A wide swath of Mozambique devastated by Cyclone Idai two weeksago is now at a tipping point, humanitarian agencies said on Tuesday.
About two million people have seen their homes or crops destroyed, and cholera is spreading fast. Malaria, measles and starvation may follow unless help reaches enough people quickly.
At the same time, there are encouraging signs: 900,000 doses of cholera vaccine arrived on Tuesday, and a vaccination campaign is to start on Wednesday.
Water service has been restored to large portions of Beira, a coastal city of 500,000 people. More than 700,000 mosquito nets are being shipped in an effort to forestall a malaria outbreak.
The main road to Maputo, the capital, was reopened five days ago, and other roads are being repaired, so large shipments of food are arriving.
“Most of our operation has switched to land, so we can move a lot more,” Robert A. Holden, an emergency officer with the World Health Organization, said in a telephone interview. “There are still some areas in the north we can only reach by helicopter, and some where we’re still using boats. It’s a real tapestry of land, air and sea capabilities.”
Oxfam, CARE and Save the Children jointly sent boats on Tuesday to Buzi, an area southwest of Beira with no clean water or sanitation, said Dorothy Sang, Oxfam’s local humanitarian campaign manager.
The boats carried hand-operated pump filters, water-storage bladders, latrine slabs (pit covers that users squat on), tarps, soap and other supplies.
But the situation is still perilous. The W.H.O. has asked for $40 million to cover operations in Mozambique for the next three months. Other agencies have made their own financial appeals.
Cholera, usually transmitted in contaminated water, is rapidly spreading. The Mozambique government said Tuesday that it had recorded more than 1,000 cases, including one death.
Aid officials privately called that an underestimate, saying treatment centers are seeing hundreds of cases each day. Some victims are already dead when they are carried in.
The disease drains the body of fluids and electrolytes. If cholera victims reach help in time, they can almost always be saved with rapid rehydration and one dose of antibiotic.
Nine treatment centers with about 500 beds offering intravenous rehydration have been set up, eight of them run by Doctors Without Borders and one by the International Red Cross Federation.
Short-term centers with oral rehydration for ambulatory patients have also been created.
“If the epidemic continues the way it is now, that should be enough,” said Dr. Gilles van Cutsem, an H.I.V. specialist with Doctors Without Borders helping out in the crisis. “If cases massively increase, we’ll have to increase capacity.”
The aid group has hired 80 local doctors and nurses, and trained them to treat cholera, he said.
The Mozambique health ministry and aid agencies are collaborating on a campaign using radio and local health workers to tell people to seek help at the first sign of diarrhea and to be vaccinated against cholera.
But cholera is just the first and most imminent threat.
Although the cyclone and floods killed most mosquitoes and their larvae, standing water, where mosquitoes lay their eggs, is everywhere.
Millions of them are hatching, and many Beira residents already carry malaria parasites in their blood, which can be picked up and spread by mosquitoes. Experts fear a major outbreak in the coming weeks.
Measles is another looming danger.
More than 130,000 displaced Mozambicans are living in more than 150 makeshift camps on high ground. Under such conditions, in a chronically undernourished population, measles outbreaks can kill 10 percent of all children infected, according to the W.H.O.
“We’ll do an emergency measles vaccination campaign soon,” Mr. Holden said.
Dengue fever, which is spread by mosquitoes, and leptospirosis, a lethal bacteria found in the urine of many animals and commonly spread by floodwater, are also both endemic in the area.
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There are still other threats to public health, agencies warn. The storm also tore the roofs off dozens of health centers, soaking the medicines, supplies and equipment inside.
Pregnant women need places to give birth, and large numbers of people taking H.I.V. and tuberculosis drugs need to get back on treatment.
And because crops were wiped out in nearby Manica Province, which is Mozambique’s breadbasket, food shortages will persist until the next harvest. Prices will soar unless food is supplied from outside.
In an encouraging sign, Mr. Holden said, some settlement camps are shrinking as the water recedes and families venture home.
Those who want to leave are given aid packages containing tents, tarps, mosquito nets, bedding, tools for farming and home repair, cooking pots, seeds, and other goods.
“The next few weeks are crucial, and speed is of the essence if we are to save lives and limit suffering,” Dr. Matshidiso R. Moeti, director of the W.H.O.’s Africa regional office, said in a statement after visiting the area on Monday.