The de facto authorities in North Kivu province, eastern Democratic Republic of Congo, have been imposing restrictive measures related to seeking care for sexual violence for months. These policies have obstructed people from accessing essential care, putting them at greater risk, according to Médecins Sans Frontières (MSF). The measures have been in place since the beginning of 2026.
The restrictive measures include pressuring health workers to reduce victim and survivor numbers by narrowing the definition of sexual violence. Health workers are required to limit recognition of sexual violence to people presenting with visible signs of injury. Additionally, victims and survivors are required to report to the police before seeking care, and eligibility for care is restricted 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 and stigmatizing questioning. This documentation includes victims and survivors' names, addresses, and details of alleged perpetrators, undermining patient confidentiality and putting victims and survivors at further risk. These measures go 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 imprisonment if they do not comply with the new measures. These threats have already deterred some healthcare workers from providing essential care to victims and survivors of sexual violence.
The impact of these measures is evident, with consultations for victims and survivors of sexual violence falling sharply. In several health centers supported by MSF in North Kivu, dozens of entries relating to these consultations were erased from records, drastically reducing the official number of reported cases. Some centers have also stopped recording cases altogether.
MSF has maintained regular dialogue with the de facto authorities, including their leadership. While these exchanges have resulted in commitments to address the issue, the harmful and restrictive measures have continued. MSF calls for immediate action from the FNR to ensure that care for survivors of sexual violence is protected, confidential, accessible, and focused on health needs.
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 victims and survivors from seeking urgent treatment and potentially exposes them to further harm. The organization urges the FNR to remove barriers to care, strengthen protection and access to justice, and address the conditions that allow sexual violence to persist.
Key points
- Médecins Sans Frontières (MSF) reports a 41% decline in people seeking care for sexual violence in North Kivu between January and August 2026.
