The eastern Democratic Republic of the Congo (DRC)—a region scarred by three decades of armed conflict—reached a major turning point in early 2025 when the major cities of Goma and Bukavu fell under the control of the AFC/M23 armed group. This takeover occurred with documented support from neighboring Rwanda—which acknowledged this backing for the first time in January 2026. The group’s territorial control now spans a vast area stretching from North Kivu to South Kivu, creating an unprecedented situation akin to a de facto occupation. Long neglected by the central government in Kinshasa, this region is now effectively cut off from the rest of the country as the AFC/M23 works to establish a parallel administration. While international observers describe the AFC/M23 as a "rebel group," the organization positions itself as a "liberator" of the Congolese people and seeks to project a peaceful image.

Although 2025 saw a flurry of diplomatic mediation efforts and the signing of a peace agreement between the DRC and Rwanda—brokered by Donald Trump in December—the conflict on the ground showed no signs of abating. Peace efforts appear designed to advance economic objectives linked to the region's mineral exploitation and trade—goals openly acknowledged by the U.S. President—rather than to bring relief to the people of the DRC.

In Goma and the Rutshuru territory—the first area seized by the M23 in 2022—Médecins Sans Frontières (MSF) is witnessing civilian life deeply and daily disrupted by socioeconomic upheaval and a persistent, simmering violence. Beneath the surface of a seemingly normal daily routine, Goma remains plagued by waves of crime and violent score-settling. The banking and judicial systems, as well as the airport, are no longer operational. Civilians are gripped by a collective fear of speaking out, and political rallies are being used to enforce the conscription of young men. Residents in both urban and rural areas are being subjected to new levies imposed by armed groups, and survival sex appears to be becoming increasingly common.

Outside the city, active front lines and localized fighting continue to put pressure on the civilian population. Mass displacement persists as villages are looted and burned, and farmland becomes the site of military operations. Access to fields is restricted in certain parts of Rutshuru. Furthermore, many agricultural lands—particularly food crop fields—are no longer being cultivated due to security concerns raised by armed groups, such as the presence of trees that could provide cover for fighters from rival factions. This situation directly impacts people's livelihoods and threatens to worsen the area's nutritional crisis. MSF is unable to access the region, either due to a lack of authorization or because of genuine security risks. Civilians are reporting abuses committed by various armed groups operating in the area (including the M23, FDLR, and CMC, as well as unidentified criminal elements). Survivors recount harrowing experiences, including instances of people wounded in the fields who are unable to access medical care. Sexual violence remains widespread—disproportionately affecting women—even in Goma.

Compounding this geographical and social divide in the East is a drastic reduction in international aid—particularly from the United States (USAID previously provided 70% of humanitarian aid to the DRC)—which is further straining already fragile health services. Many NGOs and international organizations are withdrawing due to a combination of financial and security concerns. For example, the European Union is withdrawing its support for the pediatric ward at Rutshuru Hospital—a facility where MSF operates—with a clear impact on access to care and the hospital's cost-recovery capacity.