Mortality in Eastern Democratic Republic of the Congo: A Population-Based Survey Following the 2025 M23 Offensive and Humanitarian Funding Withdrawal
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Introduction
In early 2025, North and South Kivu Provinces in the Democratic Republic of the Congo (DRC) underwent a major geopolitical shift marked by the concurrent abrupt withdrawal of humanitarian support and large-scale military takeover by the M23 armed group. This study sought to quantify mortality before and after the humanitarian and security collapse.
Methods
We conducted a retrospective, two-stage cluster household survey comparing mortality in the pre- and post-crisis periods. Difference-in-differences were analyzed using survey-weighted Poisson regression with a log-link and person-time offset to estimate adjusted incident rate ratios for crude, under-five, and sex-specific mortality. We interviewed community leaders and health facility staff as key informants to provide qualitative data.
Results
The adjusted risk of death was 2.02 times higher in the post-crisis than the pre-crisis period (95% CI 1.07, 3.80; p=0.03). Crude mortality rose from a pre-crisis adjusted marginal mean of 0.38 (95% CI 0.22, 0.53) to 0.74 (95% CI 0.56, 0.92) deaths/10,000/day. The increase in mortality was consistent across DRC-Government and M23 controlled areas. Results indicate that 165,391 (95%CI: 63,557, 267,225) excess deaths occurred in the post-crisis period, equating to 245,397 annual excess deaths.
Conclusion
The crisis in DRC is driven by the convergence of humanitarian funding withdrawals and escalating conflict. Averting further preventable deaths requires large-scale restoration of humanitarian assistance. The resources needed to do so represent a small fraction of global economic capacity.
What is already known on this topic
Elevated population mortality has been widely documented in periods of conflict. Eastern DRC is currently experiencing an escalation of conflict and simultaneous withdrawal of humanitarian aid, indicating increased risk of preventable death.
What this study adds
This study will provide the first published mortality estimates based on primary data collection for eastern DRC since the fall of Goma in January 2025.
How this study might affect research, practice or policy
This study measured a doubling of population mortality over a 7-month period, meeting the emergency threshold of a humanitarian crisis. Declaration of a crisis should trigger urgent response from humanitarian actors to avert further preventable death.
