Mozambique: “At night I can’t sleep between being hungry and haunted”

In Cabo Delgado, ongoing attacks and repeated displacement have left communities traumatized and in need of mental health care.

A woman holds a polaroid photo of a family in Mozambique.

Mozambique 2024 © Martim Gray Pereira/MSF

Six years after the start of the violent conflict in northern Mozambique, people in Cabo Delgado still live in fear. In 2024 alone, over 80,000 people had to flee attacks by armed groups. Displaced people are in urgent need of food, shelter, relief items, and health care, including mental health care.

“Displaced people often have been highly traumatized by the violence,” said Esperança Chinhanja, a psychologist with Doctors Without Borders/Médecins Sans Frontières (MSF) in Macomia, one of the most affected districts of Cabo Delgado. “Some people experience anxiety, panic attacks, insomnia, isolation, and recurring thoughts. Some share that they have lost the meaning of life and mention suicidal thoughts.”

Families have been displaced multiple times since 2017. Most have experienced or witnessed extreme violence including killing, sexual violence, kidnapping, extortion, and the burning of villages. Many have seen their relatives and neighbors being killed by decapitation or gunfire. Some have lost their entire family. 

The violence isn't abating, so people have to flee repeatedly. As of January 2024, there were about 76,000 displaced people living in Macomia, and in February, some 3,600 people were newly displaced following multiple attacks in the district. Their stories are harrowing.

Photo of a Mozambican man holding his hand over his face.
"At night, many people can’t sleep because they are still afraid," said Joaquim. Mozambique 2024 © Martim Gray Pereira/MSF


Joaquim*, 42, has been displaced since 2022. Today he is responsible for registering new arrivals at a camp for displaced families in Macomia. He records the names of all newcomers and carries their stories, experiences, needs, and frustrations.  

“At night, many people can’t sleep because they are still afraid. Several prefer to stay awake to ensure everything is OK and nothing bad is happening,” he shared, stressing that food is the most urgent need for displaced families.

A Mozambican man holds both hands over his face.
Amade was forced to flee his village in Pangane in February. Mozambique 2024 © Martim Gray Pereira/MSF


Amade*, a 60-year-old farmer, was forced to flee his village in Pangane in February. He is currently staying in a camp in Macomia village, about 45 km from his hometown. “When we heard shots being fired, we started running,” he shared while visiting an MSF clinic. “This was the fourth time fleeing attacks in my village since 2020. We don’t have any food and we are relying on the generosity of others to eat. I have lost so much weight that I do not even recognize my body—my pants are falling off as they don’t fit any longer. At night I can’t sleep between being hungry and haunted by the memories of the attacks.”

Violence continues displacing and traumatising thousands in Cabo Delgado
Ernestina was displaced in February from Chai and currently lives in Macomia village. Mozambique 2024 © Martim Gray Pereira/MSF


Like Amade, Ernestina Jeremias, a 32-year-old midwife, was also displaced in February from Chai and is currently staying in Macomia. “The attacks destroyed everything we had, including our lives,” said Ernestina. “This is the third time I have fled from Chai. The last attacks were the most brutal as they happened repeatedly for two weeks. I have been in a displacement center since I arrived in Macomia. Here, I am providing support to pregnant women from my community who also fled the attacks, and I refer the most serious cases to MSF clinics. This is what keeps me going.”

A Mozambican woman who has been displaced by violence.
Atija is a 28-year-old mother displaced in Macomia. Mozambique 2024 © Martim Gray Pereira/MSF


Atija, a 28-year-old mother, shared her story while accompanying her two children to the MSF clinic in Nanga. “I was pregnant when our village was attacked in Meluco district in 2022. I saw my house being burned down, we lost everything we had on that day. My family and I fled to the bush and walked for two days. Since then, I have never been the same and I am still struggling with panic attacks, insomnia, and I want to be alone most of the time. I find my strength to continue living from my children and trying to find food for us. I am working in other people’s fields, and they give me dried cassava in exchange.”

A Mozambican woman holding a baby smiles at her other child.
"I find my strength to continue living from my children," said Atija. Mozambique 2024 © Martim Gray Pereira/MSF

The conflict continues to significantly impact public services, particularly with the destruction of health facilities. This poses serious challenges in accessing basic health care. In Macomia, out of seven existing health centers managed by the Ministry of Health before the conflict, only one is functioning. MSF supports three clinics in the village and provides lifesaving assistance and medical care to displaced people.

The security situation remains volatile in Cabo Delgado and life has yet to return to normal. As of December 2023, over 540,000 people remained displaced while 600,000 returned to their villages. On several occasions, those returning to their areas of origin still live in fear due to their trauma and the risk of becoming displaced once again by new attacks.

MSF has been working in Cabo Delgado since 2019. At present, we work in the districts of Macomia, Mocimboa da Praia, Mueda, Muidumbe, Nangade, and Palma, providing independent, impartial, and neutral humanitarian and medical assistance to displaced communities and those returning home. In 2023, MSF reached over 85,000 people with mental health group activities and provided 5,000 individual mental health sessions in Cabo Delgado. 

*Names have been changed to protect privacy