Tents have been supplied by multiple organizations to provide shelter just part of the thousands displaced people knowing struggling to live in Metuge. Up to 15 people are living, crammed together in the tents. Others have had to build their own shelters with leftover tarps and cloth. © MSF/

‘Like the end of the world’: Thousands caught in crossfire of invisible conflict in Northern Mozambique

The number of displaced people is growing in Cabo Delgado. In February, at least 200,000 people were displaced due to the conflict.  Since, numerous attacks on villages across the region have uprooted thousands more from their homes. Armed groups are waging attacks in this complex, resource rich region. Today, the north of Mozambique is the epicenter of social and economic tensions, resulting in devastating consequences on the population. 

During the insurgent attack on May 28, 2020, four MSF staff members were working at the Health Center in Macomia just before it was ransacked and burned. That day, 27 MSF staff living in Macomia fled with the population, dodging stray bullets as the combat intensified around them. No MSF personnel were killed during this incident, however the trauma they lived is very real.

All roads were blocked in and out of Macomia as insurgents entered the village. The only way to escape the erupting violence was to flee into the bush.

“The only way to escape was through the bushes at the back of the hospital. I ran from the area when I heard shooting around Macomia.  The entire town was running towards the bush.

We were at least a thousand people – men, women, elderly, children, the sick and their caregivers – all running away from the sounds of shooting. It was like the end of the world.

People were running through thick forest – areas where no human had gone before.  This was wild bush with a lot of thorns. People were thirsty and hungry, there was no water in that area –  just stone and hills.

People were trying to stop and rest, but the helicopters were flying very close.

The road to Licangano wasn’t easy – there were numerous hills. It was up and down. Many old people, sick people, and kids could not manage to jump over the obstacles, or to climb the steep cliffs.  Many kids were lost in the panic…

I saw a woman with a baby trying to get down the hill.  She could not manage without help, so she left her baby above and lowered herself over the ledge.  At that moment, heavy shooting started nearby.  The woman was yelling for help – pleading for someone to pass her baby to her. No one could help her.

People were running…terrified.”

Following the attack on May 28, no official report provided the number of civilian casualties and wounded.  MSF has received unverified reports of at least 15 dead, including multiple children, some due to starvation as they hid in the bush for days to escape the fighting. 

MSF did not have access to the area immediately after the attack.  Some of our staff were allowed back to survey the damage and begin reducing MSF’s presence, following the decision to suspend operations in Macomia due to the heightened security risks.

Crippling access to heath care

After Cyclone Kenneth ripped through the north of Mozambique in April 2019, MSF helped rebuild and renovate the Macomia Health Center and Medical Lab.  During the May 28 attack, that lab (pictured here) and health center were completely destroyed. 

The Macomia Health Center provided vital medical services for the entire town of over 29,000 people.  MSF provided support in the form of human resources: 27 people including nurses, a pharmacist, water sanitation and hygiene teams, drivers and guards.

Amidst an ongoing violent conflict, little access to health care and poor living conditions continue to worsen the daily struggle of thousands of Mozambicans in the north.  

Moving forward


MSF is committed to supporting the displaced populations throughout the Cabo Delgado Province.  Our role is clear – to provide humanitarian and medical assistance to the people that need it most.  To do so, MSF must guarantee a minimum amount of security for its medical teams, patients and the facilities that it works in.  It’s the most vulnerable people who will needlessly suffer the most – and we will do everything we can to lessen that suffering for the people who are victims of this ongoing conflict.