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Background: Medical evacuation is the transfer of a patient from a health institution to another for more appropriate care. The medical evacuation process is framed by legal texts. Dysfunctions are still possible. Objective: The aim of this article is to study the medical evacuation process in order to identify possible dysfunctions. Methods: A cross-sectional qualitative study was conducted from December 2017 to August 2018. We recruited 11 people according to saturation principles. They were all involved in the medical evacuation process. Data were collected according to an interview guide and recorded using a Dictaphone. Data analysis consisted of gathering the information extracted from the verbatim. Results: Dysfunctions were noted in the doctor’s decisions for a possible evacuation, the constitution of the medical evacuation file and the signature of the clinical observation by the doctors. Irregularity in the Medical Evacuation Board meetings was also noted, leading to inappropriate decision-making. We found the absence of inter-sectorial collaboration in evacuation, leading to poor follow-up of transferred patients. We also found the payment for hospitalization and medical care in private accounts instead of selected hospitals’ accounts as stated in the evacuation guide. Conclusion: The medical evacuation process in the Republic of Congo suffers from many irregularities including the doctor’s decision, administrative and financial decisions, as well as the follow-up of patient in the host country and in the hospital abroad.