Proposal for Mozambique Refugee Clinic

July 31, 2007

Stephen Henrichon

(Photos REUTERS Grant/Neuenburg Mozambique 2/07)

1. Executive Summary

In February 2007, heavy rains ravaged Mozambique. An estimated 285,000 people were affected by severe flooding along the banks of the Zambezi River. More than 160,000 Mozambicans have been displaced and have congregated in refugee camps to the north. Just two weeks later, on February 22, 2007, Cyclone Favio added to an already catastrophic situation when it made landfall in the province of Inhambane and devastated the countryside. Essential infrastructure, health centers, educational facilities, and thousands of hectares of crops were destroyed in the aftermath. Cyclone Favio affected an additional 150,000 Mozambicans and many displaced families joined the crowded refugee camps in the north.i (For Maps of Mozambique, see Appendix A and Appendix B)

Refugees have congregated in two camps which are now home to 100,000 and 50,000 refugees respectively. The relocation process for the refugees is further complicated by the presence of many thousands of landmines left behind in the wake of a 16-year civil war. Many landmines have been dislodged and shifted by the floods and much of the countryside is now rendered unsafe.

Many refugees have constructed makeshift homes out of materials they have collected nearby. Even plastic tarps, tin/aluminum siding, and other more sturdy building materials are a luxury and refugees have resorted to using wood, sticks, palm fronds, and grasses in the construction of their homes. The refugee camps lack essential resources such clean water, proper sanitation, basic healthcare, and electricity.

As a whole, the country of Mozambique is one of the most impoverished nations in Africa, ranking very low (96 out of 103) on the UNDP Human Development Scale. 69% of the population lives below the national poverty line.i In the healthcare sector, there exists a mere 700 trained physicians for a country of 20 million people. That equates to 2.4 doctors for every 100,000 people. It is anticipated that the majority of refugees have never received any medical treatment at all.ii (For background/history & Healthcare outlook see Appendix C and Appendix D)

Real Medicine Foundation (RMF) has been approached by the Sole of Africa (SoA) to construct a free medical clinic to service the basic health needs of the refugee camp residents. SoA’s main focus is to rid Mozambique of the landmines which terrorize the countryside however their mission has broadened to include assisting in the country’s rural healthcare, education, and economic development. This is to be done in a sustainable manner by educating and promoting self-reliance. The proposed medical clinic is one component of Sole of Africa’s goal to leave a “footprint” on Mozambique. (For more information on Real Medicine Foundation and Sole of Africa, see Appendix E and Appendix F)

The project will be carried out in two phases. In the first phase, resources will be directed towards opening the clinic in a timely fashion so the refugees can begin receiving medical treatment. Local healthcare practitioners are scarce so emphasis will be placed on implementing an efficient solution which best utilizes the limited personnel resources available to us. A referral system will be initiated so patients requiring more advanced procedures and surgeries can receive the proper care they need from the Pemba Hospital, the closest full-service medical center to the refugee camps albeit an 11-hour drive.

The second phase of the project will be aimed at prevention and education in an attempt to help alleviate public health concerns at the source. Outreach programs to be deployed include HIV/AIDS testing & treatment program, hygiene & sanitation education, and prenatal education.

The target date to open the clinic is October of 2007. This will be slightly before the rainy season. It will be important to have the clinical resources available to the residents at that time as an increase in health issues due to the approaching heavy rains is anticipated.

2. Mission

The Mozambique Clinic will focus on providing comprehensive treatment and health education for physically, mentally, and financially afflicted residents of the refugee camps. To preserve the integrity and efficacy of the project special consideration will be given to the following values and principles:

  • Flexibility — The clinic will be mobile to best cater to the relocation and permanent placement of the refugees.
  • Sustainability and Self-reliance — The clinic will be managed and operated by Mozambicans.
  • Accountability — The project will ensure proper stewardship of all funds.
  • Cultural sensitivity — The project will be responsive to local culture and customs.
  • Holism — The project will provide education, prevention and care.

For the full proposal, please contact us at:




1 Humanitarian Appeal – Mozambique Flash Appeal 2007

2 Mozambique. Health Action in Crises. WHO. Sept 2005.

3 WHO. Sept. 2005.

4 WHO. Sept. 2005.

5 AIDS sharply cuts life expectancy. 2004.

6 Mozambique. The World Fact Book. CIA. 20 April 2006. factbook/geos/mz.html.

7 Bazima, Marta. Reflect in Mozambique. Education Action 12. ActionAid. Jan 2000:12.

8 Young, Lance S. Mozambique’s Sixteen Year Bloody Civil War. 1991.

9 U.S. Dept of State. Background Note. Mozambique. Bureau of African Affairs. March 2006. 7035.htm.

10 Mozambique. Canadian Dept of Foreign Affairs and International Trade. 30 Aug 2004. mozambique_background-en.asp.

11 U.S. Dept of State. March 2006.

12 Wurst, Jim. Mozambique Disarms. Bulletin of the Atomic Scientists. 50 (5): Sept/Oct 1994.

13 Canadian Dept of Foreign Affairs and International Trade. 30 Aug 2004.

14 Canadian Dept of Foreign Affairs and International Trade. 30 Aug 2004.

15 Canadian Dept of Foreign Affairs and International Trade. 30 Aug 2004.

16 “Mozambique: How Disaster Unfolded.” BBC News. 24 Feb 2000.

17 BBC News 2000.

18 “Mozambique Floods: 2000 and 2001.” Oxfam. 2006. floods/index.htm.

19 “Country Profile: Mozambique Floods.” UN International Strategy for Disaster Reduction.….

20 “Mozambique: Zambezi River continues to rise above flood warning level.” UN Office for the Coordination of Humanitarian Affairs. IRIN. 52184&SelectRegion=Southern_Africa&SelectCountry=MOZAMBIQUE.

21 “Mozambique: Drought after drought.” International Water and Sanitation Centre. 3 Nov 2005.

22 Mozambique. Health Action in Crises. WHO. Sept 2005. Sept05.pdf.

23 WHO. Sept. 2005.

24 WHO. Sept. 2005.

25 Gimbel-Sherr, Kenneth. “Rapid Scale-Up of HIV Care in Mozambique.” MOH/Clinton Initiative. Health Alliance International. 13 July 2004.

26 WHO. Sept. 2005.

27 Mozambique. WHO. 2002.

28 WHO. Sept. 2005.

29 AIDS sharply cuts life expectancy in Mozambique. Clinical Infectious Diseases. 39(8). 15 Oct 2004.

30 Paterson DL, et al. “Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Annals of Internal Medicine. 2000;133:21-30.

31 Behforouz, H, et al. “From Directly Observed Therapy to Accompagnateurs: Enhancing AIDS Treatment Outcomes in Haiti and in Boston.” Clinical Infectious Diseases. 2004;38:S429-S436.


General References

Ouyang, Helen. Comprehensive HIV/AIDS Program for Women of theMigrant Labor System in Rural Mozambique: A Proposal for a Pilot Community-Based Approach. 2006. Steve Henrichon, Project Coordinator Real Medicine Foundation 11628 Santa Monica Blvd, Suite 203 Los Angeles, CA 90025 Ph: (503) 381-2904




Map of Mozambique (Flooded Regions)




Regional Map of Mozambique



Background Country Information

Mozambique, located along the eastern coast of sub-Saharan Africa near South Africa and Zimbabwe, was recently devastated by both man-made conflict and natural disaster. Suffering from a civil war as well as more recent floods and droughts, Mozambique is still left reeling, recovering from each of these serious inflictions. Structural violence and post-conflict recovery continues to obstruct the development of a substantial health systems capacity, which is still obvious today. Furthermore, the country epitomizes the brain drain phenomenon that is currently affecting many developing countries.

Mozambique measures about 799,380 square kilometers, which is approximately twice the size of California. The capital, Maputo, is located near the southern tip of the country. The population of Mozambique was estimated to be about 19.4 million in 2005, with 48.2% male and 51.8% female. The population annual growth rate is 1.8%. The adult literacy rate is estimated to be 46.4%. The infant mortality rate is 104 per 1000 and the average life expectancy is 42 years old.i Its official language is Portuguese but only 2% of the population actually speaks it as a mother tongue, and only 30-40% knows it as a second language.ii

Mozambique is located along the Indian Ocean. Its 2,000-mile coastline and three major ports of Maputo, Beira, and Nacala are all ideally suited for naval bases and are also coveted international gateways to the landlocked countries of the region. Besides its unique geographical location, Mozambique is envied for its scarce minerals.iii

Following economic collapse from the turmoil of civil strife post-independence, its GDP has stabilized at $5.5 billion, with an 8.2% annual GDP growth rate. The per capita gross national income is $250. The country mostly relies on services and industry for its GDP, with agriculture just slightly less.iv

Post-Conflict in Mozambique

The current situation in the country cannot be properly assessed without a thorough understanding of its despairing history. Mozambique has been rebounding from back-to-back wars of fighting for its independence from Portugal, which was immediately followed by a long, bloody civil war. Armed conflict in Mozambique began back in 1964, as the Mozambique Liberation Front (FRELIMO) was formed and launched guerilla warfare against Portuguese troops. In 1975, a peaceful resolution to the end of colonization of Mozambique by Portugal was reached, resulting in the declaration of Mozambican independence.v

After independence, the country spent the first sixteen years entrenched in civil war that inflicted economic collapse, displaced persons and refugees, political instability, the failure of socialism, and the mass exodus of Portuguese The Mozambique National Resistance (RENAMO), supported by the governments of South Africa and then Rhodesia, engaged in guerilla warfare against the government, thrusting the country into over one and one-half decades of civil strife. Mozambique's civil war led to massive destruction of its economic and social infrastructure. Humanitarian aid was the only resource for much of the civilian population. The conflict claimed nearly one million lives in addition to the numerous war amputees, and to this day, the country still bears a legacy of active landmines. By 1992, when the peace agreement was signed, at least 1 million people had been killed, an additional 1.7 million had fled the country, and 2-3 million more had been left homeless.vii Free and open multi-party elections held in 1994 and 1999 were won by FRELIMO. Since then, clashes between FRELIMO and RENAMO have been confined to the parliament.viii At the end of the civil war, Mozambique ranked among the poorest countries in the world, though it has achieved substantial economic strides in the last decade. Poverty remains widespread, with more than 50% of Mozambicans living on less than $1 a day. Juggling a high foreign debt with a decent track record on economic reform, Mozambique’s economic position led to the complete international forgiveness of a considerable volume of debt.ix

For all of the destruction the country has experienced, Mozambique did expediently re-build following the war. Institutions gained stability and the political culture improved. A massive reconstruction effort was carried out in the span of a decade. Nevertheless, Mozambique still has many challenges ahead. It is one of the world's poorest countries and still suffers the effects of war on top of the usual structural problems experienced by most developing countries. Agriculture is still a very fragile sector: barely half of the livestock lost during the war has been replenished, and only a tenth of the arable land has been re-cultivated.x

Natural Disasters in Mozambique

Though the country has shown its resilience through its post-conflict recovery, the country suffered serious setbacks in 2000 and 2001 when it was hit by floods, which affected about a quarter of the population, destroying much of its infrastructure.xi In early 2000, a cyclone swept across southern Africa, ravaging Mozambique. The worst flooding in 50 years, tens of thousands were forced from their homes, with those in makeshift homes in the slums around Maputo most severely affected. At the end of the three weeks of flooding, aid workers estimated that 100,000 people needed to be evacuated and 7,000 more were trapped in trees, without food or water.xii Ultimately, half a million people were left homeless and 700 lost their lives, not to mention the complete destruction of much of the agricultural system and water and sanitation infrastructure, in addition to the usual infectious diseases that accompany homelessness and displacement.xiii However, this was not the last of the floods for the already devastated country, for they recurred in 2001, drenching the region once again in tragic desolation and yet another period of re-building while it was still recovering from the 2000 floods. This time, there was intense flooding of the Zambezi River, which was almost of the same magnitude as the 2000 floods. Fortunately, lessons learnt and experiences gained from the 2000 floods allowed for better preparation. It was estimated that 230,000 people were displaced and 115 died from the 2001 floods,xiv and even today, the region is often issued warnings that the Zambezi River is rising above floods warning levels.xv

Besides the floods, the country is plagued with recurring droughts. In fact, in central Mozambique, the region suffered four years without a single rainfall. Cholera and other infectious diarrheal illnesses are common occurrences as people are forced to resort to unsafe waters in dire times.xvi

Despite all its efforts in rebuilding, the people of Mozambique still bear its unfortunate history, as the country continues to rank low on the UNDP Human Development Index scale, at 96 out of 103. Sixty-nine percent of the population still lives below the national poverty line.xvii



Existing Health Sector Infrastructure and Capacity

Surviving armed conflict and natural disasters, the infrastructure of the country has suffered tremendously. Even with reconstruction and international aid, the health sector is still anguishing the consequences. Besides having to emerge from the cloak of colonialism, the other crises Mozambique has endured leaves the country particularly vulnerable to unique public health issues.

Structurally, the national health system is divided into three administrative levels: the MoH for policy formation, the 11 provincial offices for policy implementation and regional coordination, and the 144 health district divisions for health services provision. The health centers provide care at the most basic and rural level and refer to the rural and district hospitals for medical emergencies, basic surgical and obstetrical intervention, leaving the provincial and central hospitals to provide more specialized care. A total of 1,141 health posts and centers, and 43 hospitals were tallied in 2001. The private sector includes privately-owned clinics in the larger main towns, as well as health centers set up by international NGOs, bilateral agencies and religious organizations. Traditional healers cover about 60% of the population, and although not officially recognized by the MoH, they are acknowledged and regulated.xviii

The health sector capacity in Mozambique is extremely small, compared to many other countries of similar size and population. Remarkably, it only has 712 physicians, which is equivalent to 2.4 doctors per 100,000 people, which is one of the lowest medical doctor to person ratios in all of Africa.xix In addition, most of its physicians are concentrated in the capital of Maputo, leaving the more remote rural regions completely marginalized.xx This is especially significant in Mozambique’s context, as 72% of its people live in the rural areas, re-calculating the doctor to patient ratio to be 1:60,000 in the parts of the country inaccessible to the capital. Low yearly output of medical graduates, an insufficient education system, and inadequate salaries all contribute to these abysmal statistics. xxi The country spends about 5.8% of its annual GDP on health expenditures.xxii



Real Medicine Foundation

The Real Medicine Foundation is a humanitarian organization with a creative approach. Rather than go in with preconceived answers, we approach each situation by asking, "How can we help?" In this way, we can respond effectively and appropriately with customized services designed to best meet the immediate and long-term needs of the specific individuals and communities we serve. Our global network of "Friends Helping Friends" enables us to directly connect with those in need, carefully access how to make the greatest impact, and cooperatively deliver the highest-quality support. Whether we are providing physical, emotional, social, or economic support, our goal is to empower with real solutions that heal, give hope, and rebuild lives, both now and in the future.

The Real Medicine Foundation was founded in May 2005 inspired by lessons we learned after working for months in the tsunami relief efforts in Sri Lanka. We established a children's clinic in an area devastated by the tsunami. The clinic remains open, fully functional and very effective in healing the physically and emotionally displaced children of the region. While in Sri Lanka, we realized that most organizations going into crisis areas to provide aid for immediate needs tend to ignore that people's lives remain shattered long after physical trauma is no longer an issue. The Real Medicine Foundation was created to provide longer term, sustained support in disaster, war-torn and poverty ravaged areas in addition to immediate physical aid. This long-term support addresses physical, emotional, economic and social needs, helping heal the 'whole person' and the 'whole community'.

In Sri Lanka, we promised to take on the financing of several specific projects such as long-term medication for children, salaries for local doctors and treatment for post-traumatic stress syndrome. What started out as a promise to a small village in a devastated area on the Indian Ocean is growing quickly into an international network of "friends helping friends" around the world.

As Real Medicine prepared to deploy psycho trauma support teams around the world, Hurricane Katrina hit the United States on August 29. Quickly, the organization re-directed efforts and Mobile Psycho-Trauma teams were dispatched to work with children from Louisiana who had been displaced by the hurricane. The effectiveness of this domestic effort was then duplicated as Real Medicine dispersed teams of medical doctors in response to the South Asia earthquake of October, 2005, creating programs for long-term support and local training, rather than just medical triage.

Currently, the organization includes Real Medicine USA, Real Medicine Asia (with branches in Sri Lanka, India, Pakistan and Indonesia), Real Medicine Africa (with projects in Kenya, Nigeria, Uganda and Mozambique), and Real Medicine Europe (so far in Germany).

Our vision, our dream, is to extend this pace of development over the next three years. By July 2010, the Real Medicine Network will include regional headquarter operations on each continent with teams deployed on long term missions in every country where the need arises around the world. The Real Medicine Global Network will provide medical support as well as long term psychological, economic and social support where disaster, poverty and war drive the need to care for children and their families, and re-build community.



Sole of Africa The primary objective of The Mineseeker Foundation is to upgrade, construct and deploy airships equipped with the worlds foremost ground penetrating radar technology into the field to assist in the international plight to rid the world of landmines. The precise mapping and pinpointing of landmines across the world will vastly escalate the landmine removal process and as importantly will designate vast sectors of land to be landmine free, thereby aiding third world agricultural and economic sustainability.

The Mineseeker perspective concerning the funding and deployment of this unique technology is to focus on the immediate needs of a single country whose economic growth has been stunted by the effects of landmines within its borders. In the recent past Mozambique was devastated by over sixteen years of civil war. Today, under a free, peaceful and democratic society, the country’s social and economic growth still suffers from the crippling effects caused by landmines.

In November of 2004 The Mineseeker Foundation selected Mozambique as the first country in which to launch the Mineseeker Airship. Discussions with the government of Mozambique commenced and Project Mozambique was established.

In a meeting in Maputo in 2004, Mike Kendrick was inspired by Mrs Machel’s view of the possibilities that could be achieved for Mozambique. He suggested taking the Mineseeker concept a step further by including and applying an across the board self sustainable empowerment program. Once de-mined, the liberated land should be planted and the local population empowered and “foster managed” to sow, grow and harvest the unlocked land.

He conceived the “Sole of Africa” campaign and designed the powerful logo as a strong symbol that effectively reflects and underpins the entire program.

The Real Medicine Foundation is designed to capitalize on the passion of its members and supporters, always avoiding the crippling effects of bureaucracy. With a simple, lean coordinating management team in the US, operational teams are located in America, Asia, and Europe. All these teams are composed of people wanting to contribute their skills, time, knowledge, and their passion to support people in need.

Specifically, the work of the Real Medicine Foundation is to: provide medical support to disaster, post-war, and poverty stricken areas: to connect people to people: to re-build communities: to care for the future by caring for the children: to devise strategies for global solutions: to provide training for local people to extend the mission.

Partner with us and let’s make a difference in the world, together.

Country Page: Mozambique Initiative Page: Mozambique Mobile Clinic Project