The northern province of Cabo Delgado in Mozambique is one of the poorest regions in the country. Those living in Cabo Delgado have been suffering violent attacks from a Non-State Armed Group since 2017—attacks that have left close to 700,000 people displaced, traumatised, and without access to essentials like water and healthcare.
The 25 de Junho camp for internally displaced people in Mozambique’s Cabo Delgado province. Armed conflict has resulted in hundreds of thousands of people being displaced from their homes in Cabo Delgado and fleeing to camps like these. © Tadeu Andre/MSF
Over the past year, the attacks in Cabo Delgado grew in strength and brutality, as illustrated by the latest major attack on Palma in the end of March. While the reasons for this conflict might be multifaceted, those who have been displaced are suffering the consequences, living with fear, insecurity and without the basics for survival.
Here are five things you need to know about how this conflict is affecting the people in northern Mozambique:
In March 2020, international organisations estimated that 156,000 people had been displaced in Cabo Delgado. Now, a little over a year later, the estimations have quadrupled, reaching nearly 700,000 that have been forced to leave their homes due to the escalating violence.
Entire villages have been burned to the ground, many have seen relatives being killed in front of them, others have had their loved ones disappear, without knowing if they will ever come back. Thousands of people have fled to the bush, where they have spent several days walking in fear of being found, without access to water or food in search of safety. Host communities and resettlement camps are overcrowded, and people have been living in extremely poor and unsanitary conditions.
Patients wait in a clearing under a tree to be seen by a medical team providing consultations out MSF's mobile clinic at Nicuapa reallocation site. © Tadeu Andre/MSF
People in conflict zones often have to leave their homes with very little notice, sometimes with only the clothes on their backs. After many days of walking through the bush, scared and without access to food or water, those who have fled—often with children or more elderly survivors with them—arrive with nothing. Some of the essentials they need include a place to sleep at night, tents or material to build their own hut, mosquito nets to protect them from malaria, clothes, blankets, food, water and medical care.
Families have left their entire lives behind in search of safety, but their journey is only the first obstacle they must overcome to find stability as the conflict in Cabo Delgado shows no signs of being resolved.
Ibrahimo, a health promoter working with MSF in Montepuez, works in local hospitals and visits homes where displaced people are living, providing basic health education and connecting those in need of care with MSF teams. © Tadeu Andre/MSF
After having escaped the violence and survived the long and difficult journey to reach the resettlement camps and host communities, people have yet another challenge to face: dealing with the trauma. As they struggle to cope with a lack of access to food, water, clothing and healthcare, most are also trying to adjust to their new life. However, a feeling of hopelessness and frustration overcomes them as every aspect of life as a displaced person proves to be a struggle.
Many are suffering from post-traumatic stress disorders, have problems sleeping and have nightmares. They have lost their appetite even though they haven’t eaten for days. The separation from loved ones and lack of news also brings anxiety as reunification seems impossible. Many experience constant fear of another attack, with children among those who have experienced horrific trauma. As the mental health programme in Mozambique is not very developed, providing this service has become one of MSF’s priorities in Cabo Delgado.
MSF staff conduct a mental health session with people who have sought shelter in the Nangua camp for internally displaced people. These sessions are used to help those displaced by the armed conflict in Cabo Delgado talk about their experiences and get support for issues like PTSD. © Tadeu Andre/MSF
According to the UN, about 36 per cent of health facilities across the province have been damaged or destroyed because of the violence. By the end of 2020, there were no functional clinics in Mocimboa da Praia, Macomia, Muidumbe, and Quissanga, districts that have been hit especially hard by the conflict.
Palma has been added to this list following the recent attacks at the end of March. The insecurity in certain areas of Cabo Delgado prevents the government and humanitarian organisations from providing critical care, such as sexual and reproductive healthcare, immunisations, and access to drugs and treatment for HIV and tuberculosis, which have very high prevalence in Mozambique.
MSF physician Nazario Jaime during a consultation with a patient living in the Nicuapa site in Cabo Delgado province. The camp is now home to internally displaced people who have been forced to flee fighting in Mozambique’s northern most province. © Tadeu Andre/MSF
As the number of people displaced by the conflict in Cabo Delgado continues to increase quickly and without halt, the basic needs of internally displaced persons and the communities that host them remain largely unmet. The national efforts to provide a response are insufficient and while UN agencies and some international organisations are present in the province, currently they only have the capacity to cover a fraction of the growing needs of the affected people.
We have expanded our medical activities over the last months, implementing mobile clinics that provide access to medical care to several districts in the province, water and sanitation interventions ensuring access to safe water as well as mental health support. Our main concerns health wise remain responding to malaria, diarrhoea and respiratory infections, which are the main diseases we are treating in our facilities.
We intend to continue operating in Cabo Delgado, providing medical care and related services to as many as we can, but our presence remains limited due to administrative hurdles and restrictions. There is an urgent need to scale up the overall response by bringing in additional humanitarian staff and supplies to respond to this egregious crisis.
