Tropical Cyclone Freddy exposes major health risks in the hardest-hit Southern African countries: lessons for climate change adaptation
Nicholas Aderinto
Abstract
Introduction Tropical Cyclone Freddy made landfall on the southeastern coast of Mozambique on February 11, 2022, before continuing its path of destruction across several other Southern African countries, including Zimbabwe and Malawi1. The storm brought strong winds, heavy rains, flooding, significant infrastructure and agriculture damage, and the displacement of thousands of people. The devastation caused by the cyclone has exposed major health risks in the hardest-hit countries of Madagascar, Malawi, and Mozambique, where emergency response efforts are being ramped up to provide relief to affected communities. The cyclone’s impact on the health of populations in the region has been significant. More than 300 health facilities have been destroyed or flooded in Madagascar, Malawi, and Mozambique, leaving communities without adequate access to health services2. The destruction of health facilities has raised public health risks, including the increased spread of cholera, malaria, vaccine-preventable diseases, COVID-19, and malnutrition. Trauma and mental health support are also critical needs. In Malawi and Mozambique, the cyclone struck during cholera outbreaks. While cholera cases in Malawi have been declining, with cases falling to 1424 as of March 20, 2023, compared with 1956 the previous week, the widespread flooding and infrastructure damage caused by the cyclone risks reversing recent progress made against the disease3. Meanwhile, in Mozambique, cholera cases have more than doubled over the past week, rising from 1023 to 2374 as of March 20, 20234. The scale of the damage caused by Cyclone Freddy underscores the urgent need to address the health risks associated with climate change in Southern Africa. Climate change and health risks in Southern Africa Climate change poses significant health risks in Southern Africa, with the region experiencing some of the most extreme impacts of a changing climate. The increased frequency and severity of extreme weather events, such as tropical cyclones, is one of the region’s most visible and devastating impacts of climate change. These events can cause significant damage to infrastructure, homes, and crops and displace large numbers of people. The health impacts of such events can be severe, with injuries, infectious diseases, and mental health problems being common concerns. In addition to extreme weather events, climate change affects temperature and rainfall patterns, significantly impacting agriculture and food security. Changes in precipitation patterns can lead to droughts, reducing food production and exacerbating malnutrition. Warmer temperatures can also increase the spread of vector-borne diseases like malaria and dengue fever, already significant regional public health challenges. Recent extreme weather events in Southern Africa provide examples of the health risks associated with climate change in the region. Tropical Cyclone Idai, which hit Mozambique, Malawi, and Zimbabwe in March 2019, resulted in over 1300 deaths and displaced over 3 million people5. The storm also caused widespread flooding and destruction of infrastructure, including health facilities, which exacerbated health risks in affected communities. Cholera outbreaks were reported in the storm’s aftermath, highlighting the increased risk of infectious diseases due to extreme weather events. Similarly, Tropical Cyclone Eloise, which hit Mozambique, South Africa, Zimbabwe, and Eswatini in January 2021, caused significant damage to infrastructure and homes, displaced thousands, and increased the risk of infectious diseases. In Mozambique, for example, there was a surge in malaria cases following the storm. The health risks associated with climate change in Southern Africa are significant and multifaceted, requiring urgent attention from policymakers, health professionals, and communities. Addressing these risks will require concerted efforts to reduce greenhouse gas emissions, mitigate the impacts of a changing climate, strengthen public health systems, and improve access to health services in affected communities. Health impacts of Tropical Cyclone Freddy in Southern Africa Tropical Cyclone Freddy, which hit Madagascar, Malawi, and Mozambique in March 2023, caused significant physical and psychological damage to affected communities, resulting in numerous direct and indirect health impacts. The direct health impacts of the cyclone include physical injuries and deaths. The death toll is estimated to be in the thousands, with thousands more injured. The destruction of homes and infrastructure has also led to many people’s displacement, leaving many homeless and vulnerable to further health risks. The cyclone’s impact on water sources has increased the risk of waterborne diseases. Flooding caused by the cyclone has contaminated many water sources, making it difficult for communities to access safe drinking water. This has increased the risk of waterborne diseases such as cholera and typhoid fever. The widespread destruction of crops and infrastructure has also led to food insecurity and malnutrition, particularly among vulnerable populations such as children, pregnant and lactating women, and the elderly. The mental health impacts of the cyclone are also significant. Displacement, loss of homes, and the trauma of the storm and its aftermath have increased anxiety, depression, and posttraumatic stress disorder in affected communities. These impacts will likely persist in the long term, particularly in communities lacking mental health services. Vulnerable populations are particularly affected by the health impacts of the cyclone. These populations include children, the elderly, pregnant and lactating women, and those with preexisting health conditions. In addition, communities that lack access to health services are at greater risk of health impacts, as they may not have access to healthcare for injuries or treatment for waterborne diseases. These populations are also more likely to experience mental health impacts, as they may lack access to mental health services. Lessons learned and opportunities for action The devastating health impacts of Tropical Cyclone Freddy in Southern Africa underscore the urgent need for preparedness and resilience in the face of climate change and extreme weather events. As the frequency and severity of extreme weather events increase, communities, governments, and international organizations must work together to build resilience and prepare for these events. In the aftermath of Tropical Cyclone Freddy and other extreme weather events, successful responses to health risks have included the rapid deployment of medical teams to affected areas, the provision of clean water and sanitation facilities, and the distribution of food and other essential supplies. These efforts have been critical in mitigating the health impacts of extreme weather events, particularly for vulnerable populations. There are numerous opportunities for collaboration and action to address the health risks of climate change in Southern Africa. Building resilience in the health sector through investments in infrastructure and capacity-building for healthcare workers is essential. This includes strengthening healthcare systems to ensure that they can respond effectively to disasters and emergencies. In addition, interventions that address the root causes of health risks, such as climate change and food insecurity, are needed. International collaboration is also critical to addressing the health risks of climate change in Southern Africa. This includes collaboration between governments, international organizations, and nongovernmental organizations to provide technical assistance, funding, and other resources to support preparedness and resilience efforts. In addition, collaboration with communities and local organizations is essential to ensure that responses to health risks are tailored to the needs of affected populations. Conclusions The devastating impacts of Tropical Cyclone Freddy in Southern Africa have exposed the region’s major health risks associated with climate change. The increased frequency and severity of extreme weather events, temperature and rainfall patterns changes, and the spread of vector-borne diseases all contribute to these health risks. The cyclone’s direct and indirect health impacts, including physical injuries and deaths, displacement and loss of homes, waterborne diseases, food insecurity, and mental health, have particularly affected vulnerable populations. It is essential to prioritize preparedness and resilience in the face of climate change and extreme weather events. Successful responses to health risks in the aftermath of Tropical Cyclone Freddy and other extreme weather events serve as valuable examples. Collaboration and action are urgently needed to address the health risks of climate change in Southern Africa. There is a need for a concerted effort to address the underlying drivers of climate change and to implement policies that support health and well-being in the region. The lessons learned from Tropical Cyclone Freddy should inform immediate and sustained action to build resilience, protect vulnerable populations, and promote sustainable development. Failure to act urgently will lead to catastrophic consequences for people’s health in Southern Africa and beyond. Ethical approval NA. Consent NA. Sources of funding None. Conflicts of interest disclosure The authors declare that they have no financial conflict of interest with regard to the content of this report. Research registration unique identifying number (UIN) 1. Name of the registry: Not applicable. 2. Unique Identifying number or registration ID: Not applicable. 3. Hyperlink to your specific registration (must be publicly accessible and will be checked): Not applicable. Guarantor Nicholas Aderinto. Provenance and peer review Not commissioned, externally peer-reviewed.