The tragedy of Cyclone Idai is just beginning to unfold. Whilst the storm itself has been devastating parts of South East Africa in the past week, leaving hundreds confirmed dead (possibly thousands in Mozambique) and affecting more than 2.5 million by current estimates, the real danger looms in shadows of the floodwaters and refuse covering the region.
Whilst the number of immediate and direct cyclone fatalities will likely be relatively low compared with the 2004 Boxing Day Tsunami, the risks of morbidity and mortality to the affected population stemming from a “second wave” of illness and death is extremely concerning and will inevitably mirror the experiences faced in the aftermath of the Tsunami. As the flood waters recede, the malaria-transmitting Anopheles mosquitoes will begin laying their eggs in the remaining open surface water; their numbers increasing exponentially. With the length of their breeding cycle and the time before adult mosquitoes become infective, we have about three weeks before we begin to see a significant rise in malaria case-loads. Simultaneously, the Aedes mosquitoes responsible for transmitting dengue fever (along with chikungunya and yellow-fever among others) will breed rapidly in waste water containers, or pooled water collecting in refuse, debris, and containers commonly associated with the living conditions survivors of Cyclone Idai will face. We could see a simultaneous dengue fever outbreak within as little as two to three weeks.
It is going to take a concerted and immediate, coordinated response from various stakeholders to get the affected populations through this mounting disaster as best as possible. Time and resources are of the essence. Local health systems, distribution networks, stocks and service providers will be severely hampered if not completely broken. Responders likely face a significant shortage of RDTs (Rapid Diagnostic Tests) and treatment drugs for malaria, at least in the early stages. It is clear that there is going to be a very urgent need for supply of prevention tools; especially LLINs (Long Lasting Insecticidal Nets), and probably some IRS (Indoor Residual Spraying) for the temporary shelter camps which will be required for the hardest hit areas where up to 90% of housing has been severely damaged. To make matters worse, any stocks of these tools previously in the flooded areas risk being damaged by the storm, meaning over 500,000 people in Mozambique alone are immediately extremely vulnerable to disease. For dengue fever, no specific drug treatment exists and all care is supportive, thus our priorities should focus on prevention at the breeding sites (larviciding water containers/surface water pools, water container management, and waste removal).
Finally, in the wake of Cyclone Idai, damage to facilities will mean latrines across the impacted areas will have overflowed, contaminating surface water and leaving faeces everywhere. This means the rate of diarrheal disease will rise sharply. A combination of water-bourne, faecal-oral route, and fly-bourne mechancial transmission could potentially manifest these diseases at epidemic levels. Integrating the response to a focus on the above, whilst letting others get basic primary health service support back up and running will have a huge impact on mitigating the impact of the post-flood phase on communicable disease outbreaks and deaths.
The expected reality of these looming dangers is of little question at this point. We have learned these lessons consistently through decades of vector-bourne disease control in emergency settings. MENTOR is uniquely placed to have a skilled team and the needed supplies on the ground within days. We are already working with partner organisations to source some of the emergency funding required to get the response started, while institutional donors prepare to provide more support. The immediate needs of search & rescue, shelter, and food are obviously the first concern, but the health needs will start to take precedent in only a matter of days, weeks at most, a stage which will be drawn out for months.
MENTOR is committed to responding to this mounting emergency in the wake of Cyclone Idai, wherever and however we possibly can.
If you would like to help or contribute in any capacity towards these efforts, please contact me directly at [email protected]