Responding to cholera in Mozambique

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The rapidly deteriorating humanitarian emergency in Cabo Delgado, Mozambique, is marked by attacks by non-state armed groups and has quadrupled the number of people displaced by the crisis from March (over 110 000) to November 2020 (nearly 530 000), with current estimates of more than 600 000 internally displaced persons (IDPs) living in difficult conditions with limited access to health services and safe water. This insecurity has led to the destruction of 27% of health facilities across Cabo Delgado province and there are no functional health facilities in the districts hardest hit by the conflict (Mocimboa da Praia, Macomia, Muidumbe and Quissanga). This has reduced the capacity to detect and respond to disease outbreaks (in particular, cholera, measles and COVID-19) as well as to provide critical care such as sexual and reproductive healthcare, immunization and other essential health care services.

The absence of a well-functioning surveillance system, particularly in Cabo Delgado, has significant implications for the ability of health partners working in Mozambique to launch an effective cholera response. Access is a major concern, with four districts in Cabo Delgado completely inaccessible. Furthermore, high levels of misinformation led to persecution and aggression against local leaders supporting the cholera response. According to WHO data as of 21 March 2021, while there is currently a decreasing trend in cholera cases in Cabo Delgado, the cases in 2021 (3 215) have already surpassed levels from 2020 (2 176). Cholera surveillance was disrupted in Mocimboa da Praia and Macomia due to insecurity, preventing new cases from being identified.

The Mozambique Health Cluster is working with the WASH Cluster to coordinate the cholera response. Thanks to WHO, UNICEF and Médecins Sans Frontières, some work on cholera clinical case management, surveillance and Risk Communication and Community Engagement (RCCE) has been possible. In Chiure, Ancuabe, Metuge, Montepuez and Pemba districts, WHO and Médecins Sans Frontières are working with district health authorities to enhance cholera surveillance, clinical case management while WASH partners - UNICEF and national NGOs Helvetas , Ayuda en Accion and SolidarMed - are involved in community-based RCCE interventions such as health promotion, soap distributions and disinfecting affected households. Helvetas and SolidarMed have also been involved in hygiene promotion and IPC improvement at the cholera treatment centres (CTCs). WHO has supported the organization of cholera response operations at both the district and provincial levels, with a specific focus on enhancing surveillance capacities to understand the dynamics of the outbreak and for guiding response actions with partners. WHO also supported directly the enhancement of clinical case management capacities in CTCs in some of the districts. However, partners have found staffing challenges due to health and hygiene promotion personnel implementing a concurrent malaria campaign. Other health workers have been affected by COVID-19, further limiting the available staffing capacity to respond to the cholera outbreak. Both Health and WASH partners have very limited technical, human and financial resources available to them for scaling up the cholera response in a timely manner.

The complexity of the crisis in Cabo Delgado requires a multi-sectoral approach to meet the wider humanitarian health needs, with Health and WASH clusters. Health Cluster partners such as the International Committee of the Red Cross (ICRC) are working on both the Health and WASH components of the cholera response and wider humanitarian needs. The ICRC, together with the Mozambican Red Cross (CVM), are providing medical equipment and supplies to overburdened health facilities in Cabo Delgado and working to rehabilitate water supply infrastructure. The CVM volunteers also will be engaged to raise awareness in communities on communicable diseases. In addition to the ongoing collaboration between Health and WASH clusters, the Mozambique Health Cluster has been advocating within the Inter-Cluster Coordination Group to strengthen the Health response. In coordination with the Protection Cluster, the Mozambique Health Cluster joined the Protection against Sexual Exploitation and Abuse (PSEA) Network Cabo Delgado meeting, where participants agreed to develop a joint plan for PSEA risk reduction.

There is an urgent need for additional partners to scale-up or shift activities towards health and to support the congested health facilities at resettlement sites. The Mozambique Health Cluster is advocating at the country, regional and global levels for adequate resources to create an operational environment where partners can improve the health, safety and well-being of the population. Further advocacy through the Humanitarian Coordinator, with the government to relax essential drugs importation taxes and to fast-track visa issuance of health staff deployed from partners has been conducted. Despite the ongoing regional support from WHO Regional Office for Africa and resource mobilization efforts, funds are not yet available to deliver a timely and effective response to the ongoing humanitarian crisis. One major barrier to the Health Cluster’s advocacy efforts has been the lack of information management support but WHO has engaged an IMO who is still working remotely due to delays on visa issuance. Additional support from partners is essential to build information management capacity and maintain this core function of the Health Cluster.

“The people of Mozambique urgently need our help to tackle the triple threat of conflict, the climate crisis and the COVID-19 pandemic. I call on the international community to step up and support the humanitarian response plan for Mozambique, which needs US$254 million to respond to escalating humanitarian needs brought on by the triple crises.” – UN Secretary-General António Guterres

At a glance

Mozambique was hit by tropical cyclones Idai and Kenneth in March and April of 2019, which destroyed and damaged over 60 health centres, compromised access to safe water and increased the incidence of chronic undernutrition. This was the first time in recorded history that two strong tropical cyclones hit Mozambique in the same season, and Tropical Cyclone Kenneth is the strongest cyclone to ever hit the African continent. The subsequent droughts, high poverty levels and loss of crops and livelihoods has increased the violence and insecurity, particularly in the north of Mozambique. As Mozambique enters its rainy season this year, the Sofala province has already been hit on 22 and 23 January 2021 by tropical cyclone Eloise, and the country braces for further storms.

Partners working on the Cabo Delgado humanitarian health response: