Cyclone Freddy Collapses Malawi’s Health System, Washing Away Medicines and Patient Records
A partly submerged house in Nsanje in Malawi after Cyclone Freddy.

Submerged houses, collapsed buildings, uprooted trees and floating household items are what remains of Mtemangawa Village in Nsanje district, located in southern Malawi, bordering Mozambique.

This is where one of the longest-lasting storms in the southern hemisphere, Tropical Cyclone Freddy, entered Malawi on March 12, 2023. 

Home to about 300 000 people, Nsanje is Malawi’s poorest district. Some 81% of its population is ranked as poor and 56% as ultra-poor, meaning that they live on less than one US dollar a day.

“Rising water levels were noticed around 2pm on Monday, 13 March,” recalls resident Laika Kawela. “We ignored it. Our area is usually like that during the rainy season. But by 6pm, water spread all over our entire village. Luckily, we ran to higher ground carrying only the nearest basic things.”

Kawela only managed to save her family and her mobile phone. All her belongings, including her and her husband’s HIV antiretroviral (ARV) drugs, were washed away.

“For close to a week, we have missed our medication. We have been disconnected from many things, including medical services,” laments Kawela.

Kawela’s family is amongst the 660 families seeking temporary shelter at Kapalokonje camp. They have survived on anything they could in the past week as a truck full of relief food only arrived on Tuesday, a week after their displacement.

“We have been squeezing ourselves into the few surviving structures nearby for a week as we waited for aid. We had two tents mounted at this camp yesterday. Food prices in the district have more than doubled and many of us cannot afford it. We have been starving,” she tells Health Policy Watch.

Her main worry is how she can pick up her life again: “My house is not habitable. It will require a lot of maintenance. This applies to many people here. Where are we going to start from? Other than life, I don’t have anything else.” 

Kawela is one of the estimated half a million people who have been displaced by Cyclone Freddy in the country’s 15 affected districts. Her situation is a reflection of what many people living with HIV are facing after being displaced by the disaster. 

According to the Coalition of Women Living with HIV (COWLA), over 250 women living with HIV in the affected districts are disconnected from treatment.

A collapsed house in Nsanje in Malawi after Cyclone Freddy.

Collapsed system

Public health experts say that the cyclone came at an unexpected time and it has had a severe impact on people’s health. Services have been disrupted by damaged roads and bridges, and there is an acute shortage of staff as some health workers have also been displaced and lost property. Many local health centres have lost some or all their supplies, leading to a critical shortage of supplies in these facilities.

“The previous cyclones (Ana and Gombe) severely damaged our water, sanitation and hygiene infrastructure along with shelters, all of which exacerbated the current cholera outbreak,” said Dr Titus Divala, a public health expert.

“I can’t even begin to imagine how and when we will be able to get out of this. Considering the poor shelter, scabies and many other communicable diseases will also increase. It’s going to be painful. Authorities and their development partners need to act quickly,” Divala predicts.

Satellite image of Cyclone Freddy before it hit Mozambique on 10 March.

Roads washed away

According to the Ministry of Health (MoH), Nsanje has been disconnected from health facilities as roads have been washed away.

Even before the cyclone, Malawi’s health sector had been struggling to deal with the most prolonged cholera outbreak in a decade. The outbreak started last March and has claimed 1,686 lives.

MoH spokesperson, Adrian Chikumbe says the fight against cholera has been affected by the cyclone in some places.

“Patients are failing to go to facilities either because the facilities are affected or roads are impassable,” Chikumbe told Health Policy Watch.

A report from the ministry and the Public Health Institute of Malawi report warned that Cyclone Freddy has contributed to the breakdown of water and sanitation facilities, leading to contaminated water sources and collapsed latrines.

“Congregate settings like camps are a fertile ground for disease outbreaks,” they warn.

However, the MoH has trained volunteers and Health Surveillance Assistants (community health workers) to monitor the camps amid ongoing assessments in the affected areas, the report, which was issued on Monday, adds.

Professor Adamson Muula, Head of Community and Environmental Health at Kamuzu University of Health Sciences, notes that living with friends, relatives or strangers at the camp is a nightmare for survivors – even in countries that are used to managing displaced individuals.

“The schools, churches and other places, which have turned into shelters, are not designed to cater for displaced individuals. The schools are created to offer services to children and adolescents for classes. They are not meant to house adults. Many of the survivors don’t know when they will leave these shelters. We also need to be aware that there are psychological ramifications which must be attended to,” Muula said.

Pregnant women, people with chronic medical conditions including high blood pressure and heart diseases, and those on ARVs, are particularly at risk, he warns.

“Those on tuberculosis and HIV treatment, their medication and health records have been lost. All these people are in camps now or staying in strange environments. The system has been compromised and we need to intervene before things become worse,” he said.

However, Muula observed that the current tragedy is largely man-made: “This is not the time to blame one another. But as the dust settles, there is a great need for soul-searching and an honest discussion about how to prevent future losses of life. No doubt, these cyclones will continue to come, more frequently.”

More extreme weather events

Malawi President Lazarus Chakwera declared a state of disaster on 13 March 13, and 14 days of national mourning from 15 March. The death toll on Wednesday stood at 507 deaths, with 1,332 people injured, according to the Department of Disaster Management Affairs.

Last Monday, United Nations Secretary-General, Antonio Guterres warned that, unless countries dramatically scale up their efforts to counter the climate crisis, the world faces a global disaster as the planet is “nearing the point of no return”.

Global emissions of carbon dioxide and other greenhouse gases keep increasing, largely because of the burning of fossil fuels, deforestation, and intensive agriculture, said Guterres at the launch of the sixth synthesis report of the Intergovernmental Panel on Climate Change (IPCC).

“Emissions should be decreasing by now and will need to be cut by almost half by 2030 if warming is to be limited to 1.5°C,” the report warns, referring to the temperature target adopted by most countries in the Paris Agreement in 2015.

Herbert Mwalukomo, Executive Director for the Centre for Environmental Policy and Advocacy, said that Malawi should expect more extreme weather events.

“The global community must wake up. The piecemeal solutions to climate change will not help. The UN report is very clear that the pace and scale of what has been done so far and current plans are not sufficient,” said Mwalukomo.

“Developed countries must shift away from carbon energy in their own countries now if they care about climate change. No amount of preparedness will help if emissions continue to rise.”.

Mwalukomo said that the most immediate policy action is to enact a national Disaster Risk Management Bill. 

“Cabinet, the Ministry of Justice and the Department of Disaster Management Affairs must do the needful to ensure that the Bill is tabled in the current sitting of Parliament. The Bill is not a magic bullet, but it will go long way to ensure that Malawi has a legal framework for preparedness, effective response and recovery from disasters,” he said.

“As citizens, we have to invest in our own preparedness. We cannot continue building and living in areas that are prone to flooding. It is a suicide mission. We also have to pay attention to early warning messages provided by the Department of Meteorological services,” he said.

Dodma says the world has for some time known that it is in a climate crisis and the department is putting in place adaptation plans including early warning system, anticipatory plans and bringing back the environment.

Charles Kalemba, Commissioner for Disaster Management Affairs, said that “disasters will continue to happen, it’s not a new thing. We are prepared for anything that may come in future”.

The department’s main strategy to reduce the impact of future disasters, he added, was encouraging people to relocate from flood-prone areas through local councils that need to find suitable safe places for the citizenry.

“We have asked councils to be aggressive in enforcing laws on illegal settlements especially those settling at the foot of mountains. They need to relocate these people, especially in Blantyre where such residents were hard hit,” Kalemba said.

Image Credits: NASA Worldview, Josephine Chinele.

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