MSF response in wake of devastating Cyclone Idai



A weather system that produced heavy rains flooded parts of Malawi in early March 2019, before developing into Cyclone Idai which struck Mozambique and Zimbabwe on 14-16 March 2019.

Flooding in Malawi has displaced 87,000 people in camps, with the district of Makhanga one of the worst affected areas, which remains an island, cut off from all road access.

In Mozambique, Cyclone Idai wreaked 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.

In Zimbabwe, the impact from the cyclone on the eastern highlands has been massive with nearly 22,000 people displaced and several bridges and roads have been washed away. Some communities are reachable only on foot.

We have emergency response teams on the ground in all three countries. In recent days, assessments have been carried out and we are now undertaking medical activities and responding to humanitarian needs, including providing non-medical items such as buckets and soap, and ensuring safe water and sanitation.

Teams in all the affected countries are mobilising to provide medical and non-medical assistance. In our warehouses in Brussels and Dubai, enormous supply and logistics operations are underway, with tons of supplies being sent to the affected areas, particularly Mozambique.


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


High winds and high waters have so far killed 468 people, injured a further 1,522 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.

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.

With the government declaring a cholera outbreak in Beira on 27 March, and our teams seeing cases of acute watery diarrhoea elsewhere, we are working to treat people who are already ill, while setting up clean water supplies and informing the community about how to protect themselves in order to stop more people from becoming sick.

While treating people with the immediate needs in the wake of the cyclone, including injuries, infections and cases of diarrhoea and cholera, normal functioning of the health system must also be supported with mothers still needing to deliver babies safely, and people still needing vital medication for illnesses such as HIV.

 Beira and surrounds 

Ninety per cent of the area around Beira has been 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.

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 cyclone substantially damaged the city’s water supply system, resulting in many people having to drink from contaminated wells or stagnant water.

The Government declared an outbreak of cholera in the city on 27 March.

 Buzi, Dondo and Mafambisse 

The areas surrounding Beira, including Buzi to the southwest, and Dondo and Mafambisse to the northwest, sustained damage from the cyclone, including to local health infrastructures. 


We currently have more than 300 staff on the ground in the flood-affected areas. We are hiring more local staff daily and have more international staff en route as we scale up our response.

Charter flights with more than 100 tons of international air freight supply have arrived in Beira from Belgium and Dubai, with more to come in the coming weeks.


MSF was working in Beira before the cyclone to provide antiretroviral medicines (ARVs) for people living with HIV and to provide treatment for patients with advanced HIV. Following the cyclone, these activities have been disrupted. In Beira, around one in 10 people are HIV positive.

MSF teams are undertaking medical and non-medical activities in Beira and in areas on the outskirts of the city:

  • Our teams are supporting three MoH health centres (Munhava, Chingassuru and Ponta Gea) for general healthcare and to treat cases of cholera or suspected cholera.
  • MSF is now running the 60-bed Macurungo Cholera Treatment Centre in Beira which is acting as a referral centre for complicated cases such as pregnant women and people with co-infections.
  • Across the Munhava and Chingassura treatment units and Macurungo treatment centre, we have so far treated several hundred patients suffering from cholera or suspected cholera.
  • We are providing medical consultations via mobile clinics in several neighbourhoods of the city, including going door-to-door, providing primary health care and identifying cases of diarrhoea or cholera.
  • Our teams are also providing care via mobile clinics in transit centres and shelters, where people who have lost homes are sheltering.
  • Consultations have included treating small wounds, stomach issues (particularly intestinal worms), and respiratory tract infections.
  • Teams are also carrying out non-medical activities, including helping to repair and rehabilitate the Munhava, Chingassuru and Ponta Gea health centres after the damage they sustained during the cyclone.


  • A team of five is present 24/7.
  • We started rehabilitating the local health centre on 28 March and were also able to assist with the referral of a critically ill young boy to Beira.
  • A health promotion team is working in the community to help them protect themselves for a possible outbreak of water-borne diseases.
  • We are constructing a small cholera treatment centre in case of need.
  • A psychologist is also on the ground helping the community come to terms with what has happened.  

 Dondo and Mafambisse 

  • Teams are repairing and rehabilitating the local health centres.


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 or blocked by rock falls, and the only way to reach some communities is now by foot.
  • Many have been left without homes or livelihoods. 
  • Access to safe drinking water is an issue with many pipes washed away.


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.

  • An MSF team is supporting the ministry of health staff in Chimanimani with patient management, and helping to maintain supplies of essential medications.
  • 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.
  • Our teams are also distributing basic supplies, and aqua tablets to purify water for drinking.
  • 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. The Makhanga district is the worst-affected area in Malawi, remaining cut off from road access.


  • 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 underwater 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 the coming weeks.
  • There’s been huge destruction of agricultural crops and animals; an estimated 50 per cent of the area’s crops might have been lost.
  • Electricity has returned to hard-hit Makhanga district, on the eastern bank of the Shire river, which essentially remains an island, cut off from all road access.


We have a team of 18 people currently working with local authorities, communities and the health ministry to cover the needs of people with health, sanitation and non-food-item supplies.

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.
  • Working with the Malawian District Health Office, the our medical team has done an outreach clinic to ensure access to primary health care services and to drugs for patients with chronic diseases, including HIV and tuberculosis, who lost their medications in the floods.
  • We have so far reached more than 2,000 households with hygiene kits, which includes buckets, cups, and soap.
  • 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 are constructing a basic, four-bed cholera treatment unit and conduct training, to be prepared just in case the need arises.




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