Context National and international strategies were implemented in eastern Democratic Republic of Congo (DRC) to address sexual and gender‐based violence (SGBV). Objectives The objective was to assess community attitudes of SGBV and health facility capacity to address SGBV in eastern DRC. Design and setting The design and setting are as follows: a cross‐sectional, population‐based cluster survey of 998 adults in eastern DRC territories, a convenience sample of 27 adults using semi‐structured directed interviews, qualitative data from 37 focus groups conducted in three health zones, assessment of 64 health facilities and a comparative analysis of SGBV strategies. Main outcome measures The main outcome measures opinions regarding SGBV prevention and justice and health facility capacity to address SGBV. Results The majority of respondents favored the legal system over community mediation to obtain justice for SGBV. However, 61.1% (95% CI, 51.8–70.5%) of SGBV survivors reported being forced to accept community mediation. Among SGBV survivors, 81.2% (95% CI, 74.5–87.8%) reported no available mental health care. Less than half of all respondents reported access to a hospital, clinic or pharmacy. The analyses and facility assessment reinforce the need to improve SGBV care. Conclusions Mixed methodologies point to the complexities of addressing SGBV, assess key elements of SGBV prevention, justice and response, and may ultimately inform national and international strategies. Copyright © 2012 John Wiley & Sons, Ltd.