Voice from the floods

While access to the East Bank flood areas is improving, Makhanga in Nsanje District remains an island cut off by devastating floods that led to loss of lives, homes, livestock and crops. LABANA STEVEN was part of Medecins sans Frontieres (MSF) team responding to medical needs of floods survivors at Makhanga. He shares his experience.

I have been part of MSF’s emergency team working in Makhanga, Nsanje District, to support thousands of people affected by severe flooding. Makhanga was one of the worst affected areas by heavy rainfall early March.

MSF team slowed by a river in Makhanga

The extreme weather merged with Cyclone Idai, one of southern Africa’s worst tropical cyclones which struck Mozambique and Zimbabwe from March14 to 16.

Having worked with MSF Belgium for 20 years in Malawi, I was also part of the Doctors without Borders response to severe flooding in the same area in 2008 and 2015.

My past understanding and deep engagement with local partners and communities in southern Malawi has been vital to MSF’s ongoing response.

Makhanga is a fertile valley, home to around 18 000 people who rear cattle and grow maize and rice. It is low and flat and surrounded by the Shire River and its largest tributary, the Ruo, so it basically looks like an island.

This makes it prone to flooding. If there are rains in nearby Mulanje District or upstream in Blantyre City—and the Ruo swells—then the area is at risk.

If there are rains upcountry and the Mwanza River swells, it can cause the Shire to spill and the entire area is at risk. Heavy rains starting in early March affected all the southern districts, so the entire area has been largely submerged for weeks.

Learning from the past

The severe flooding that hit Makhanga in 2008 and 2015 provided critical lessons that shaped MSF’s current emergency response efforts. 

Three years ago, we mapped the most risky, flood-prone areas to focus our response. We also identified people to work with closely in the community.

These relationships enabled MSF to come in quickly, when the flooding started, to assess the situation and plan an immediate response with the community who already had some experience of how to chlorinate the water and distribute relief items.

In our previous responses to floods, we shared information on how to find and prioritise people who needed medical care.

In 2015, numerous people died in this area, but this year, fewer lives have been lost partly because people now know where to find higher ground and the water started to rise during the day.

Makhanga Health Centre was severely flooded, but MSF experience of responding to previous floods proved helpful.

In 2015, a lot of drugs were soaked in floodwater, ruining them. Afterwards, MSF raised the height of the shelves so that the drugs would be safe from rising water. So, this time the stocks were spared.

Untold shortages

Fewer lives have been lost in the 2019 floods but the damage caused to homes and crops has been immense.

It isn’t just crops that have been lost, it’s also food stored in homes in an area that was in need of food support even before it was flooded. The floods have contributed to great hunger already in the area.

The floods also submerged boreholes and destroyed toilets, pushing thousands to defaecate in the open. This increases the risk of waterborne diseases, such as diarrhoea and cholera.

Moreover, the area’s many swamps are breeding grounds for mosquitoes putting people at risk of contracting malaria.

People in Makhanga are vulnerable in terms of their health right now. Many sleep outdoors or in their chicken coops because their homes were destroyed.

The borehole at Makhanga Health Centre was contaminated by the floodwaters, but MSF staff cleaned it to ensure that the water is safer to use. Elsewhere, MSF’s water and sanitation teams distributed chlorine, cleaned water points and constructed toilets and showers.

Our main concern was to prevent an outbreak of diarrheal diseases and cholera.


The flooding in Makhanga has pushed most health workers to higher ground in the north for safety reasons, leaving the few remnants under severe pressure.

In the beginning, there was just one medical assistant and one hospital attendant at Makhanga Health Centre.

To support them, two MSF staff provided basic healthcare, HIV services and disease surveillance, with approximately 150 consultations per day. We’re now seeing a lot of respiratory infections and malaria.

Working with the District Health Office, the MSF medical team held an outreach clinic to ensure access to primary health care services and drugs for patients with chronic diseases—including HIV and tuberculosis—who lost their medications in the floods.

MSF provided healthcare, water and sanitation and distributed essential relief items and hygiene kits, we ended our activities on April 11, 2019 but our wish is to see more organisations responding in areas that we cannot manage, such as food and support with building materials to help people rebuild their houses. Looking ahead, the community of Makhanga still needs more support.

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