"I was born in war. It's all I have ever known," says Floribert*. The young man had been shot in the leg and was among a dozen patients recovering from ballistic trauma injuries at the Mweso General hospital, North Kivu province, Democratic Republic of Congo (DRC). "I can't see peace coming any time soon."
Eastern DRC has been mired in conflict for the past three decades. And 2025 has been no exception - on the contrary. During the first half of the year alone, teams from Médecins Sans Frontières (MSF) had treated more than 3,600 people for violence-related injuries across North Kivu, South Kivu, Ituri, and Maniema provinces.
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 our teams continue to treat large numbers of violent injury cases each day.
Follow us on WhatsApp | LinkedIn for the latest headlines
Civilians pay the price
Eastern DRC is home to more than 100 armed groups, with the total rising into the multiple of hundreds when including smaller factions. The region is also an arena of several 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, our teams have witnessed recurrent fighting - sometimes finding themselves, intentionally or otherwise, on the receiving end. Health facilities we support have seen a steady flow of 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 another, civilians typically represent the majority of violence-related admissions; up to 80 per cent of patients have identified as such in Mweso. Bullet wounds remain among the most common form 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 people arriving with violent trauma 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," says Mamba Mwazié, an MSF social worker, while 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, 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, our teams treated close to 28,000 victims and survivors of sexual violence across North Kivu, South Kivu, Ituri, and Maniema province - of those, 97 per cent were women and girls, while 10 per cent were minors.
Mona*, a young woman from Minova in South Kivu province, is among the survivors treated by MSF this year. Between long sighs, she explains her story.
"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," says Mona. "They took my 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."
Perpetrators are typically, but not exclusively, armed men, who operate on all sides of the various conflicts playing out in eastern DRC.
"If the war stopped here, there would be much less sexual violence," says Merveille*, an MSF midwife working in Minova. "Today most of the rapes are committed by armed men. 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," Merveille continues. "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 victims and 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," says Dr Konstantinos Zoumparis, an MSF psychiatrist working at Mweso hospital.
"Because so many people are suffering and living in shared, precarious and life-threatening situations, they sometimes struggle to express fear and anxiety," says Dr Zoumparis. "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," he continues. "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," explains 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," says Shako Omokoko.
Hospitals under fire
Unfortunately, armed violence regularly affects health facilities where MSF staff work, with direct consequences for 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 colleague was killed by a stray bullet while on duty in the MSF base. A few weeks later, a second MSF colleague was killed by an armed man - this time at home. In total, three MSF staff have been killed in North Kivu in 2025.
In October, two health centres 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, our 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, and 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 centres; and MSF premises have been robbed by armed bandits, most recently in the city of Kisangani, in Tshopo province.
Sign up for free AllAfrica Newsletters
Get the latest in African news delivered straight to your inbox
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," says 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 aerial bombing of Bibwe by plane in September, as well as the increased use of drones in North and South Kivu provinces, 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," says Emmanuel Lampaert, MSF's country representative in DRC. "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," says Lampaert. "But wars have rules, and we call on all armed groups to respect international humanitarian law, particularly with regards to not targeting civilian communities and health facilities, and facilitating safe passage of health workers and supplies."
*Names have been changed to protect patient and some staff identities.
