The effects of the El Niño weather pattern continue to strain Malawi’s public health systems, particularly in districts like Chikwawa. Waterborne diseases such as diarrhoea and cholera have been a direct result of prolonged droughts and flash floods that have compromised access to clean water.
In Chikwawa, 19-year-old Flora Nsona from Piyasi Village joins dozens of women who walk to Bereu Health Centre to access under-five services for her baby.
Like many others, she is also seeking medical advice on how to prevent diarrhoea, a recurring issue in her community where clean water is scarce and chlorine distribution is irregular.
“The last time we consistently received chlorine was in January,” she says. “When it is not available, our children get sick more often,” she said, emphasizing that she becomes very worried when her toddler has loose stools.
Flora’s story is not unique.
It mirrors the lived reality of thousands of families across Chikwawa, one of the districts hardest hit by the 2023/24 El Niño-induced crisis that devastated southern Malawi.
The El Niño weather cycle unleashed a double disaster. Prolonged droughts scorched crops and dried up water sources while flash floods displaced households and contaminated clean water points.
The impact on public health was immediate and severe; triggering outbreaks of diarrhoea, cholera and other waterborne diseases.
“For the past five years, we have been battling environmental health challenges caused by floods and droughts,” says Chifundo Kika, Chikwawa’s Environmental Health Officer.
At Bereu Health Centre, the daily queue is long. Serving a catchment of 28,940 people, including 17% children under five, the facility receives over 100 patients daily, with the majority seeking treatment for malaria, diarrhoea and other preventable ailments.
Samuel Msiska, the facility’s in-charge, says the situation would be worse without partner support.
Lezida Maimase Mphundi is a Health Surveillance Assistant who supports outreach clinics held every Tuesday and Friday. She notes a consistent pattern: at least 10 children are diagnosed with diarrhoea at every visit.
“We visit the villages and the advantage is they have formed care groups, which help us with counselling and we orient them on what to do when they detect signs and symptoms of diarrhea,” she said.
In Ngabu, another disaster-prone area of Chikwawa, the community is working proactively.
After recording 214 cholera cases in 2022–2023, traditional and faith leaders have been holding regular meetings to improve disaster preparedness and promote hygiene.
Group Village Headman Lynoss Chamboko remembers how four of those cholera cases in 2023 were children. But thanks to UNICEF-supported interventions, including chlorine distribution and community sensitization meetings, Ngabu reported zero cholera cases in 2023–2024.
“The floods affected us a lot, including an increase in waterborne diseases, thankfully we are being assisted to restore and get our lives back to normal,” he said.
UNICEF Malawi, with funding from the European Civil Protection and Humanitarian Aid Operations (ECHO), embarked on an integrated emergency project focusing on nutrition, health and child protection in 10 of the most affected districts, including Chikwawa.
Mobile clinics now reach remote villages, and community-led systems are strengthening.
District wide, cholera cases have dropped from 663 in 2022–2023 to just 10 in 2023–2024.
Still, Kika warns that inconsistency in community outreach programmes risks a resurgence of diseases such as cholera and diarrhoea. She therefore calls on partners, especially UNICEF and other humanitarian agencies, to maintain and even scale up their support.
