DR Congo: Fear and insecurity on both sides of the front line in South Kivu

Provinces near the front line under intense pressure

The current front line at Katogota in South Kivu bisects the vital road connecting the cities of Bukavu and Uvira, significantly limiting access for the communities and isolating them on either side. Caught in the violence, many people had to flee to the nearby hills or elsewhere, forced to live in precarious conditions without access to drinking water and health care facilities.

M23/AFC’s capture of the capital of South Kivu, Bukavu, in February marked a significant expansion of their territorial control, putting pressure on surrounding provinces.

“We have lost everything,” says Vianney*, who was displaced from the nearby hills around Kamanyola, South Kivu. “Our fields are overrun by armed men, and we cannot afford health care. I fear for my children's health.” Since the beginning of the year, an ongoing humanitarian crisis has worsened as intense fighting between the armed group M23/Alliance Fleuve Congo (AFC) and the Congolese army (FARDC), supported by their respective allies, spilled over from the neighboring province of North Kivu.

Uvira community is vulnerable

The position of M23/AFC at the front line in Katogota has been putting significant pressure on Uvira, which is under government control. 

“We all panicked when we heard gunfire inside the hospital,” says Aisha, a mother caring for her infant son at the mpox treatment center at Uvira General hospital. “When it stopped, I asked to leave, even though my son was still sick. I didn’t feel safe.”

In February, residents reported increased violence and clashes in Uvira between the Congolese army and its alleged allies, the Wazalendo fighters—a coalition of armed groups opposed to M23/AFC. Medical facilities were not spared from gunfire, hampering patients' access to care.

MSF teams began working in Uvira in September 2024 to respond to the mpox outbreak, and were present during the February clashes. Despite challenges, they kept supplying medical equipment and launched emergency interventions, once the security situation allowed.

Since the beginning of the fighting in the area, Uvira has hosted more than 250,000 displaced people, increasing its need for food, health care, and humanitarian assistance. 

“It is in this context that we increased our response to strengthen capacities for treating war injuries, cholera cases, and victims and survivors of sexual violence,” explains Dr. Aurora Revuelta, MSF medical team leader in Uvira. Between February and May 2025, MSF treated nearly 400 war-wounded people, and 800 people with cholera in three treatment centers in collaboration with the Ministry of Health. We also repaired several drinking water points to help prevent the spread of infectious diseases.

Restoring health care access in in Kamanyola

On the other side of the front line, in the city of Kamanyola, next to Katogota, the situation is equally complex. This area, under M23/AFC control, has also seen its health care system weakened by violence. During the initial clashes, people and families fled to the nearby hills for several weeks.  

“We suffered in the fields where we were displaced,” explains Jeannette*. “I lost two of my children because we couldn’t access medical care. We had to bury them like animals, without being able to give them a dignified funeral.” 

While some stability has returned to the town, allowing some communities to come back, most of the fighting continues in the surrounding hills, making access to fields impossible and increasing insecurity for residents in nearby small villages. 

In response, MSF launched an emergency intervention in mid-March to support medical needs and local health structures.

“Our priority was to support the general hospital and surrounding health centers, which lacked medical supplies,” explains Dale Koninckx, MSF project coordinator. “We strengthened the management of war injuries, provided medical equipment, and implemented sanitation activities to prevent the spread of disease.”

With MSF's support, 7,500 free medical consultations were conducted over eight weeks with the Ministry of Health, of which nearly 40 percent were for children under 5 years old, primarily for malaria, acute respiratory infections, and diarrhea.

MSF teams also improved hygiene conditions in health facilities it is supporting, including rehabilitating water tanks, emptying septic tanks at the hospital, and connecting several health centers to water. More than 3.7 million gallons of water was distributed during the intervention—a crucial effort to prevent disease spread.

Insecurity presents a major logistical challenge

Persistent insecurity has rendered the road between Bukavu, Kamanyola, and Uvira nearly impassable, making it impossible for humanitarian organizations to move between the two sides of the front line. To overcome this situation, MSF has adapted by crossing various countries to deliver aid and provide care on each side.

“The health situation was already precarious, but today it is even more critical,” says Olivier Pennec, head of MSF programs in South Kivu. “The absence of humanitarian organizations, combined with challenges in reaching the area—whether physically, logistically, or in terms of safety—adds to the complexity.” 

As health care access deteriorates due to fewer humanitarian organizations on the ground and US funding cuts, MSF remains one of the few organizations physically present and providing medical care to communities caught in this area.

*Names have been changed for privacy.