"Once again it hits the poorest"
Barbara Kruspan has lived in the province of Cabo Delgado for almost 30 years and has been working for SolidarMed for almost four years. Mozambique has become her home. She used to live in Mocímboa da Praia - where Islamist-motivated terrorists are now carrying out their attacks. She knows the situation very well.
How long have you lived in Mozambique and how well do you know the Cabo Delgado region?
In March 2021, I will be living in Mozambique for 30 years, precisely in the province of Cabo Delgado. First, I lived in the very north in Mocímboa da Praia - exactly where all the attacks are now taking place and where most of the refugees come from. For this reason, this situation still affects me personally, because I know people who have fled and whom I can no longer reach. Back then, between 1991 and 1994, it was so pleasant to live there. The region was already very poor at that time, but the gap between rich and poor in Cabo Delgado has become much bigger.
To see and feel that not much has been done for the very poor over the last 30 years anyway, makes me feel uncomfortable. But Cabo Delgado is my home and I still have the desire and strong will to make my contribution here. But of course I have also seen many things where we have made an impact and that motivates me again. I know Cabo Delgado very well. But since the province is twice as big as Switzerland, I don't know every single corner as well.
What are you particularly concerned about in the current situation?
It's especially hard to see that once again it hits the poorest. It is those who suffer the most, who have no means to build a new existence or flee far away. They have been plagued by so many crises over and over again; civil war, drought, floods, and hit very badly by Cyclone Kenneth in 2019. And then, in addition, there is this crisis. People just can't get out of this cycle. I'm also concerned that after each crisis there has never been something like a reconciliation.
Many people are mentally unwell. But then this pressure to survive kicks in and people run after existential things in order to survive. It's a survival mode and the soul can never recover at all. That's already an aspect that hurts me to witness. I also have a hard time accepting that this is addressed so little. Of course the basic needs are very central when one is so poor. But if the soul suffers, probably also the will to live is no longer as great. Many people have lost their already small possessions by fleeing. This overall situation makes me very concerned.
What are the internally displaced people facing?
First of all, it is important to mention: The hardship in the villages of this area is already great without refugees. The local people also live in great poverty. It is now clear that most of the refugees are staying with local families (relatives or acquaintances). Thus, the pressure on the local population is also growing. What happens in the countless houses and backyards, for example in the provincial capital Pemba, in Montepuez, Ancuabe, Chiúre, Metoro, etc., is less visible from the outside than the situation of the people in the resettlement villages. The people there are housed in very small huts - these are even smaller than is already common here. One can hardly stand upright in them. The building material is bamboo, wood and clay, the roofs are made of grass. The sanitary facilities are also very poor. The people hardly have anything to eat and clean drinking water is very rare. These conditions are conducive to diseases such as cholera - the first cases of cholera have already appeared in Ancuabe. All this is very worrying.
Chronic malnutrition is already very bad, but it is now exacerbated by the threat of famine. It is well known that inadequate nutrition has negative consequences for children's health and great effects on brain development. The children are then more likely to have difficulties in school, which in turn has consequences for the country's economy later on.
What does this crisis mean specifically for health facilities?
The great staff shortage is a huge problem. This was already a problem and now more and more people are arriving. Another difficulty is that many resettlement villages are far from health centers. People who don't have transportation or are seriously ill don't receive treatment. The resources are simply very limited.
Currently, we are switching to integrated mobile clinics ("Brigadas Móveis Integradas"). It's very important to be able to offer people comprehensive services, so as many services as possible are integrated into these mobile clinics. We are trying to strengthen this offer. The clinics are actually mobile: that means the health authorities, together with partners such as SolidarMed, organize trips to the remote villages. The clinic is equipped with the necessary material for these visits and the staff travels with them. During a trip, the staff is then able to examine pregnant women, give vaccinations and HIV and tuberculosis tests, for example, while also providing dental care.
The government is now also making an attempt to deploy the refugee health personnel from the north here in the region. We as SolidarMed think this is good and support them. However, the additional health workers should also be provided with a functioning infrastructure and they should be able to live decently. We support them in this, so that they can work in the health centers and live in houses that are in a good condition.
How does SolidarMed support the people?
We support the local health authorities in their plan to send mobile health teams to the particularly remote resettlement villages. On the one hand, we provide our own experts and, on the other hand, we cover additional costs for transport or personnel. We also raise people's awareness about hygiene issues in order to limit the outbreak of cholera and the spread of covid-19. We also support the authorities in distributing mosquito nets to protect children who are particularly at risk from malaria. Of course, we also continue to strengthen the health facilities, which are now in even greater demand, for example with staff training.