Nearly one million people (IOM – DTM North Mozambique Crisis – Round 16) are currently displaced in northern Mozambique after fleeing their homes in search of safety, due to the conflict that began in Cabo Delgado province in October 2017.
Many people have been displaced multiple times, needing to abandon their few possessions, livelihoods, loved ones and communities with each displacement.
Living through such prolonged conflict, with little or no prospect of a stable future, has profound consequences for mental health.
Five years later, some communities in Cabo Delgado still live 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.
“We are separated from our family and from the rest of our people,” says a community leader from Mocímboa da Praia, a district in northern Cabo Delgado.
He has had to start from scratch over and over again, and currently lives in a temporary settlement in the Palma district.
“We’re starting to hear now that there are some people in one place and some in another,” he says.
“Sometimes we hear about a sick family member, but we have no way to visit them.
Sometimes we hear that someone passed away, but we can’t reach them.
Every day that passes, we get sadder about it.” Tatiane Francisco, director of mental health activities at Médecins Sans Frontières (MSF), says that acute stress and anxiety due to uncertainty and lack of perspective, as well as loss and grief, are the main reasons why people look for mental health consultations in our projects.
“The stories that people bring us are of 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; people who witnessed the death of other family members, ”says she Tatiane.
“When you are constantly under this fear, it is difficult to think about the future, it is difficult to plan things.
You are still living in survival mode.
People have been living in a kind of limbo for years.”
Maria Maleve, an elderly woman from Ancuabe, arrived in the city of Montepuez in July after an outbreak of violence that uprooted more than 80,000 people (OCHA Situation Report – Flow of displacement in Cabo Delgado and Nampula, Mozambique, June 1 to July 21, 2022) for a few weeks.
“When the war broke out, we all ran in a different direction,” says Maria.
“I came here alone, with a child I found on the way.
His father was shot to death.
Her mother was kidnapped.
I would like the war to end so that we can return 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 both returning to their places of origin and people who are forced to flee and begin to move again,” says Tatiane.
“There may be no violence where there are some people, but for them there is no guarantee that this will not change in the future.” “In other words, psychologically, the message our bodies get when we still see violence elsewhere is ‘the attacks are still happening and we have no way of predicting where the next one will be,’” says Tatiane.
On top of that, extreme violence often leaves painful psychological scars for those who suffered it.
“Some people have the courage and desire to return to where they are from, but others, due to the type of events they have experienced, prefer not to risk going back until they are sure that things are fine,” says Josuel Moreira, a MSF psychologist in Palma.
“This shows us that both the experiences and 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 such as health care, water, food and shelter, continue to be a struggle for many.
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 carried out, and more than 64,000 people attended group activities.
Due to the volatile and constantly changing context, our teams have had to be flexible, agile and adaptable.
Humanitarian assistance is disproportionately distributed in Cabo Delgado, with more assistance being provided in the south of the province, which is considered more stable.
In some of the districts where we work, such as Macomia, Palma and Mocímboa da Praia, often no or very few organizations have a regular presence.
More needs to be done so that people in hard-to-reach areas have access to life support.
“Many people lost not only their possessions, their families, but also their sense of dignity, of living as people,” says Josuel.