Key points you should know:
- The first ever community-funded Long COVID surveillance in Mozambique and Congo started in 2023 thanks to trailblazing researchers.
- Outbreaks or intensifications of civil wars have scattered both study participants and clinicians, thus curtailing progress.
- Long COVID is not merely a clinical challenge for doctors, pharmaceutical companies, and medical scientists to resolve. As these examples show, the condition closely is intertwined with crises like war and natural disasters caused by climate change.
In summer 2023, clinical nurse Rino Da Costa was well into recruiting participants for a study to monitor Long COVID cases in Naquitengue, a village in Cabo Delgado, northern Mozambique.
It was a promising research endeavor until a flaring of gunfighting sunk her efforts.
“The rebels returned to Naquitengue, did killings, looted our properties, and many locals ran off to….who knows? Our clinical trials collapsed,” says Da Costa.
Diana Sengeledo, a nurse and participant in Da Costa’s study who fled the war, expressed frustration that the trial was disrupted. “I should be out there documenting my clinical progress with the condition. I should be out there helping other patients,” she said. Instead: “I am sitting here as a war refugee, wasting my skills and passion.”
An Islamist insurgency has festered in Cabo Delgado, a severely under-developed province in northern Mozambique. The war and killings began in 2017, sparked by the discovery of natural gas riches worth over $50 billion in 2010. According to the European Civil Protections and Humanitarian Aid Operations, 1.2 million locals have been internally displaced and 5,000 have died — though the figures are likely undercounted.
Outcomes from Da Rino’s community-led Long COVID survey, which were to be analyzed by volunteer radiologists at the Eduardo Mondlane University medical school in the capital, Maputo, were vanquished by war, too.
It’s an agony shared by Dr. Jean Baganda, over 1010 miles away in Kivu Province, in eastern Democratic Congo Republic of Congo (DRC). As a doctor, he was leading a pro-bono community effort to capture the first glimpses of Long COVID prevalence in eastern Congo — until rebels occupied his field clinic, sending himself and his trial participants running for their lives. “We can’t seem to do any serious local medical trials until guns are silent,” he said.
Mozambique and Congo are emblems of the global disparity in long-term clinical research and surveillance, which currently focus on rich parts of the world. With wars expanding across the continent, clinical investigations cannot start, or be completed. Battles are scattering both clinicians and their patients.
“It’s frustrating — wasting money to assemble Long COVID investigators and clinical survey participants only for war to extinguish the progress,” Da Costa said.
Calamity in Mozambique
The extent of both COVID-19 and Long COVID cases in Africa have not been fully captured. While governments and communities underplay the severity of the disease and claim the continent was much less impacted compared to the U.S., or Europe, some limited data paint a different picture. One 2023 review paper suggested that nearly 50% of people who had COVID-19 in Africa developed Long COVID. Also in 2023, researchers from Canada’s University of York found that infection rates in African countries were underreported.
Da Costa was motivated to research Long COVID by the condition of her sibling, Paulos. He complained of a draining cough, extreme fatigue, and night sweats for months. When HIV and malaria were ruled out, physicians in Dar es Salaam, a city in the neighboring Republic of Tanzania where the healthcare system is much more advanced, told him he likely devolped Long COVID.
It immediately made sense to Da Costa as a nurse. Over time, she had noticed that three of her nursing colleagues and the head nurse at her hospital were equally struggling with signs of what looked like Long COVID. She knew that the condition in her war-torn district needed to be investigated fully, using any methods available.
“I know the real toll of COVID-19 and Long COVID is vastly underreported in Mozambique,” she said, explaining how she assembled the research endeavor. There is no state clinical infrastructure to survey and monitor Long COVID in Cabo Delgado, let alone political will, she said.
Instead, Da Costa enlisted an epidemiologist friend based abroad, in Dubai in the United Arab Emirates. They raised $7,000 to buy cheap Chinese-made kits for pulmonary function tests, and shipped the tests to Da Costa.
Da Costa described the study as a “very basic effort” to map how deeply Long COVID had become established in her community. A relative who worked as a radiologist at the Eduardo Mondlane University agreed to receive raw data sent from Da-Costa’s community effort once every three months, and analyze them using sophisticated software on a pro-bono basis.
She began with reports from Sengeledo, the clinic’s head nurse, who was suffering from persistent fatigue and irregular heartbeat. Based on weekly reports from Sengeledo’s tests, the radiologist reasoned that she could be living with Long COVID. “I was happy to participate and know what was making me sick. Our efforts were going somewhere,” Sengeledo said.
That’s when calamity appeared. Without warning, Al Qaeda-linked Islamist rebels ran rampage in Naquitengue on September 15, 2023, opposing the Mozambique government and foreign troops. They burned schools, food pantries, and private homes — they attacked army bases, grabbing hostages and forcing locals to flee.
Da Costa’s clinic was torched. She, her brother, and Sengeledo ran away for their safety to Pemba, the capital of the province. They haven’t returned as of early 2025.
“We came out only with [the] clothes on our back. All our medical equipment, paper data, nursing diplomas were reduced to ashes. How can science survive these senseless wars?” Da Costa said. As a nurse, she has become a refugee, too.
All our medical equipment, paper data, nursing diplomas were reduced to ashes. How can science survive these senseless wars?
Rino Da Costa
Evidence destroyed in the Congo
This is a dilemma that angers Baganda, in the DRC, too. He’s an experienced doctor specializing in respiratory illness, who has spent years treating people in Masisi, a town in Kivu, east DRC. In early 2023, Baganda began to collect data on potential Long COVID cases while doing field visits in villages and gold mines of Masisi.
“In my mobile clinics, I met so many mothers, men, teenagers, even ex-rebel soldiers who had got ill with COVID-19 and told me that two years on, their lives have stopped due to lingering short breath, anxiety, and severe tiredness,” he said.
His country, the DRC, is one of the world’s poorest nations despite it being arguably the richest in resources due to the lavish cobalt, lithium, copper, and other rare earth minerals that it holds. According to a 2021 World Bank study, the DRC spends only $21 per citizen for healthcare, with just $2 of that coming from the government. The east of the Congo, where Baganda worked, is currently governed by up to 30 warring militias that routinely commit mass rapes and killings while fighting for mineral wealth.
“The government [doesn’t] care to maintain hospitals here, let alone worry about surveilling Long COVID,” he said.
So he set out to do it himself, documenting suspected cases and hoping to build a database at his clinic in Masisi. He began with Neveristo Machel, a miner who had caught COVID-19 twice and is now bedridden with extreme fatigue.
“I thought I was bewitched because I couldn’t figure out my illness, until Dr. Baganda worked with me and mentioned Long COVID, something which is a total mystery here,” Machel said.
By summer 2024, Baganda had documented 70 cases and was hoping to use his work to develop a proper surveillance program, supported by the Congo’s government health agency. Then, the worst happened in September. A group of rebels called M23 deepened their deadly forays in eastern Congo, then captured Masisi in January.
Government soldiers ran away from their posts. Baganda’s field clinic, along with his laptop and paper data, were forsaken, either burned or becoming part of the loot. He and his patients made a dash for their lives to Goma, the bigger city and provincial capital, which has since fallen to M23 rebels, too.
“I was carried on the back of a lorry, sick as I am and ran for my life too,” Machel, the miner working with Baganda, said. “I am now an internally displaced refugee with Long COVID.”
When interviewed in late November, Baganda said he feels utterly devastated by the turn of events. He will likely never see his survey participants again, as they are now scattered all over the Congo, a country equivalent to Western Europe in size. “I wish the war’s actors would make a humanitarian distinction and say, ‘hey this is a field clinic, these are medics doing important community health surveys, we mustn’t target them,’” he said.
I am now an internally displaced refugee with Long COVID.
Neveristo Machel
War scatters medicines
It’s a common, yet undercovered pattern for relentless wars to destroy critical healthcare and disease surveillance in Africa, said Shamiso Mupara, a public health environmentalist.
It’s not only Long COVID, but all types of disease from HIV to measles vaccination, she said. For example, in northern Mozambique, war and displacement have scattered some people who live with HIV, cutting them off from lifesaving anti-retroviral medications, according to the nonprofit Medicenes San Frontieres. “It’s a double tragedy,” Mupara added.
On the other hand, impoverished and under-capacitated governments in countries like Mozambique spend little on healthcare, and the few pennies they distribute are largely geared towards malaria and HIV. Long COVID is hardly considered. Whenever community medics like Da Costa and Baganda try to lead pro-bono efforts to investigate the extent of Long COVID in their localities, insecurity and local wars destroy their efforts. “It’s a catch-22,” Mupara said.
Sengeledo would like to see wealthy donor governments like the U.S. and European Union send aid money directly to medics and patients of neglected conditions like Long COVID in conflict-ridden locations like Mozambique. “Yes, funding peace-keepers is great, but not all healthcare budgets must go to Malaria and HIV. Think of neglected conditions like Long COVID, too,” she said.
Tsitsi Bhobo contributed reporting.
Ray Mwareya is a freelance journalist covering public health and diplomacy and climate crises across Africa. His work is published in Think Global Health,Telegraph Global Health Security, Reuters, Al Jazeera, and many other outlets.
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