Mozambique is working to contain the cholera outbreak after the cyclone

QUELIMANE, Mozambique — Weeks after massive Cyclone Freddy hit Mozambique for a second time, the still-flooded country faces a spiraling cholera outbreak that threatens to add to the devastation.

More than 19,000 confirmed cases of cholera had been registered in Mozambique’s eight provinces as of March 27, a figure that nearly doubled in a week, according to the UN Office for the Coordination of Humanitarian Affairs.

Freddy was possibly the longest-lived cyclone ever, lasting more than five weeks and hitting Mozambique twice. The tropical storm killed 165 people in Mozambique, 17 in Madagascar and 676 in Malawi. Two weeks later, more than 530 people are still missing in Malawi, so the country’s death toll could well exceed 1,200.

Freddy made a second landfall in Mozambique’s Zambezia province, where many villages remain flooded and water supplies remain contaminated.

At a hospital in Quelimane, Zambezia’s provincial capital, National Institute of Health director-general Eduardo Sam Gudo Jr. reported 600 new confirmed cases a day in Quelimane district alone, but said the real number could be as high as 1,000.

At least 31 people died of cholera in Zambézia and more than 3,200 were hospitalized between March 15 and 29, according to the Ministry of Health.

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Most of the cases occur on the outskirts of the city, around Icidua, where most residents live in bamboo or mud huts and carry water in buckets from community wells. Cyclone flooding exposed most of these wells to water contaminated with sewage overflow and other sources of bacteria. Cholera is spread through faeces, often in drinking water.

But until the water pipes broken during the floods are repaired, these wells are the only source of water in Icidua and communities like it. For now, temporary solutions offer the only hope of containing the epidemic.

Volunteers go door-to-door distributing Certeza, a local chlorine-based water purifier. Each bottle should last a family for a week, but supplies are running low as local production struggles to keep up with demand. There aren’t enough people to distribute Certeza, even if larger supplies could be obtained, Gudo said.

Meanwhile, health workers are struggling to treat the infected, and many clinics and hospitals have been severely damaged. “The cyclone destroyed the infrastructure here,” said José da Costa Silva, clinical director of the Icidua health center. “We are working on the parts of the hospital that were not destroyed. Some colleagues work outside because there is not enough space for everyone.”

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According to INGD, the country’s disaster management agency, a total of eighty health centers were affected by Freddy’s two landfalls in Mozambique.

Although cyclones occur in southern Africa from December to May, human-induced climate change has made tropical cyclones wetter, more intense and more frequent. The now dissipated natural La Nina event also worsened cyclone activity in the region. Although Cyclone Freddy itself has not yet been attributed to climate change, researchers say it has all the hallmarks of a warming-induced weather event.

The extremely long-lived cyclone formed off the coast of Australia in early February, making an unprecedented crossing of more than 8,000 kilometers (5,000 miles) from east to west across the Indian Ocean.

It followed a looping path rarely recorded by meteorologists, first reaching Madagascar and Mozambique in late February and then March before moving into Malawi.

Restoring normal water supplies in Mozambique will take time, as many damaged pipelines run through areas that are still inaccessible two weeks after the last cyclone hit.

“It’s a mission impossible to manage a cholera epidemic in a flood plain where the water table is very high,” Myrta Kaulard, the UN Resident Coordinator in Mozambique, told The Associated Press. “Sanitation is a huge issue and the flooding has affected key infrastructure such as water lines and electricity… Repairing infrastructure in flooded areas is another ‘mission impossible’.

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Meanwhile, the rural areas of Quelimane face other threats. Many villages and fields are still under water, and the humidity has bred swarms of malaria-carrying mosquitoes. According to Hilário Milisto Irawe, a local chief, in a temporary displacement camp on the banks of a flooded rice field near the village of Nicoadala, 20 of the 290 residents have malaria.

As of March 24, 444 cases of malaria were reported in the Quelimane district alone, but the number is likely to be much higher as many, such as those in the camp near Nicoadala, do not have access to health facilities.

Adding to the public health crisis, the livelihoods of hundreds of thousands are at risk as Freddy strikes just before the main harvest. It also transported seawater inland, threatening long-term soil fertility in an area where malnutrition is already chronic.

“All our farms were flooded. Our rice farms were destroyed. All we can do is start over, but we don’t know how we’re going to do that,” Irawe said.