workers to reduce victim and survivor numbers by narrowing the definition of sexual violence, for example, by limiting recognition of sexual violence to people presenting with visible signs of injury; requiring intrusive and medically unnecessary physical examinations to prove violence or assault; requiring victims and survivors to report to the police before seeking care; and restricting eligibility for care to people who present within 72 hours of the assault.

The de facto authorities have also instructed organisations and health providers, including MSF, to use documentation that requires intrusive, stigmatising, and non-essential questioning that is irrelevant to treatment — including victims and survivors’ names, addresses, and details of alleged perpetrators. This undermines patient confidentiality, puts victims and survivors at further risk, and goes against international medical ethical standards. Patients – particularly women – report being questioned or threatened against seeking care at humanitarian-supported clinics. ​

Healthcare workers and health partners have told MSF they have been threatened with suspension or even imprisonment if they do not comply with the new measures. These threats are already deterring some healthcare workers from providing essential care to victims and survivors of sexual violence, and, in some cases, causing them to stop their work altogether out of fear. This further reduces people’s already limited access to care.

MSF is already seeing the impact of these measures, with consultations for victims and survivors of sexual violence falling sharply. In several health centres MSF supports in North Kivu, dozens of entries relating to these consultations were erased from records, drastically reducing the official number of reported cases. Some centres have also stopped recording cases altogether, or have reported very few for several months. ​

Reviewing data from some of the health facilities we support in North Kivu, 41 per cent less people had sought this care in August 2026, when comparing to January 2026. ​ Other facilities we support in North Kivu also saw significant declines, from providing care to around 80 victims and survivors per month in 2025 to as few as nine per month in 2026. Communities also report growing fear about accessing services. ​

“Making the crisis less visible does not make the underlying violence disappear,” says Akke Boere, MSF director of operations. “A drop in reported cases does not mean sexual violence is decreasing. It simply means survivors face barriers to safe and confidential care.” ​

“The priority must be to remove barriers to care, strengthen protection and access to justice, and address the conditions that allow sexual violence to persist,” says Boere. “The current restrictive measures are not the way to achieve this — they only further harm survivors,”

MSF has maintained regular dialogue with the de facto authorities, including with their leadership. While these exchanges have resulted in commitments to address the issue, the harmful and restrictive measures have continued.

“MSF calls for immediate action from the FRN to ensure that care for survivors of sexual violence is protected, confidential, accessible, and focused on health needs,” says Boere. “Official guidance must be issued to health authorities to ensure healthcare workers are no longer subjected to pressure, and activities must be overseen in a way that preserves confidentiality and does not intimidate or harm survivors or health workers.”

At the same time, MSF emphasises that access to healthcare should never depend on reporting to the authorities or pursuing legal action. While accountability for perpetrators is essential, making care conditional on reporting risks deterring victims and survivors from seeking urgent treatment and potentially exposes them to further harm.

Sexual Violence in Eastern DRC: A Persistent Emergency

Contains description of sexual abuse

A 39-year-old woman recounts how, a year ago, she was forcibly taken by armed men and sexually assaulted while working in the fields with her husband. “I didn't have access to health facilities back then, and since the assault, I have had a lot of health problems and infections that never stopped. But a few days ago, I heard a woman in the street [an MSF community health worker] talking about medical care when you've suffered violence, even if it's been a long time ago. I came here [to the MSF-supported health centre] for an appointment. With the medicines I received, things are much better now.

“Today, I am afraid for my daughter. She is 16. That is the age when something can happen to her because she is quite grown up now. And there are too many problems around, too much insecurity”.

About MSF's response to sexual violence in eastern DRC

Sexual violence in eastern DRC is a longstanding crisis, driven by decades of armed conflict, the actions of all parties to the conflict, weak justice and protection systems, social normalisation, and harmful gender norms. MSF currently provides medical care across 16 projects in North Kivu, South Kivu, and Ituri provinces, and remains one of the few organisations providing immediate care to victims and survivors in many areas.

In 2024, nearly 45,000 victims and survivors received care in MSF-supported facilities across DRC; this rose to 53,000 in 2025. In the first half of 2026, MSF teams treated over 19,400 people for sexual violence in North Kivu alone.