Piecing together bodies and minds: MSF and violence in Eastern DRC

Eastern Democratic Republic of Congo (DRC) has been mired in conflict for the past three decades. And 2025 was no exception – on the contrary. During the first half of the year alone, MSF treated more than 3,600 people for violence-related injuries across the provinces of North Kivu, South Kivu, Ituri and Maniema. ​

This high caseload is likely due to a combination of factors – including intense fighting between the Congolese army (FARDC), the Alliance Fleuve Congo (AFC)/M23 and their respective allies in the first months of 2025 and the fact that front lines moved closer to areas of MSF’s areas of operation in North and South Kivu. ​

Continuous offensives and clashes across the region mean that MSF teams continue to treat large numbers of violent injury cases each day. ​

Civilians pay the price

Eastern DRC is home to more than one hundred armed groups, with the total rising into the hundreds when including smaller factions. ​ It is also an arena of multiple overlapping conflicts, each with its own dynamics. ​

While there is no simple explanation for successive waves of violence across DRC in 2025, they do share one thing in common: civilians pay the heaviest price.

Over the course of the year, MSF teams have witnessed recurrent fighting – sometimes finding themselves, intentionally or otherwise, on the receiving end. Health structures we support have seen a steady flow of wounded patients and casualties. Patients have testified to myriad acts of violence – from massacres to violent kidnappings, to beatings and horrific acts of sexual violence. In some contexts, civilians are targeted deliberately – at other times, they find themselves caught in the crossfire, frequently as victims of stray bullets.

While the proportions differ from one MSF project location to nother, civilians typically represent the majority of violence-related admissions – with up to 80% of patients identifying as such in Mweso. Bullet wounds remain among the most common forms of injury, while attacks with bladed weapons, bombings and torture also account for a significant number of injuries. ​

At a now-closed project in Salamabila (Maniema province), the vast majority of the 366 violent trauma cases seen in the first half of 2025 had been whipped, often accused of not paying ‘tax’ to members of an armed group controlling a major gold mine in the area. ​

“Recently we treated a man who had to stay laying on his stomach for 10 days because the wounds on his back were very deep,” said Mamba Mwazié, an MSF social worker working on the project in September. ​

While across many of the projects, young men account for the majority of violence-related injuries, women and children are not spared. Between January and September 2025, MSF treated 333 victims of violence at the Salama clinic in Bunia (Ituri province). Nearly one third were female patients, and one in seven were minors - both girls and boys. ​

Among them was a nine-year-old who had been shot in the abdomen after seeing his mother and siblings hacked to death with machetes. ​

Sexual violence

This violence by armed men extends beyond shootings and intimidation; all too often, it takes the form of sexual violence – mostly against women.

In the first half of the year, MSF treated close to 28,000 survivors across the provinces of North Kivu, South Kivu, Ituri and Maniema– of those, 97% were women and girls, while 10% were minors. ​

Mona *, a 35-year-old woman from Minova (South Kivu) is among the survivors treated by MSF this year. Between long sighs, she explained her story. ​

“Yesterday at around 9 pm, I went to see my older brother to ask him for food. On my way back home, four men came towards me on the road, one of them armed. They took my fabric skirt and blindfolded me with it. One of them grabbed me by the neck and squeezed it very hard. During that time, one of them raped me, then the second, and then the third — they all raped me one after another. Now, the owner of the house I rent wants me to leave because he wants to avoid problems,” she said. ​

Perpetrators are typically, but not exclusively, armed men– operating on all sides of the various conflicts playing out in eastern DRC.

“If the war stopped here, there would be much less sexual violence. Today most of the rapes are committed by armed men. Most cases happen when women go to the fields or to look for food,” said Merveille*, an MSF midwife working in Minova. ​

“The situation is alarming because many of the women who are sexually assaulted stay locked in their houses, daring not to look for food, while their children go hungry. They stop all activities and some of them develop mental health problems.”

Today, MSF is one of the only organisations able to deliver a full package of healthcare – including medical and psychological support – to survivors of sexual violence in eastern DRC. Cuts to international humanitarian and development spending mean that other partners have been forced to scale back or stop delivering care altogether.

Psychological scars 

Besides physical injury, rampant violence across eastern DRC has devastating impacts on people's mental health.

In Mweso, between two and five people are hospitalised with mental health disorders every week. ​

“It is fair to assume that being shot at, displaced, robbed, sexually assaulted – or even just hearing shooting on a regular basis – has an impact on mental health,” said Dr Konstantinos Zoumparis, an MSF psychiatrist working at the hospital. ​

“Because so many people are suffering and living in shared precarious and life-threatening situations, they sometimes struggle to express fear and anxiety. These feelings are then sometimes expressed in sudden outbursts and dissociation or through catatonia.” ​

“In the former category, patients sometimes flee their homes, screaming, and running into the forest in an alarmed state. In the latter, they stop eating, speaking and simply stare, unresponsive, into space.” ​

The need for mental health services in eastern DRC is reflected in the sheer number of consultations. At North Kivu’s Masisi General Reference hospital alone, close to 2,000 mental health consultations were carried out from January to July. ​

“In conflict and post-conflict situations, mental health activities are very important to relieve the suffering of our patients,” explained Charli Shako Omokoko, MSF’s mental health and psychosocial supervisor at the site. ​

But while mental health issues can be partially treated through therapy and medication, the underlying causes of many mental health issues remain.

“We do our best to support patients, but when they leave the clinic, they return to a context of insecurity, with many lacking food and housing,” she said.

Hospitals under fire 

Unfortunately, armed violence regularly affects health facilities where MSF staff work, with direct consequences for the health workers and patients. ​

In the first few months of the year, several civilians were wounded and killed in front of the Masisi General Reference hospital during armed clashes for control of the city. Staff working in the hospital and the base were not spared: several were wounded and, tragically, an MSF employee was killed by a stray bullet while on duty in the MSF base. A few weeks later, a second MSF employee was killed by an armed man – this time at home. In total, three MSF employees have been killed in North Kivu in 2025. ​

In October, two health centers supported by MSF were hit by stray bullets in Masisi and Rutshuru territories in the same week – and other health facilities in the country have not been spared either. ​

Since the start of 2025, MSF teams across eastern DRC—from Tshopo to South Kivu—have faced numerous security incidents. Fighters from several armed groups, including the Congolese armed forces (FARDC), Wazalendo and Alliance Fleuve Congo (AFC)/M23, have violated international humanitarian law, entering and opening fire in health facilities, threatening, and even attacking health workers and patients. In April 2025, such incidents notably resulted in one death and several injuries in Kyeshero hospital in Goma. In Walikale, vehicles and the MSF base have suffered damage; gunfire was reported inside the hospital in Uvira; ambulances have been held up while trying to reach health centers; and MSF premises have been robbed by armed bandits, most recently in the city of Kisangani (Tshopo).

Armed violence as a barrier to care

Years of armed clashes, coupled with chronic underinvestment, have massively disrupted access to healthcare in Eastern DRC. ​

In 2025 – and not for the first time – numerous health facilities were looted amid ongoing insecurity. Health workers have been driven from conflict hotspots by the violence and medical staff are often unable to reach patients due to ongoing fighting – and vice versa.

“There are many patients who only arrive at the hospital several days after being injured. This means they often arrive in a critical state, reducing their chances of survival,” said Dr Bassirou Amani, an MSF manager working at the General Reference Hospital in Rutshuru – the only facility in the territory of close to one million people with staff equipped and trained to carry out trauma surgery. ​ 

Beyond limiting access to care and weakening public health infrastructure, insecurity has disrupted vaccination campaigns; and driven mass displacement and malnutrition.

In recent years, the dynamics of conflict in eastern DRC have shifted. The recent aerial bombing of Bibwe by plane in September as well as the increased use of drones in North and South Kivu, raises the prospect of further death and destruction.

“The scale of the violence in eastern DRC continues to weaken an already fragile health system suffering from years of insecurity and chronic underinvestment,” said Emmanuel Lampaert, MSF’s Country Representative. “It represents a tragedy for individuals – the wounded, the killed, the raped and their families – and for entire communities who are constantly on the move, unable to access vital health services, food and other basic means of survival.”

“MSF remains committed to assisting people on all sides of the various frontlines in eastern DRC. But wars have rules, and we call on all armed groups to respect international humanitarian law, particularly with regards to not targeting civilian populations and health facilities; and facilitating safe passage of health workers and supplies.” ​

*Names have been changed for the protection of patients and staff.