On a hot day last November, Deborah M., a 22-year-old woman living in a camp for displaced people in the Democratic Republic of Congo, decided she had to take a risk. There was no food for her or her three children in the camp, where donated rations were chronically insufficient, so she set out in the early morning on a four-hour walk back to the small farm plot they had fled when Rwandan-backed rebels occupied their village earlier in the year.

She thought that there might be vegetables to harvest. But she also knew she might encounter rebels, or Congolese soldiers, or members of a local militia — and what could happen if she did.

Deborah’s gamble went badly. There was no food left in her garden, and she was confronted there by three armed men, who dragged her at gunpoint into an abandoned house, beat her and raped her.

In pain and distraught, she made it back to the camp late at night. The next morning, tears streaming down her face, she tied her 9-month-old daughter on her back with a frayed piece of cloth and walked to a clinic that treated victims of sexual violence, where she told me her story.

At the clinic, run by Médecins Sans Frontières, the international medical and humanitarian organization, staff members moved her efficiently through a series of steps they take hundreds of times a week: emergency contraception; prophylaxis for H.I.V.; vaccination against hepatitis; a rudimentary group counseling session. An hour later, Deborah was finished.

But no evidence was collected. She did not talk to law enforcement officials. She said she would not report her attack.

“To whom?” she asked blankly. “Why?”

Over decades of fighting in eastern Congo, and through the current conflict that has left the Rwandan-backed rebel group M23 in control of much of the east of the country, the warring parties on all sides have targeted a particular viciousness at women and girls, carrying out acts of sexual violence so widespread that rape has been almost normalized.

They do so knowing they are likely to enjoy complete impunity.

Within a few weeks of Deborah’s rape, M23 had seized control and installed a new military regime. The chance of any kind of legal recourse for sexual violence victims became even more improbable than it had been in the era of mass displacement but nominal civilian rule.

Territorial control of the eastern DRC has flipped between armed groups repeatedly over 30 years. When rebels or militias are in control of the region, there are no legal authorities. And even when the Congolese national government has control, the state is so weak that there are few prosecutions, and the military takes no action against soldiers accused of assaults.

At present, in the area where Deborah lives, women who are attacked have no authority to report to other than the rebels, whose own troops may have carried out the rape.

“They are the ones who make the law — they are the administration, they are in control,” said Rose Mathé, a human rights advocate in Goma.

Efforts to respond to Congo’s sexual violence over the past 20 years have attracted the attention of celebrities and won a Nobel Peace Prize for a local doctor, Denis Mukwege, in 2018. More than a dozen aid groups have had programs for “gender-based violence” for years; while rates of sexual violence have never significantly diminished, victims received some rudimentary support.

But since M23 seized the region, even that basic care has fallen apart. The vast camps for displaced people were forcibly dismantled. Camp-based clinics for rape victims, including the one Deborah went to in the Bulengo camp, were shuttered.

And the Trump administration’s termination of U.S. foreign assistance to Congo has cut off supplies to local hospitals for the essential rape response kits, which included emergency contraception and H.I.V. and hepatitis prevention medications. A contract for 100,000 kits intended for Congo this year was canceled when the United States Agency for International Development was shut down in January.

Médecins Sans Frontières says it treated nearly 40,000 victims of sexual violence in eastern Congo in 2024, when women in camps around Goma had better access to its facilities.

“Since the start of the year, M.S.F. teams have seen about 2,000 a month in health centers, but we know that it’s not everyone,” said Margot Grelet, the Goma-based emergency coordinator for the organization, which is also known as Doctors Without Borders. Currently M.S.F. is the only nongovernmental organization still providing counseling, prevention and care for assault victims, she said; some public hospitals also offer basic medical care.

Before the war escalated in late December, Dr. Jeanette Mafika, a gynecologist at a Goma hospital called HealAfrika, treated 70 women a month for injuries sustained in sexual assaults. In January, the number rose to more than 100 a month.

“We have grown accustomed to the situation — but we do not accept it,” she said.

The region is rich in minerals, and successive strongmen, most recently President Paul Kagame of Rwanda, have sought to control it. Civilians have long paid the price — before the war reignited in December, more than 2.8 million lived in grim plastic-and-stick shelters in displacement camps.

Displaced people were especially vulnerable, but much of the population is prey to assault. Women and girls, and small numbers of men and boys, are assaulted alone and in groups, in cities and villages and remote rural areas. Every group — the M23, the national armed forces, the militias equipped by the Congolese state to bolster its ragtag army, small tribal forces — has been found by human rights organizations to have inflicted sexual violence on victims.

“When we interview victims, they identify all of the different actors as perpetrators,” said Joyeux Mushekuru, who manages the program in Congo for Physicians for Human Rights.

Before the war resurged, the provincial government set up a new police unit focused on sexual violence — but it had no resources, not even paper. A victim who went there had to pay for the process of even filing a complaint, said Lyliane Moseka, a lawyer with Dynamique des Femmes Juristes, one of a handful of organizations that try to provide victims with legal help.

A case without a lawyer would never advance, she said. And no woman in the camps would even know how to find a lawyer, let alone have means to pay one.

Over the years, Ms. Moseka has brought a few cases to court; her organization tries to advance prosecutions pro bono. Victims had to travel a hundred miles or more to a courtroom, where proceedings occurred in French, a language they did not speak, and were overseen by a magistrate who wanted physical evidence to consider a rape case — when no clinic in Goma has the capacity to take photographs of a victim or prepare a rape kit.

The lack of resources behind the effort is indicative of the lack of true commitment to ending it, Ms. Moseka said.

Even before the war escalated, physicians and aid groups were warning of a grim trend in the assaults: The victims were younger and younger. Unicef says that it tallied about 10,000 cases of sexual assault whose victims had sought medical care in January and February and that as many as a third of the victims were under the age of 18. Ms. Mathé said that in reports her organization had received about victims who were minors, the majority were girls of reproductive age, but some were as young as 8.

Congo’s government and the M23 have signed a declaration of principles to end fighting, but the rebels continue to advance over more territory, and no decision has been made about who would govern the area.

Laetitia Ndeke, who works with a Goma-based women’s rights organization called PACOFEDI, said that even in areas where there is no active fighting, women continue to be sexually exploited: They are forced by men in uniforms to engage in sexual activity in order to pass through checkpoints and reach their small farms each day, she said.

Even during long stretches of relative peace, nothing has been done, said Ezra Kambale, a manager with Dynamique des Femmes Juristes.

Women were set upon in the same places regularly and reported that they were raped by men in uniform, and it is possible to identify which military forces control the area, he said. “You’re not really talking about unknown actors,” he said. The authorities must investigate, he said. “They don’t.”

The problem “is fed by impunity — they see no cases punished, and now they do what they want,” Mr. Kambale said. “If any were punished, it would change.”

The impunity combines with the extreme poverty caused by decades of displacement. Women in the camps survived by going into the forests of Virunga National Park to collect young trees they could bring back and turn into charcoal used for cooking. Some they used, and most they sold, for a dollar or two to buy food to augment meager ration parcels. Groups of women left before 4 a.m. each day, to walk five hours to the camp; they traveled together for protection but were regularly set on and raped by groups of armed men.

“Sometimes by bad chance you meet them,” said Agnès Kichanga, who lived in Bulengo with her family since they were displaced in 2023. “You are a group of 50. They begin shooting, you flee, everyone tries to save themselves or they could also kill you.”

Ms. Kichanga has six children of her own and is also raising a grandchild. Her teenage daughter became pregnant after a sexual assault not long after the family arrived in the camp. Many days over the following 18 months, Ms. Kichanga and her daughter went back into the forest to the same place the attack occurred. “There isn’t an option,” she said.

Her daughter did not report her attack. She did, months later, accompany a friend to report a rape, Ms. Kichanga said. But all trace of that process was lost when the camp was taken over by the rebels.

After the M23 takeover, Ms. Kichanga and her children were driven out of the camp. There was no way back home to their village. They found refuge with members of their extended family in the city, and Ms. Kichanga replaced her treks for firewood with earning a few cents each day working as a porter in the market. Soldiers who preyed on women in the forest have been replaced with bandits and marauders in the city, where there is no public security. “Still the rapes are happening,” she said.