An interpretive literature review of the Karuho phenomenon in eastern Democratic Republic of the Congo: A socio-anthropological analysis of cultural constructions of illness in conflict settings

Abstract

Introduction

In eastern Democratic Republic of the Congo (DRC), prolonged armed conflict, structural violence, and the weakening of health systems have contributed to the emergence of culturally grounded explanatory models of illness. Among these, Karuho—commonly understood as a form of intentional poisoning or culturally mediated harm—has become a dominant framework through which many chronic and unexplained illnesses are interpreted.

Purpose

This study examines how Karuho functions as a socio-cultural construct that reshapes biomedical illness into socially meaningful narratives of interpersonal aggression and moral causation.

Methods

This study employed an interpretive literature review of scholarly publications on Karuho, therapeutic pluralism, and illness representations in eastern DRC and the Great Lakes region. Literature published between 2009 and 2026 was retrieved from electronic databases including Google Scholar, PubMed, MEDLINE, JSTOR, EBSCOhost, and Cairn.info from 7 April to 20 November 2025 and 6 to 16 June 2026 The analysis was guided by an integrated theoretical framework combining Arthur Kleinman’s explanatory model of illness and Critical Medical Anthropology, particularly the political ecology of health. The review focused on empirical and conceptual studies conducted in North Kivu, South Kivu, and Ituri that addressed illness interpretation, poisoning narratives, and therapeutic care-seeking pathways.

Results

Findings indicate that Karuho operates at the intersection of biomedical uncertainty, social mistrust, and cultural meaning-making. First, it provides a culturally intelligible explanation for chronic and stigmatising illnesses that are often difficult to diagnose biomedically. Second, it serves as a coping and stigma-management strategy by allowing individuals to reframe socially discrediting conditions such as HIV/AIDS and tuberculosis as externally induced harm. Third, the belief system surrounding Karuho sustains a pluralistic and increasingly commercialised therapeutic landscape in which neo-traditional practitioners mediate between biomedical and cultural logics. Finally, the phenomenon reflects broader processes of social fragmentation and mistrust associated with prolonged armed conflict, contributing to accusations of poisoning and altered therapeutic itineraries.

Conclusion

The Karuho phenomenon reflects a culturally embedded explanatory system shaped by structural violence, insecurity, and weakened health institutions. Rather than representing irrational belief, it constitutes a meaningful response to biomedical uncertainty and social fragility. Its persistence underscores the need for health systems to integrate culturally informed explanatory models into clinical practice. A transdisciplinary approach involving clinicians, psychologists, and cultural mediators is essential to improve diagnostic uptake, reduce therapeutic delays, and strengthen trust in biomedical care in conflict-affected settings.