Doctors Without Borders/Médecins Sans Frontières (MSF) has witnessed a renewed spike in atrocities in eastern Democratic Republic of Congo (DRC)’s Ituri province, where its medical teams are providing care for civilians with horrific injuries.
In a new report released, “Risking Their Lives to Survive,” MSF underscores the extreme needs of many communities endangered by recent attacks, increased displacement, and reduced humanitarian aid.
MSF calls on all state and non-state armed groups in Ituri to spare civilians as well as health care facilities, which are sanctuaries essential to the survival of local communities.
For decades, people in Ituri province—in northeastern DRC—have been targeted directly and treated as “collateral damage” in a complex conflict characterized by violence, ethnic divisions, and the participation of various armed groups. This conflict has also greatly hampered access to health care and the means for families to feed themselves, while the restricted provision of humanitarian aid has caused further suffering in a region that receives little international attention.
Violence in Ituri has displaced around 100,000 people so far in 2025, according to the UN. 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 4 years old 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 children, in Ituri,” said Alira Halidou, MSF head of mission in DRC. “The crisis here is characterized 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.”
Hindering access to healthcare
Health facilities in Ituri are also attacked, leaving only a small proportion of people who can access health care. In Djugu territory, the Fataki General Hospital was forced to suspend services and evacuate patients in mid-March following threats from armed groups. This closure left thousands of people without access to medical care. In Drodro health zone, nearly 50 percent of healthcare centers were partially or fully destroyed and had to be relocated. When violence escalated at the beginning of 2024, 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 seek care at medical facilities, but they also put medical staff at risk. One doctor interviewed for the report said he still went to the health center to perform cesarean sections even though it was forced to shut down for two months.
“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
Of the 39 victims of violence MSF treated at Salama clinic in Bunia city between January and mid-March 2025, more than half were women and children. One mother, whose 4-year-old was injured, lost her 6-month-old baby and her husband during an attack by a person wielding a machete.
Two sisters aged 4 and 16 and their mother who was eight months pregnant were severely injured by multiple machete wounds. MSF medical staff also treated a 9-year-old boy with a gunshot wound to the abdomen who had witnessed assailants attack and kill his mother and two siblings with a machete.
When civilians seek refuge in displacement camps, they are still not safe. In one instance in September 2024, MSF treated five civilians with bullet wounds following an attack on the Plaine Savo camp in the Fataki health zone.
When there is an upsurge in attacks against civilians, the number of victims of sexual violence seeking care at MSF facilities also increases. Women are often attacked when they leave the camp in search of work or food to feed their families. In 2023 and 2024, around 84 percent of sexual violence survivors treated by MSF in Drodro 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 organizations, people’s needs very much exceed the resources available. Food insecurity worsened sharply in Ituri in 2024 and is chronic for 43 percent of the population. Poor hygiene conditions and dilapidated shelters in displacement camps allow diarrheal and respiratory diseases to spread easily, affecting children under 5 the most.
People in Ituri must be guaranteed safe access to health care and must not be forced to risk their lives in search of food and other needs.
