Systematic Review of Health System Barriers to Trauma-Informed Care for Gender-Based Violence Survivors in Conflict-Affected Eastern Democratic Republic of Congo

This systematic literature review addresses a critical gap by examining the health system barriers to implementing trauma-informed care (TIC) for survivors of gender-based violence in the conflict-affected Eastern Democratic Republic of Congo (DRC). It synthesises evidence on the structural, resource, and operational impediments within medical services that hinder effective TIC delivery. Adhering to PRISMA guidelines, a comprehensive search of five academic databases for literature published between 2021 and 2026 yielded 22 pertinent qualitative and mixed-methods studies for thematic synthesis. Key findings reveal entrenched, multi-level barriers. These include severe shortages of mental health specialists, inadequate TIC training for frontline staff, chronic drug stockouts for psychological support, overwhelming caseloads, and a pervasive lack of safe, confidential clinical spaces. The analysis identifies a fundamental misalignment between the holistic, survivor-centred ethos of TIC and the acute, resource-constrained emergency medical model predominant in the region. These systemic failures risk retraumatising survivors and perpetuate a cycle of unmet need. The review concludes that without targeted health system strengthening—prioritising sustainable workforce development, integrated psychosocial support, and the co-design of contextually adapted TIC protocols—the profound health needs of GBV survivors will remain unaddressed. This undermines both public health outcomes and post-conflict recovery efforts in the African Great Lakes region.