Amsterdam/Barcelona/Brussels/Geneva/Paris – In a new retrospective report, Médecins Sans Frontières (MSF) reveals that – together with the Ministry of Health – we had treated an unprecedented number of victims and survivors of sexual violence in Democratic Republic of Congo in 2023. This upward trend has continued in the first months of 2024. MSF is calling on all national and international stakeholders to take urgent action to better prevent this crisis and improve care for survivors.

In 2023, MSF teams in Democratic Republic of Congo (DRC) helped treat 25,166 victims and survivors of sexual violence across the country. That’s more than two every hour.

This figure is by far the highest number ever recorded by MSF in DRC. It is based on data from 17 projects set up by MSF, in support of the Ministry of Health, in five Congolese provinces – North Kivu, South Kivu, Ituri, Maniema and Central Kasai. In previous years (2020, 2021, 2022), our teams treated an average of 10,000 victims per year in the country. The year 2023 therefore marks a massive increase in admissions. 

This trend accelerated in the first months of 2024. In North Kivu province alone, 17,363 victims and survivors were treated with MSF assistance between January and May. Not even halfway through the year, this already represented 69 per cent of the total number of victims treated in 2023 in the five provinces mentioned above.   

Displaced women are the first victims

Analysed and verified over several months, the 2023 data presented in the report, We are calling for help, show that 91 per cent of victims treated with MSF assistance in DRC were admitted in North Kivu province. Clashes between the M23 group, the Congolese army and their respective allies have been raging in the province since late 2021, forcing hundreds of thousands of people to flee.

The vast majority of victims (17,829) were treated in displacement sites around Goma, North Kivu’s capital. The number of displacement sites continued to grow throughout 2023.  

“According to the testimonies of patients, two-thirds of them were attacked at gunpoint,” says Christopher Mambula, head of MSF’s programmes in DRC. “These attacks took place on the sites themselves, but also in the surrounding area when women and girls – who accounted for 98 per cent of the victims treated by MSF in DRC in 2023 – went out to collect wood or water, or to work in the fields.”

While the massive presence of armed men in and around displacement sites explains this explosion in sexual violence, the inadequacy of the humanitarian response and the inhumane living conditions in these sites fuel the phenomenon. The lack of food, water and income-generating activities exacerbates the vulnerable situation of women and girls (1 in 10 victims treated by MSF in 2023 were minors), who are forced to go to neighbouring hills and fields where there are many armed men. The lack of sanitation and safe shelter for women and girls leaves them vulnerable to attack. Others are victims of sexual exploitation to support their families.

“On paper, there seem to be many programmes to prevent and respond to the needs of victims of sexual violence,” says Christopher Mambula. “But on the ground in displacement sites, our teams struggle every day to refer victims who need help.”

“The few programmes that do exist are always too short-lived and grossly under-resourced,” says Mambula. “Much more is needed to protect women and meet the urgent needs of victims.”

Urgent calls for action

Based on the needs expressed by the victims, and building on previous work to solve this long-standing problem in the country, the report lists some 20 urgent actions to be taken by the parties to the conflict, the Congolese authorities – national, provincial and local – as well as international donors and the humanitarian sector. For MSF, there are three main areas of urgent action.

Firstly, we call on all parties to the conflict to ensure respect for international humanitarian law. In particular, we call for the absolute prohibition of acts of sexual violence, but also respect for the civilian nature of displacement sites. The protection of people caught up in the fighting must be a priority. The call to protect civilians from abuse is also addressed to those involved in humanitarian programmes.

Second, MSF calls for the improvement of living conditions in sites for internally displaced people. Access must be improved to meet basic needs – food, water, income-generating activities – as well as improving safe and well-lit sanitation and shelter. These investments must also be accompanied by increased efforts to raise awareness of sexual violence. While humanitarian funding must be sufficiently flexible to respond to emerging and urgent needs, implementing partners must also demonstrate accountability in delivering interventions.

Finally, we call for specific investment in better medical, social, legal and psychological care for victims of sexual violence. This requires long-term funding to improve medical training, the supply of post-rape kits to care facilities, legal support, as well as the provision of shelters for survivors. Funding is also needed for awareness-raising activities to prevent stigmatisation or marginalisation of victims, which sometimes prevents them from seeking help. Given the high number of requests for abortion from victims, MSF is also calling for the adaptation of the national legal framework to guarantee access to comprehensive medical abortion care.

Sexual violence is a major medical and humanitarian emergency in DRC. According to the latest Gender-Based Violence Area of Responsibility DRC informationhttps://reliefweb.int/report/democratic-republic-congo/republique-democratique-du-congo-bulletin-dinformation-du-gbv-aor-avril-juin-t2-2024-aout-2024, which compiles data from various humanitarian organisations offering gender-based violence care services in 12 provinces of DRC, 55,500 survivors of sexual violence received medical care in the second quarter of 2024.