Almost one million people are currently displaced in northern Mozambique following five years of conflict between government forces and non-state armed groups in Cabo Delgado province. Doctors Without Borders/Médecins Sans Frontières (MSF) has been present in the region since February 2019, providing medical care and humanitarian aid to many who’ve fled their homes in search of safety.
Some people have been displaced multiple times, forced to abandon their few possessions, means of survival, loved ones, and communities. Living through such a prolonged conflict—with little to no prospect of a stable future—has profound mental health consequences.
Since the conflict began in October 2017, some people in Cabo Delgado still live in constant fear and continue to experience trauma and loss. Many have witnessed murders as more than 4,000 people have been killed. Others have lost contact with their relatives and still don’t know where they are.
“We’re separated from our family and the rest of our people,” said a community leader from Mocímboa da Praia, a district in northern Cabo Delgado. He has had to start from scratch time and time again and currently lives in a temporary settlement in the district of Palma. “Sometimes we hear about a sick family member, but we have no way to visit them. Sometimes we hear someone’s passed away, but we can’t get to them. Every day that goes by, we get sadder about it.”
Tatiane Francisco, an MSF mental health activity manager, said that acute stress and anxiety due to uncertainty and a lack of prospects—as well as loss and grief—are the main reasons people seek mental health consultations at MSF’s projects. In 2021, MSF teams provided almost 3,500 individual mental health consultations and facilitated group mental health activities for more than 64,000 people in Cabo Delgado.
“The stories people bring to us are about mothers who had to leave their children during an escape and do not know how they are today, children who witnessed the death of their parents, and people who witnessed the death of other family members,” said Francisco. “When you're constantly feeling this fear, it's hard to think about the future. It's hard to plan things. You're still living in survival mode. People have been living in a kind of limbo for years now.”
Maria, 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 different directions,” said 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. However, uncertainty, fear, and trauma make it difficult to return to normal life.
“Right now, in different parts of the province, there are people both returning to their places of origin and people forced to flee and starting displacement again,” said Francisco. “There may not be violence where some people are, but nothing guarantees that this won't change in the future. In other words, psychologically, the message our bodies receive when they still see violence elsewhere is ‘attacks keep happening and we have no way of predicting where the next one will be.’”
Extreme violence often leaves painful psychological scars for those that suffered from it. “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,” said Josuel Moreira, an MSF psychologist in Palma. “This shows us that both 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 continues, these mental health issues, as well as access to basic services like health care, water, food, and shelter, remain a struggle for many.
In some districts where MSF works—including Macomia, Palma, and Mocímboa da Praia—we are the only humanitarian organization with a regular presence, or one of very few. Assistance is disproportionally distributed in Cabo Delgado, with more aid being provided in the south of the province, which is considered to be more stable. More needs to be done so people in hard-to-reach areas can access lifesaving support.
“Many people lost not only their possessions and their families, but they also lost their sense of dignity of living as a person,” said Moreira.
MSF first started working in Mozambique in 1984 during the Mozambican civil war. In Cabo Delgado, MSF currently has projects in Macomia, Mocímboa da Praia, Palma, and Mueda, as well as the neighboring districts of Muidumbe, Nangade, and Meluco through mobile clinics. MSF teams in these locations and clinics provide primary health consultations, mental health care, water and sanitation services, secondary health care support to local hospitals, and the distribution of emergency relief item kits.