Connecting people to lifesaving support: FHI 360's humanitarian response in northern Mozambique

A young woman wearing a white top, red and yellow patterned skirt and a pink head wrap leans against a wall and smiles for the camera. — Lina Amade poses for the camera.

Lina Amade*, 15, no longer lives in her home in Mozambique’s Cabo Delgado province. The northern part of the province has been ravaged by conflict since 2017. Now, Lina lives in the Metuge District, still in Cabo Delgado but away from the worst of the violence.

Six years of conflict have displaced more than 1 million people from their homes in Cabo Delgado. In 2020 alone, increasing attacks by armed groups forced more than half a million people to flee.

When people flee their homes, there’s no time to waste. Once the violence intensified, FHI 360 moved swiftly to begin the Integrated Response to Affected Mozambique Populations (IRAMP) project, funded by the U.S. Agency for International Development’s Bureau of Humanitarian Assistance. Between July 2021 and May 2023, the IRAMP project provided comprehensive support to both displaced people like Lina and the residents of host communities in the Metuge and Ancuabe districts.

“We provided services for health, protection, nutrition, and water and sanitation. We phased them in three stages, focusing first on the most life-threatening needs,” said Henry Omara, FHI 360’s crisis response coordinator for IRAMP. “Those who are displaced have lost their homes and livelihoods. Additionally, we helped neighboring host communities increase their resources to welcome those who are displaced.”

Top *left: Henry Omara, FHI 360’s crisis response coordinator for the IRAMP project. Top right: The IRAMP project provided clean drinking water for patients at the Nacuta Health Center.* Bottom: An aerial view of the Metuge District in Mozambique’s Cabo Delgado province. The Metuge and Ancuabe districts are host communities for displaced people from the north of the province. Lower

Creating safe spaces for displaced children and women

Lina is one of many displaced children and adolescents in Cabo Delgado. Young people and women are especially vulnerable to harm and abuse, so FHI 360 opened a safe healing and learning space in the Metuge District. The space offered play spaces, recreational activities and education in a protected environment.

A group of children sit in rows on the ground and draw on paper using crayons. — Children and adolescents who were displaced by violence learned reading, writing and Portuguese at a safe healing and learning space run by FHI 360. It also offered psychosocial support, play spaces and recreational activities.

Two men wearing blue t-shirts stand a whiteboard in the front of a small room, instructing a large group of children seated on the ground. — Children and adolescents who were displaced by violence learned reading, writing and Portuguese at a safe healing and learning space run by FHI 360. It also offered psychosocial support, play spaces and recreational activities.

Lina and the other children and adolescents who were displaced and not in school also needed psychosocial support. So the center used a social emotional learning approach to teach resilience, in addition to reading, writing and Portuguese.

The center has helped parents as well as children. Some of the children in the safe space were separated from their parents as they fled the violence and ended up in different camps. FHI 360 staff helped identify the children, gave them necessities and accompanied them in finding their parents. In certain cases, FHI 360 staff worked with government social services to coordinate follow-up home visits.

During Lina’s time at the center, she said, she spent much of her time playing football (American soccer) and studying. She strongly believes in the impact of having a safe space. “I like this place,” she said.

Three young women wearing straw hats stand side by side facing away from the camera. One girl is preparing to hit a volleyball back to the team on the other side of the net. — The FHI 360-run safe healing and learning space was a haven for displaced children, adolescents and women, who are particularly vulnerable to harm and abuse. From left: Adolescent girls enjoying a game of volleyball; the exterior of the space; Sara Ibrahimo*, 10, posing for the camera.

An aerial view of two side-by- buildings with green metal roofs and bamboo siding. — The FHI 360-run safe healing and learning space was a haven for displaced children, adolescents and women, who are particularly vulnerable to harm and abuse. From left: Adolescent girls enjoying a game of volleyball; the exterior of the space; Sara Ibrahimo*, 10, posing for the camera.

Taking care of people’s health during an emergency

Fatima Wabibe is a mother of four who lives in Nacuta, a village in the Metuge District. She came to the Nacuta Health Center for a consultation, saying she had “pain in the heart.”

A woman in a yellow top and a blue head wrap cradles her baby in her arms and smiles for the camera. — Fatima Wabibe, a resident of the nearby host community, visited the Nacuta Health Center to seek treatment for herself after her fourth child, pictured here, was born. At right: Head nurse Estrela Fausto cares for Wabibe and her baby.

The woman sits in the chair holding her baby in her lap and talks to a healthcare worker seated across from her. — Fatima Wabibe, a resident of the nearby host community, visited the Nacuta Health Center to seek treatment for herself after her fourth child, pictured here, was born. At right: Head nurse Estrela Fausto cares for Wabibe and her baby.

The arrival of so many displaced people from northern Cabo Delgado stretched the already weak and strained health centers in the Metuge and Ancuabe districts. Through the IRAMP project, FHI 360 supported two permanent health facilities, including the Nacuta Health Center where Wabibe sought care, as well as three temporary health facilities and several mobile medical units.

The additional support and health care staff provided both temporary and long-term residents with better access to primary health care services as well as referrals for complicated cases. In total, the health sector activities reached more than 120,000 people.

Wabibe was treated for her chest pain and released. “Everything has changed,” she said of the IRAMP project’s impact. “With the new staff, when we come, we are well assisted.”

A mother and a medical provider measure a baby's length by laying him down on a board. — The IRAMP project’s health sector activities reached more than 120,000 people. The Nacuta Health Center, seen here, served an average of 200 people per day; on some days, more than 300 were seen. The patients were both displaced people and people from nearby villages. At right: Head nurse Estrela Fausto cares for an infant.

A medical provider's hands measure the circumference of a baby's head while his mother holds him. — The IRAMP project’s health sector activities reached more than 120,000 people. The Nacuta Health Center, seen here, served an average of 200 people per day; on some days, more than 300 were seen. The patients were both displaced people and people from nearby villages. At right: Head nurse Estrela Fausto cares for an infant.

Revitalizing water supplies and hygiene services

Regina Martins waters crops in Nacuta. The water source installed by FHI 360 “has made a big difference in my life,” she said.

Regina Martins also lives in the host community of Nacuta. Every day, she said, she would walk for an hour and a half to retrieve water for herself and her four children. “Everything is water-based,” Martins said. “We use water for washing clothes, bathing, cooking.”

Because there were so few local water resources already, the influx of displaced people from the north resulted in fights at Martins’ water collection point. “When the water was far away, we suffered,” she said. “We fought with each other and insulted each other.”

FHI 360 installed a new water collection point near Martins’ home to reduce congestion and improve accessibility. Nacuta was one of 23 host communities, along with 23 resettlement sites, where FHI 360 rehabilitated, upgraded and/or installed water sources. The IRAMP project also distributed hygiene kits in all these communities and sites.

Now, in Martins’ community, there are fewer people retrieving water from the same collection points. “Some fetch [water] there, and we fetch water here,” she said. “Now, we no longer suffer. … It has made a big difference in my life.”

A blue bucket getting filled at a water station. — *The new water source that FHI 360 installed in the Mozambican host community of Nacuta allows villagers and temporary residents to now get clean water without having to walk for 90 minutes or more.*

A child stands beside a water spout and catches droplets in her cupped hands. — *The new water source that FHI 360 installed in the Mozambican host community of Nacuta allows villagers and temporary residents to now get clean water without having to walk for 90 minutes or more.*

Educating mothers on maternal, infant and child nutrition during an emergency

To address concerns of malnutrition among the large number of people who fled the violence in Cabo Delgado, FHI 360 established a health clinic that offered nutrition services at the Nanona Camp in the Ancuabe District, where many displaced people were staying in surrounding villages.

A woman wearing the USAID and FHI 360 t-shirt holds an ear of corn and a poster while instructing a large group of mothers with their babies. — The nutrition program at IRAMP’s health clinic in the Nanona Camp used mother-to-mother support groups to teach mothers about foods that support their babies’ development — especially those available locally. Foods particularly high in energy are on the right side of the table.

A close up of green bowls containing fish and dried beans. Two brown eggs sit on the table next to them. — The nutrition program at IRAMP’s health clinic in the Nanona Camp used mother-to-mother support groups to teach mothers about foods that support their babies’ development — especially those available locally. Foods particularly high in energy are on the right side of the table.

Yassimin Abdul Manuel, an FHI 360 nutrition assistant, helped mothers at the camp understand the essential aspects of child nutrition. She teamed up with mothers from neighboring communities and held support groups. Manuel helped participants to exclusively breastfeed their babies, provided nutrition education to pregnant and lactating women, and offered training on the preparation of nutritious meals with local ingredients. The program offered referrals for more complicated cases.

“I love my work; I love being a nutritionist,” Manuel said. “It is fulfilling to see that you’ve helped a family and can see the change on their faces.”

A man wearing a long white medical coat and a stethoscope around his neck stands in front a building with a "Hospital" sign on it. — *Dr. Domingo Ricardo Matlhombe (left) is the Metuge District’s chief medical officer. Yassimin Abdul Manuel (right) is an FHI 360 nutrition assistant at the Nanona Camp.*

Still, her work is hard. “Our biggest challenge is showing the mothers how to find the food,” she said. “One of the hardest things about my work is the insecurity of the district itself.”

The IRAMP project had a positive impact not only in terms of nutrition, but also on childhood vaccination rates, said Dr. Domingo Ricardo Matlhombe, chief medical officer in the Metuge District.

“We have had many patients diagnosed with acute malnutrition, and others with moderate to severe acute malnutrition,” he said. “These patients have been referred for subsequent treatment as well as the allied vaccination program … which results in a fully vaccinated child.”

Comprehensive support that met urgent needs

From 2021 to 2023, the IRAMP project helped address the humanitarian crisis in Mozambique’s Cabo Delgado province by providing services for protection, health, water and sanitation, and nutrition:

SAFE SPACE: More than 6,500 children benefited from the safe space in the Metuge District. In addition, more than 1,600 children used gender-based violence support services; in an end-of-project survey, 100% of the children reported an improvement in their sense of safety and well-being.
HEALTH FACILITIES: The health facilities in the Metuge and Ancuabe districts included two comprehensive prenatal clinics, which facilitated more than 2,000 births. In 99.8% of those, the newborns received postnatal care within three days of delivery.
WATER, SANITATION AND HYGIENE: The project distributed hygiene kits to 25,000 people in host communities and resettlement sites. In total, nearly 45,000 people benefited from water-related interventions.
NUTRITION: At the Nanona Camp, there were five mother-to-mother support groups, each of which had a mother as a lead teacher. Those groups taught nutrition to 60 other women.

A model for comprehensive support

With the IRAMP project, FHI 360 integrated health, protection, nutrition, and water and sanitation services and implemented them in a comprehensive approach. This could serve as a model for future humanitarian assistance — the need for which is increasing.

More conflicts, violence and disasters globally are causing historic and unprecedented numbers of people being displaced within their own countries. The number of displaced people worldwide hit an all-time high in 2022. Humanitarian and development organizations are increasingly being called upon to provide immediate assistance to these populations and put healthy lives back into reach.

“The critical work we do in crisis response is saving lives,” said Omara, the IRAMP project’s coordinator. “Of course, there is climate change, and disasters keep coming every year. We need to continue saving lives.”

*The names of young people have been changed.

View from inside a shelter with the bottom of the roof and the top of a fence partially obstructing the view. In the middle, a group of women and children walk away from the camera toward a road that runs through middle of a corn field.

Residents walk to and from the health clinic in the Nanona Camp.

Footnotes

All photos credited to Mbuto Machili for FHI 360

Connecting people to lifesaving support: FHI 360’s humanitarian response in northern Mozambique

Creating safe spaces for displaced children and women

Taking care of people’s health during an emergency

Revitalizing water supplies and hygiene services

Educating mothers on maternal, infant and child nutrition during an emergency

Comprehensive support that met urgent needs

A model for comprehensive support

Footnotes

Related articles