Enelesi Namanedi, a 42-year-old mother residing in Nkhulambe village, Phalombe district, located in the southern region of Malawi, tragically lost her youngest child, a four-year-old boy, to the powerful floods unleashed by Cyclone Freddy in March 2023. This event marked the most severe climate change disaster in the country’s recorded history.

Approximately 300 metres from Enelesi’s former residence stands Nkhulambe Public Hospital, the sole healthcare facility serving the village. Following the cyclone, the hospital now lies beneath rocks, debris and mud, leaving nearly 50,000 people in the area entirely isolated from local healthcare services.

As Enelesi gestures towards a damaged maternity shelter, her visible concern reflects the imminent threat to the lives of expectant mothers. This hospital holds particular significance for her, as it is where she gave birth to all her children.

»We are now forced to travel about 12 kilometres to the nearest hospital, since ours was damaged by the flood waters. The majority of pregnant women are now delivering on their way to the hospital. This is a life threatening situation,« she said.

Pregnant women worst hit by cyclone impacts

According to the United Nations Population Fund, UNFPA when Cyclone Freddy made landfall in Madagascar, Mozambique and Malawi, 32,000 pregnant women were due to give birth within the coming weeks. However, the cyclone caused havoc and destruction to homes, health facilities and transportation routes, significantly increasing the risks associated with childbirth.

The floods and mudslides in Phalombe district alone rendered about six hospitals non-operational, posing a significant threat to the overall sustainability of health systems.

In nearly all situations, the consequences of flooding are severe, encompassing infrastructure damage, loss of life and property destruction.

Total losses in the health and nutrition subsector across all 16 affected local authorities amount to almost $4 million according to the Post-Disaster Needs Assessment Report. Not only does this portray the extent of damage, it also shows how susceptible the health sector is to climate change impacts.

Sosten Chiwotha, the Regional Programme Director at Leadership for Environment and Development Southern and Eastern Africa (LEAD), outlined the health impacts of climate change on the general population. Chiwotha specifically highlights expectant mothers as the most vulnerable group due to their reliance on dependable transportation and medical care, both of which become disrupted during and after disasters such as floods.

»The damaged hospitals resulted in the disruption of reproductive health services. Expectant women who needed routine check-ups had to traverse longer distances on foot because the roads were damaged, and ambulances were unable to navigate through. It posed a significant challenge for them,« he emphasized.

In addition to reproductive health concerns, Chiwotha noted that climate shocks, such as the recent floods, also have a clear impact on mental health.

»For three months, they were having nightmares about seeing the floods coming, then they woke up and realized it was just a dream, the experience was very stressful,« he added.

Could COP28 be a game-changer?

On 3 December, the World Health Organization (WHO) and its partners conducted the inaugural Health Day at COP28.

Speaking at the conference, Malawian Minister of Health Khumbize Kandodo Chiponda addressed the profound impact of climate change on the nation’s health sector, resulting in an upsurge in disease outbreaks.

She emphasized that the cyclones wreaking havoc in the country have destroyed health facilities, underscoring the urgent need for funding to fortify the health systems, enabling them to effectively respond to emergencies.

»In the last four to five years, Malawi has been hit by cyclones almost every year and the prevalence and pattern of disease has changed. We had the worst outbreak of cholera, which lasted over a year. These are the issues that prompt us to sit back and reflect on what exactly is happening,« she said.

»The health system has been overstretched and overwhelmed. Some of the diseases we thought we were done with are coming back. The cyclones are affecting the population; people have lost their livelihoods due to flooding. We need to build our health systems so that they are capable of responding to all these emergencies; as it stands, we are failing to respond in a timely manner,« Chiponda added.

Cyclones rage over Malawi every year

George Jobe, a health activist, said the Loss and Damage Fund operationalized at COP28 should be made available to countries like Malawi to enable them to rebuild health infrastructures destroyed by the cyclones and adapt to the impacts of climate change. 

As the global community faces the urgent need to address challenges, advocates also highlight the crucial role of international collaboration in fostering resilience and sustainable health systems worldwide.