The conflict in the northern Mozambique province of Cabo Delgado that began in 2017 has now forced nearly 670,000 people from their homes. Living conditions in temporary camps, set up to accommodate thousands of exhausted displaced families, are increasingly inadequate. As they try to cope with a lack of food, clothing, medicines and plastic sheeting to protect themselves during the rainy season, many feel hopeless and frustrated. Every aspect of life in the camps is a struggle and the traumas that internally displaced people (IDPs) have lived through are taking their toll.
Doctors Without Borders/Médecins Sans Frontières (MSF) is providing water and sanitation services in the camps, including building latrines and supplying clean water. In December 2020, we launched a mental health program in Nangua and 25 de Junho—the two most populous camps in Metuge, on the outskirts of Pemba, Cabo Delgado’s capital—to reinforce our ongoing mobile health clinics. MSF has also launched a mental health program in Montepuez, the province’s second largest city, where thousands of IDPs are also being resettled.
“Being here is not our choice or decision”
Most of the people who have taken shelter in Montepuez fled from the coastal district of Quissanga, where fighting between the Mozambican army and a non-state armed group has been most intense. Many villages have been burned to the ground, and displaced people tell stories of losing their homes, belongings, and loved ones in the violence.
“We try to understand what their lives were like before they escaped . . . whether there was fighting in their area when they ran away and about their journeys to reach the camps,” said Frida* a member of the MSF mental health team. “Most of them tell us they walked here. They didn’t have the opportunity, or the means, to pay for a vehicle to transport them.”
MSF mental health activities include conversation circles, theater, soccer games, dancing, and singing. Conversation circles are safe spaces for people to express themselves and talk about their concerns in an atmosphere of trust. MSF teams create separate circles for women and men.
The people who attend MSF’s conversation circles share stories of the trauma they experienced as they fled their homes, said Frida. “During an MSF conversation circle in Nangua camp, one woman said, ‘I found this child alone in the bush. I don’t know where her mother is. We left our homes in Cajembe last year. We suffered in Macomia and now we are here in Metuge. We are in a lot of pain! We, the people of Cajembe and Nankaramo, have suffered too much. Being here is not our choice or decision; if we could choose, we would have moved on to places where our life could have been better.”
A nightmarish journey
For some, the journey to safety means days of walking through the bush. It takes strength that children and the elderly don’t have, and some families lose members along the way. “A lot of people become ill,” said Frida. The journey to Pemba from Mueda, where a lot of the displaced people are from, is nearly 170 miles. “Some develop swollen legs after having walked such long distances. Their bodies are tired, sore.”
Their experiences on the run take a heavy toll on mental health, as well. People arrive in the camps with horrific stories about what they saw on the long journey. Many come across the dismembered bodies of murdered relatives or neighbors, or people who died of starvation or dehydration as they fled the violence.
And reaching the camps offers little relief. “We ask them to tell us how they have adapted to their new reality, and all we hear are their sorrows,” said Tamara*, another member of the MSF mental health team. “They tell us they have problems sleeping because of everything they have been through, the things they have been forced to witness. These haunting images deprive them of sleep, of wanting to eat and, sometimes, deprive them of the will to live.”
Providing much-needed support
MSF’s mental health services can help displaced people cope with their loss. “Just the fact that we are there to listen to what they have to say, to their stories—it makes them feel better,” said Tamara. “We sing and dance, we do activities that will relieve their pain, even if just for a moment. It allows them to share everything that was positive from their villages, to remember all the good moments. The women can express themselves more freely through singing. Every song tells a story and illustrates what they are feeling or what they hope for the future.”
“There is something I find very beautiful in all of this, and that is the work that we do,” said Frida. “I think our work is very meaningful and the fact that they are always asking us to come back is, to me, very special.”
*Names have been changed to protect our staff’s safety.
MSF has been present in Mozambique since 1984. In the city of Pemba, we currently support health authorities in improving access to water and sanitation for displaced people as well as responding to possible outbreaks of diarrhea. MSF is also present in Maputo and Beira, providing care to people with advanced HIV, tuberculosis, and hepatitis C. Across all projects, MSF supports the Mozambican Ministry of Health in its response to COVID-19 through the implementation of preventative measures, including infection control, triage, and disease surveillance.