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Cyclone Idai & Malawi flooding: Crisis update


In early March a storm cell brought heavy rains to Zimbabwe and Malawi before heading out to sea off the coast of Mozambique and intensifying into Cyclone Idai.  In the late night of 14 March, Idai returned to land wreaking havoc in the city of Beira, home to some 500,000 people, as well as in the surrounding districts of Manica and Sofala where it has destroyed the lives and livelihoods of hundreds of thousands more people.

High winds and high waters have so far killed at least many people [see updated government or OCHA stats below] and damaged or destroyed thousands of buildings - homes, schools, health centres and hospitals - across the area. Many families are left homeless and most communities are without reliable access to clean water or electricity.

Since then all five of MSF’s international emergency response teams have mobilized in Mozambique and have begun what looks likely to be a truly enormous response

Update: 29 March 2019

  • The cyclone has had a devastating impact on people living in flood- and cyclone-affected areas. There are already huge medical and public health needs, and we expect these needs to increase in the coming weeks with cholera and other water-borne diseases, skin infections, respiratory tract infections and malaria spreading throughout the community given the lack of shelter, poor hygiene conditions and limited access to food.  


  • It’s not surprising that cases of cholera have been confirmed in the city of Beira. After a natural disaster of this magnitude, water-borne diseases are of great concern. The challenge now is to treat the patients who are already ill whilst at the same sign setting up clean water supplies and informing the community about how to protect themselves in order to stop the outbreak from spreading.


  • The extensive damage to the health infrastructure and to medical stocks means enormous support will be required to meet the health needs of the people in disaster-affected areas. The immediate consequences of the cyclone will require an enormous response, but the normal functioning of the health system must also be maintained; mothers still need to deliver babies safely, people still need vital medication for illnesses such as HIV and TB.


  • MSF was as quick as possible (given the huge access constraints) to respond - with medical activities within three days of the first team members arriving - and is rapidly scaling up in an attempt to meet the needs of people. Initially in the city of Beira but also in other districts of Sofala province and in Manica province, where flooding has caused widespread destruction and needs are huge in terms of food, water, shelter and health care. We have over 70 international staff and more than 200 Mozambican staff on the ground in the flood-affected areas and are hiring new reinforcements.


  • MSF is working with the MoH and other actors to prepare for an oral cholera vaccination to prevent further spread of the disease. There are currently 900,000 doses of the vaccine available and people need two doses to achieve maximum protection.
Map showing the development of the weather system that brought heavy rain to Malawi, before developing into Cyclone Idai, and the cyclone's trajectory.
A map showing the development of the weather system that brought heavy rain to Malawi, before developing into Cyclone Idai, and the cyclone's trajectory. 


    Update: 27 March 2019


    "Given the sheer amount of water that passed through Beira during Cyclone Idai and the volume of damage caused, it’s not surprising that there are outbreaks of water-borne diseases like cholera in the city. MSF is already supporting the Ministry of Health to care for patients suspected of suffering from cholera in three health centres of Beira and has so far been treating more than 100 patients a day. In the coming days, we will work alongside the Ministry of Health to scale up as much as possible and provide support to more cholera treatment units as well as work to rehabilitate a larger cholera treatment centre." - Gert Verdonck, MSF Emergency Coordinator in Beira.

    26 March 2019: Updates of MSF’s emergency response in Southern Africa:


    • A 35-person emergency-experienced disaster response team has been deployed in Beira, with additional teams to follow shortly.
    • MSF teams are currently operating out of a partially rehabilitated health centre. An additional two health centres are being rehabilitated for medical use.
    • Mobile clinics are currently operational in several Beira neighbourhoods, providing medical consultations.
    • A shipment of 43.3 tons of medical kits, water and sanitation supplies, logistical equipment and other emergency response items have landed in Beria, Mozambique.


    • MSF teams are providing consultations and medical supplies in the joint-stabilisation centre set up on the outskirts of Chimanimani.
    • An MSF team is working with health ministry staff out of Chimanimani hospital.
    • Two outreach teams operating in Chimanimani are attempting to access as many of the 20 health clinics and surrounding settlements as possible assessing health needs, and distributing medicines to clinics and village health workers.                                                             


    • An MSF team of 18 people is supporting the health ministry to cover the needs of an estimated 18,000 people in Makhanga on the eastern bank of the Shire River, with health, sanitation and non-food-item supplies.
    • In Makhanga health centre, MSF continues to ensure primary health care, HIV services and basic disease surveillance. We are currently seeing approximately 150 consultations per day. 
    • Outreach teams are visiting communities to clean and repair boreholes. In addition to this process, our teams are testing water quality, building basic latrines, showers, shelters and distributing NFI materials and hygiene kits. Our teams have reached over 2,000 households in Makhanga.


    Mozambique, and particularly the city of Beira, in the centre of the country, has been the hardest hit by Cylcone Idai, which struck on 14 March.


    • Ninety percent of the area around Beira has suffered damaged, with roads, electricity and communications having been cut off.
    • Buildings have been submerged and severely damaged; many people are staying with family or friends or in transit centres because their homes are uninhabitable.
    • Healthcare infrastructure has been damaged, including the hospital; our staff have not yet seen a health centre that is undamaged and fully functional.
    • While clean-up efforts by communities are underway, clearing the streets of debris and uprooted trees, extensive repair work to buildings and infrastructure is much needed.
    • The flooded area is massive, extending beyond the direct path of the cyclone.
    • More than 440 people have been confirmed to have died so far, with authorities expecting the toll to be much higher; over 1,500 people have been injured.


    We currently have four emergency teams, and 35 emergency-experienced staff, on the ground in the flood-affected areas. More staff are en route as we scale up our response. Three charter flights with 43.3 tons of cargo have left Belgium and are arriving in Beira; four more cargo flights are booked in the coming days from Belgium and Dubai, with more planned for the coming weeks.

    Beira and surrounds

    Medical and non-medical activities have begun in Beira and in areas on the outskirts of the city.

    • Our teams are providing medical consultations via mobile clinics in several neighbourhoods of the city, including going door-to-door.
    • We are working at full capacity in one partly-rehabilitated health centre, and are getting up to speed in two other partly-rehabilitated centres.
    • So far, consultations have been mostly for treating small wounds, stomach issues (particularly intestinal worms), and respiratory tract infections.
    • Teams are also carrying out non-medical activities, including re-roofing two health centres in the poorest and most-affected neighbourhoods.



    Cyclone Idai hit Chimanimani, a small district of approximately 30,000 people in Manicaland province, late Friday 15 March, after passing through Mozambique. 


    • The damage in Chimanimani district is massive, with many roads completely wiped away for several kilometres, and the only way to reach some communities is now by foot.
    • Access to safe drinking water is an issue with many pipes washed away.
    • Official figures, as of 22 March, estimate there have been 154 deaths, 162 injuries, and nearly 5,000 displaced people as a result. 


    We have sent an emergency response team to the mountainous areas of Manicaland province, including the districts of Chimanimani and Chipinge.

    Chimanimani and surrounds

    An MSF team was finally able to access the district; this is the first time many parts have been accessed from outside help since the cyclone hit. With many roads washed away or flooded, the teams are walking between 3 to 12 kilometres to reach stranded communities, who have no safe water supply.

    • We are providing consultations and medical supplies in the stablisation centre set up on the outskirts of Chimanimani.
    • Our priority has moved to inside Chimanimani and our staff are working with MoH staff out of the hospital.
    • Two outreach teams are also moving around Chimanimani, trying to access health clinics and surrounding settlements to assess health needs, and distribute medicines to clinics and village health workers. 
    • Teams are responding to health needs including treating trauma injuries, refilling antiretroviral treatment for people living with HIV, and providing medication for people with chronic diseases.

    Longer term, the consequences of blocked access should be considered: electricity was disrupted affecting routine vaccination services; impending stockouts of medical supplies and drugs; treatment interruptions for HIV, TB and chronic disease patients; and a lack of detergents and chlorine.


    • A team has reached Copper, a valley to the south, which was one of the hardest hit areas, to conduct an assessment.



    Extremely heavy rains in lower Shire River districts of Chikwawa and Nsanje, in Malawi’s far south, has been compounded by further rains from Cyclone Idai.


    • Flooding affected the majority of Nsanje district, in southern Malawi; rains have now largely stopped and access to the flooded areas is improving.
    • Some areas remain under water or cut off with limited phone communication.
    • Around 16,000 households are affected, according to the national disaster report; a huge number of houses have collapsed.
    • Many thousands of people are in displacement camps and makeshifts sites such as schools and churches. Big reconstruction efforts will be required in coming weeks.
    • There's been huge destruction of agricultural crops and animals; an estimated 50 percent of the area’s crops might have been lost.
    • Electricity has returned to Makhanga district, on the eastern bank of the Shire river, which remains the worst-affected area and is still cut off from all road access. 
    Malawi floods following Cyclone Idai
    MSF and District Health staff board a boat at Bangula, on the swollen river banks on the Shire river in Nsanje district on their way to do a follow up visit in Makhanga. Photo: MSF


    We are responding in several areas with mobile clinics, and water and sanitation activities, and continue to work with local Malawian authorities and the Disaster Management department, plus local and international organisations. Most of our response is occurring in hard-hit Makhanga.

    So far, our teams have not detected acute medical needs, but we’re concerned about the many people on chronic medication, including for HIV and TB treatment. To date, there are no reports of waterborne diseases, including cholera, but this remains a concern.


    • Outreach teams have visited communities to clean and repair boreholes plus test the water quality to ensure access to clean water.
    • Teams are building basic latrines, showers, shelters; are distributing non-food items and hygiene kits, and educating communities on hygiene and safe water practices.


    • A team of 18 people is supporting the health ministry, moving by boat, to cover the needs of an estimated 18,000 people with health, sanitation and non-food-item supplies.
    • In Makhanga health centre, we continue to ensure primary health, HIV services and basic disease surveillance; we are currently undertaking approximately 150 consultations per day.
    • We have so far reached more than 2,000 households with hygiene kits, which includes buckets, cups, and soap.
    • Due to the concern about cholera, we will construct a basic, four-bed cholera treatment unit and conduct training, to be prepared just in case the need arises.

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