"Makhanga area, which is very fertile, is home to around 18,000 people who rear cattle and grow crops like maize and rice. It is low and flat and surrounded by the Shire River and its largest tributary, the Ruo, so it basically looks like an island," said Steven. "This makes it very prone to flooding. If there are rains in nearby Mulanje district or upstream in the city of Blantyre, and the Ruo swells, then the area is at risk. If there are rains upcountry and the Mwanza River swells, it can cause the Shire River to spill and the entire area is at risk. Heavy rains starting in early March affected all the southern districts, so the entire area has been largely submerged for weeks."
Learning from previous floods
Steven's involvement in MSF's previous flood responses in Makhanga in 2008 and 2015 are now informing our current emergency efforts. "In 2015 we mapped the most risky, flood-prone areas in order to focus our response and identified people to work with closely in the community," he said, adding that these relationships have enabled MSF to respond quickly, when the heavy rains were just starting, to assess the situation and plan an immediate response with the community, who already had some experience of how to distribute relief items.
"In our previous flooding responses we shared information on how to find and prioritize people who needed medical care. In 2015, a lot of people died in this area, but this year fewer lives have been lost to the flooding, partly because people now know where to find higher ground," he said.
Makhanga health center was severely flooded, but Steven says lessons learned in previous floods helped to minimize the loss of supplies. "In 2015, a lot of drugs were soaked in floodwater, ruining them. Afterwards MSF raised the height of the shelves so that the drugs would be safe from the water, so this time the stocks were spared," he said.
Shortages of food and clean water
Though fewer lives have been lost in the 2019 floods compared to previous disasters, the damage caused to the community is immense. "It isn't just crops that have been lost, it's also food stored in homes in an area that was in need of food support even before it was flooded," said Steven. "The floods have contributed to great hunger [that was already a problem] in the area."
The flood waters have also submerged water boreholes and destroyed toilets, raising the risk of the outbreaks of waterborne diseases like diarrhea and cholera. The area's many flood-swollen swamps are also breeding grounds for mosquitos, putting people at risk of contracting malaria. "People here are vulnerable in terms of their health right now, with many sleeping outdoors or in their chicken coops, because their homes were destroyed," said Steven.
The borehole at Makhanga Health Center was contaminated by the floodwaters, but MSF staff have managed to clean it and ensure that the water is safe to use. Elsewhere, MSF's water and sanitation teams are distributing chlorine, cleaning water points, and constructing toilets and showers. "Our main concern is that we prevent an outbreak of diarrheal diseases and cholera," Steven said.
Challenges accessing medical care
The flooding in Makhanga has also pushed most of the district's health workers to higher ground in the north for safety reasons, leaving those who remain under severe pressure. "In the beginning there was just one Ministry of Health medical assistant and one hospital attendant," explains Steven. "To support them, two MSF staff [members] are providing basic health care, HIV services, and disease surveillance, with approximately 150 consultations per day. We're now seeing a lot of respiratory infections and malaria."
Working with the Malawian District Health Office, the MSF medical team runs an outreach clinic to ensure access to primary health care services and drugs for patients with chronic diseases, including HIV and tuberculosis, who lost their medications in the floods.
"MSF is providing health care and water and sanitation, and distributing essential relief items and hygiene kits, but our wish is to see more organizations responding in areas that we cannot manage, such as food [supply]," said Steven. "Looking ahead, the community of Makhanga is really going to need more support."
In the flood-affected regions of southern Malawi, the rains that started in early March have now largely stopped and access to the flooded areas is improving. To date, flooding has caused 59 deaths, 677 injuries, and the displacement of around 87,000 people, according to the United Nations Office for the Coordination of Humanitarian Affairs.
Makhanga is one of the worst-affected areas, cut off from all road access, though electricity has been restored. While many thousands of people are currently sheltering in schools, churches, and makeshift camps for displaced people, some are starting to return home to rebuild their houses.