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Humanitarian workers in northern Mozambique are confronting a growing mental‑health crisis as conflict, cyclones and disease continue to strain an already fragile health system.

MSF teams travel dangerous roads to reach displaced families

In the town of Chiúre, a man known as Enric gathers doctors, nurses and counsellors from Médecins Sans Frontières before they set out in a convoy of Land Cruisers. The vehicles, fitted with radio antennas, wind their way past potholes and missing road sections toward the province of Nampula, where temporary clinics have been erected near the town of Alúa in Eráti district.

Last October, attacks by Islamist militants forced more than 39,000 people to flee villages such as Chipene and Necoro. The International Organisation for Migration reported at least 30,000 additional refugees in November. Many of those displaced are children; nine of the twelve people in one family’s group were under age.

One survivor, Isabel Carlos Pereira, described a two‑week trek after militants struck her community. Her youngest granddaughter died of measles on the trail, and another child in her village succumbed to epilepsy. Pereira said patients pay a metical – about 26 cents – to enter a health centre, with additional fees for medication, a sum that is negligible for most but highlights the chronic scarcity of supplies.

Health facilities struggle to stay open

Government data from 2023 shows the health workforce meets only 44 % of the population’s needs. In Nampula, where 70 % of children live in monetary poverty, less than half of births occur in a medical facility, contributing to an under‑5 mortality rate of roughly 72 per 1,000 live births.

MSF deputy coordinator Benjamin Janeiro Mwangombe explained that many clinics are damaged or destroyed by recent storms. After Cyclone Chido in December 2024, only four of eight health centres in Mocímboa da Praia remained functional; in Macomia, one of seven stayed open, and Palma’s main centre was looted in 2021.

Repairing roofs, restoring water and sanitation are prerequisites before any health services can resume. Yet even when facilities reopen, they often lack staff, medicines and basic equipment. The shortage of health workers is exacerbated by unpaid salaries, strikes and the displacement of professionals.

In the wake of these disruptions, disease outbreaks follow. Cholera, malaria and other illnesses spread after storms, while the psychological impact of conflict adds another layer of demand that the system is ill‑equipped to meet.

Psychologists like Paulina Antitur Seguich warn that untreated mental‑health conditions can become chronic, describing it as the “chronification of symptomatology.” The country has only 0.1 psychiatrists per 100,000 people, according to the World Health Organization’s 2024 mental‑health profile; essentially all of them practice in the capital, Maputo, leaving Cabo Delgado with a single psychiatrist.

While the scarcity of specialists is evident, community‑level efforts are beginning to fill gaps. Mental‑health technicians, trained over 30 months in three provinces, now operate in every district, offering basic diagnoses and prescribing medication.

These developments are modest, but they illustrate a shift from a system that once relied entirely on foreign‑trained psychiatrists to one that is building local capacity.

In Alúa, the psychologist Vânia Paulino Luciano runs group sessions that blend traditional activities with therapeutic tools. She uses colour‑coding from the book “The Colour Monster” to help children label emotions, and incorporates games such as Ntxuva to engage men who might otherwise avoid counseling.

Understanding the cultural context is essential. In Alúa, most internally displaced people are Muslim, sharing language and customs with the host community, which eases access to shelter and food. In contrast, displaced Mwani people in Makonde‑dominated Mueda face discrimination, sometimes being denied housing because of ethnic tensions.

Such local realities mean a single approach to mental‑health care would miss critical needs.