CO-506575 Mozambique is currently experiencing an outbreak of cholera and yet another cycle of floods resulting from heavy rains and discharges from dams upstream (South Africa and Eswatini). According to the latest data from the Ministry of Health (referred to February 22, 2023), around 5,537 cases of cholera and 37 deaths due to the disease were recorded, mostly in Niassa Province. The first cholera patients were recorded in September 2022 in Niassa Province, Lago district, which borders Malawi, a country that has registered morethan 46 500 cases of the disease in recent months. Mozambican health authorities suspect that the cases were imported from Malawi. The Mozambican government has not yet declared a state of alert. Six (6) provinces namely: Niassa, Tete, Zambézia, Sofala, Manica and Gaza are registering an increase in cholera cases. The affected areas include Lago, Lichinga, Chimbunila, Mandimba, Muembe, Sanga,Mecanhelas and N'gauma, districts of Niassa Province; Milange in Zambézia Province; Búzi, Chibabava, Caia, Marromeu, Cheringoma, Maringue and Gorongosa in Sofala Province; Tambara in Manica Province; and Xai-Xai in Gaza Province, southern of Mozambique. The main factors associated with the cholera outbreak in the affected communities are the lack of food hygiene, lack of safe water and low coverage and use of latrines (open defecation), a situation that could worsen with the record of heavy rainfall and discharges by the dams upstream, which have caused and are causing floods in southern and central of Mozambique.

The rainy season represents even more of a threat of spread of the disease throughout the country, particularly in areas already considered endemic due to poor sanitation in the environment. In the last few weeks the number of cholera cases has increased significantly in Sofala, Tete and Niassa provinces and there is much fear of a rapid spread of cases in these three provinces, including Zambezia Province due to their vulnerability and propensity..

The general socio-economic situation of the at-risk communities and communities with the ongoing outbreak is worrying. WASH conditions are already poor with very limited access to safe drinking water, latrines, and poor living conditions. InMozambique, 14.8 million people out of 31.26 million do not have access to clean water. Meanwhile, only one in five individuals usesafe sanitation facilities. At 36 per cent, Mozambique has one of the highest open defecation rates in sub-Saharan Africa. About 76per cent of the population do not have or do not use improved sanitation facilities with 88 per cent in rural areas, and 53 per cent in urban and peri-urban areas.

A report in 2020 indicated that 60% of the Mozambique population was using either surface or groundwater as their normal drinking water, yet both of these sources of water are unreliable and appear to be diminishing within the country. Severe storms and flooding can damage drinking wells and lead to well contamination from livestock waste, human sewage, chemicals, and other impurities. Nearly 90% of all diarrheal disease can be attributed to WaSH while diarrhea is one of the largest causesof morbidity and mortality in children under five years of age. Mozambique has one of the highest rates of under-5 mortality in theworld, along with a high burden of diseases related to contaminated water and poor sanitation, such as diarrhea and cholera. Weak governance and infrastructure gaps exacerbate inequalities between both urban and rural populations and rich and poor populations, which strains service delivery institutions.

The humanitarian situation in Mozambique remains challenging. Shocks linked to protracted conflict - and recurrent natural hazards, including cyclones, droughts and disease outbreaks have been compounded by increased food prices and socioeconomic vulnerabilities. An estimated 46.3 percent of children experience multidimensional poverty. Women and girls face great exposure to the risks linked to poverty, exploitation and harmful practices.
The conflict in CaboDelgado Province has left 946,000 people internally displaced, 80 per cent of them women and children. Basic services, including health and education, require flexibility amid the continuous population movements; and access to safe water and sanitation remains inadequate.

Despite significant progress over the years, only half of Mozambicans have access to improved water supply and less than a quarter (one in five) use improved sanitation facilities. Overall, glaring inequities persist in water and sanitation services between people who live in rural and those who live in urban areas.