One of the few groups that is present is Doctors Without Borders, commonly known by its French acronym, MSF. It released a report this week that documents a disturbingly high rate of sexual violence perpetrated by armed groups in Kasai. Rapes are being committed many times a day, and they have treated more than 200 victims of sexual violence per month on average since January 2018. Eighty percent of victims said they were raped by armed men.

The war in Kasai began in August 2016, when a local traditional leader hostile to the central government was killed. A militia named after him, called Kamuina Nsapu, began to target Congo’s national army, which in turn employed another local militia called Bana Mura to suppress the rebellion. MSF started working in the region in May 2017.

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“Of the 2,600 victims of sexual violence treated by MSF since May 2017, the vast majority were women,” says the report. “Thirty-two were men, some of whom reported having been forced under armed threat to rape members of their own community. Another 162 were children under the age of 15, including 22 under the age of five.”

The conflict has been characterized by its brutality. Last year, Congo’s Catholic church released a report claiming that it had documented over 3,300 killings. At the time, the United Nations had found evidence of at least 42 mass graves, which they attributed mostly to atrocities committed by government forces. Millions have been cyclically displaced from their homes, fleeing to other parts of Congo and neighboring Angola.

Congo’s president, Joseph Kabila, used the Kasai conflict as a pretense to delay elections in 2016 that would have seen him unseated. Those elections are now slated to take place next month, and Kabila will not be running.

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In the late 1990s and early 2000s, war spread across eastern Congo and the widespread use of rape as a tool of war earned the country the title “Rape Capital of the World.” MSF’s report on Kasai points to a level of sexual violence that is shockingly close to reaching the levels of that era’s far-larger conflict.

Earlier this year, the Nobel Peace Prize was awarded to Denis Mukwege, a gynecologist in the eastern Congolese city of Bukavu, who has treated tens of thousands of victims of sexual violence.

In its report, MSF warned that its estimate of the number of victims was probably very conservative. Many cases surely go unreported, and others may result in the death of the victim. Three-quarters of those who did seek help at an MSF-run hospital, only did so at least a month after being attacked, raising the risk of complications and the spread of sexually transmitted disease.

“Most explain that they were unaware of the availability of free care or lacked the means to travel to centers offering medical services,” said the report.