Background <p>The World Health Organization encourages all countries to implement Maternal and Perinatal Death Surveillance and Response (MPDSR), a continuous quality improvement cycle of death identification, reporting, and review to prevent future mortality. However, MPDSR implementation in humanitarian settings requires contextual adaptations for effective implementation. The aim of this study was to understand the landscape of existing health surveillance and information systems that capture maternal and perinatal mortality in crisis-affected areas of Eastern Democratic Republic of the Congo (DRC) to inform future implementation of MPDSR.</p> Methods <p>A mixed-methods study was conducted in North Kivu and South Kivu in Eastern DRC. Within each province, three health zones were targeted. We conducted 109 key informant interviews to identify and understand how existing surveillance and health information systems capture data on maternal and perinatal mortality. Surveys were administered for each identified system (<i>N</i> = 53). Data collection occurred in December 2022 in South Kivu and in June 2023 in North Kivu. Descriptive statistics of survey findings were conducted to compare key characteristics of reporting systems. Thematic content analysis of interview transcripts was conducted and triangulated with survey findings to understand implementation realities by system and health zone type.</p> Results <p>Two categories of death reporting systems were identified: health systems (National Health Information System, MPDSR, and their extensions into communities via community health workers) and administrative systems (civil registration and other community-based systems). Commonly reported implementation challenges in all health zones included insufficient human and financial resources, unavailable tools, and complex socio-cultural dynamics which created obstacles in the identification, reporting, and review of deaths. Insecurity within the region <b>o</b>ften limited system functionality. However, promising practices related to health authority and community engagement were implemented to overcome implementation challenges.</p> Conclusion <p>Our findings uncover a wealth of implementation experience that is essential to inform the development, implementation, and extension of MPDSR systems tailored for optimal functionality in crisis-affected contexts. Structural system inputs must be addressed alongside socio-cultural dynamics that influence reporting and review of maternal and perinatal deaths. The intervention mechanism in crisis contexts must include a component aimed at strengthening the community networks involved in information gathering.</p>