As the storm that was to become Cyclone Idai gathered force over the ocean east of Mozambique, the Doctors Without Borders/Médecins Sans Frontières (MSF) team in the port city of Beira began preparing for the worst. Medications were stacked high on the shelves so they would not be destroyed by flood waters, and sand bags were placed around supply containers to keep them safe and dry. These measures were taken in the pharmacy, warehouse, offices, and staff living quarters just in case.
“We asked our Mozambican staff to take the same precautions at home—to stack their belongings high up on the shelves, protect the windows, and make plans to evacuate if needed. But none of us really had any idea what was coming,” recalls Gabriele Santi, MSF project coordinator in Beira.
Cyclone Idai swept through Beira and surrounding districts on March 14 and 15. High winds and heavy flooding killed at least 602 people in Mozambique, according to official figures, and left many more injured. In Beira alone—a city of half a million people—thousands of homes, schools, and health centers, as well as essential infrastructure like roads, were damaged or destroyed.
News of the devastation began to emerge days later, once mobile phone service was partly restored. Only then did MSF international staff—who had been evacuated from Beira only to be trapped by high flood waters in Chimoio, some 200 kilometers (124 miles) away—start to receive delayed messages that had been sent during the cyclone by their Mozambican colleagues. One local staff member had spent the night on top of a plastic table with his whole family as flood waters rushed through their home, another had her roof blown away, and a third was stuck in the capital, Maputo, afraid that his family in Beira had died.
As soon as Beira airport reopened on March 16, MSF sent an emergency team from the capital, Maputo, to check on our staff and assess the needs of the wider community. As the immense needs became more clear, MSF rapidly deployed additional medical and logistical staff and sent in supplies from Maputo, Brussels, and Dubai.
One month later, MSF has nearly 1,000 staff on the ground—800 of them from Mozambique. We are supporting a massive cholera vaccination campaign led by the Ministry of Health to contain the spread of the outbreak. So far, almost 750,000 people have received the vaccine.
But many families are still struggling to find food, shelter, and health care services. While this disaster has not received sustained international media attention, it is critical that people in the areas hardest hit are not forgotten. People remain at risk of illnesses like malaria and malnutrition, which are common after natural disasters, and the local health system will take some time to recover.
Fighting a cholera outbreak
For many years, Beira residents have experienced outbreaks of cholera toward the end of the rainy season. Given the structural damage to the water system and massive flooding brought by Cyclone Idai, a cholera outbreak following the disaster was almost inevitable. Knowing this, MSF quickly began working with the Ministry of Health to isolate and care for patients with suspected cholera in two city health centers, starting on March 21.
“At first we were treating up to 200 patients a day in just one cholera treatment unit,” says Quezia Monteiro, an MSF infectious diseases specialist who usually runs an advanced HIV clinic at the Munhava health center but worked as part of MSF’s cholera response for several weeks. Cyclone Idai was the first time a major natural disaster hit a country with a high prevalence of HIV.
“In those early days, the triage area was constantly full of people who had collapsed from dehydration. Our nurses worked non-stop, finding vein after vein, making sure every patient had the lifesaving rehydration [fluids] they needed. The worst affected were, as always, the most vulnerable—children, pregnant women, and the elderly. Our sickest patients also had HIV, so needed treatment for both diseases.”
By the time the cholera outbreak in Beira was officially declared on March 27, MSF and the Ministry of Health had construction underway for three purpose-built cholera treatment centers with a combined capacity of about 350 beds, in addition to two cholera treatment units in use at the time. Smaller units were then set up in the remote town of Buzi, as well as in Dondo, Mafambisse, Matua, and Tica, on the road between Beira and the inland city of Chimoio. These centers were designed not only to care for existing patients, but also to prepare for a possible exponential increase in new patients contracting cholera.
“Cholera is highly infectious and can spread incredibly fast in a crowded urban area like Beira,” explains Anja Wolz, MSF emergency coordinator in Beira. “Alongside the Ministry of Health, we planned to have at least 350 beds available quickly and to be able to stretch to 1,000 if needed. We had to prepare for the worst while knowing that if we did things properly, and in partnership with the community, the worst might not come.”
The combined MSF and Ministry of Health teams have so far treated over 3,400 cholera patients in the flood affected region.
MSF has also provided logistical, technical, and planning support to the Ministry of Health for a cholera vaccinationcampaign in Beira, Dondo, Nhamatanda, and Buzi. MSF teams are responsible for helping to ensure that the vaccines are stored and transported correctly, arrive at the vaccination sites on time, and that the teams have everything they need to administer nearly 900,000 doses of the vaccine.
“We are not ready to say that we have beaten this outbreak, because we still have new patients arriving,” says Anja Wolz, MSF’s emergency coordinator in Beira. “But from what we see, the number of suspected cholera cases is heading in the right direction. Thanks to the vaccination campaign and the huge community response we believe we can soon bring this outbreak under control.”
Responding to the wider needs
Coastal villages and towns in the surrounding provinces of Manica and Sofala (which includes Beira) were hit hard by the flooding and winds that battered the region for weeks before they developed into Cyclone Idai.
More than seven meters (23 feet) of flood water engulfed the town of Buzi, just south of Beira. Many residents lost everything. To help with their recovery, MSF has established a cholera treatment unit and is helping to rehabilitate the health center. We are focusing on maternity services, to help ensure that Buzi’s mothers can give birth safely, and the outpatient department, so that patients can regain access to routine health care, including HIV treatment.
MSF has distributed essential hygiene items like soap and chlorine solution for laundry to around 5,000 families in Buzi to help prevent the spread of waterborne diseases like cholera. “The importance of health care is undeniable, but dignity is also key,” says Joaquim Guinart, MSF’s project coordinator in Buzi. “In the days after we distributed soap and chlorine solution, every house had clean washing on the line. One woman thanked me, saying she had not been able to wash clothes in the three weeks since the cyclone.”
Teams have also provided education and counseling to community members to help them understand how the trauma of the cyclone and flooding disaster might affect them psychologically.
To the west of Beira, in Dondo, where MSF is also running a cholera treatment center, entire families are turning up sick. This is a common occurrence as cholera is spread through contaminated food and water, and it shows that more work needs to be done in the community to educate families about the importance of hygiene.
“During a cholera outbreak, a family that eats together falls sick together,” says Esperanza Santos, MSF emergency coordinator in Dondo. “Thankfully, the cases in Dondo are concentrated in specific areas and our water and sanitation teams are already out looking at how they can make the water sources safe.”
Protecting the community
Back in Beira city, local authorities were quick to focus their energy on restoring the supply of clean water. While this decision saved countless lives, clean water was not reaching all of Beira’s residents. In order to supplement the water supplied by the authorities, MSF installed a water treatment facility in Chingussura, a suburb north of Beira. Our facility provides up to 7,500 liters of clean water per hour for the local health care center and the local community.
MSF water and sanitation teams are also working across the flood-affected areas to clean flood water from shallow wells, disinfect infected water sources, and ensure that people in the most at-risk areas have chlorine to keep their drinking water safe.
In many ways, life appears to be returning to normal in Beira. The streets are alive with small kiosks selling cold drinks, clothes, and groceries. In some neighborhoods, loose roof tiles and trees stripped bare of their leaves are the only reminders of the destruction that Cyclone Idai brought to the city. Yet, in others, particularly the informal settlements found throughout the city, homes remain completely flattened or uninhabitable and people are struggling to find adequate shelter, food, and health care.
In any outbreak, working with the community to explain the risk of disease outbreaks and help families stay healthy is absolutely essential. In Beira, MSF health promotion teams are running street theater groups and going door-to-door to tell people how they can protect themselves against cholera and how they can access medical care if they fall ill.
“After a disaster of this magnitude, this is not only good strategy, it is also the right thing to do,” says Santi, the project coordinator. “We wanted to show the community that we are here and looking for ways to help them after the storm.”
At the same time, our medical outreach team has set up oral rehydration points across Beira to prevent serious dehydration. The mobile team includes a nurse to assist people with suspected cases of cholera or other serious ailments, providing care close to home. MSF’s network of referral ambulances transfers those who need to be hospitalized to one of the cholera treatment centers. Mobile clinics are also running in some of the more remote informal settlements located far from any health centers.
These community teams are taking the opportunity to put in place a surveillance system that can quickly spot cases of malaria and malnutrition, both of which could emerge as serious issues in the coming weeks and months. Cyclone Idai has left behind large pools of stagnant water and destroyed agricultural fields, increasing the risks for a vulnerable population. Already in Nhamatanda, an increase in the number of patients suffering from malaria has been reported. In response, MSF is starting the distribution of mosquito nets and hygiene kits in hard to reach villages and towns across the flood-affected region, as well as conducting assessments of food security.
MSF currently has more than 800 national staff from Mozambique and 185 international staff responding to the emergency caused by Cyclone Idai. Beyond these disaster-related projects, MSF is continuing its work to combat the ongoing HIV epidemic in Mozambique. MSF has projects caring for the populations most affected by the dual risks of HIV and TB, including sex workers, men who have sex with men, and drug users. Teams care for patients with advanced HIV or TB and hepatitis co-infections in Beira and in the capital, Maputo.