Médecins Sans Frontières (MSF) has witnessed a renewed spike in atrocities in eastern Democratic Republic of Congo (DRC)'s Ituri province, where our medical teams are providing care for civilians with horrific injuries. In a new report released today, Risking Their Lives to Survive, MSF underscores the extreme needs of many communities endangered by recent attacks, increased displacement, and reduced humanitarian aid.
Risking their lives to survive pdf -- 12.31 MB Download
For decades, people in Ituri - in the northeast of DRC - have been both direct targets and treated as collateral damage in a complex conflict characterised by violence, ethnic divisions, and the participation of various armed groups. This conflict has also greatly hampered access to healthcare and the means for families to feed themselves, while the restricted provision of humanitarian aid has caused further suffering among a community that already gets little international attention.
MSF calls on all state and non-state armed groups in Ituri to spare civilians, as well as healthcare facilities, which are sanctuaries essential to the survival of local communities.
Violence in Ituri has displaced around 100,000 people since the beginning of the year, according to the UN.1 In January and February alone, it also reported an intensification of violence against civilians, with attacks leaving more than 200 people dead and dozens injured. In February, MSF's medical teams treated children as young as four and pregnant women for machete and gunshot wounds, following militia attacks in Djugu territory.
"These most recent attacks follow decades of violence and its devastating consequences for civilians, including women and children in Ituri," said Alira Halidou, MSF head of mission in DRC. "The crisis here is characterised by repeated displacement, in which violence forces civilians to pick up and start their lives over, again and again. What is worse, is that the stories patients and communities tell us represent only the tip of the iceberg."
A woman prepares food outside her shelter in the Gengere 1 refugee camp. Ituri province, DRC, January 2025. © Fanny Hostettler/MSF
Hindering access to healthcare
Only a small proportion of people can access healthcare in Ituri, where health facilities also fall prey to attacks. In Djugu territory, the Fataki general hospital was obliged to suspend its activities and evacuate patients in mid-March following armed group threats. This closure affects thousands of people, left without access to medical care.
In Drodro health zone, also in Djugu, nearly 50 per cent of healthcare centres have been partially or fully destroyed and have had to be relocated. When violence escalated this time last year, a patient was killed in her bed in an armed attack on Drodro's general hospital.
Not only do these attacks make patients reluctant to go to medical facilities, but they also put medical staff at risk. One doctor interviewed for the report recounted how, when a health centre was forced to shut down for two months, he still went in to perform caesarean sections.
"It was dangerous, and I was risking my life, but we didn't have a choice," said the doctor. "We had to sneak there with the women, otherwise they would have died."
Targeting the most vulnerable
More than half of the 39 victims of violence MSF treated at Salama clinic, Bunia, up until mid-March 2025 were women and children. One mother, whose four-year-old child was injured, lost her 6-month-old baby and her husband during an attack wielded by machete. Two sisters aged four and 16 took machete blows to the head and arms, and their mother (eight months' pregnant) was also severely injured by multiple machete wounds. We treated a nine-year-old boy with a gunshot wound to the abdomen, who had witnessed assailants attack and kill his mother and two siblings by machete.
When civilians seek refuge in displacement camps, they are still not safe. In one instance in September 2024, our teams treated five civilians with bullet wounds following an attack on Plaine Savo camp, in Fataki health zone.
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When there is an upsurge in attacks against civilians, the number of victims of sexual violence coming to MSF facilities also increases. Women in particular face attack, as they go out in search of means to feed themselves and their families. In Drodro, in 2023 and 2024, around 84 per cent of the victims of sexual violence treated by MSF were attacked while working in fields, collecting firewood, or on the road.
Exacerbating unmet needs
Despite the efforts of the Ministry of Health, MSF, and other humanitarian organisations, people's needs very much exceed the resources available. Food insecurity worsened sharply in Ituri in 2024 and is now chronic for 43 per cent of people. Poor hygiene conditions and dilapidated shelters in displacement camps mean that diarrhoeal and respiratory diseases spread easily, affecting children under five the most.
People in Ituri must be guaranteed safe access to healthcare and must not be forced to risk their lives in search of food and other needs.
