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Struggle to survive 5-year ‘war’ in Cabo Delgado

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Picture Credit: Picture: Camille Laffont/AFP – A local resident sits near the remains of a destroyed bank in Palma, Cabo Delgado province, last month. In March last year, Islamic State fighters attacked the port city – the jewel in the crown of Mozambique’s gas project that would supposedly shower the province with quality jobs and desperately-needed infrastructure.

By Doctors Without Borders (MSF)

As we approach World Mental Health Day, we draw attention to the immense humanitarian and mental health needs we see. Almost 1 million people are currently displaced in northern Mozambique after fleeing their homes in search of safety, due to the conflict that started in Cabo Delgado province in October 2017.

Many people have been displaced multiple times, needing to abandon their few possessions, means of survival, loved ones and communities during each displacement. Living through such a prolonged conflict, with little to no prospect of a stable future, comes with profound mental health consequences.

Five years on, some communities in Cabo Delgado are still living in constant fear and continue to experience trauma and loss. Many have witnessed murders; others have lost contact with their relatives and still don’t know where they are. Maria Maleve, an elderly woman from Ancuabe, arrived in the city of Montepuez in July following an outbreak of violence that uprooted more than 80 000 people over a few weeks.

“When the war broke out, we all ran in a different direction,” says Maria. “I arrived here alone, with a child I found on the way. His father was shot dead. His mother was kidnapped. I’d like the war to be over so we can go back to our land.”

Like Maria, many people dream of returning home and rebuilding their lives as farmers, fishermen and community members. However, uncertainty, fear and trauma make it difficult to return to normal life.

“Right now, in different parts of the province, there are people returning to their places of origin and people forced to flee and starting displacement again,” says Tatiane.

“There may not be violence where some people are, but to them, nothing guarantees that this won’t change in the future.” “Some people have the courage and desire to go back to where they are from, but others, because of the kinds of events they have experienced, prefer not to risk going back until they are sure things are good,” says Josuel Moreira, an MSF psychologist in Palma.

“This shows us that the experiences, as well as the feelings associated with these past experiences, are still vivid and people still carry them. You can’t even call it post-traumatic stress; the trauma is still there.”

As the conflict in Cabo Delgado carries on, these mental health issues, as well as access to basic services such as health care, water, food and shelter, remain a struggle for many. The MSF teams have been working in response to the crisis in Cabo Delgado since 2019.

In 2021 alone, more than 52 000 malaria cases were treated, almost 3 500 individual mental health consultations were conducted, and more than 64 000 people attended group mental health activities. Due to the volatile and constantly changing context, our teams have had to be flexible, agile and adaptive.

Humanitarian assistance is disproportionately distributed in Cabo Delgado, with more assistance being provided in the south of the province, which is considered to be more stable. In some of the districts where we work, such as Macomia, Palma and Mocímboa da Praia, often no or very few other organisations have a regular presence.

More needs to be done so people in hard-to-reach areas have access to lifesaving support. “Many people have lost not only their possessions and their families. They have also lost their sense of dignity, of living as a person,” says Josuel.

This article was first published by Médecins Sans Frontières (