By Payal Shah , Physicians for Human Rights

The escalating conflict in the eastern Democratic Republic of the Congo (DRC) has caused a “massive influx” of widespread sexual violence perpetrated by the DRC military, armed groups associated with neighboring countries, United Nations (UN) peacekeepers, and community members, according to a new report published today by Physicians for Human Rights (PHR). This widespread and severe sexual violence – at least 113,000 cases reported by the UN in 2023 alone – demands immediate action by the DRC government, neighboring countries, and the global community to support survivors and end the violence, PHR said. “Our report establishes a staggering influx of people who have suffered conflict-related sexual violence – including rape and sexual slavery – being treated in health facilities across eastern DRC, said Payal Shah, JD, report co-author and director of research, legal, and advocacy at PHR. “Survivors are facing sexual violence due to increasing insecurity and insufficient food and cooking wood in Internally Displacement Persons (IDP) camps. Yet clinicians lack the resources to treat this growing number of survivors and ensure forensic documentation for accountability.” “Massive Influx of Cases”: Health Worker Perspectives on Conflict-Related Sexual Violence in Eastern Democratic Republic of the Congo documents clinicians’ testimonies about patients who faced violent encounters with armed forces, which included armed sexual assault by multiple perpetrators, penetration with foreign objects, and forced captivity. The health workers reported that the sexual violence resulted in a wide range of medical and psychological harms, including lacerations, paralysis, sexually transmitted infections, unwanted pregnancies, and post-traumatic stress disorder (PTSD). The resurgence of violence and related displacement has led to staggering levels of sexual violence, with the UN reporting more than 113,000 cases registered in 2023. Documented cases of conflict-related sexual violence more than doubled in the first half of 2024, compared to the same period in 2023. These figures are likely underestimates due to the challenges of reporting. Medicines San Frontiers (MSF) reports that the organization treated more than 17,000 cases of sexual violence in only five provinces of DRC in the first five months of 2024. The United Nations High Commissioner on Human Rights (OHCHR) also reports 940,000 people displaced in 2024 alone, bringing the total to 6.4 million people displaced in DRC. PHR’s new report is among the first studies to date to document the perspectives and accounts of health workers who have cared for child and adult survivors of conflict-related sexual violence in eastern DRC. “The world must not look away from these violations of international law,” said Shah. “The DRC government, other parties to the conflict, and regional and international actors must act now to prevent conflict-related sexual violence by improving security in eastern DRC, including around IDP camps, and addressing food and fuel shortages. Clinicians tell us they urgently need resources for better medical care, psychosocial support, and forensic documentation to prevent long-term suffering by survivors of sexual violence and to ensure survivors can pursue justice.”PHR’s findings are based on semi-structured interviews with 16 health care professionals and humanitarian workers in conflict-affected areas of North and South Kivu, DRC. PHR’s survivor-centered research methodology mitigates the risk of retraumatizing survivors and captures the perspectives of clinicians, who are witnesses to the physical and psychological trauma endured by survivors. The clinicians interviewed by PHR report: Survivors of conflict-related sexual violence are as young as three years old.A stark increase in sexual violence cases in Minova, Kirotche, and Goma health zones as violence has “increased dramatically” in North Kivu and South Kivu since 2022.Survivors experienced violence at the hands of multiple perpetrator groups, including various governmental military forces, rebel, and militia groups active in the conflict:Members of multiple armed groups, including those supported by the DRC’s neighbors(such as March 23 Movement or M23) and the DRC military itself, were identified by survivors as perpetrators who used sexual violence to instill fear, intimidate, and displace affected communities.Community members, family members, peers, and employers were also identified as perpetrators of sexual violence, as well as staff affiliated with the United Nations.One health care worker below described the United Nations Organization Stabilization Mission in the DRC (UN MONUSCO) forces giving “favors” to families in exchange for sexual relations with their children.Sexual violence was perpetrated by Swahili, Lingala, and Kinyarwanda speaking perpetrators.Survivors also report multiple forms of sexual violence, including rape in captivity as well as penetration with foreign objects.In one case, a survivor reported to a health worker being held for five days and in another case a survivor reported being held in captivity for one month before escaping.Survivors reported rapes after leaving IDP camps or their communities to look for food or firewood for cooking in insecure areas nearby the displacement camps.Survivors presented at health facilities with a range of medical and psychological needs, including lacerations, sexually transmitted infections, unwanted pregnancies, incontinence, paralysis, post-traumatic stress disorder, depression, and developmental delays.Survivors reported multiple drivers of sexual violence, including being forced from their homes by armed actors, experiencing sexual violence while fleeing along dangerous routes, and being attacked while searching for food or firewood, as resource shortages forced them into unsafe areas.Health care providers struggle to cope with the crisis as they lack adequate supplies, staffing, training, or compensation to manage the acute influx of survivors.Significant barriers for survivors to access care include limited forensic documentation capacity in the health sector, a lack of resources, fear and stigma, and inadequate access to health services, including contraception and abortion care. Eastern DRC’s decades-long conflict escalated in North and South Kivu in 2021 with the reemergence of the M23 rebel group, which UN experts have identified as being controlled by Rwanda. The conflict’s escalation has led to widespread attacks against civilians, mass displacement, a weakened health system, and food insecurity. The ongoing conflict has also increased the incidence of communicable diseases, including mpox. The capacity of the DRC health system to respond to sexual and gender-based violence, already weak, has been further weakened, with many survivors unable or unwilling to seek care due to stigma, facility closures, and fear of further violence. The planned withdrawal of international peacekeeping forces by the end of 2024, including the MONUSCO and the East African Community Regional Force (EAC-RF), has raised concerns about the potential for further escalation. PHR’s report calls on all parties to the conflict to abide by international human rights law and to take immediate steps to end conflict-related sexual violence. It urges the international community to strengthen monitoring, investigation, and documentation of conflict-related sexual violence, and to promote accountability and justice for violations by all parties. PHR also calls on the international community to ensure the withdrawal of MONUSCO is managed and monitored to ensure that prevention and accountability for sexual violence is not hindered and that knowledge and capacity is transferred to local actors. The DRC health workers interviewed by PHR identify a range of practical recommendations to policymakers and donors to improve the response to the crisis, as well as emerging good practices to support child survivors of sexual violence in DRC, notably child-friendly spaces and child-focused programming.

 New York: Physicians for Human Rights, 2024. 46p.