Goma’s unfolding crisis: the humanitarian catastrophe and its devastating public health consequences in the eastern Democratic Republic of the Congo

Summary box.

• Since 23 January 2025, intensified fighting between the Congolese armed forces and Rwanda-backed armed groups in and around Goma has triggered a major humanitarian crisis, leading to the collapse of public institutions, the internal displacement of over 700 000 people (as reported by the UN Office for the Coordination of Humanitarian Affairs) and widespread disruption of essential services.

• The health system is nearing collapse, with the destruction of several referral hospitals and health centres, acute shortages of qualified personnel and critical interruptions in the supply of medicines and medical equipment.

• Insecurity and direct attacks on health infrastructure have severely restricted access to primary and emergency healthcare, contributing to rising cases of cholera and mpox, especially among vulnerable populations such as pregnant women, children and patients with chronic illnesses.

• Overcrowding at displacement sites, coupled with a breakdown in water, sanitation and hygiene systems, has created ideal conditions for disease transmission, further exacerbating public health emergencies.

• Urgent, coordinated international humanitarian assistance is needed to strengthen the outbreak response, restore disrupted health services and prevent further deterioration of the health situation.

Introduction

The Democratic Republic of the Congo (DRC) has been grappling with recurrent armed conflicts for decades, particularly in its eastern provinces, driven by a complex nexus of ethnic tensions, regional geopolitical dynamics and competition over natural resources. Among the key actors contributing to the region’s instability is the March 23 Movement (M23), a rebel group that originally emerged in 2012 from a mutiny of former members of the Congolese national army. Despite its military defeat in 2013 and subsequent peace efforts, the group has periodically resurfaced in the Kivu region, with renewed hostilities reported since 2022. In early 2025, the conflict intensified markedly. On 23 January 2025, M23 forces reportedly seized control of Goma, the capital of North Kivu Province and a strategic urban and economic hub.¹ This occupation triggered a profound humanitarian crisis marked by massive population displacement, the disruption of basic public services and a surge in insecurity and human rights concerns. Several reports and international observers have alleged external support for M23, particularly from neighbouring Rwanda, although this remains a subject of geopolitical dispute and ongoing investigation.¹ The current escalation represents one of the most acute phases of conflict in the eastern DRC since the early 2000s, underscoring the urgent need for coordinated regional diplomacy and comprehensive humanitarian responses.

This commentary highlights the multifaceted health crisis unfolding in Goma in early 2025 and calls for urgent, evidence-based humanitarian and diplomatic interventions. Our proximity to the events—both professionally and personally—allows us to offer a nuanced, insider perspective on the unfolding of a humanitarian catastrophe. As public health professionals and researchers based in the DRC, we left Goma only 3 days before the city was overtaken by M23, and many of our family members remained there. Their experiences, combined with our ongoing field engagement, inform our understanding of the crisis. Drawing on recent data from humanitarian organisations and direct observations, we underscore the breakdown of healthcare infrastructure, the resurgence of epidemic-prone diseases and the widening gaps in humanitarian assistance across the region.²

In framing an appropriate health response, we underscore the critical need to align interventions with internationally recognised humanitarian standards.³ These guidelines serve as a foundational framework for ensuring the provision of essential health services, including water, sanitation and hygiene (WASH) measures, in emergency contexts. Adhering to such standards is essential to ensuring equity, accountability and effectiveness in the delivery of humanitarian aid in complex and rapidly evolving crises.

Impact of the conflict on the population and health system collapse

The humanitarian toll of the Goma crisis is devastating. Even prior to the takeover by M23 forces in late January 2025, the city already hosted approximately 700 000 internally displaced persons (IDPs), in addition to its estimated 2 million residents.^{4 5} As violence intensified, displacement camps were destroyed or forcibly evacuated by the new de facto authorities, leaving over 248 000 people affected by the dismantling of more than 90 sites. Nearly 395 000 IDPs remain in precarious conditions across the health zones of Goma, Karisimbi and Nyiragongo.⁶ Families are crowded into makeshift shelters with inadequate protection, facing severe food insecurity due to disrupted supply chains and limited market access—conditions falling well below Sphere standards for shelter and nutrition. These living conditions have compounded the health burden and heightened vulnerability to disease.

The violence has resulted in nearly 3000 civilian deaths,⁷ with over 1000 bodies already buried by mid-February 2025.⁸ Many were left in public spaces, requiring emergency retrieval and burial by the International Committee of the Red Cross.⁹ The loss of livelihoods and basic services has further increased the risk of malnutrition and illness, particularly among children, pregnant women and elderly individuals.

The ongoing conflict has pushed Goma’s already fragile health system to the brink of collapse. When the WHO health system building blocks framework was applied, all core components—service delivery, health workforce, medicines, information systems, financing and governance—were critically impaired.² Between 26 January 2025 and 2 February 2025, over 27 health facilities were attacked or damaged, leading to the widespread suspension of routine and emergency services.^{8 10} Chronic conditions such as HIV/AIDS, cancer, diabetes, hypertension and mental health disorders often remain untreated because of shortages in supplies and personnel.¹¹ Maternal health has deteriorated sharply: many women can no longer access skilled birth attendants, resulting in increased maternal mortality.

The health workforce is in crisis. Many professionals have fled, leaving health centres severely understaffed. Those who remain under extreme conditions lack personal protective equipment, face overwhelming demand and experience high levels of psychological stress.¹⁰ Moreover, the supply chain for medicines, vaccines and equipment has collapsed. For example, the looting of a monkeypox treatment centre led to the premature discharge of patients and the suspension of care provision.² Cold chain failures have compromised vaccine storage and increased the risk of outbreaks.

Access to healthcare has been obstructed by insecurity, roadblocks and damaged infrastructure, delaying or preventing care for patients in critical need. Humanitarian operations face similar constraints, with movement restricted and the delivery of assistance severely hampered.¹²

Epidemic risk and environmental health hazards

The collapse of Goma’s health and public infrastructure triggered a resurgence of infectious diseases, exacerbated by deteriorating WASH conditions. Between 3 February 2025 and 15 February 2025, 420 cholera cases, including one death, were reported (figure 1).^{12 13} The looting of a monkeypox (Mpox) treatment centre caused a dramatic drop in hospitalisations—from 143 to 15—and led to the discharge of untreated patients.² As of 18 February, 519 confirmed Mpox cases (36.2% of all reported cases) had been identified across 11 displacement sites. Only three of the original seven treatment centres remain functional, with the rest dismantled due to insecurity.⁸

Figure 1. Weekly trend of cholera cases in Goma from 30 December 2024 to 5 May 2025.¹³.

Moreover, measles outbreaks surged following the breakdown of immunisation programmes. In late January and early February 2025, North Kivu reported 816 and 684 measles cases, respectively—over 20% of all first-quarter cases—underscoring the collapse of routine healthcare and immunisation systems (figure 2).¹⁴ These overlapping outbreaks in overcrowded, underserved settings represent a syndemic scenario in which multiple epidemics interact with structural vulnerabilities to fuel a worsening public health crisis.

Figure 2. Weekly measles cases and fatality rates in North Kivu from 14 January 2025 to 6 May 2025.¹⁴.

Since 22 January 2025, the destruction of Goma’s main power line has disrupted electricity supply, crippling hospital operations and compromising the functionality of essential medical equipment. Moreover, the water supply system has collapsed, forcing households to rely on unsafe water from Lake Kivu.^{15 16} At some displacement sites, only six latrines serve more than 800 people—a ratio far below Sphere standards—significantly increasing the risk of faecal-oral transmission.⁸

Poor waste disposal, stagnant water and the accumulation of unburied bodies—due to overwhelmed morgue services and restricted humanitarian access—pose significant environmental and epidemiological threats.⁹ Without urgent WASH interventions, including the restoration of safe water access, improved latrine coverage and dignified burials, the risk of diarrhoeal disease outbreaks and environmental contamination will continue to escalate.

Mental health and psychosocial consequences

The Goma crisis has inflicted widespread psychological trauma, compounding physical devastation. Continuous exposure to violence, forced displacement, loss of family members and pervasive sexual and gender-based violence has sharply increased the prevalence of post-traumatic stress disorder, anxiety, depression and other mental health disorders among people of all ages.¹⁷ The region’s sole specialised mental health facility—the Saint Vincent de Paul Neuropsychiatric Centre—is severely under-resourced and unable to respond to the escalating demand for care.

Children and adolescents are disproportionately affected, often presenting with behavioural disturbances, emotional dysregulation, nightmares and sleep disorders. These symptoms are exacerbated by the breakdown of family structures, school closures and prolonged instability. Reports of rape, including gang rape, among IDPs have increased, with at least 45 cases recorded, including 21 survivors requiring hospitalisation.¹⁶ Stigmatisation and fear of retribution often prevent survivors from seeking care, leading to untreated psychological wounds, chronic mental health conditions and social isolation.¹⁸

The psychological burden is further reflected in increasing reports of substance abuse, suicidal ideation, domestic violence and family disintegration. These outcomes not only affect individual well-being but also strain social cohesion and resilience within communities already destabilised by protracted conflict. Without urgent investment in psychosocial support and the integration of mental health and psychosocial support into emergency health services, the long-term recovery and reconstruction of the region will be gravely undermined.

Barriers to humanitarian access and response coordination

Ongoing insecurity, armed roadblocks and the closure of Goma’s port, airport and key transport routes—including the strategic RN2 highway and the Gisenyi border—have severely hindered the delivery of humanitarian assistance. The looting of multiple warehouses on 28–29 January 2025, including those of the World Food Programme, Médecins Sans Frontières, the International Committee of the Red Cross, the United Nations High Commissioner for Refugees and several international non-governmental organisations, has further disrupted aid operations and endangered personnel.^{12 19}

These incidents, compounded by attacks on medical convoys and ongoing supply chain disruptions, have undermined both the safety of frontline workers and the availability of essential health commodities. The resulting collapse of local revenue systems and acute shortfalls in international funding have critically reduced the operational capacity of humanitarian actors.

Furthermore, the volatile security environment has fragmented coordination mechanisms, limiting the reach and coherence of emergency responses. Even experienced organisations such as the Alliance for International Medical Action (ALIMA) have faced significant setbacks, including diminished field presence, disrupted referral systems and suspended outreach in high-risk zones.²⁰ Persistent logistical barriers, bureaucratic delays and financial constraints have collectively crippled scale-up efforts, placing thousands of lives at risk and exacerbating public health emergencies.

Recommendations and calls to action

A phased and context-sensitive response is urgently needed to address the humanitarian and public health crisis in Goma and the wider North Kivu Province. Interventions must simultaneously deliver life-saving services and lay the foundations for long-term system resilience and peacebuilding.

In the acute phase of the crisis (0–6 months), the top priority is to implement immediate life-saving interventions by securing safe humanitarian access. This can be achieved through locally negotiated humanitarian corridors facilitated by trusted intermediaries such as religious leaders, community elders and local health officials. This approach, which is used effectively in Borno and Yobe States in Nigeria, has enabled mobile clinics to reach populations that are otherwise cut-off from essential services.²¹

Once access is secured, mobile medical teams should be rapidly deployed via a hub-and-spoke model. Relatively stable neighbourhoods in Goma, such as Katindo or Le Volcan, can serve as operational bases for coordination, storage and staging. Staffed by locally recruited health workers, these teams should be equipped with emergency kits, point-of-care diagnostics, solar-powered cold chains and secure communication tools. Their routing must remain adaptable to real-time conflict dynamics and community feedback.

To reduce the risk of outbreaks, community-based disease surveillance systems must be reactivated. Trained health volunteers can report syndromic alerts via mobile phones and FM radio. Tools such as RapidPro (for SMS alerts) and KoboToolbox (for offline data collection) have proven effective in fragile contexts such as the Central African Republic and South Sudan.²² Simultaneously, WASH interventions must be implemented—including chlorinated water distribution, latrine installation and hygiene promotion—to reduce disease transmission. Mental health and psychosocial support should also be scaled up through mobile counselling teams, psychological first aid and safe spaces within displacement settings.²³ Coordinated, multisectoral implementation—engaging both humanitarian and development actors—is vital to maximise impact, avoid duplication and build resilience despite insecurity.²⁴

Medium-term (6–24 months) stabilisation requires rehabilitating health facilities in high-displacement areas and restoring water, solar electricity and infection control infrastructure. Local supply chains should be reinforced by prepositioning medicine stocks in decentralised, secure warehouses managed with contingency plans co-developed with local faith-based networks and community representatives. Strengthening the health workforce through remote training, trauma-informed supervision and protection protocols is critical. District health authorities, church-run networks and IDP committees should jointly monitor progress to ensure accountability and adaptability.

Long-term (>24 months) recovery must align with the humanitarian–development–peace nexus. As Olu et al^{24 25} emphasise, this requires integrated planning, inclusive governance and sustained investment. In Goma, health services can become platforms for reconciliation by jointly serving IDPs and host populations, integrating community feedback and promoting equity through subsidised or free care for vulnerable groups. Decentralised primary healthcare systems—built on task-shifting, digital tools and shock-responsive structures—can enhance resilience and rebuild social trust.

Ultimately, bridging humanitarian, development and peace efforts is essential to address the root causes of instability. Coordinated action, multiyear flexible funding and inclusive governance mechanisms are vital to ensuring that no population is left behind during or after this crisis.

Conclusion

The crisis in Goma illustrates the devastating intersection of armed conflict and the collapse of public health. The destruction of hospitals, the spread of epidemics and the suffering of civilians reflect the urgent need for humanitarian action. Without immediate intervention, the situation will worsen, leading to increased morbidity and mortality. We call on national authorities, warring parties and the international community to prioritise health, guarantee humanitarian access and commit to long-term stabilisation. Goma’s population cannot wait. Adherence to internationally recognised humanitarian standards—such as those outlined in the Sphere Handbook—is crucial to ensuring safe, dignified and effective healthcare delivery. Implementing minimum WASH and infection prevention standards in health facilities is not only a technical necessity but also a moral imperative in such fragile settings.

Data availability statement

There are no data in this work.