Haunted lives: trauma, mapepo and the weight of violence in Ituri, Democratic Republic of Congo

This study is the first to investigate the relationship between biomedical concepts of trauma and local understandings of mapepo (resentful spirits) in Ituri province, northeastern Democratic Republic of Congo (DRC). Drawing on ethnographic research with affected families, healers, and health workers, we argue that trauma and mapepo function as co-constitutive elements within a syndemic of suffering. These are mutually reinforcing afflictions intensified by structural violence, poverty, and fractured kinship networks. A key conceptual contribution is our extension of syndemic theory to incorporate spiritual affliction as a structurally produced form of vulnerability alongside psychological and material distress. We further show that while trauma is typically anchored to past events, mapepo affliction reflects ongoing relational and moral disturbances — a distinction that helps explain why both frameworks coexist and interact rather than simply competing for explanatory authority. Families navigate this landscape pragmatically, seeking relief through hospitals, churches, and traditional healers, guided by perceived efficacy, moral meaning, and access. These findings challenge the universality of biomedical trauma frameworks and point to the need for interventions that engage local moral worlds alongside clinical models. More broadly, this analysis contributes to debates on mental health in conflict settings by demonstrating that spiritual and biomedical frameworks are not parallel systems to be managed separately but interacting dimensions of the same syndemic process, with implications for the design of culturally responsive health interventions.