Medic Xavier Corella Carrasco and his colleagues in Mozambique’s Cabo Delgado province must act fast when word of an attack by Islamist insurgents in the war-torn region reaches their health programme.
Stationed in Mueda, a town in the province’s northeast, the Médecins Sans Frontières (MSF) field team know that within a few hours of an assault on a rural village, the first of the families caught up in the violence start turning up at their facility looking for help.
To ensure they have time to prepare for what is to come, MSF has set up an early warning system that uses a network of community leaders to alert them to the violence once it breaks out.
“Those displaced by an attack usually arrive here with nothing. They have been forced to flee many times so have lost everything already,” he explains, before adding: “They need all the basics: water, shelter, food, clothes and medical attention.”
Carrasco says some of the displaced hide out in the region’s dense forests for days before making their way to Mueda, often arriving in the district capital in bad physical condition as a result.
“It’s cold at night in the forest and they have little cover, so they catch malaria or get affected by respiratory problems,” he explains over the phone.
However, the refugees – particularly the children – can also be very traumatised from witnessing the jihadists’ terror tactics, which include brutally killing and maiming villagers to instil fear and panic in the local population.
Carrasco says the victims of repeated attacks often end up consumed by feelings of despair and hopelessness, which can lead to significant behavioural problems in children.
“The refugees are left so on edge and fearful that small incidents or noises in the IDP [internally displaced people] camp can often trigger widespread panic,” he says.
Since MSF established its humanitarian operation in Mueda in 2021, the international medical charity has helped hundreds of thousands of people affected by insurgency, which started in Cabo Delgado in October 2017.
The militant group responsible for destabilising the province is known locally as Al-Shabaab (the youth), and one of its aims is to establish sharia law in the region. It has publicly aligned itself with the international terror group Islamic State (also known as Isis) in recent years.
However, its footsoldiers are made-up of disaffected, impoverished local youth who believe the government is far more interested in benefiting from the province’s mineral, gem and gas resources than their economic upliftment.
Initially Al-Shabaab launched sporadic attacks against police and villages, but in early 2020 these escalated dramatically. In March 2021 Al-Shabaab made global headlines when its fighters attacked Palma, a strategic town located near a multibillion euro liquefied natural gas project being developed by French energy company Total, killing dozens of people including foreign contractors.
According to the Armed Conflict Location and Event Data Project, a not-for-profit organisation that tracks political violence, 4,363 soldiers, militants and civilians have been killed during organised political violence in Cabo Delgado over the last five years.
The United Nations has said that just under one million people had been forced to flee their homes due to the conflict by September this year, with 84,000 of these displacements occurring after a wave of violence in June.
Following the Palma attack the Mozambican government consented to military interventions in the resource-rich province by a regional southern Africa force and Rwanda, in a bid to stabilise the province.
To date the army’s collaboration with the two international forces has led to battlefield successes against the insurgents that have helped to restore some order, especially to the strategically important Palma and Mocímboa da Praia district.
Carrasco and his MSF colleagues may also be seeing the knock-on effect of this military intervention, as recently the refugee numbers arriving at Mueda have decreased.
“We have not seen the massive waves of refugees in the past month that we have seen earlier in the year after recent attacks in the district,” he says.
A study released on November 1st by the Rural Observatory of Mozambique, a Maputo-based poverty research body, found that thousands of Cabo Delgado’s displaced people had begun to return since September.
For the most part, this was due to the increased stability the military interventions had achieved, it said, but also because of a loathing of the resettlement camps the refugees found themselves in after fleeing the violence.
The report, titled A Return to a New Future or a Return to the Past?, also warns that refugees who make the arduous journey back home face a future fraught with danger.
“Until the beginning of the next harvests [in April], periods of widespread famine amongst the population and the insurgents are expected, but also amongst the armed forces, with impacts on small crime, armed attacks, prostitution, and collaboration with violent groups.”