DAKAR, Senegal (AP) — Various conflicts involving armed groups and government forces in Congo have killed more than 1,300 civilians in the past eight months and violence has surged in recent weeks in eastern provinces, the United Nations High Commissioner for Human Rights said Friday.

Michelle Bachelet said some incidents may amount to crimes against humanity or war crimes, with armed groups committing massacres and security forces also responsible for grave human rights violations.

“I am appalled by the increase in brutal attacks on innocent civilians by armed groups, and by the reaction of the military and security forces who have also committed grave violations, including killings and sexual violence," she said. “These are not only reprehensible and criminal acts, but they also break the trust between people and the state representatives.”

The recent violence in Ituri province has also displaced more than 200,000 people, according to medical charity Doctors Without Borders.

Multiple armed groups have been present in Congo’s mineral-rich eastern provinces for decades, attacking civilians and fighting for control of the territory and its valuable resources.

The U.N. said the principal armed group staging attacks in Ituri province is known as CODECO and is comprised mainly of fighters from the Lendu community. Its main leader was killed in March.

“The attacks and the nature of the violence committed by the armed groups have grown increasingly more gruesome, including sexual violence, beheadings and mutilation of corpses,” according to a statement by the U.N. Joint Human Rights Office of Congo.

Since October more than 531 civilians have been killed by armed groups in Ituri province, the U.N. said, including 375 since March.

In North Kivu province, the main armed group known as the Allied Democratic Forces has been staging retaliatory attacks since the military launched major operations against it in November. ADF rebels have abducted children, attacked schools and hospitals and used machetes, axes and heavy weapons, according to the U.N.

A local rights group, the Center for the Promotion of Peace, Democracy and Human Rights, called on Congo's government to reassess its operations after attacks by ADF and an Islamic State-linked group on several villages last month killed at least 40 people. According to the rights group, more than 627 civilians have been killed since Oct. 30.

The U.N. on Friday called on Congolese authorities to establish state authority in conflict regions by increasing the presence of security forces and ensuring civilian protection.

“When the state leaves a vacuum, others tend to fill it,” the statement said.

The U.N. said more than 110,000 civilians also have been displaced in South Kivu province, where 74 people have been killed since October and at least 36 women and children have been raped in a resurgence of ethnic violence. That conflict between the Banyamulenge and the Bafuliro, Babembe, and Banyindu communities has been “fuelled by hate speech disseminated through the media, social media and in public discourse,” according to the U.N. Soldiers have also been responsible for rights violations there, it said.

Doctors Without Borders this week called on international and national organizations to step up assistance in Ituri province. It said children have been killed in the attacks, including a 15-month-old who was shot while strapped to his mother’s back during an attack in Drodro on May 17.

Health centers are also being targeted, with at least four attacked in May. This is a major concern as neighboring North Kivu province combats an Ebola outbreak and as COVID-19 spreads.

“The violence is systematically targeting villages and health centers in order to prevent the people who fled from returning,” said the organization’s field coordinator, Benjamin Courlet. “Some people are too terrified to go the health centers that are still functioning in the villages or in the camps. Instead they stay in the bush, so we have set up mobile clinics to reach them there.”