Invisible mothers in fragile systems: rethinking maternal and newborn health governance for internally displaced populations in conflict-affected eastern DRC

Background Governing maternal and newborn health (MNH) in contexts experiencing protracted crisis represents a major health systems challenge. In eastern Democratic Republic of Congo, recurrent conflict has caused massive displacement, severely affecting access to care for women and newborns. Building on prior political economy analyses, this study examines how policy content, implementation processes, and humanitarian dynamics shape the governance and delivery of MNH services for internally displaced persons (IDP) in North Kivu province, particularly following the resumption of armed clashes in October 2022. Methods A descriptive case study was conducted in Goma and surrounding areas, combining a document analysis (2012–2023) and 22 semi-structured interviews with key actors from health authorities, civil society, international humanitarian agencies, and healthcare providers. Using Walt and Gilson's health policy triangle, the analysis assessed both the content and coherence of MNH policies, as well as their implementation for IDPs living in formal camps, informal sites, and host communities in Goma city and its outskirts. Results Findings show that access to MNH services for IDPs is primarily shaped by institutional visibility, with eligibility for humanitarian assistance depending on the administrative identification of displacement sites. Formal camps benefit from greater coverage, while informal camps and IDPs integrated into host communities remain largely invisible to humanitarian mechanisms. This occurs in a context marked by the absence of MNH-specific policies for IDPs and highly fragmented governance, dominated by emergency-driven humanitarian interventions aligned with partners’ mandates and funding priorities rather than long-term national planning, with the state playing a largely administrative and regulatory role. Host communities’ perceptions of IDPs oscillate between solidarity and social fatigue. Despite an incomplete service package and reliance on short-term funding, providers caring for IDPs demonstrate resilience in adapting general MNH guidance to IDP needs despite the absence of dedicated policies. Conclusion In the absence of MNH-specific policies for IDPs, fragmented and emergency-driven governance shapes access to care through implicit mechanisms of humanitarian eligibility. Integrating MNH for IDPs into national policies, linking humanitarian and development approaches, and strengthening support for health personnel are essential to achieving equitable and sustainable care.