Six years into the conflict
Mozambican security forces have been fighting armed groups from Ansar al-Sunna and the Islamic State in Cabo Delgado since the end of 2017. This is part of a current uprising aiming to set up an Islamic state in the area. Since the start of the conflict, the insurgency has displaced nearly one million people in Cabo Delgado, Nampula, and Niassa provinces.
Armed Conflict Location & Event Data Project (ACLED) data shows a steady and continuous number of violent events by armed groups targeting civilians and the different military and police forces active in Mozambique. The interactive graph below shows the number of people killed in these events – most of them in the north and along the coast of Cabo Delgado.
An extensive field research in the province by the Institute for Security Studies and the Judicial Training Institute of Mozambique provides some insights into the origin and nature of the insurgency. The attacks on civilian infrastructure are part of a campaign against the state of Mozambique to set up an Islamic state in the region.
The assailants in Cabo Delgado, as per Eric Morier-Genoud in The Conversation, told local people that "they would not hurt them, that their fight was with the state and the police. They explained that they rejected state health and education facilities and refused to pay taxes. They also called on people to remove their children from Western-style schools."
Health facilities
under attack
Armed groups have targeted hospitals and health centres multiple times, with attacks ranging from the destruction of buildings to the looting of medicine and health supplies.
As seen on the interactive map of health facilities in Cabo Delgado province, the conflict has mostly damaged health facilities in the north and along the coast of the province. The most affected districts in terms of number of damaged facilities are Macomia, Mocimboa da Praia, Muidumbe, Palma, and Quissanga.
> 50% of health facilities have been fully damaged.
According to the latest data published on the Health Resources and Services Availability Monitoring System (HeRAMS) in December 2022, out of the 36 health facilities in these five districts, 16 have been fully damaged and need to be rebuilt from scratch. The other 13 have been partially damaged and need large-scale repairs, but not a full reconstruction.
The survey data reports conflicts, attacks, and looting as the main causes of destruction. Only seven facilities (one-fifth of the total) have not been damaged.
36
health facilities in 5 districts
_______
16
fully damaged facilities
_______
13
partially damaged facilities
> 80%
of the health facilities in Macomia, Mocimboa da Praia, Muidumbe, and Quissanga are still non-functioning.
A news article published in August 2022 by allAfrica cites Anastacia Lidimba, director of the provincial health services, stating: “Mozambican health authorities are reopening most of the 34 wrecked health units […] in the northern province of Cabo Delgado." However, HeRAMS data shows that, as at December 2022, not only were health units in those districts still damaged, but in the districts of Macomia and Mocimboa da Praia, over 80% were non-functional, even if some do not report structural damage.
In Mocimboa da Praia district, for example, out of the four partially damaged health facilities, only one is partially working, and the rest are non-functioning. A similar situation is present in Quissanga district, where out of three partially damaged facilities, only one is partially working.
Multiple districts have non-functioning health facilities, primarily because of a lack of security for the staff and limited health supplies.
In some cases, multiple districts have health facilities that have not been damaged but are non-functioning, primarily because of a lack of security for the staff and limited health supplies. This is the case for one facility in Macomia district and three facilities in Muidumbe district.
According to the latest Annuary of Statistics published in 2020 by the Instituto Nacional De Estatistica, the combined population of Macomia, Mocimboa da Praia, Muidumbe, and Quissanga is 435,642, or 17.3% of the total Cabo Delgado population. According to HeRAMS data, there are only four partially working health facilities out of a total of 29 in these districts. This is roughly equivalent to one health unit for every 109,000 people. The interactive map below shows the status of the facilities in the province.
Hospitals and health units are undergoing reconstruction or repairs as part of the Cabo Delgado Reconstruction Plan, an investment programme by the Mozambican Government to rebuild roads, telecommunication infrastructure, health facilities, and schools in the conflict-affected province. That said, Secretary of State for Cabo Delgado António Supeia has admitted delays in the plan.
What's next
The latest monthly report from Cabo Ligado, a conflict observatory on the Cabo Delgado insurgency started by ACLED, says that fighting is still continuing in Macomia and Muidumbe districts. Displaced people have also been returning to Mocimboa da Praia over the past month.
Even though the Government keeps telling a positive story about the insurgency, there are more military forces in Cabo Delgado, especially Rwandan forces. According to the report, analysts observe that “many local and international analysts that Cabo Ligado has spoken to believe we are far from the end of this conflict and its associated humanitarian crises”. They add, “despite improved security in some key locations, large areas of Nangade, Muidumbe, and Macomia districts remain ungovernable”.
The ACAPS INFORM Severity Index shows the severity of the conflict escalating in the beginning of 2021, before peaking in March 2021 when the coastal city of Palma was under attack. The capture of the city brought international attention to the conflict, with wide coverage from global news organisations. The index has remained consistent since.