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Medical supplies bound for the Zambezia Province of Mozambique are staged at Direct Relief's warehouse in Santa Barbara, California, on Friday, March 22, 2019. The organization is shipping essential medical supplies, like antibiotics, wound care, and water purification tablets, to health partners in the region. (Lara Cooper/Direct Relief)
Cyclone Idai, which struck near the city of Beira, Mozambique on March 17, is already being described as “Africa’s Hurricane Katrina.”
The land around Beira was already saturated with flood waters when Idai arrived. With the additional heavy rains from the storm, as well as storm surge cresting as high as 7.5 feet, Cyclone Idai produced an “inland ocean” which stretched for thousands of square miles, soaking the homes, roads and belongings of some of the world’s most impoverished communities.
The official death toll from the initial impact is already in the hundreds, with search and rescue operations ongoing. Many more than that total may ultimately lose their lives.
Despite the heavy losses of the storm’s landfall, the highest risks for people living in Mozambique and neighboring Zimbabwe still lie in the future.
(Source: World Health Organization)
Communities in the storm-affected area face many of the planet’s most pressing health crises. Now they must do so under conditions where transportation and communications networks have been disrupted, agricultural fields have been inundated with salt water, homes have been lost, and food is scarce.
Mozambique’s health care system was already fragile. Now, in many places, it has been rendered non-functional. In Sofala province, 28 out of 157 health facilities have been either entirely or partially destroyed.
Waterborne Diseases
The muddy storm waters of Cyclone Idai contain multiple risks to human health. Cholera is foremost among these. The area from Quelimane to Beira and inland across the border into Zimbabwe includes numerous areas which are considered under standard conditions to be high risk for cholera infections. Central Mozambique saw outbreaks of the disease in 2015 and again in 2017.
Cholera is caused by the infection of water supplies with sewage which may contain the vibrio cholerae bacteria. Flooding from Cyclone Idai has severely affected sanitation throughout the region.
Reported Cholera Cases (Map/Direct Relief)
Areas which have seen cholera infections in the recent past may see a rapid resurgence of the bacteria. According to reports from IFRC, the first cases in the inundated area have already been detected.
Along with cholera, risks of waterborne illness include bacterial infections causing acute watery diarrhea, and typhoid, both of which are endemic throughout the storm-affected zone.
HIV and TB
Mozambique suffers from one of the most severe HIV burdens of any country. Current estimates place their HIV prevalence rate at 12.5% of the population. HIV, although it is transmitted by viral infection, is now considered largely to be a chronic illness given access to anti-retroviral drugs which can control the severity of the disease and bring patients’ viral loads into manageable ranges.
However, under conditions where drug supplies may be disrupted as a result of natural disaster patients may not be able to access health facilities nor receive access to HIV medications. As a result, many patients are at serious risk of experiencing complications from the disease.
Change over time in Mozambique’s HIV prevalence rate (Source: World Bank)
Likewise, Mozambique has among the highest burdens of TB, at 552 cases per 100,000 population. Much like HIV, tuberculosis can be controlled through the administration of antibiotics and other medicines, but often requires direct observation of the patient over regular periods.
Disruption of health systems is an exceptional problem for patients who may have active tuberculosis. Likewise, the conditions of the disaster produce the increased probability that people with TB may come into contact with others and risk the spread of the disease.
Malaria and Dengue
Cyclone-strength storm winds tend to disrupt insect populations and may have an initial effect of reducing exposure to vector-borne diseases. However, central Mozambique has high burdens of malaria, dengue, chikungunya and other infections which are transmitted by mosquitos. Mozambique has the 10th highest malaria rate in the world at 337 cases per 100,000 population.
As the storm waters recede and mosquito breeding grounds re-establish themselves, it is likely that people throughout this area may see spikes in vector-borne diseases. For those currently being treated for malaria and other illnesses, the disruption of access to medicines may make their conditions more severe than otherwise would be the case.
Maternal and Child Health
Pregnant women in Mozambique are among the most at-risk under normal circumstances. The country’s maternal mortality rate is 489 per 100,000 deliveries, which is the world’s 21st highest. Among the leading causes of risk for safe deliveries is the lack of access to a skilled birth attendant, usually at a health facility.
Given the scale of impact to the health infrastructure of this area women will experience reduced access and therefore higher rates of risk that complicated pregnancies may result in severe injury or death.
According to the “Find a Fistula Repair Center” application, some of the busiest providers of obstetric fistula care for the country are in Beira and Quelimane, where between 100 and 150 fistula repair surgeries are provided annually.
Obstetric fistula as a result of prolonged obstructed labor is among the most common birth injuries suffered by women in Mozambique. According to the “Find a Fistula Repair Center” Application, some of the busiest providers of obstetric fistula care for the country are in Beira and Quelimane, where between 100 and 150 fistula repair surgeries are provided annually.
As is often the case in crises, children under the age of five face some of the most severe health risks, including respiratory illnesses, diarrheal disease and other infectious diseases including cholera, malaria and measles. Mozambique’s child mortality rate is among the world’s highest at 72.4 per 1000.
Food Security and Nutrition
Access to food ranks among the most urgent post-disaster issues for people affected by the storm. Major shortages are being reported throughout Sofala and Zambezia as transportation logistics have been cut off and communities struggle to meet their basic nutritional requirements.
Food security is, however, perhaps even more serious as a concern over the medium to long term. The midsection of Mozambique is a significant agricultural production region. Most families make their livelihoods here as smallholder farmers.
The wind-speed of the cyclone badly damaged tens of thousands of acres of staple crops. Even worse, the surge of salt water into key production regions may take those areas offline in terms of viable agricultural production for the remainder of this year until the fertility of the soil can be restored.
Long-term disruption of food security has implications not only for the communities directly affected by the storm but potentially for the entire country which will have to figure out how to replace what has been lost.
Direct Relief is stepping up medical aid shipments throughout the affected area and will be closely tracking health risks to the people of Mozambique as they continue to change throughout what promises to be a long and challenging recovery effort.
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