Democratic Republic of Congo: Harmful policies obstruct care for sexual violence survivors
Attempts to reduce the recorded number of sexual violence survivors in North Kivu by narrowing the definition and limiting care, goes against international medical ethical standards.
The Front for the Refoundation of the Nation (FRN), the de facto authority in North Kivu province in eastern Democratic Republic of Congo (DRC), has been imposing harmful restrictions on seeking care for sexual violence. These policies, carried out over recent months, obstruct people from accessing this essential care and put them at greater risk. Doctors Without Borders/Médecins Sans Frontières (MSF) acknowledges the commitments made by the FRN (formerly the AFC/M23) leadership in early October to address these issues. However, these corrective measures have not yet been implemented. Restrictive measures remain in place. We urge the FRN to immediately implement the agreements made to guarantee safe, confidential access to care.
Since the beginning of 2026, the authorities overseeing health services in North Kivu have introduced or proposed measures for healthcare workers, health facilities and humanitarian organizations that raise serious concerns about medical confidentiality, medical ethics, survivor protection and access to healthcare.
“A drop in reported cases does not mean sexual violence is decreasing. It simply means survivors face barriers to safe and confidential care.”
Akke Boere, MSF director of operations
These measures include:
- pressuring health workers to reduce survivor numbers by narrowing the definition of sexual violence, for example, by limiting recognition of sexual violence to people presenting with visible signs of injury
- requiring intrusive and medically unnecessary physical examinations to prove violence or assault
- requiring survivors to report to the police before seeking care
- restricting eligibility for care only to people who present within 72 hours of the assault.
The de facto authorities have also instructed organizations and health providers, including MSF, to use documentation that requires intrusive, stigmatizing, and non-essential questioning that is irrelevant to treatment. These include survivors’ names, addresses and details of alleged perpetrators. This undermines patient confidentiality, puts survivors at further risk and goes against international medical ethical standards. Patients – particularly women – report being questioned or threatened against seeking care at humanitarian-supported clinics.
Healthcare workers and health partners have told MSF they have been threatened with suspension or even imprisonment if they do not comply with the new measures. These threats are already deterring some healthcare workers from providing essential care to victims and survivors of sexual violence, and, in some cases, causing them to stop their work altogether out of fear. This further reduces people’s already limited access to care.
Policies are already deterring victims
MSF is already seeing the impact of these measures, with consultations for survivors of sexual violence falling sharply. In several MSF-supported health centres in North Kivu, dozens of entries relating to these consultations were erased from records, drastically reducing the official number of reported cases. Some centres have also stopped recording cases altogether or have reported very few for several months.
Reviewing data from some of the health facilities we support in North Kivu, 41 per cent fewer people had sought sexual violence care in August 2026, when compared to January 2026. Other facilities we support in North Kivu also saw significant declines, from providing care to around 80 survivors per month in 2025 to as few as nine per month in 2026. Communities also report growing fear about accessing services.
“Making the crisis less visible does not make the underlying violence disappear,” says Akke Boere, MSF director of operations. “A drop in reported cases does not mean sexual violence is decreasing. It simply means survivors face barriers to safe and confidential care.”
“The priority must be to remove barriers to care, strengthen protection and access to justice and address the conditions that allow sexual violence to persist,” says Boere. “The current restrictive measures are not the way to achieve this — they only further harm survivors.”
MSF is continuing its dialogue with the FRN.
“MSF calls for immediate action from the FRN to ensure that care for survivors of sexual violence is protected, confidential, accessible, and focused on health needs,” says Boere. “Official guidance must be issued to health authorities to ensure healthcare workers are no longer subjected to pressure, and activities must be overseen in a way that preserves confidentiality and does not intimidate or harm survivors or health workers.”
MSF emphasizes that access to healthcare should never depend on reporting to the authorities or pursuing legal action. While accountability for perpetrators is essential, making care conditional on reporting risks deterring survivors from seeking urgent treatment and potentially exposes them to further harm.
About MSF’s response to sexual violence in eastern DRC
Sexual violence in eastern DRC is a longstanding crisis, driven by decades of armed conflict, the actions of all parties to the conflict, weak justice and protection systems, social normalization and harmful gender norms. MSF currently provides medical care across 16 projects in North Kivu, South Kivu and Ituri provinces, and remains one of the few organizations providing immediate care to survivors in many areas.
In 2024, nearly 45,000 survivors received care in MSF-supported facilities across the DRC; this rose to 53,000 in 2025. In the first half of 2026, MSF teams treated more than 19,400 people for sexual violence in North Kivu alone.
