Mozambique + 2 more

MSF emergency response to Cyclone Idai and flooding

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Crisis Update - 17 April 2019


A weather system that produced heavy rains flooded parts of Malawi in early March 2019, before developing into Cyclone Idai which struck Mozambique and Zimbabwe on 14-16 March, 2019.

Flooding in Malawi has displaced nearly 87,000 people in camps, with the district of Makhanga one of the worst affected areas, which remains an island, cut off from all road access.

In Mozambique, Cyclone Idai wreaked havoc in the city of Beira, home to some 500,000 people, as well as in the surrounding districts of Manica and Sofala, where it has destroyed the lives and livelihoods of hundreds of thousands more people.

In Zimbabwe, the impact from the cyclone on the eastern highlands has been massive with nearly 22,000 people displaced and several bridges and roads have been washed away. Some communities are reachable only by foot.

We have emergency response teams on the ground in all three countries. We are undertaking medical activities, including treating cases of cholera and acute watery diarrhoea. We are also responding to humanitarian needs, such as providing non-medical items including buckets and soap, and ensuring safe water and sanitation.

Teams in all the affected countries are mobilising to provide medical and non-medical assistance. Our warehouses in Brussels and Dubai have sent tons of supplies to the affected areas, particularly Mozambique.


Mozambique, and particularly the city of Beira, in the centre of the country, has been the hardest hit by Cyclone Idai, which struck late on 14 March.


High winds and high waters have so far killed 602 people, injured more than 1,600 and damaged or destroyed thousands of buildings - homes, schools, health centres and hospitals - across the area. Many families are left homeless and most communities are without reliable access to clean water or electricity.

There are already huge medical and public health needs, and we expect these needs to increase in the coming weeks with cholera and other water borne diseases, skin infections, respiratory tract infections and malaria spreading throughout the community.

The government declared a cholera outbreak in Beira on 27 March, and later in Tica, Buzi and Dondo. Our teams are also seeing cases of acute watery diarrhoea elsewhere. We are working in collaboration with the Ministry of Health to treat people who are already ill, while setting up clean water supplies and informing the community about how to protect themselves in order to stop more people from becoming sick.

While treating people with the immediate needs in the wake of the cyclone, including injuries, infections and cases of diarrhoea and cholera, normal functioning of the health system must also be supported with mothers still needing to deliver babies safely, and people still needing vital medication for illnesses such as HIV.

Beira and surrounds

  • Ninety percent of the area around Beira has been damaged, with roads, electricity and communications having been cut off.
  • Buildings have been submerged and severely damaged; many people are staying with family or friends or in transit centres because their homes are uninhabitable.
  • Healthcare infrastructure has been damaged, including the hospital.
  • While clean-up efforts by communities are underway, clearing the streets of debris and uprooted trees, extensive repair work to buildings and infrastructure is much needed.
  • The cyclone substantially damaged the city’s water supply system, resulting in many people having drunk from contaminated wells or stagnant water.
  • The Government declared an outbreak of cholera in the city on 27 March.


  • Houses, farmland and structures have been destroyed and some are still flooded.
  • The health centre was badly damaged.
  • More than 55,000 people, out of 300,000 inhabitants in the district, are homeless.
  • Access to clean water is severely limited, with just one clean water well available for thousands of people.
  • A cholera outbreak was declared in the district, Nhamadanta (of which Tica is the main town).


The town and surrounding area sustained damage from the cyclone and flooding, including to local health infrastructures.
A cholera outbreak has been declared by the Ministry of Health.

Buzi, Dombe, Macharote, Matua and Mafambisse

The areas surrounding these towns sustained damage from the cyclone and subsequent flooding, including to local health infrastructures.


We currently have nearly 1,000 staff on the ground in the flood-affected areas, the vast majority of whom are Mozambican. We are hiring more local staff daily as we scale up our response. Some areas lack access to clean water.

Much of our work is in support of the local Ministry of Health, who have prioritised access to clean water - although thousands in outlying areas still need improved access - the treatment of cholera in establishing treatment centres and units, and the prevention of cholera and acute watery diarrhoea through vaccination campaigns.

Fears of a mass cholera outbreak in Beira have not materialised, with the number of cases now stabilising. We remain vigilant about new cholera hotspots in other areas and have established cholera-treatment capacity in five towns or villages.

Charter flights with more than 100 tons of international air freight supply have arrived in Beira from Belgium and Dubai.


MSF was working in Beira before the cyclone to provide antiretroviral medicines (ARVs) for people living with HIV and to provide treatment for patients with advanced HIV. Following the cyclone these activities were disrupted, but have now been completely restarted. In Beira, 16 percent of people are HIV positive.

MSF teams are undertaking medical and non-medical activities in Beira and in areas on the outskirts of the city. Medical activities include treating cholera in cholera treatment centres (CTC) and cholera treatment units (CTU):

  • Running one 100-bed CTC in Macurungo.
  • Running one 50-bed CTU in Munhava.
  • Running an ambulance and referral system to ensure that suspect patients are taken to the closest CTC with available beds.
  • Running oral rehydration salt points in the community so those who are not too sick with cholera can avoid adding to the workload of the treatment centres.
  • Running water and sanitation and health promotion activities in the poorest areas of Beira to talk about the risks of cholera and help the community protect themselves.
  • Wastewater management and desludging of latrines both in the CTCs and in the community.
  • Installing water treatment plant at Chingussura to provide clean water for the health centre, CTC and local community.
  • Distributing chlorine solution for drinking water and soap and conducting assessments for future distribution needs (materials to repair houses etc).
  • Assessing areas north of Beira and distributing water and sanitation kits in remote villages.
  • Providing mental health support to the community and to the Mozambican staff who went through the trauma of the cyclone.
  • Providing health consultations through mobile clinics in hard to reach areas (slums) and in transit camps.


  • Rehabilitating the health centre to make it fit for use again.
  • Working on the supply of clean water in the community.
  • Undertaking health promotion in the community to explain the psychological symptoms that people might be experiencing after the trauma of the cyclone and flooding.
  • Running a 12-bed cholera treatment unit.
  • Providing peri-natal (just before and just after birth) care in the community as well as supporting the local midwives at the hospital.


  • Supporting the MoH to provide care for cholera patients in a 20-bed CTU and providing ambulance referrals to the CTU.
  • Providing primary health care at Dondo healthcare centre.
  • Providing decentralised oral rehydration solution to reach 30 different locations in the most heavily affected areas.
  • Supporting rehabilitation of the damaged health centre.
  • Distributing 4,500 non-food item kits in affected areas with difficult access: Chibuabuabua, Tundane, Savare and Samora Mahel.
  • Developing health promotion and targeted water and sanitation activities in the community in urban areas and those most affected by the cyclone.
  • Providing support to the health system in the most affected areas of Dondo district (between six and 10 health areas), including –
  • Malaria treatment and surveillance in the community
  • Support for ensuring infection prevention control (hygiene facilities) in selected structures.
  • Support to outpatient activities via small donations and training
  • Set-up of tents in badly damaged health structures in Macharote, Matua, Chibuabuabua, and Tundane, to enable them to continue their activities (outpatient departments, sexual and reproductive health, deliveries)


Assessment of medical as well as water and sanitation needs in the IDPs camps in Dombe Macharote

  • Helping to rehabilitate the health centre which was heavily destroyed by the floods and cyclone.
  • Providing primary healthcare out of the health centre.


Helping to rehabilitate the health centre to make it fit for use again.
Preparing for a possible cholera outbreak with the construction of a 20-bed CTU and provision of ambulance referrals to the CTU.
Providing primary health care at the healthcare centre.


  • Preparing for a possible cholera outbreak with the construction of a 20 bed CTU and provision of ambulance referrals to the CTU.
  • Providing primary health care at the Matua healthcare centre.
  • Helping to rehabilitate the health centre.
  • Tica and Nhamatanda district

  • Setting up and running a 20-bed CTU, treating cholera and malaria cases.

  • Repairing the health centre in Tica which has been damaged by Cyclone Idai to have it fully operational again.

  • Providing logistical support to the Ministry of Health for the cholera vaccination campaign which will target 170,000 people.

  • Undertaking epidemiological surveillance for malaria, acute watery diarrhoea, mental health and malnutrition.

  • Assessing needs in the 17 health centres in Nhamatanda district.


Cyclone Idai hit Chimanimani, a small district of approximately 30,000 people in Manicaland province, late Friday 15 March, after passing through Mozambique.


  • The damage in Chimanimani district is massive, with many roads completely wiped away for several kilometres or blocked by rock falls, and the only way to reach some communities is now by foot.
  • Many have been left without homes or livelihoods.
  • Access to safe drinking water is an issue with many pipes washed away.


We have sent an emergency response team to the mountainous areas of Manicaland province, including the districts of Chimanimani and Chipinge.

Chimanimani and surrounds

An MSF team was finally able to access the district; this is the first time many parts have been accessed from outside help since the cyclone hit. With many roads washed away or flooded, the teams are walking between 3 to 12 kilometres to reach stranded communities, who have no safe water supply.

  • An MSF team is supporting ministry of health staff in Chimanimani with patient management, and helping to maintain supplies of essential medications.
  • Two outreach teams are also moving around Chimanimani, trying to access health clinics and surrounding settlements to assess health needs, and distribute medicines to clinics and village health workers.
  • Our teams are also distributing basic supplies, and aqua tablets to purify water for drinking.
  • Teams are responding to health needs including treating trauma injuries, refilling antiretroviral treatment for people living with HIV, and providing medication for people with chronic diseases.
  • Providing logistical and technical support to the Ministry of Health for a cholera vaccination campaign which started on 15 April.
  • Longer term, the consequences of blocked access should be considered: electricity was disrupted affecting routine vaccination services; impending stockouts of medical supplies and drugs; treatment interruptions for HIV, TB and chronic disease patients; and a lack of detergents and chlorine.


  • Providing aqua-tabs to ensure people have access to clean water.
  • Providing essential medicines and medication for diseases including diabetes, hypertension, and asthma.
  • Assisting with psychosocial support to affected communities.


Extremely heavy rains in lower Shire River districts of Chikwawa and Nsanje, in Malawi’s far south, has been compounded by further rains from Cyclone Idai. The Makhanga and Nsanje districts are the worst affected, with 14 of Malawi’s 28 districts experiencing severe flooding.


  • Flooding affected the majority of Nsanje district, in southern Malawi; rains have now largely stopped and access to the flooded areas is improving.
  • Some areas remain under water or cut off with limited phone communication.
  • Around 16,000 households are affected, according to the national disaster report; a huge number of houses have collapsed.
  • Many thousands of people are in displacement camps and makeshifts sites such as schools and churches. Big reconstruction efforts will be required in coming weeks.
  • There's been huge destruction of agricultural crops and animals; an estimated 50 percent of the area’s crops might have been lost.
  • Electricity has returned to hard-hit Makhanga district, on the eastern bank of the Shire river, which essentially remains an island, cut off from all road access.


We have a team of 18 people currently working with local authorities, communities and the health ministry to cover the needs of people with health, sanitation and non-food-item supplies.

We are responding in several areas with mobile clinics, and water and sanitation activities, and continue to work with local Malawian authorities and the Disaster Management department, plus local and international organisations. Most of our response is occurring in hard-hit Makhanga.

So far, our teams have not detected acute medical needs, but we’re concerned about the many people on chronic medication, including for HIV and TB treatment. To date, there are no reports of waterborne diseases, including cholera, but this remains a concern.


Outreach teams have visited communities to clean and repair boreholes plus test the water quality to ensure access to clean water.
Teams are building basic latrines, showers, shelters; are distributing non-food items and hygiene kits; and educating communities on hygiene and safe water practices.


  • A team of 18 people is supporting the health ministry, moving by boat, to cover the needs of an estimated 18,000 people with health, sanitation and non-food-item supplies.
  • In Makhanga health centre, we continue to ensure primary health, HIV services and basic disease surveillance; we are currently undertaking approximately 150 consultations per day.
  • Working with the Malawian District Health Office, the our medical team has done an outreach clinic to ensure access to primary health care services and to drugs for patients with chronic diseases, including HIV and tuberculosis, who lost their medications in the floods.
  • We have so far reached more than 2,000 households with hygiene kits, which includes buckets, cups, and soap.
  • Due to the concern about cholera, we are constructing a basic, four-bed cholera treatment unit and conduct training, to be prepared just in case the need arises.