Cyclone Freddy killed hundreds of people in February and March as it pummeled Madagascar, Malawi, and Mozambique. While the long-running storm’s victims were mostly in Malawi, floodwaters in Mozambique have created a fresh threat there from cholera. Cases have nearly doubled in one week to 19,000 amid a shortage of facilities, many of which were badly damaged by the cyclone, especially in the worst-hit province of Zambezia.

The neighborhood of Icidua, on the outskirts of Quelimane city in Mozambique’s central Zambezia province, has reported the highest number of cholera cases.

Most here lived in flimsy huts made of mud or bamboo that were flattened by the cyclone’s up to 215 kilometer per hour winds.

The local health center’s building is no longer stable, so doctors and nurses work outside under the shade of trees.

Mothers lined up patiently this week with their children for cholera treatment in one of the few wards that survived the storm.

The clinic’s director José da Costa Silva says the staff are working at high risk as the roof could collapse at any minute.

“Cholera cases are increasing, and the health center does not have the capacity to treat everybody. Most patients are referred to the provincial hospital,” he said.

The outbreak is not confined to Quelimane city.

The U.N. says more than 19,000 cases have been confirmed across eight of Mozambique’s 10 provinces.

The World Health Organization’s office has called it the worst cholera outbreak in Mozambique for 20 years.

At Quelimane Provincial Hospital, the director general of Mozambique’s National Health Institute this week addressed health workers in a packed room under a torn roof with two gaping holes.

Eduardo Sam Gudo Jr. tells the workers the cholera outbreak is getting more serious by the day.

Confirmed cases in Quelimane district alone have reached about 600 a day, he says, but the real number could be as high as 1,000.

“The disease is not localized to one neighborhood, it’s everywhere,” he said. “It can only be fought with a local chlorine water treatment product called ‘Certeza,’ but supplies are stretched and there aren’t enough people to distribute the bottles.”

Every day, volunteers collect crates of Certeza from outside the hospital and drive to neighborhoods like Icidua, where they walk from house to house, distributing bottles.

Each one should last a family for a week, but demand is massively outstripping supply as the cholera spreads.

For many Mozambicans still recovering in the cyclone’s wake, cholera is just one of many problems.

Outside the village of Nicoadala, about 300 people live in a makeshift camp of tarpaulin huts on a road next to a flooded field.

Their villages and fields are still under water, forcing them to fish in flooded rice paddies to survive.

Sixty-four-year-old Joaquina Bissane says she had to reach the camp by canoe after her village was submerged.

“Cholera is less of a problem here than malaria, as the damp and heat has turned these flatlands into a breeding ground for mosquitoes,” she said. They have received no support from the government, so they are supporting each other.

The World Food Program estimates the cyclone’s floodwaters destroyed 215,000 hectares of crops in Mozambique.

Seventy-year-old farmer Inácio Abdala says his family’s home and fields were among those destroyed.

He says they eat one day and don’t eat the next as they lost everything in the floods. Even the schools are flooded, so their children can’t go to school.

Even after the floods subside, saltwater brought inland by the cyclone may have damaged much of the soil.

Freddy hit just before the main harvest and officials say it will take months, or even years, for farmlands to fully recover — long after they hope to bring the cholera outbreak under control.

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