“I was born in war—it’s all I have ever known,” said Floribert*. The 20-year-old, who was shot in the leg, is among a dozen patients recovering from ballistic trauma injuries at Mweso General Hospital, North Kivu, in the eastern part of Democratic Republic of Congo (DRC) where Doctors Without Borders/Médecins Sans Frontières (MSF) works. “I can’t see peace coming any time soon.”
DRC has been mired in conflict for the past three decades. During the first half of 2025 alone, MSF treated more than 3,600 people for violence-related injuries across the eastern 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), Alliance Fleuve Congo (AFC)/M23, and their respective allies earlier this year, and because front lines moved closer to areas where MSF works in North and South Kivu.
As offensives and clashes continue across the region, MSF teams continue to treat large numbers of patients with injuries from violence every day.
Civilians caught in the crossfire between hundreds of armed groups
Eastern DRC is home to more than a hundred armed groups. It is also an arena of multiple overlapping conflicts, each with its own dynamics. The successive waves of violence across DRC in 2025 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 on the receiving end. The health structures we support have seen a steady flow of wounded people, and patients have told us about myriad acts of violence—from massacres to violent kidnappings, beatings, and horrific acts of sexual violence. In some places, civilians are deliberately targeted; at other times, they find themselves caught in the crossfire, frequently falling victim to stray bullets.
Civilians typically represent the majority of violence-related admissions where MSF works—in Mwesto, it’s up to 80 percent. 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 were caused by whipping, with victims often accused of not paying a “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 in September.
Across many of MSF’s projects in the area, young men account for the majority of violence-related injuries, but 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 9-year-old who had been shot in the abdomen after seeing his mother and siblings hacked to death with machetes.
Widespread sexual violence in eastern DR Congo
The violence by armed men extends beyond shootings and intimidation; all too often, it takes the form of sexual violence—usually against women. The perpetrators operate on all sides of the various conflicts in the region.
Cuts to international humanitarian and development spending mean that other partners have been forced to scale back or stop delivering care altogether. Today, MSF is one of the only organizations able to deliver a full package of health care—including medical and psychological support—to survivors of sexual violence in eastern DRC. In the first half of the year, our teams treated close to 28,000 survivors across North Kivu, South Kivu, Ituri. Ninety percent were women and girls.
“Yesterday at around 9 p.m., I went to see my older brother to ask him for food,” said Mona*, who comes from Minova, South Kivu, and was treated by MSF this year.
“On my way back home, four men came toward me on the road, one of them armed. They took my skirt and blindfolded me with [the fabric]. 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.
“If the war stopped here, there would be much less sexual violence,” said Merveille*, an MSF midwife working in Minova. “Most cases happen when women go to the fields or to look for food. 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.”
Psychological scars of constant violence
In addition to physical injury, rampant violence across eastern DRC has had a devastating impact on people's mental health. In Mweso, between two and five people are hospitalized 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,” he added. “These feelings are sometimes expressed in sudden outbursts and dissociation or through catatonia [a neuropsychiatric syndrome]. Patients sometimes flee their homes screaming, and run into the forest in an alarmed state, [or] 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 and health workers in the line of fire
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 FARDC, Wazalendo and AFC/M23, have violated international humanitarian law, entering and opening fire in health facilities, threatening, and even attacking health workers and patients. In April, such incidents resulted in one death and several injuries at 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.
Several civilians were wounded and killed in front of Masisi General Reference hospital during armed clashes for control of the city this year. 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 within the same week. Other health facilities in the country have not been spared either.
Violence makes health care harder to access
The clashes, coupled with chronic underinvestment, have massively disrupted access to health care in eastern DRC. In 2025—and not for the first time—numerous health facilities were looted amid ongoing insecurity. Health workers have had to flee conflict hotspots due to 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 a territory of close to one million people that has staff equipped and trained to carry out trauma surgery.
The insecurity has also disrupted vaccination campaigns and driven mass displacement and malnutrition.
“MSF remains committed to assisting people on all sides of the various frontlines in eastern DRC,” said Emmanuel Lampaert, MSF’s country representative. “But wars have rules. We call on all armed groups to respect international humanitarian law, particularly with regard to not targeting civilian populations and health facilities; and facilitating safe passage of health workers and supplies.”
*Names have been changed.
