Prioritizing health and research needs of internally displaced populations in Mozambique: a policy and practice review

1 Introduction

Internally displaced persons (IDPs) constitute one of the most structurally vulnerable populations in contemporary humanitarian crises (1). Unlike refugees, who cross international borders and are entitled to protection under international refugee law (2, 3), IDPs remain within the territorial boundaries of their country of origin, often without adequate legal safeguards or access to coordinated assistance mechanisms (1, 4, 5). Over the past decade, internal displacement has expanded in both magnitude and complexity, driven by protracted armed conflicts, escalating climate-related disasters, and recurrent public health emergencies (6).

The United Nations High Commissioner for Refugees (UNHCR) defines IDPs “individuals or groups who have been forced or obliged to flee or to leave their homes or places of habitual residence, in particular as a result of, or in order to avoid, the effects of armed conflict, situations of generalized violence, violations of human rights, or natural or human-made disasters, and who have not crossed an internationally recognized State border” (5). This population represents a critical humanitarian concern not only because of its growing size, but also due to the multidimensional vulnerabilities and persistent protection gaps faced by displaced individuals (7). In contrast, under the 1951 Refugee Convention, a refugee is defined as a person who, owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group, or political opinion, is outside their country of nationality and is unable or unwilling to avail themselves of that country's protection” (2).

According to the UNCHR 2025, an estimated 123.4 million people worldwide were forcibly displaced by the end of 2024 due to persecution, conflict, violence, human rights violations, or events seriously disturbing public order. IDPs accounted for approximately 60% of this total, followed by refugees at around 30%, with the remainder comprising asylum-seekers and others in need of protection (8). Between 2018 and 2024, the number of IDPs more than doubled, rising from 40.5 million to 83.4 million, representing the highest level of internal displacement ever recorded across 111 countries and territories. In 2024 alone, 65.8 million new internal displacement movements were registered, as documented by the Internal Displacement Monitoring Center's (IDMC) Global Report on Internal Displacement 2025. These figures reflect displacement events rather than individuals, as repeated displacement of the same person is counted multiple times. Of these movements, 45.8 million were triggered by disasters and 20.1 million by conflict and violence (6).

The burden of internal displacement falls disproportionately on low- and middle-income countries. Nearly half of the global IDP population is concentrated in a single region, with sub-Saharan Africa accounting for an estimated 38.8 million people living in internal displacement (6).

Internal displacement rarely results from a single driver; instead, it reflects the intersection of armed conflict, climate and environmental hazards, weak governance, and deep-rooted structural vulnerabilities (9–12). Across diverse settings, IDPs consistently experience poorer health outcomes than surrounding populations, including elevated burdens of infectious diseases, malnutrition, mental health disorders, and maternal and child health risks (13).

Recent reviews highlight critical gaps in the evidence base. A scoping review by Swartz et al. indicates that existing research remains narrowly focused on communicable diseases and conflict-related mental health, while chronic conditions, maternal and reproductive health, long-term care needs, and health impacts in protracted or climate-related displacement contexts remain under-examined (14). Geographic coverage of research is similarly uneven, with limited data from regions experiencing recurrent climate-related disasters or prolonged armed conflict crises (15). Complementing this, Swartz et al. emphasized that IDP health outcomes are shaped not only by displacement itself but by overlapping structural determinants, fragile health systems, service disruption, insecurity, and chronic socio-economic deprivation factors that receive limited empirical attention (14). Together, these gaps underscore the need for integrated, context-specific research that captures the full spectrum of health risks faced by IDPs.

Addressing these challenges requires moving beyond narrow biomedical perspectives to incorporate the social determinants of health (SDH), including poverty, housing, food security, education, and gender, which shape health inequities in displacement settings. Without this broader lens, responses risk remaining fragmented and insufficient (16–19). Strengthening research is therefore essential to document inequities and inform multisectoral strategies that link humanitarian coordination, health systems, and social protection frameworks. Yet systematic, context-sensitive analyses remain scarce (20, 21).

Rather than assuming systemic misalignment or gaps, the emphasis should be on assessing whether existing governance mechanisms, coordination structures, and policy frameworks are adequately aligned, effectively implemented, and responsive to evolving displacement dynamics. Strengthening government responsibility, updating national policies, and reinforcing research on the SDH are critical steps. The Technical and Scientific Programme on Vulnerable Populations of the National Institute of Health (INS), Mozambique, addresses the health and wellbeing of migrants, including internally displaced populations. Building on this, the review delineates strategic pathways to strengthen the integration of research, policy, and practice in the field of internal displacement. It seeks to generate actionable, policy-relevant evidence to inform interventions and guide strategic priorities, thereby advancing health equity, system resilience, and institutional accountability for internally displaced persons (IDPs) in Mozambique.

2 Methodology

2.1 Article design and perspective

This article adopts a narrative, policy and practice-oriented perspective to synthesize empirical evidence, operational data, and governance and health research frameworks on internal displacement and health, with a focus on Mozambique and comparable crisis-affected, low-resource settings. A narrative review approach was selected to integrate heterogeneous evidence, policy documents, humanitarian assessments, and operational datasets, which are central to decision-making and health-system planning but not amenable to formal systematic review or quality appraisal. This approach enables integration of evidence relevant to programme design, health research prioritization, and health-system responses (22, 23). A PICO-informed framework was applied contextually (not as a systematic filter): Population—internally displaced persons (IDPs); Exposure/Intervention—conflict, disaster, and climate-related drivers; Context—humanitarian response, health systems, governance, and health research environments; Outcomes—health needs, protection gaps, service access, livelihood impacts, and research/data gaps. Sources published in English or Portuguese between 1999 and 2025 were eligible (24, 25).

2.2 Evidence identification and selection

To enhance transparency and reproducibility, explicit inclusion and exclusion criteria and a structured search strategy were defined a priori and documented in a written review guidance framework. Eligible sources included empirical studies, reviews, national policy documents, and technical or humanitarian reports addressing IDPs' health, displacement drivers, protection, humanitarian response, data systems, and health research or governance; purely theoretical works and non-empirical editorials were excluded. The author conducted screening and data extraction, with a second co-author independently verifying the results and focusing on reference allocation, figures and indicators, and internal consistency. Gray literature was explicitly included due to its central relevance for policy and practice (23, 26). Searches covered Medline libraries through PubMed search engine and Google Scholar, as well as institutional repositories including, but not limited to, those of the United Nations High Commissioner for Refugees (UNHCR), Internal Displacement Monitoring Center (IDMC), International Organization for Migration (IOM), United Nations Office for the Coordination of Humanitarian Affairs (OCHA), World Health Organization (WHO), United Nations Children's Fund (UNICEF); World Bank, Food and Agriculture Organization of the United Nations (FAO), International Federation of Red Cross and Red Crescent Societies (IFRC), Norwegian Refugee Council (NRC), and the Women's Refugee Commission (WRC), using key word combinations of displacement, geography, health, climate or conflict, and policy terms. Sources were prioritized for substantive contribution and relevance to policy and practice rather than exhaustive retrieval; a total of 126 documents were finally included. Although formal quality appraisal or risk-of-bias scoring was not applied, credibility was strengthened through triangulation across peer-reviewed literature, operational data, and policy documents. Additionally, key references were independently verified, and internal consistency checks were conducted across reported displacement and health system data.

2.3 Supplementary discovery tools and data handling

ChatGPT (OpenAI, GPT-5.2) was used solely as a supplementary support tool during evidence identification, primarily to assist in locating institutional reports, policy documents, and gray literature. Clear and restrictive prompts were applied (e.g., requesting accurate, verifiable reports from recognized institutions), and all AI-suggested sources were independently retrieved from original repositories and screened against predefined eligibility criteria. ChatGPT was not used for data extraction, analysis, interpretation, or synthesis, and all inclusion decisions remained the author's responsibility (27–29). A snowballing strategy was applied primarily to peer-reviewed literature, through systematic screening of reference lists and forward citation tracking of influential publications. Authors with two or more relevant publications were systematically searched to strengthen coverage of established research trajectories (30). Grammarly Desktop [Version 1.146.3 [1.146.3.0]] was used to support language checking, stylistic consistency, and translation between Portuguese and English (31). Grammarly was not used for content generation, data interpretation, or analytical decisions; the author made all substantive revisions. Data extraction captured bibliographic details, document type, keywords, and concise summaries. Documents were mapped within a multi-domain conceptual framework to capture the thematic breadth of evidence on internal displacement and health. Internally Displaced Persons (IDPs) were positioned as the central analytical focus (1), surrounded by eight thematic domains: (2) governance and policy; (3) drivers of displacement; (4) humanitarian response (including protection services and gender-based violence [GBV]); (5) health dimensions; (6) climate and environmental factors; (7) socioeconomic conditions; (8) research and health data systems; and (9) methodological approaches. Each document was assigned to one or more domains based on its primary analytical contribution. Because many sources address multiple dimensions of displacement, classifications were not mutually exclusive, reflecting the interconnections between governance, health systems, climate risk, and humanitarian response. Domain counts, therefore, represent thematic linkages rather than unique document totals. References classified across multiple domains are summarized in Supplementary Table 1. This mapping enabled a structured synthesis of interdisciplinary evidence while preserving the complexity of displacement-related research (Figure 1).

3 Conflict–disaster–vulnerability nexus

3.1 Armed conflict and violence

Global monitoring data indicate that, by December 2024, conflict and violence had displaced an estimated 73.5 million people, accounting for approximately 90% of the global internally displaced population. This represented a 10% increase from 2023 and a 45% rise over the past decade. Although violent events were recorded in 61 countries and territories, displacement remained highly concentrated, with 10 countries accounting for nearly three-quarters of all conflict-related IDPs. The largest populations were observed in Sudan (11.6 million), Syria (7.4 million), Colombia (7.3 million), the Democratic Republic of Congo (6.2 million), and Yemen (4.8 million) (6, 32).

Contemporary displacement dynamics are increasingly characterized by recurrent, overlapping, and protracted trajectories, as illustrated by long-standing crises in Mozambique and Afghanistan (6). Specific episodes further demonstrate the persistence of conflict-related displacement: in Lebanon, the 2006–2007 war displaced approximately 1 million people and left agricultural land contaminated by unexploded ordnance (33); in Haiti, escalating gang violence increased displacement from 315,000 in 2023 to over 1 million in 2024, with many individuals experiencing multiple displacements (34). Gaza represents an extreme case, where approximately 90% of the population has been repeatedly displaced due to sustained bombardment (35).

3.2 Disaster and climate hazards

By the end of 2024, approximately 9.8 million people were living in internal displacement as a result of disasters, a 29% increase from 2023, alongside historically unprecedented levels of recurrent disaster-related displacement movements across 163 countries and territories, more than double the long-term average since monitoring began in 2008 (6). Recent events in sub-Saharan Africa illustrate this escalation. Extreme flooding in Chad displaced more than 1.3 million people, exceeding the cumulative displacement of the previous 15 years and marking the largest displacement event in the country's history (36). Recurrent droughts in the Horn of Africa continued to force pastoralist communities in Somalia, Ethiopia, and Kenya to move in search of water and pasture (37). In Nigeria, annual flooding in the Niger and Benue river basins displaced hundreds of thousands of people, reflecting the combined effects of inadequate infrastructure, unregulated urban expansion, and increasing climate variability (38).

Disaster and climate-related hazards, including floods, droughts, earthquakes, and tropical cyclones, are major drivers of internal displacement in low- and middle-income countries, where limited coping capacity, high exposure, and entrenched vulnerabilities magnify their impacts (39, 40). Climate change is intensifying these hazards by increasing their frequency, severity, and geographic reach, thereby escalating displacement risk (41). The resulting outcomes reflect interactions between hazard, exposure, vulnerability, and capacity, explaining why events of comparable magnitude generate disproportionately severe consequences in settings characterized by poverty, rapid urbanization, and weak infrastructure (42, 43).

3.3 Structural vulnerabilities

Evidence from the IDMC shows that since 2009, the number of countries affected by both conflict and disaster-related displacement has more than doubled, increasing from fewer than 30 to over 60 countries by the early 2020s, reflecting increasingly convergent drivers (6, 42). This overlap is compounded by climate exposure, with more than three-quarters of conflict-displaced people living in highly climate-vulnerable settings (6, 44). In sub-Saharan Africa, concurrent flooding and conflict in Nigeria and the Democratic Republic of Congo, alongside cyclones affecting conflict-impacted regions in Mozambique and Myanmar, illustrate how overlapping crises repeatedly disrupt humanitarian response and intensify food insecurity (6). These dynamics underscore the need for integrated preparedness, anticipatory action, and health-system resilience strategies that address conflict and climate risks simultaneously, specific to contexts marked by poverty, weak governance, and fragile health and social systems (45).

4 Social-health profile of internally displaced persons

Understanding the social and health profiles of IDPs is essential for designing equitable and effective responses. Evidence indicates that displacement systematically intensifies vulnerability, with IDPs experiencing poorer health outcomes than surrounding populations, including elevated risks of infectious and non-communicable diseases, maternal and child health complications, and mental health disorders, shaped by broader social determinants such as poverty, disrupted livelihoods, and social exclusion (15). Situating IDP profiling within this wider analytical frame is critical for guiding targeted research, informing preparedness, and strengthening health-system responses, particularly in contexts where public health threats compound existing risks and humanitarian systems are capacity-limited (20, 46, 47).

4.1 Social profile of internally displaced persons

Comprehensive profiling of IDPs should integrate demographic attributes (age, sex, household composition), socioeconomic conditions (poverty, livelihoods, education), and displacement trajectories (single, repeated, or protracted), as these factors collectively shape risk and resilience. Globally, women and girls constitute a slight majority of IDPs, and children represent roughly 45% of the displaced population, with women facing heightened risks of economic marginalization and gender-based violence. IDPs experience elevated poverty, disrupted livelihoods, limited access to education, and constrained health services, placing them among the most vulnerable population groups (48). Most displacement occurs over short distances within the same region: around 42% of IDPs live in urban areas, while only about one-quarter reside in camps or informal settlements, and the remainder live within host communities, often in informal or protracted arrangements (36). Repeated and protracted displacement further exacerbates cumulative needs by interrupting livelihoods and increasing dependence on already strained local systems, highlighting the importance of capturing displacement trajectories to inform durable, context-sensitive interventions (49).

4.2 Health profile of internally displaced persons

A global systematic review of 1,759 mortality surveys found that IDPs experience an estimated 2.5-fold excess mortality compared with baseline populations, largely due to preventable infectious diseases, malnutrition, and limited access to care (50). Surveillance in Somali IDP settlements reported crude death rates of 1.26–3.15 deaths per 10,000 persons per day and under-five mortality of up to 7.05 per 10,000 per day, consistent with severe humanitarian emergencies (51). Infectious diseases remain major contributors to morbidity. Malaria shows a pooled prevalence of approximately 36% (95% CI 25–47%) among displaced populations in Africa, with some settlements in Nigeria reporting prevalence approaching 68% (52). Respiratory and diarrhoeal diseases are consistently reported as leading causes of illness in camps and informal settlements (15). Nutritional indicators are similarly concerning, with surveys reporting stunting or acute malnutrition levels of 14–23% among displaced children in Somaliland and Cameroon (53, 54). Mental health burdens are substantial. A 2025 systematic review and meta-analysis estimated a pooled prevalence of depressive symptoms of approximately 64% among displaced populations in sub-Saharan Africa (55). These risks are further amplified by repeated and protracted displacement, which erodes coping capacity and heightens dependence on overstretched local systems (51, 52).

5 Mozambique overview

5.1 Demographic and socioeconomic

Located in southern Africa, Mozambique borders Tanzania to the north, Malawi and Zambia to the north-west, Zimbabwe to the west, South Africa and Eswatini to the south-west, and the Indian Ocean to the east. The country covers approximately 799,380 km² and is administratively divided into 11 provinces, including Maputo City. The southern region comprises Maputo City, Maputo, Gaza, and Inhambane; the central region includes Manica, Sofala, Tete, and Zambézia; and the northern region encompasses Nampula, Cabo Delgado, and Niassa (Figure 2) (56, 57). Mozambique has a tropical climate, with a cool, dry season from April/May to October/November and a hot, rainy season from November/December to March/April, with peak rainfall between December and January (58).

Mozambique remains at an early stage of demographic transition, characterized by rapid population growth and a predominantly young and rural population (Table 1). In 2025, the population is projected at 34.1 million (51.6% women; 48.4% men), with a density of 41 inhabitants per km² and an annual growth rate of 2.5%. Projections from the National Statistics Institute (INE) suggest that the population could approach 60 million by 2050. The age structure is heavily skewed toward youth, with 43% under 15 years and only 3% aged 65 years or older. Approximately 65% of the population (22.1 million) resides in rural areas, compared with 35% (11.9 million) in urban centers (56, 59–61).

Table 1. Mozambique socio-demographic indicators.

^aDependency burden = proportion of population aged 0–14 and 65+ relative to the working-age population (15–64), per INE standard.

^bMPI uses the Alkire–Foster multidimensional method with indicators across health, education, and living standards.

^cLiteracy definition (UNESCO/INE): the ability to read and write a simple statement.

^dImproved water & sanitation definitions per the WHO/UNICEF joint monitoring programme (JMP).

^eNo verified global or sub-Saharan Africa (SSA) comparator available for mobile phone ownership.

^fNo national total reported; only urban and rural values are available in INE 2022–23.

Poverty remains widespread and structurally entrenched. Mozambique ranks 182nd of 193 countries in the United Nations Development Programme (UNDP) Human Development Report, with a Human Development Index (HDI) of 0.493. More than half of the population is multidimensionally poor (MPI 0.607); 38.8% experience severe poverty, and 74.5% live below the international poverty line of US$2.15 per day (Table 1) (62).

Educational outcomes reflect persistent gendered and geographic disparities. Adult illiteracy remains high at 39%, with marked differences between women (49.4%) and men (27.2%) (59). Although youth illiteracy has declined, it remains substantial, affecting 34.5% of young women and 21.6% of young men (63). Spatial inequalities are pronounced: approximately 31% of rural adults have never attended school, compared with around 10% in urban areas (64). Learning outcomes are critically low, with only 4.9% of grade-three pupils able to read a simple text and 7.7% demonstrating basic numeracy skills (65). Primary school dropout remains high at 24% nationally, with large rural-urban disparities (18% vs. 6.7%) (Table 1) (66).

Living standards remain severely constrained (Table 1). In 2022, 62.9% of the population lived in poverty (67). Access to basic infrastructure is limited: only 36% of households have electricity, 72% in urban areas compared with 9% in rural settings (68). Coverage of safely managed drinking water and sanitation services remains low at 28% and 34%, respectively (69). Asset ownership also reflects stark inequalities: while mobile phone ownership reaches 69% nationally, only 11% of rural households own a television, and radio ownership declines to 29% (70). Informal employment dominates the labor market (77%), limiting income stability and access to social protection (71).

Mozambique's rapid population growth, predominantly rural settlement patterns, and youthful age structure generate significant structural vulnerabilities. These demographic pressures intersect with high poverty, low educational attainment, and limited access to basic services, collectively reducing resilience and amplifying exposure to climatic, economic, and conflict-related shocks. Low-income households have limited capacity to absorb and recover from such shocks, increasing susceptibility to displacement. Displacement, in turn, disrupts livelihoods, social networks, and access to essential services, reinforcing poverty cycles and constraining progress toward the Sustainable Development Goals (SDGs) (71, 72). These structural constraints undermine coping capacity and disproportionately affect IDPs, who often resettle in areas with weak infrastructure, limited services, and community resources operating under sustained strain (15, 72).

5.2 Health profile

The health indicators presented in Table 2 reveal persistent structural vulnerabilities that continue to constrain population resilience and human development in Mozambique. Life expectancy remains low at 56.9 years in 2023, 59.9 years for women and 54.0 years for men, well below sub-Saharan Africa (SSA) averages, reflecting longstanding inequities in access to essential health and social services (59, 61, 73).

Table 2. Mozambique health indicators.

^aIncidence calculated using the total population denominator from the Ministério da Saúde—Anuário Estatístico de Saúde 2024.

^bNo nationally endorsed mental-health epidemiological survey exists; WHO/IHME modeled estimates are not used in national reporting.

As shown in Table 2, indicators of sexual, reproductive, and maternal health (SRMH) highlight substantial gaps in service coverage and quality. Fertility remains high at 4.9 children per woman, sustaining population growth and intensifying demand on already overstretched services (70, 74). Maternal mortality, although declining, remains elevated at 233 deaths per 100,000 live births, while under-five mortality stands at 60 per 1,000 live births-both among the highest in the region and indicative of persistent weaknesses in antenatal care, skilled birth attendance, and emergency obstetric capacity (75, 76). Contraceptive uptake remains low, with limited condom use reported at last intercourse (8% among women and 16% among men), reflecting broader constraints in access to modern family planning services in Mozambique, including supply shortages and gaps in skilled sexual and reproductive health providers (70, 77).

Mozambique continues to face a heavy burden of infectious diseases. Malaria remains the leading cause of outpatient consultations, with 11.6 million confirmed cases and an incidence of 349 per 1,000 population in 2024, substantially exceeding regional averages (75). HIV prevalence among adults aged 15–49 years remains high (12.5%), with a disproportionate burden among women, while tuberculosis incidence stands at 134 per 100,000, driven mainly by HIV co-infection (78–80). Routine immunization coverage for essential vaccines (60–05%) remains below global benchmarks, contributing to recurrent measles outbreaks (546 confirmed cases in 2024) and the detection of wild poliovirus during 2022–2023, underscoring persistent immunity gaps and operational weaknesses in routine immunization programmes (75, 81).

Non-communicable diseases (NCDs) constitute an increasingly important component of the national disease burden. Data from the InCRÓNICA 2024 survey indicate that 31.6% of adults aged 18–69 years have hypertension, comparable to the global average of approximately 31% (82, 83). Diabetes prevalence is 16.1%, substantially exceeding international averages (8–9%), while overweight and obesity affect 41.7% of adults, signaling an advanced epidemiological transition that is not matched by diagnostic capacity or chronic-care services (82, 84). Daily tobacco use remains relatively high at 9.7%, adding preventable risk for cardiovascular and chronic respiratory diseases (82, 85). No nationally representative survey exists to estimate the prevalence of common mental disorders; available evidence derives from small-scale studies and operational assessments, which consistently report high psychological distress, particularly among conflict and displacement-affected populations, but cannot be generalized nationally (86–88).

Human resource shortages remain a critical constraint on health-system performance. With approximately eight physicians and 77 nurses per 100,000 population, levels well below regional and global benchmarks, the system struggles to ensure service quality, equitable geographic coverage, and operational resilience, challenges that are most acute in underserved rural areas (75, 89). As detailed in Table 2, health-system readiness is low across major service domains: 52% of facilities meet readiness standards for communicable-disease services, 41% for maternal and newborn care, and only 28% for NCD management (90). Structural gaps include limited essential equipment (45%), insufficient availability of key medicines (56%), and weak laboratory capacity (39%). These deficits are compounded by inadequate surveillance of antimicrobial resistance (AMR), despite an estimated 5,760 AMR-attributable deaths in 2021 (91).

Overall, Mozambique's health profile reflects persistent structural constraints that limit population resilience and magnify the health impacts of shocks. High burdens of communicable and non-communicable diseases, low service readiness, and chronic shortages of health workers and essential inputs weaken the continuity and quality of care, more pronounced in rural and underserved areas. These constraints disproportionately affect IDPs, who are more likely to rely on overstretched facilities with limited capacity to absorb additional demand. As a result, displacement amplifies existing inequities, increasing vulnerability to preventable morbidity and mortality while constraining recovery in contexts already characterized by fragile health systems.

6 Internal displacement in Mozambique

Mozambique exemplifies a context in which armed conflict, climate-related hazards, and long-standing structural vulnerabilities interact to produce sustained internal displacement. Since independence, the country has experienced recurrent population movements, initially driven by armed conflict and, from the early 2000s, increasingly compounded by hydrometeorological disasters. Between 2016 and 2025, an estimated 4.2 million internal displacement movements were recorded, reflecting the growing overlap and intensification of these drivers. As summarized in Table 3, displacement dynamics have shifted from largely episodic events to a protracted, multi-driver crisis since 2017 (92).

Table 3. Selected conflict and climate-related internal displacement events in Mozambique (1977–2025).

^aDisplacement figures are point-in-time estimates unless otherwise specified and are derived from operational displacement tracking and are subject to revision.

^bAffected/evacuated populations are reported only where explicitly distinguished from displaced in the source.

^cSocio-demographic percentages (female-headed households; hosting by families) are derived from IOM-DTM household modules and vary by assessment round and location.

6.1 Conflict-driven displacement

The civil war (1977–1992) generated displacement on an exceptional scale, with demographic reconstructions estimating 3.0–4.0 million IDPs at peak and humanitarian archives documenting several million cumulative displacement movements alongside large-scale refugee outflows to neighboring countries (92, 93). Displacement was nationwide, disproportionately affecting central provinces, and was characterized by extensive rural-urban movements and a high proportion of children. The post-war period was marked by mass returns and reintegration, including the resettlement of internally displaced populations (93).

Following a period of relative stability, renewed armed clashes between government forces and the Mozambican National Resistance (Resistência Nacional Moçambicana—RENAMO) led to a resurgence of conflict-related displacement in central Mozambique. Human rights and conflict monitoring reports document temporary displacement linked to violence and road ambushes in Sofala and Manica, with many households returning after de-escalation. However, displacement became more recurrent during 2015–2016, affecting approximately 15,000 persons (32, 94–96).

A major structural shift occurred in Cabo Delgado following the insurgency from 2017 onwards. Operational tracking indicates a rapid escalation of displacement during 2019–2020, followed by a transition to protracted and cyclical displacement characterized by repeated movements, partial returns, and re-displacement. By March-April 2025, national estimates confirmed the persistence of large-scale internal displacement nearly a decade after the insurgency began (34). Across assessment rounds, children and female-headed households remain disproportionately represented, and most displaced households reside with host families rather than formal sites (34, 36, 97).

6.2 Disaster-related displacement

Hydrometeorological hazards have been a major driver of internal displacement since 2000, producing recurrent large-scale movements alongside conflict. Major disasters, including floods and cyclones Eline (2000), Favio (2007), Dineo (2017), Idai and Kenneth (2019), Eloise (2021), Freddy (2023), and Chido (2024), have led to large-scale displacement and significant humanitarian disruption. Still, typically these are short-duration displacements that often affect hundreds of thousands of people. These events are consistently associated with housing destruction, mass evacuations to accommodation centers, and severe disruption to livelihoods, health services, and basic infrastructure, followed by phased returns (98–106).

Beyond nationally visible disasters, recurrent provincial and district-level floods and droughts generate smaller but repeated displacement episodes that are often under-captured in national statistics (98). Recent assessments of El Niño-related drought displacement illustrate how livelihood loss and food insecurity can prolong displacement by constraining return options and increasing pressure on host communities (97, 106).

6.3 Cumulative burden and conflict–climate nexus

As summarized in Table 3, internal displacement in Mozambique is cumulative rather than episodic, with recurrent conflict and disaster-related movements repeatedly affecting the same regions and households, progressively eroding recovery capacity and reducing the feasibility of durable solutions over time (34, 36, 98).

Hydrometeorological hazards continue to generate prominent but typically short-duration displacement peaks, often followed by phased returns once immediate risks subside (98–106). In contrast, conflict-related displacement, which began with the onset of the Cabo Delgado insurgency, has become increasingly protracted, characterized by repeated displacement, partial returns, and re-displacement, as insecurity, infrastructure destruction, and protection risks constrain sustainable return options (34, 36).

Climate hazards increasingly intersect with conflict dynamics, acting primarily as risk multipliers rather than independent drivers of protracted displacement. Cyclones Kenneth (2019) and Chido (2024), which struck northern Mozambique during periods of active insecurity, intensified displacement by damaging shelters, disrupting humanitarian access, and undermining recovery in already conflict-affected areas (101, 105). While conflict remains the principal driver of sustained displacement in northern Mozambique, longer-term climate anomalies, including El Niño-associated droughts, can act as both independent drivers and multipliers of protracted displacement, particularly in areas already hosting IDPs from earlier cyclone events (100, 102, 106).

The cumulative burden of these overlapping drivers is reflected in persistent vulnerabilities among displaced populations, with children and female-headed households consistently overrepresented (6, 97). The spatial concentration of conflict and climate hazards, most notably in Cabo Delgado and cyclone and flood-prone central provinces such as Sofala and Zambézia, has shifted displacement from a temporary emergency to a chronic condition, underscoring the need for integrated, longer-term responses (97).

7 Health impacts of internal displacement in Mozambique

7.1 Health and protection impacts of internal displacement: mechanisms and pathways

National-scale health research assessing Mozambique's vulnerability to and adaptation needs for addressing climate change provides essential context for understanding health risks in displacement-affected settings. Using district-level epidemiological, socio-economic, and climate data, Muleia et al. identified widespread health vulnerability, notably in rural and northern districts, driven by low adaptive capacity, limited access to health services, inadequate water and sanitation, and high burdens of malaria, diarrhoeal disease, and malnutrition. Although not specific to IDPs, these vulnerabilities spatially overlap with displacement-affected areas and help explain disproportionate health impacts during conflict and climate shocks (107).

Operational evidence demonstrates that internal displacement amplifies health risks by disrupting access to essential services. Reporting by UNICEF and OCHA shows that insecurity-related displacement has constrained routine service delivery, necessitating mobile health and nutrition brigades and disproportionately affecting maternal, neonatal, and child health through interrupted care, immunization gaps, elevated communicable disease risk, and increased acute malnutrition (108). Environmental shocks further act as risk multipliers, damaging health infrastructure, interrupting disease surveillance, and increasing outbreak risk, notably cholera, thereby amplifying preventable morbidity and mortality among displaced populations in low-capacity settings (109).

Emerging evidence also indicates a substantial mental health and protection burden. Studies among IDPs in Cabo Delgado report high prevalence of post-traumatic stress disorder, depression, and anxiety, with elevated risk among women and those exposed to repeated violence and loss (88). Qualitative research by UNHCR and the London School of Hygiene and Tropical Medicine (LSHTM) documents pervasive risks of gender-based violence (GBV) in displacement and resettlement settings, including intimate partner violence, sexual exploitation, and forced or early marriage, alongside limited availability of specialized GBV services (110–112).

7.2 Health outcomes among internally displaced persons in Mozambique

In Mozambique, IDPs experience compounded health risks arising from repeated displacement, disrupted livelihoods, and limited access to essential services. Mobility-tracking data indicate that many IDPs reside in host communities or return to areas where health, WASH, and nutrition services were already constrained, resulting in cumulative exposure to service gaps rather than short-term shocks (97).

Evidence from northern provinces shows that displaced women and children are conspicuously affected by interrupted antenatal care, delayed facility-based delivery, immunization gaps, and elevated risk of acute malnutrition. Loss of health documentation, uncertainty about service availability, and repeated movements further undermine continuity of care, especially for maternal and child health services (97, 113).

Across conflict and climate-affected settings, repeated displacement generates sustained psychosocial stress while access to mental health and psychosocial support remains minimal. Prolonged insecurity, uncertainty around return, and dependence on overstretched host communities contribute to persistent distress among IDPs, with limited capacity within district health services to respond beyond acute care (113).

7.3 Health-system pressures in displacement-affected districts

Internal displacement places sustained pressure on district health systems by shifting populations into areas with limited absorptive capacity. In displacement-hosting districts in Cabo Delgado, Nampula, Sofala, and Manica, health facilities face overcrowding, longer waiting times, recurrent medicine stockouts, and increased demand for maternal, child, and emergency services (97).

Recurrent climate-related displacement further disrupts service delivery through infrastructure damage, road inaccessibility, and environmental exposure. Flooding and cyclones have damaged health facilities, contaminated water sources, and constrained outreach activities, reducing access to routine care and heightening outbreak risk during and after displacement episodes. These pressures weaken service continuity, delay recovery, and strain already fragile systems, specifically in districts simultaneously hosting IDPs and supporting returnees, where staffing, infrastructure, and financing gaps are most pronounced (97, 107).

7.4 Policies for internally displaced persons: health implications

Mozambique has taken an important step toward the structured governance of displacement by adopting the Policy and Strategy for the Management of Internally Displaced Persons (Política e Estratégia para a Gestão de Pessoas Deslocadas Internamente—PEGDI) (114). The policy aligns broadly with the UN Guiding Principles on Internal Displacement (5) and the African Union Kampala Convention (ratified by Mozambique in 2017) (115), and adopts a multisectoral framework spanning prevention, preparedness, response, and recovery. PEGDI assigns the Ministry of Health responsibility for primary healthcare, sexual and reproductive health, nutrition, and health promotion in displacement settings.

However, PEGDI's effectiveness as a health-governance instrument remains limited. The policy lacks legal enforceability, provides limited operational guidance for prioritizing high-risk groups, and insufficiently integrates conflict and disaster-related displacement within a unified framework. Weak monitoring and accountability mechanisms further constrain tracking of health outcomes among IDPs and returnees. At the same time, the emphasis on short-term response over long-term resilience increases the risk of persistent health vulnerabilities (114).

7.5 Health research, surveillance, and governance gaps related to displacement

Mozambique's National Research Agenda in Human Health (Agenda Nacional de Pesquisa em Saúde Humana-AGISA) prioritizes vulnerability, resilience, health equity, and health-systems strengthening areas highly relevant to protracted displacement (107, 116, 117). However, internal displacement is not consistently framed as a structural determinant of health. Displacement-related impacts on primary care, maternal and child health, nutrition, WASH, and mental health are addressed mainly implicitly within broader emergency or vulnerability categories, limiting systematic analysis of cumulative and long-term effects (97, 113).

This gap is reflected in governance and implementation. Despite persistent displacement-related health impacts, responses remain predominantly emergency-oriented, with limited integration of displacement into routine health planning, surveillance, and climate-adaptation frameworks (114). Fragmented coordination and weak interoperability among displacement-tracking, early-warning, and health information systems further constrain evidence-based planning, notably at the district level, where capacity and fiscal autonomy are most limited (97, 107). Existing frameworks also inadequately address the health risks associated with premature or unsupported returns, which often occur in contexts of restricted access to healthcare, WASH, and livelihoods (97, 113).

8 Technical and scientific programme on vulnerable populations: displacement-sensitive health research and policy alignment

The Technical and Scientific Programme on Vulnerable Populations of the National Institute of Health (INS), Mozambique addresses internal displacement as a structural public health and health systems challenge in a national context increasingly shaped by conflict and climate-related population mobility. Through five strategic objectives, the Programme outlines priority pathways to advance displacement-sensitive, equity-oriented health research that informs policy, practice, and system strengthening. Aligning these objectives with explicit displacement-focused research priorities and empirical evidence from Mozambique and comparable settings clarifies pathways from evidence generation to policy action, supports the integration of digital innovation and implementation research, and helps target strategic research investment. By linking epidemiological, implementation, and governance dimensions, the Programme aims to improve equitable access to health care and essential services for IDPs, while strengthening resilience and responsiveness in host and resettlement communities (118).

Objective 1. Integrate digital technologies and artificial intelligence to strengthen research, enhance analytical processes, and ensure robust data modeling on risks and vulnerabilities affecting vulnerable populations.

This objective advances displacement-sensitive epidemiological and implementation research by leveraging digital platforms and advanced analytics to collect primary data and integrate secondary data sources, including routine health information systems and displacement-tracking datasets. By improving data triangulation, linkage, and modeling capacity, it strengthens the evidence base on health risks, service disruptions, and vulnerability patterns among IDPs and host communities. Peer-reviewed studies consistently document elevated burdens of infectious diseases, non-communicable conditions, and mental health disorders among IDPs, driven by disrupted services, overcrowding, and structural exclusion. Evidence from the East and Horn of Africa demonstrates how population-based surveys and facility-linked analyses can identify gaps in care continuity, referral pathways, and treatment access in displacement settings (119, 120).

Methodological work by the IOM further shows how displacement-tracking systems, including the Displacement Tracking Matrix, improve population estimates, mobility profiles, and vulnerability mapping through multi-source data collection and validation, strengthening denominators for health planning where routine systems do not capture displacement status (121). Global syntheses highlight how conflict and climate-related displacement interact with health-system capacity to shape disease risk and service disruption, underscoring the need for integrated analytical approaches to preparedness and response (122).

Objective 2. Foster the dissemination and utilization of scientific evidence to inform, educate, and guide public health interventions and policies.

This objective strengthens the translation of displacement-focused evidence into humanitarian action, health-system planning, and policy processes. Empirical studies among IDPs document substantial barriers to healthcare access, utilization, and affordability, alongside poorer quality of life, specifically in contexts of protracted displacement and insecurity (6). WHO evidence briefs and global syntheses emphasize the value of accessible, policy-oriented knowledge products, such as evidence briefs, operational summaries, and situational analyses, to support displacement-sensitive decision-making in conflict and climate-affected settings (122, 123).

Objective 3. Monitor and evaluate the effectiveness of interventions addressing the needs of vulnerable populations.

Research under this objective assesses whether interventions reach IDPs equitably and achieve intended health outcomes over time. Available evidence links displacement status to care discontinuities, reduced service utilization, and poorer outcomes, explicitly for mental health and chronic conditions (6, 119, 120). Methodological guidance supports adapting monitoring and evaluation approaches by incorporating information on population mobility and by improving the interpretation of health indicators and outbreak signals, even where routine systems do not systematically record displacement status (121). These approaches support displacement-sensitive monitoring of coverage, equity, and programme performance.

Objective 4. Ensure the active participation of vulnerable populations in the generation of scientific evidence, in the development and incorporation of strategies that promote equity and improve health.

Evidence indicates that barriers to healthcare access among IDPs are closely linked to social exclusion, information gaps, and limited participation in decision-making processes (6). WHO policy-oriented evidence highlights that participatory approaches are central to displacement-inclusive health systems, thereby improving relevance, acceptability, and trust in health interventions, especially in fragile and climate-affected contexts (122, 123). This objective is operationalised through participatory research designs, community validation of findings, and inclusive dissemination strategies that ensure IDPs contribute meaningfully across the research and policy cycle.

Objective 5. Strengthen governance, coordination, and multisectoral action through evidence-informed approaches.

Health outcomes for IDPs are shaped by governance arrangements that extend beyond the health sector, including disaster risk management, social protection, and climate adaptation. Global monitoring reports documenting the scale, drivers, and protracted nature of internal displacement underscore the need for coordinated, multisectoral responses grounded in robust evidence (124). Strengthening governance and coordination is therefore a prerequisite for translating research into sustained, system-wide improvements.

Together, Objectives 1–5 articulate a theory of change in which displacement-sensitive health research generates robust evidence on health risks and service-delivery constraints affecting internally displaced persons (Objective 1), translates this evidence into policy and practice (Objective 2), and continuously adapts interventions through displacement-aware monitoring and evaluation (Objective 3). Meaningful participation of IDPs enhances the relevance, legitimacy, and uptake of evidence (Objective 4), while evidence-informed governance and multisectoral coordination embed these processes within resilient health and social systems (Objective 5). Collectively, these pathways provide a practical framework for integrating internal displacement into health research, planning, and governance in Mozambique, and for reducing displacement-related health inequities in protracted crisis settings (125).

The following policy and practice implications translate this framework into priority actions for health authorities, humanitarian actors, and development partners.

9 Policy and practice implications

The evidence synthesized in this review highlights several priority actions to strengthen health equity and system resilience in displacement-affected settings. These implications translate strategic research and governance priorities into practical directions for policy formulation, programme design, and implementation.

First, displacement should be systematically incorporated into routine health planning and service delivery rather than treated solely as a humanitarian exception. Health authorities should ensure continuity of essential services, specifically primary care, maternal and child health, nutrition, and mental health, in districts hosting displaced populations, including during periods of return, relocation, or renewed displacement.

Second, a stronger linkage between displacement-tracking mechanisms and health information systems is required to improve situational awareness and planning. Integrating mobility-sensitive population estimates into surveillance and monitoring frameworks would enhance outbreak detection, service coverage assessment, and accountability in settings characterized by frequent population movement.

Third, monitoring and evaluation approaches should be adapted to capture the equity and effectiveness of interventions targeting displaced and host populations over time. This includes tracking service access, continuity of care, and outcomes across displacement trajectories, as well as assessing whether programmes reach populations experiencing repeated or protracted displacement.

Fourth, meaningful engagement of internally displaced persons should be embedded within programme design, implementation, and evaluation. Participatory approaches can improve the relevance, acceptability, and sustainability of interventions, while helping to identify barriers related to information access, trust, and social exclusion that are not captured through routine data systems.

Finally, improved governance and multisectoral coordination are essential to address the health impacts of displacement as part of broader development and climate adaptation efforts. Aligning health-sector planning with disaster risk management, social protection, housing, and livelihood interventions can reduce fragmentation, strengthen district-level capacity, and support more durable solutions for displaced and host communities.

10 Conclusion

Internal displacement has become a defining global public health and health-systems challenge, affecting tens of millions of people and increasingly driven by the convergence of armed conflict, climate-related hazards, and long-standing structural vulnerabilities. Understanding who IDPs are, how displacement unfolds over time, and how social, economic, and environmental conditions shape health risks is essential for designing equitable and effective responses. IDPs are not a homogeneous population; health outcomes vary according to displacement trajectories, gender, age, poverty, exposure to violence, and the capacity of host communities and health systems to absorb sustained population movements.

Mozambique illustrates how national demographic, socioeconomic, and health-system characteristics can amplify the health impacts of displacement. Rapid population growth, widespread poverty, low educational attainment, high burdens of communicable and non-communicable diseases, and persistent health-system constraints interact with conflict and climate shocks to increase vulnerability to displacement and prolong its consequences. In this context, displacement functions as a multiplier of existing inequities, disrupting access to care, undermining service continuity, and deepening exposure to adverse social determinants of health, including food insecurity, inadequate housing, unsafe water and sanitation, and limited livelihoods.

This review demonstrates that addressing the health impacts of displacement requires moving beyond short-term humanitarian responses toward displacement-sensitive research, health-system planning, and integrated governance frameworks. Policies and programmes that fail to account for the cumulative and protracted nature of displacement risk reinforce cycles of vulnerability, while health systems that do not integrate displacement into routine planning struggle to ensure continuity of care for both displaced and host populations. These challenges are further compounded by a constrained and evolving global financing landscape, in which humanitarian and development funding is increasingly limited or redirected toward competing national and geopolitical priorities, reducing the predictability and sustainability of support for displacement-affected populations. Strengthening evidence generation, surveillance, and implementation research, alongside meaningful participation of IDPs, is therefore central to improving accountability, equity, and system resilience.

Mozambique's experience underscores the broader need for health policies and research agendas that explicitly recognize internal displacement as a structural determinant of health. Integrating displacement into health governance, social protection, climate adaptation, and development planning is critical not only for improving health outcomes among IDPs but also for strengthening the resilience and responsiveness of health systems facing increasingly overlapping crises. Amid tightening fiscal space and shifting donor priorities, embedding displacement within national health and development strategies is essential to safeguard continuity of care and long-term system resilience. As conflict and climate risks intensify globally, displacement-sensitive approaches are no longer optional; they are fundamental to advancing health equity and sustainable development in Mozambique and comparable settings.

11 Limitations

This article has limitations inherent to narrative, policy-oriented reviews, including potential selection bias and the absence of formal quality scoring. The evidence base draws on heterogeneous sources that vary in definitions, methodologies, and reporting quality, limiting direct comparability across indicators and settings. Geographic coverage is influenced by data availability, with contexts receiving greater humanitarian and research attention likely to be over-represented. In addition, reliance on secondary data and institutional reporting may under-represent the lived experiences of internally displaced persons. Finally, displacement dynamics evolve rapidly in response to conflict, disasters, and political change, meaning that estimates and risk profiles may shift over time. Nevertheless, triangulation across peer-reviewed literature, operational data, and policy documents strengthens the robustness and policy relevance of the synthesis.

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Supplementary material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/femer.2026.1697634/full#supplementary-material

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Footnotes

Edited by: Wibke Wetzker, Friedrich Loeffler Institute, Germany

Reviewed by: Kerem Kinik, University of Health Sciences, Türkiye

Melissa Hansen, University of the Free State, South Africa