MOZAMBIQUE — The aftermath of Tropical Cyclone Freddy has put millions of children in Malawi and Mozambique at risk of a potential increase in cholera cases.

The vulnerability of children is of particular concern, with UNICEF Regional Director for Eastern and Southern Africa, Mohamed M. Malick Fall, emphasizing their susceptibility to crisis and chaos.

The damage caused by the cyclone has resulted in death, destruction of infrastructure, displacement, and hampered access to basic services, further exacerbating the cholera outbreaks in Malawi and Mozambique.

The cyclone has exacerbated the vulnerability of children and families in both countries, which were already struggling with inadequate water, hygiene, health, and sanitation systems.

The flooding and damage caused by the cyclone have led to death, devastation of infrastructure and social services, displacement, and hampered access to health and other basic services.

Malawi and Mozambique were among the countries most affected by the cholera outbreak, which resulted in more than 68,000 cases across 11 countries in the eastern and southern Africa region.

Mozambique has been facing a cholera outbreak since September 2022, with confirmed cases in 35 districts across seven provinces.

Nearly 10,000 cases have been reported as of 18 March 2023, more than tripling case reports since early February.

Mozambique is responding to multiple competing humanitarian crises, with 2 million people in need of aid in the country’s northern region, and nationwide polio vaccination efforts ongoing.

Freddy made landfall twice in Mozambique, first in late February and then on 12 March.

In southern Malawi, the cyclone caused devastating damage to roads, infrastructure, homes, businesses, and health centers, including cholera treatment units and schools in affected areas.

Cholera has already claimed more than 1,660 lives in Malawi. This crisis is compounded by the ongoing annual lean season, during which millions of Malawians are expected to be food insecure.

As the planet warms, Malawi is likely to experience worse climate-induced hazards, such as stronger storms and droughts.

UNICEF estimates that 4.8 million children are in humanitarian need, and by the end of March, almost a quarter of a million children under five years of age are expected to be acutely malnourished, with over 62,000 expected to be severely malnourished.

A severely malnourished child is 11 times more likely to die from cholera than a well-nourished child, so a bout of cholera may be a death sentence for thousands of children in Malawi.

Cholera has been a persistent problem in Malawi since the late 1990s, typically occurring between November and May.

However, the current outbreak has lasted longer than usual and has spread to all 28 districts in the country.

The World Health Organization has reported cholera outbreaks in 22 countries, including Syria and Haiti, but only 37 million doses of vaccine are expected to be available this year.

In October, the WHO had to ration vaccine doses due to limited availability. To address the situation, UNICEF and the WHO have launched a vaccination campaign in earthquake-affected areas in northwest Syria, intending to deliver 1.7 million doses to individuals aged one year and older.

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