A sharp uptick in the numbers of civilians wounded by heavy weapons in eastern Democratic Republic of Congo (DRC) is threatening to overwhelm health facilities already struggling to provide care, further worsening one of the world’s largest and most complex humanitarian crises, Robert Mardini, director general of the International Committee of the Red Cross (ICRC), warned during a five-day visit to the country.

"What we are seeing now in eastern DRC is in many ways unprecedented and extremely worrying. With the latest upsurge in hostilities since early February, hundreds of badly injured civilians, many of them women and children, have been streaming into healthcare facilities in North Kivu – 40 percent of them victims of shelling or other heavy weapons used in densely populated urban areas. This new dynamic is adding to the deep suffering of huge numbers of civilians already worn down by decades of conflict," said Mr Mardini.

Under international humanitarian law, parties to a conflict have a responsibility to protect civilians and civilian infrastructure and must take all feasible precautions to spare them from harm.

"The use of explosive weapons in populated areas – including near displaced camps – is very likely to have indiscriminate effects, meaning they can kill and wound civilians. This is precisely what we see happening in North Kivu today – with devastating consequences," Mr Mardini added.

Fighting has intensified in recent weeks between DRC government forces and the M23 armed group – the most prominent of more than 100 armed groups reported to be active in the strategically important and resource-rich region, which has been at the epicentre of multiple conflicts since the 1990s.

Civilians are bearing the brunt, with some 7 million displaced from their homes, many of them multiple times – 2.5 million of them in North Kivu alone.

The complexity of humanitarian challenges is in stark evidence at the ICRC-supported Ndosho hospital in Goma, North Kivu's provincial capital. With a daily influx of wounded civilians – many of them children – the hospital is at more than double its normal capacity with more than 130 beds, many of them in tents.

Patients arrive on the backs of motorbikes or public transport from conflict zones around the town of Sake, a mere 25 kilometres away, often fleeing with nothing and separated from their families. Increasing numbers have very serious injuries requiring complex surgery and amputations; some die while trying to reach the hospital.

In one ward, a young mother – visibly traumatised – tries to comfort her four-year-old daughter suffering from shrapnel wounds on her face and body. Her other two children were killed in the attack on their home in Sake. Another woman whose leg had to be amputated following an attack on the displaced camp where she was living near Sake similarly lost two of her children. Nearby, a five-year-old girl who saw her mother killed and who was herself badly injured lies motionless and silent. Dozens of others have their own harrowing stories.

Other patients' injuries remain largely hidden. Sexual and gender-based violence became endemic during DRC's multiple conflicts and remains a major concern in this current phase. Many cases are never reported, for fear of stigma or reprisals, so the full magnitude of the problem is unclear. ICRC-trained psychologists provide mental health and psychosocial support – but needs far outstrip the limited response capacity.

Former child combatants are also among those recovering from physical and mental trauma in the hospital. One 15-year-old boy recruited by an armed group now desperately wants to return home and go to school, but he's afraid of being rejected by his family. Recruitment of children into fighting forces is a major concern – with a 45 percent increase recorded by the UN in the first six months of 2023 compared to the previous year.

"Seeing the levels of suffering here is really distressing – and this is just a snapshot of the scale and complexity of humanitarian challenges in the DRC," said Mr Mardini at Ndosho hospital. "We are witnessing a protection crisis on a vast scale, one that is preventable."

"Humanitarian response – while vital – is clearly not the solution. For our part, the ICRC works closely with the DRC Red Cross to protect and assist people affected by the conflict – for example by strengthening physical and mental healthcare for the wounded, sick, and traumatized; improving water supply and sanitation; and reuniting families.

"Yet the single most effective way to reduce the suffering we are witnessing is for the parties to the conflict to meet their obligations under international humanitarian law to protect civilians. We call on them to do so as a matter of the greatest urgency," added Mr Mardini. "Failure will spell a bleak future for millions of Congolese who have known war all their lives."