Cyclone Freddy has moved on from Malawi, but it has left behind it a trail of destruction and the risk of an unprecedented cholera outbreak.

It is usually spread through contaminated water and, left untreated, it can be fatal within hours, even in previously healthy people.

Poor sanitation made worse by a lack of running water and adequate toilets in evacuation camps is exposing survivors to this and other waterborne diseases.

“We draw water from the nearby river which lies below a graveyard. In the same area are pit latrines. With the rains, they are filled with water and all that stuff is being swept into the river,” said survivor Elestina Chambo.

She is currently living in crowded conditions at the Chambo Evacuation Centre in the Zomba District, north-east of Malawi’s commercial capital, Blantyre.

While Malawi was already facing its worst cholera outbreak on record before Cyclone Freddy, it is not the only health concern the region now faces as a result of poor sanitation and contaminated water.

“To make thing worse, today at Chambo we reported cases of scabies. So, you would understand how scabies can spread in a place like this and how sanitation plays a role in places like this,” said Gomezgani Nyasulu, a Disaster Desk Officer.

International organisations said they are also concerned that stagnant pools of water may increase the incidence of insect-borne and waterborne diseases, such as dengue fever, and malaria.

In the evacuation centre there are few mosquito nets available.

“We urgently need insecticide-treated bed nets. Without them, we will be infected with malaria,” said another cyclone survivor, Cathelin Tchale.

With hospitals overwhelmed by the influx of casualties coming from different areas, the already stretched healthcare services are struggling to cope, including with people who were received regular treatment for other health issues.

“Some people in the camps have non-communicable diseases like asthma and epilepsy. We also have those on antiretroviral therapy. The health issues in the communities are just so huge that they need intervention from the district council,” said Innocent Mvula, the District Environmental Officer for Zomba District Council.

It is estimated that over 183,000 people fled their homes due to the storm and flood damage caused by Cyclone Freddy. Many of them have been left without access to healthcare, clean water, food, and a feeling of security.