Paulo Milanesio serves as a project coordinator at Medecins Sans Frontieres in Mueda. This town is located in the northern Mozambican Province of Cabo Delgado where hundreds of thousands have sought refuge from ongoing conflicts.
The conflict in Cabo delgado continues for more than four years. What is the current situation?
During 2020 and the first half of this year, there was intense violence including fighting and attacks by non-state armed groups against villages and large towns. Masses of people living along the coast and northeast of Cabo delgado were forced to flee their homes to seek refuge in the transit and resettlement centers located in the west or south of the province. There are hundreds of thousands of peopleliving here at the moment, many of them having been displaced for over a year.
In recent months, Mozambique’s armies and those of other allied countries have launched offensives in order to retake areas from which people fled. Some of the areas retaken have been or are being prepared to allow those who have fled to return. The recent offensives have dispersed non-state armed group and violence has decreased, but there are still frequent outbreaks that force people to flee.
Mueda can be found close to Mocimboa da Praia or Palma, which were two of the cities that were attacked months ago. What are the MSF teams seeing there?
We opened the Mueda project in March to provide humanitarian and medical assistance to fleeing conflict-related refugees at an earlier stage of their flight. In this mountainous town there are about 12,000 displaced people living at the resettlement site of Eduardo Mondlane, which was created in April.
From there our mobile teams move to different points in the districts of Mueda, Nangade, Muidumbe and Mocimboa, where there are several hotspots of displaced communities (about 50,000 people in total), who have arrived mainly from Palma and Mocimboa. We also travel to Negomano on the border with Tanzania from Mueda. This is where some of the displaced people reenter the country after a short stay in the neighboring country.
In large areas of these cities, the health system was severely affected by the conflict. Some structures were attacked and staff fled. Many areas have become ghost towns as people fled. Other areas have public health centres that are functioning and a return to normality. Some people are slowly returning.
Nearly all families have suffered trauma. Some of our patients cannot even make eye contact. Paulo Milanesio, MSF project coordinator in Mueda
Some people don’t feel safe enough for them to return home, but they do go back to check on their crops and houses. They return to the refuge they sought. It is always a struggle to return home. Your home is your home. Even if the future is uncertain, many people prefer to go back to their home, even if it’s not easy. People will even sell their phones to help pay for transportation. They are motivated by hope.
Eruptions of violence can also cause sudden movements. Sometimes, a rumour can be enough to start despair. People are forced to flee violence with nothing but their clothes. People move in a variety of directions to escape violence or return home. It’s extremely volatile.
This requires us to be responsive as we must be able to accompany them in order to ensure that they have access to the minimum amount of humanitarian and health services while they are fleeing, displaced and returning. We must make sure that our actions do not affect their decisions in such a volatile environment.
How does the conflict affect people?
It may not be a serious medical emergency but it is a humanitarian crisis. Most of the medical conditions we see are basic. The province’s south, near the capital Pemba, is where the most humanitarian aid is concentrated. In large parts of the north, however, there are very few or no aid organizations. This makes it necessary to diversify and adapt our activities.
When we find a group of people who are displaced in these areas, we often provide water, food, shelter, or the materials to build a home. For people who have walked for long periods, we had to purchase clothes and flip-flops. Talking about malaria with someone who has lost everything is not a good idea.
There are people who have been living in the bush for months, some even more than a year, in dense and inhospitable areas. They arrive in poor health and have eaten little of what they can find along the way. These people are often elderly and have malnutrition, anemia, and clothes that are almost completely destroyed.
Sometimes people have been alone for a long time. People who have been untreated for chronic diseases like HIV or tuberculosis, which is a high-prevalence disease in Mozambique are often in poor health. There are also many cases of hypertension and respiratory problems.
Apart from these complex medical conditions, people are also suffering from psychological issues. Nearly all families have suffered trauma. Some patients cannot even make eye contact. Some of our patients have been victims or witnessed violence and even lost their homes. These experiences had a negative impact on their mental health.
Some people have also lost contact with relatives. It is not uncommon to find parents without contact with their children or orphaned children who have lost their parents or were abducted by armed groups.
What does MSF do to help?
In Mueda, we provide technical support to the rural hospital and run a health post in the main site for displaced people. As the situation has worsened, we also provide water to others. A team of midwives is available to monitor pregnant women. We also have a fleet of vehicles that can be called in to help with serious cases.
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In addition, we distribute aid kits for recently displaced people, do health promotion and, now that the rainy season is approaching, a lot of work to prevent the spread of diseases such as cholera and malaria. Our mental health team also provides psychological support.
Outside of Mueda, we run mobile clinics in various locations where we distribute aid kits. There are two types of aid kits we offer. One is called a transit kit and it includes basic utensils and food for those who are on the move. For those who have settled, the other aid kit is more comprehensive and can be used to make shelters. This includes tarpaulins and food for several weeks, as well as other items.
We also support a network of 70 community health workers who are part of the Ministry of Health. These community health workers are vital because they provide access to common diseases like malaria and diarrhoea in rural areas. Because they are in close contact with the communities, they are the first link in our chain. Through these key workers, we learn almost immediately when sudden people movements occur, and we then prepare an assessment and respond within 24 hours if security allows.
MSF has been present in Mozambique since 1984. Our teams in Cabo Delgado manage stable projects in Metuge and Macomia, as well as a surveillance structure at Montepuez. This is where our medical activities ended last October.