Mothers in the Crossfire: The Collapse of Maternal Healthcare in the Democratic Republic of Congo's Conflict Zones
By: Shail Patel
The Democratic Republic of Congo (DRC) is again at the center of a humanitarian catastrophe. The eastern provinces, long plagued by decades of conflict, are now reeling from an intensified crisis as the M23 rebel group continues its violent advance. Backed by Rwanda, M23 has captured key cities like Goma and Bukavu, displacing hundreds of thousands of people and cutting off vital humanitarian aid routes. The conflict, rooted in ethnic tensions, resource exploitation, and political rivalries, has escalated into one of the largest and deadliest crises in the world. Over 21 million people are in urgent need of assistance, and the violence threatens to destabilize the entire Great Lakes region.
Amid this chaos, one of the most devastating impacts has been on maternal healthcare. For women in eastern DRC, pregnancy has become a life-threatening ordeal. Already burdened with one of the world’s highest maternal mortality rates—620 deaths per 100,000 live births—the collapse of healthcare infrastructure due to targeted attacks on facilities has pushed maternal services to the brink. Displacement camps are overwhelmed with pregnant women who lack access to skilled care, while hospitals and clinics face relentless attacks that further erode their capacity to provide lifesaving services.
Specifically in conflict zones like eastern DRC, healthcare facilities have become deliberate targets. In 2022, there were 125 documented attacks against healthcare facilities in the DRC. These assaults are not random; they are calculated efforts to destabilize communities by targeting their most vulnerable members. In January 2025, as M23 rebels advanced into Goma, North Kivu, heavy artillery fire struck the neonatal ward of the Charité Maternelle General Hospital. The attack resulted in the deaths of newborns and injuries to pregnant women, compounding an already dire humanitarian crisis. Bishop Willy Ngumbi of Goma condemned the bombing, calling for respect for human life and infrastructure. Such attacks leave thousands without access to critical maternal care, including lifesaving interventions like blood transfusions or antibiotics for postpartum infections.
In addition to physical destruction, fear of violence creates another barrier to maternal healthcare and prevents many women from seeking care altogether. Following an armed attack, maternal health services see a sharp reduction in women seeking antenatal and postnatal care. For these mothers, home births—often unassisted and unsafe—become their only option.
The consequences are both profound and far-reaching. Maternal mortality in conflict zones such as the Democratic Republic of Congo (DRC) remains critically high, primarily due to preventable complications like postpartum hemorrhage and sepsis, which together account for a significant proportion of these deaths. Neonatal outcomes are equally grim, with displacement camps like Bulengo near Goma—home to thousands of people fleeing persistent violence—facing severe obstacles in delivering adequate maternal and newborn care through overstretched mobile clinics. At Panzi Hospital in South Kivu, an internationally recognized facility for treating maternal injuries, there has been a sharp rise in cases of obstetric fistula caused by obstructed or prolonged labor, a stark indicator of the toll conflict takes on maternal health infrastructure. These debilitating injuries not only leave survivors in chronic pain but also subject them to profound social stigma and isolation, highlighting the urgent need for robust interventions to ensure access to comprehensive maternal healthcare in these fragile settings.
Malnutrition exacerbates these risks. Food insecurity affects a significant portion of pregnant women in displacement camps, with over 3.7 million pregnant and breastfeeding women in the Democratic Republic of Congo (DRC) facing acute malnutrition as of 2024. The World Food Programme (WFP) has reported that acute malnutrition rates among displaced populations have surged due to escalating conflict and restricted access to food supplies. Malnourished mothers are at higher risk of complications during childbirth and often struggle to produce sufficient breast milk, perpetuating poor health outcomes for their newborns. These challenges highlight the urgent need for targeted nutritional support in conflict-affected regions.
Nonetheless, Congolese communities continue to find ways to support their most vulnerable members. Traditional birth attendants (TBAs) and community health workers (CHWs) play a vital role in providing maternal care in areas where formal healthcare systems have collapsed. For example, in Lembo, North Ubangi province, a health post built and equipped with support from UNHCR has significantly improved access to maternal care for refugees and host communities. The facility provides free neonatal services, delivery beds, and essential medical equipment, ensuring safer childbirth experiences for women like Chantal, a Central African refugee who received antenatal care and delivered her fifth child there without charge.
Mobile health initiatives add another layer of support by bringing lifesaving maternal care directly to displacement camps like Bulengo near Goma. Supported by UNFPA, these mobile clinics provide prenatal checkups, safe delivery services, and emergency obstetric care for displaced women. Since their establishment in 2023, they have facilitated over 31,000 safe deliveries across provinces such as North Kivu and South Kivu—a testament to their effectiveness despite operating under challenging circumstances.
However, even these community-driven efforts face significant obstacles due to ongoing violence. Armed groups frequently loot humanitarian facilities, target healthcare workers with violence or ransom demands, and disrupt already fragile healthcare delivery systems.
Thus, the collapse of maternal healthcare in eastern DRC is not merely a public health crisis—it is a profound violation of human rights. Women displaced by conflict face not only physical dangers but also systemic barriers that deny them their right to safe motherhood. Addressing this crisis requires immediate humanitarian relief and long-term systemic reforms that tackle the root causes of healthcare collapse. Ensuring accountability for attacks on healthcare facilities is essential. Under Article 8(2)(b)(ix) of the Rome Statute, targeting medical infrastructure constitutes a war crime. International bodies, such as the International Criminal Court (ICC), must investigate and prosecute these violations to deter future attacks and uphold justice for affected communities. At the same time, regional organizations like the African Union can play a critical role in enforcing protections around healthcare facilities by establishing safe zones for maternity clinics during active conflicts, and ensuring women and newborns have access to lifesaving services.
Equally important is strengthening maternal healthcare systems through strategic investments and community-based solutions. Increased humanitarian funding, like Canada’s recent contribution to UNFPA for sexual and reproductive health services in conflict-affected provinces, has proven effective in improving access to care. Expanding such targeted funding initiatives can support midwife recruitment, provision of medical equipment, and establishment of safe spaces for women and girls. Decentralizing medicine production within the DRC is another critical step in reducing reliance on fragile global supply chains and combating counterfeit medicines that often flood conflict zones. Local pharmaceutical manufacturing would ensure essential drugs are available even during emergencies.
Community-based healthcare models have also shown promise in bridging gaps left by collapsing formal systems. For example, partnerships like UNHCR’s collaboration with AIDES in North Ubangi province have equipped health posts with delivery beds and neonatal ICU equipment while providing free services to displaced populations. Scaling up similar initiatives can make maternal care more accessible to vulnerable women across the region.
Ultimately, innovative solutions offer additional hope amid these challenges.Mobile health platforms, which have been successful in other regions, could be adapted in eastern DRC to connect midwives with emergency transportation networks or provide behavior change communication to improve maternal and infant health outcomes. However, these efforts cannot replace systemic reform. The international community must prioritize rebuilding healthcare infrastructure while addressing the root causes of conflict that disrupt the region. The collapse of maternal healthcare in eastern DRC is not just a local tragedy—it reflects global shortcomings in upholding basic human rights. Through coordinated international action, targeted investments, and community-driven solutions, meaningful progress can be achieved to protect maternal health even amid conflict.
Photo by Jenna Norman via Unsplash