Harmful, restrictive measures obstruct care for sexual violence survivors in North Kivu province

Goma – The de facto authorities in North Kivu province, eastern Democratic Republic of Congo (DRC) – the FNR¹, formerly AFC/M23 – have been imposing harmful restrictions related to seeking care for sexual violence for months. These policies obstruct people from accessing this essential care and put them at greater risk, says Médecins Sans Frontières (MSF). 

MSF acknowledges the commitments made by the FNR leadership in early October to address these issues. So far these corrective measures have not been implemented. Restrictive measures remain in place. We urge the FNR 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 organisations that raise serious concerns about medical confidentiality, medical ethics, victim and survivor protection, and access to healthcare.

These measures include pressuring health workers to reduce victim and 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 victims and survivors to report to the police before seeking care; and restricting eligibility for care to people who present within 72 hours of the assault.

The de facto authorities have also instructed organisations and health providers, including MSF, to use documentation that requires intrusive, stigmatising, and non-essential questioning that is irrelevant to treatment — including victims and survivors’ names, addresses, and details of alleged perpetrators. This undermines patient confidentiality, puts victims and 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.

MSF is already seeing the impact of these measures, with consultations for victims and survivors of sexual violence falling sharply. In several health centres MSF supports 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 less people had sought this care in August 2026, when comparing to January 2026. Other facilities we support in North Kivu also saw significant declines, from providing care to around 80 victims and 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 has maintained regular dialogue with the de facto authorities, including with 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,” 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.”

At the same time, MSF emphasises 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.