Natural disasters

South Sudan 2020

From July 2020, severe flooding affected an estimated 800,000 people across a wide swath of South Sudan, inundating homes and leaving people without adequate food, water or shelter. While flooding is an annual event, in some parts of South Sudan the 2020 flood was particularly severe. Our teams provided medical care in the flood-affected areas of Greater Pibor, Jonglei, Upper Nile, and Unity states. In Greater Pibor, one of the worst affected areas, MSF ran mobile clinics in five villages and an emergency clinic in Pibor town. In two months, MSF teams treated more than 13,000 patients in and around Pibor, half of these patients for malaria.

In Old Fangak, a town of about 30,000 people in a wetland area of Jonglei state, most of the towns latrines were flooded, raising the risk of waterborne diseases. An additional 3,000 people arrived in the town in late September after heavy rains flooded their homes in surrounding villages. The local airstrip was also flooded, making it more difficult to deliver medical supplies or refer patients to other medical facilities when needed. MSF provided care for displaced people, including for respiratory tract infections and acute watery diarrhoea at the Old Fangak hospital.

"Many houses are affected on a daily basis," said Dorothy I. Esonwune, MSF’s project coordinator in Old Fangak. "The focus of everybody in Old Fangak is on scooping out water from around their homes and building up dikes out of mud."

Cyclone Idai, Southern Africa, 2019

Heavy rains flooded parts of Malawi in March 2019 before developing into Tropical Cyclone Idai, which struck Mozambique and Zimbabwe. The town of Beira, in the centre of Mozambique, was hardest hit by the cyclone.  The cyclone wreaked a path of destruction killing over 600 people and injuring 1,600 and destroyed thousands of buildings—homes, schools, health centres and hospitals across Beira and surrounding towns and villages. Families were left homeless and thousands of people lacked reliable access to clean water or electricity.

As soon as Beira airport reopened on 16 March, an MSF emergency team arrived from Maputo to check in on the team and assess the needs of the wider community. We rapidly deployed additional medical and logistics staff as well as sent in supplies. Given the structural damage to the water system and mass flooding brought by Cyclone Idai, a cholera outbreak was almost inevitable. MSF quickly began working with the Ministry of Health to isolate and care for patients with suspected cholera. When the cholera outbreak in Beira was officially declared on 27 March, three purpose-built cholera treatment centres with a combined capacity of about 350 beds were already under construction, in addition to two cholera treatment units in use at the time. Smaller units were also set up in outlying areas. As with any outbreak, working with the community is essential. In Beira, our health promotion teams ran street theatre groups and went door-to-door to tell people about how they could protect themselves against cholera, and how to access care if they fell ill. We also provided logistic, technical and planning support to the Ministry of Health for cholera vaccination campaigns around Beira. Over 750,000 people received the cholera vaccine a month after Cyclone Idai hit.

“In those early days of the cholera outbreak, the triage was constantly full of people that had collapsed with dehydration. Our nurses worked non-stop, finding vein after vein, making sure every patient had the lifesaving rehydration they needed,” said Quezia Monteiro, an MSF infectious diseases specialist. “The worst affected were as always the most vulnerable; children, pregnant women and the elderly. Our sickest patients also had HIV, so they needed treatment for both diseases.”

“Never in my life, nor in my parents’ and grandparents’ lives, had anyone seen rain like that,” said one MSF nurse from Mozambique whose husband drowned in the floodwaters. “When those in your country watch the landscape from a helicopter, you see the flooded areas and the torn trees, but there is a lot you can’t see. Beneath the waters, below the broken branches, you will find us – our stories and our sadness and our resolve to live.”

Haiti, 2010

The 2010 earthquake in Haiti remains one of the largest global emergency responses to date. The disaster killed 220,000 people and left 1.5 million homeless. The earthquake destroyed 60 per cent of the existing health facilities and 10 per cent of medical staff were either killed or left the country. MSF had to relocate services to other facilities, build container hospitals and work under temporary shelters.

MSF had been working continuously in Haiti for 19 years prior to the earthquake, providing a wide range of medical care from maternity services to physiotherapy and mental health programmes. Thanks to our local staff working on the ground and our existing programs we were able to be part of the early response. We recruited thousands of new staff, mostly Haitians, who worked in 26 medical centres – including an inflatable hospital on a football field. Over 10 months, we treated more than 350,000 patients, performed more than 16,000 surgeries and delivered more than 15,000 babies. When cholera broke out, we treated 60 per cent of cases countrywide.

Haiti showed how responding to a disaster often goes beyond the immediate crisis. The emergency phase, where we responded with surgery, medical care, psychological support, food, shelter and water, was relatively short. In the long term we needed to contain and limit the spread of infectious diseases, re-establish healthcare systems and support people who had lost their homes and were living in temporary shelters.

In the two years following the earthquake, MSF supported a Ministry of Health hospital in the Cité-Soleil slum and built four emergency hospitals in the area affected by the earthquake, an area inhabited by more than 2 million people.

Democratic Republic of Congo 2021

The eruption of Mount Nyiragongo, which is considered the most dangerous volcano in Africa, sent lava toward the densely populated city of Goma, in North Kivu province. It destroyed four villages north of the city and set off a series of tremors and minor earthquakes that forced people to flee for safety. Buildings including health structures were damaged, while roads and water and electricity supplies destroyed.

MSF provided medical services in the nearby town of Sake, where between 100,000 and 180,000 people gathered in churches, schools, mosques, and on the streets. In the town of Rutshuru, where 70,000 of the displaced sought refuge including in a football stadium, our teams provided healthcare services and constructed water and sanitation infrastructure. People who were affected by the disaster were in immediate need of food, latrines, shelters, blankets, and jerry cans to collect clean water. MSF estimated that 500,000 people in Goma lacked access to clean water.

“Most of us fled with nothing, without money,” said Magene David, who went to Sake in search of shelter. “MSF provides us water, and this helps us, but we have nothing to eat. We sleep outdoors, in the cold, with no blankets.”

Indonesia, 2018

Indonesia, which lies within the Pacific Ring of Fire where 90 per cent of earthquakes occur, was hit by two tsunamis in 2018. In Sulawesi, in September, a tsunami triggered by an earthquake claimed over 2,000 lives and displaced 90,000 people. A few months later in December following volcanic activity on the island of Anak Krakatoa, a tsunami tore through the Sunda Strait between the islands of Java and Sumatra killing 600 people and displacing 20,000. In the Sulawesi natural disaster, the earthquake caused liquefaction and the solid surface of the ground turned to liquid, engulfing homes in the mud. MSF deployed a local team to Central Sulawesi, composed of medical, logistics, and water and sanitation specialists.

The main priority for our teams was to provide support to health centres in more remote areas, as the government response concentrated mainly in the areas around the Palu City coastline and Petobo to the south. MSF focussed on restarting primary healthcare activities and ensuring the prevention of diarrhoea, skin diseases, and measles. MSF also restarted routine vaccinations and treated victims of the natural disaster including patients with closed fractures due to the impact of the earthquake. Temporary structures for consultations and maternity services were constructed as well as water and sanitation systems. Two local psychologists also joined the team to provide mental health care to those in the community most affected by the disaster.

"The affected communities have limited access to clean water, which is important to reduce the risk of possible epidemics. In some areas, people have to walk for up to two kilometres just to get water," said Timothius S.P. Benu, water and sanitation specialist. “The main goal for MSF will be to ensure that these communities have access to safe water, including by repairing or cleaning existing sources, such as hand pumps or wells, or setting up temporary solutions, such as water tanks and water treatment systems.”

Madagascar, 2021

Three consecutive years of drought severely affected harvests and access to food in the southern, desert regions of Madagascar. It also exacerbated the annual ‘food lean season’ resulting in a acute food and nutritional crisis in 2021. MSF estimated that around 280,000 people were most affected in the Amboasary district. Three mobile clinics were set up across the district but access to the affected communities proved difficult: the villages were scattered and the distances long, due to the track conditions and the geology of the region, making the delivery of humanitarian aid challenging. MSF launched a medico-nutritional programme in the area screening and treating children, adolescents, and adults for acute malnutrition.

On consultation days, hundreds of people came to the mobile clinic. People of all ages were screened, examined, and, depending on their health, admitted to the nutritional program set up by MSF. Patients suffering from acute malnutrition received systematic treatment and Plumpy’Nut therapeutic food, an enriched peanut paste. Malnutrition leads to a weakened immune system, leaving those affected particularly vulnerable to other illnesses. MSF also launched water, hygiene, and sanitation activities to improve access to safe water and supported interventions to strengthen food distribution to the communities affected by malnutrition.

“For the inhabitants of Ankamena, in the commune of Ranobe, the first functional health centre is a half-day's walk away,” said Julie Reversé, MSF emergency coordinator in Madagascar. “For these weakened communities, lacking everything, the priority is to find something to drink and eat, neglecting health.” MSF chose to launch mobile clinics in this region based on isolation, poor access to care, and vulnerability of the communities.

“So far, in the three communes where we work, we have screened 4,674 people and admitted 1,136 patients to our program [as of April 13], including 831 children under the age of five,” said Anne Tilkens, MSF emergency medical coordinator in Madagascar. “Among these children, about a third suffer from severe acute malnutrition, and two-thirds from moderate acute malnutrition.”

Man-made disasters have an element of human intent, negligence, or error involving a failure of a man-made system, as opposed to natural disasters resulting from natural processes.

Lebanon blast, 2020

In August 2020 a massive explosion caused by chemicals stored in a warehouse at the port in Beirut, Lebanon, left widespread destruction throughout the city. A hundred ninety people were killed, nearly 6,500 thousand were injured and thousands of people were made homeless. In the hours following the explosion, thousands of injured people poured into nearby hospitals. Most hospitals were quickly overwhelmed with the flow of patients and started to run low on supplies. Other health facilities closer to the port had been completely destroyed, and several others were so severely damaged they had to close and transfer patients elsewhere.

The treatment of severe and critical cases – such as head and chest injuries – was prioritised by hospitals and ambulance services on the first night. In the following days, thousands of other patients were treated for less severe injuries such as cuts caused by glass from shattered windows. Some of our colleagues went spontaneously to health facilities to see how they could lend a hand to the medics dealing with the emergency.

MSF’s emergency response was designed to work alongside community initiatives and to support existing responses. MSF teams assessed the needs of hospitals and emergencies services in collaboration with the Ministry of Public Health and others health organisations. We supported patients who were in need of medication for chronic diseases. Many had lost or run out of their drugs and could not afford refills nor access health facilities that had been damaged or destroyed. The port explosion also compounded existing traumas and mental health needs. Mental health was a key pillar of MSF’s intervention in Lebanon, and the team provided psychological support to those who needed it in the city after the disaster.

“In the first weeks after the explosion, the humanitarian response to people’s emergency needs has been primarily delivered by Lebanese civil society organisations, social movements, community members and volunteers. Following the explosion, people ferried the wounded to hospital in their cars. People opened their homes to those who had been made homeless. Across the affected areas, people have mobilised to provide food, clean water, essential items and emergency healthcare. Volunteers have been cleaning up the streets and patching up the wounded,” said Jonathan Whittall, Coordinator of MSF’s Emergency Response