Cyclone Freddy’s Devastating Impact on Maternal Healthcare in Southern Africa
Image credit: Nigeria Health Watch
Charles Pensulo and Jubiel Zulu (Lead Writers)
Christina Mthiya, 30, was eight months pregnant when Cyclone Freddy struck Malawi in February 2023. She was among the hundreds of people in Nkhulambe, located in southern Malawi, who were seriously impacted by the resulting floods.
Nkhulambe Health Centre, where Christina had been receiving antenatal care and was due to give birth, was washed away, as were many people’s homes and properties. The Mulanje mountain, one of the highest points in the country, became a site of unimaginable hardship during this devastating event.
Image credit: Nigeria Health Watch.
Cyclone Freddy, a tropical cyclone that hit Malawi and other parts of southern Africa in March 2023, lasted for 36 days, making it the longest tropical cyclone on record worldwide. In Malawi, the cyclone triggered floods and mudslides across 15 of the country’s 28 districts in the southern part of the country. Millions of people were displaced, and hundreds lost their lives.
“When the clinic was washed away, I could no longer access antenatal services,” Christina said, while holding her child. “When my baby was due, I was carried on a motorcycle to the district hospital, but it was so uncomfortable and dangerous because the roads had been damaged by the floods.”
A study published in the MDPI identified natural disasters as the biggest threat to pregnant women and infants. These events can lead to premature rupture of protective membranes, pre-term labour, low birth weight, and increased susceptibility to infectious diseases. In Malawi, over 500,000 people were displaced by Cyclone Freddy, with over 500 deaths recorded and hundreds more reported missing.
The intersection of environment and healthcare
According to Mathews Malata, an environmental activist based in Malawi, “the relationship between the environment, disasters, and healthcare provision is deeply intertwined. Events, such as Cyclone Freddy have indeed laid bare the severe impacts of disasters on health systems. When health centres are cut off due to floods or damaged infrastructure, the immediate and long-term consequences can be devastating.”
David Likiwa, chairperson of the health management committee, said it took four days after the floods had stopped to assess the situation. By that time, hospital patients, including those in the maternity wards, had been hastily transferred to classrooms in a nearby primary school.
“Some patients were put in a class, and they were dying because there was no help,” David, who saw four patients die, said. “I believe they would have survived if the clinic was functioning.”
Lysan Mcloud, a clinical officer at Nkhulambe Health Centre, explained that they were unable to offer outpatient services during the disaster. Health workers, including himself, were personally affected, losing both belongings and homes. “Some health workers were also injured. Patients could not get [proper medical attention], and even [when] referred to other hospitals, they could not get there because there was no bridge. Children were more [affected],” he said.
Disproportionate impact on pregnant women
Veronica Makondetsa, the Safe Motherhood Coordinator for the district, explained that the destruction of health clinics posed a serious threat to pregnant women, especially those nearing their due date. The closure of these facilities resulted in the disruption of critical maternal health services, jeopardising the safety and well-being of expectant mothers.
“They had to walk long distances, and with [inaccessible] roads and rivers, it was really difficult for us,” Makondetsa said. To highlight the impact of the cyclone on maternal health services, she pointed to the rise in maternal deaths before and after the disaster. Between 2022 and 2023, the district reported 13 maternal deaths. By 2024, the number had increased to 16.
The number of deliveries conducted by skilled birth attendants had also dropped. Before the cyclone hit, from 2022 to early 2023, skilled birth attendants were responsible for 97% of births. By the end of 2023, the figure had dropped to 90%. Coverage of antenatal services, which stood at 37%, had dropped to 34%. Nkhulambe Health Centre is among the 300 health facilities across three countries that were destroyed during the disaster.
Temporary structures that were set up in place of destroyed clinics were receiving nearly 700 patients a day. It has been two years since Cyclone Freddy devastated these communities. However, the clinic still operates from the temporary site. “Other activities we used to do, like Non-Communicable Diseases clinics, were stopped,” Mcloud noted, adding, “previously, we used to have thorough [discussion] and make assessments individually.”
Image credit: Nigeria Health Watch
Common problem with a ray of hope in Zambia
Malawi was not the only country affected by this disaster. In neighbouring Zambia, the cyclone’s impact was among the worst in decades. In spite of this, the Zambian government made efforts to improve health services, including maternal care by constructing additional facilities. This has made it easier for women like Anseli Phiri from Chipangali Constituency in Eastern Province.
The 24-year-old expectant mother of one said the newly built facilities at Mshawa are spacious and will accommodate more mothers. “[It will] allow more women like me to have access to maternity services, be comfortable, and be respected as compared to the old maternity wing that had one room with only two beds.”
Anseli, a resident of Chawalila farm, explained that many pregnant women who walk or travel long distance to reach the new annex will receive the effective medical help they need.
Image credit: Nigeria Health Watch
Mitigating the impact
Dickson Khauleya, Senior Chief at Nkhulambe, explained that environmental degradation, including cutting down of trees in the mountains for charcoal, has contributed to the harsh impact of the cyclone-induced floods.
To address this, the area has implemented laws to prevent people from destroying the mountain, and various charities are encouraging people to plant trees. Organisations like the International Federation of the Red Cross (IFRC) and Christian Aid are educating communities on how to build sustainable homes that can withstand disasters and how to respond during such events.
“We are [also setting up] dikes to make sure the rivers stay on their courses,” Khauleya added.
