Three months ago, Sofia Bombina and her family of 11 had to flee their home on the Mozambique coast after their town was attacked by a militant group. The 39-year-old farmer, her nine children and her sister travelled nearly 400km (250 miles) by bus from Mocimboa da Praia to Pemba, the capital of Cabo Delgado province, where they now live with a host family. Bombina is among the hundreds of thousands of people who have been displaced since an insurgency erupted in the northern province three years ago. Most of those escaping the ongoing conflict are finding shelter with family or strangers in areas further south, putting a burden on the host families and leading to overcrowding that raises the risk of spreading COVID-19, say aid groups. “We don’t have a house in Pemba and we don’t have the money to pay rent,” Bombina told the Thomson Reuters Foundation. “Fortunately, a good-hearted person is hosting us. Otherwise we would be homeless.” The United Nations’ World Food Programme (WFP) says more than 300,000 people have been forced to leave Cabo Delgado to escape the violence. Aid agencies, including the International Committee of the Red Cross (ICRC), estimate about 10% of those people are living with host families in Pemba alone. And the numbers are likely to increase as “attacks on towns and villages in Cabo Delgado are escalating in both frequency and intensity,” said Ursula Kayali, economic security coordinator with the ICRC in Pemba. “Those displaced by attacks also leave their livelihoods behind … which can make it extremely difficult for them to improve their living conditions and afford even the basics like personal hygiene items,” she added. ‘THERE’S NOTHING TO EAT’ An Islamist insurgent group with links to Islamic State has been launching deadly raids in Cabo Delgado, home to various multi-billion dollar gas projects, since October 2017. The attacks have intensified as the group seeks to impose sharia, or Islamic law, on the region, according to a study by the Institute of Social and Economic Studies in Maputo. Figures from the Armed Conflict Location & Event Data Project, a monitoring organisation, show more than 2,000 people have been killed in the fighting so far. In Cabo Delgado, one of the poorest provinces in the country according to a 2018 World Bank provincial poverty ranking, host families say they are struggling to provide food and water for displaced people who, in many cases, arrive with only the clothes on their backs. Many of the displaced had to flee while they were still trying to recover from the losses they suffered in a cyclone that hit the province in April last year. Chico Quilossa, a farmer in the north of Cabo Delgado, now has 22 people living with him since he started hosting displaced people from Mocimboa da Praia. “We’re hungry, there’s nothing to eat. (And) we don’t have beds, people are sleeping on the floor. This is a big crisis we’re facing here,” he said in a phone interview. The WFP said in a press release last month that “growing violence and insecurity have increased the threat of hunger in the northern province of Cabo Delgado as communities have lost access to food and income sources.” Some displaced people told the Thomson Reuters Foundation that they have received food from aid agencies or community leaders, but the majority said they rely on their host families and other people to provide food. “When the family we’re hosting receives food we all eat. When we buy some (food), we all eat. But when neither of us has food, we sleep without eating,” said Musa Paulino, 33, who is hosting Sofia Bombina and her family. CHOLERA AND COVID Displaced people in Cabo Delgado also face poor sanitation, chronic water shortages in some areas and limited access to healthcare, say locals and aid workers. According to the United Nations’ Office for the Coordination of Humanitarian Affairs (OCHA), the fighting has caused 25 health facilities to close in the last eight months. The lack of healthcare is a particular problem in a region where people are crammed into small houses, many with no running water, creating ideal conditions for the spread of diseases such as cholera and the new coronavirus, said Kayali at the ICRC. Data released by OCHA in September shows between January and August 2020, a cholera outbreak in several districts, including Pemba, led to more than 1,530 cases and at least 23 deaths. And Cabo Delgado has registered at least 738 coronavirus cases, the third-highest number of any province in the country, according to Mozambique’s health ministry. “We try to prevent the spread of this disease, but it is impossible to practice social distancing. We have a small yard and we all eat from the same plate,” said Ali, the host in Pemba. UNCERTAINTY To try to ease the pressure on host families, the local government in the Metuge district of Cabo Delgado has established five camps where authorities say an estimated 30,000 people are living, mainly in school buildings. Local media reports say more camps have been or will be established in three other provinces. The National Institute of Disaster Management, the government branch responsible for setting up the camps, did not respond to several requests for comment. As the attacks in Cabo Delgado continue, both host families and those who have fled their homes say they are living in a state of uncertainty. Despite reassurances by the government that no village or town is under the control of the insurgents, many of the displaced, like Sofia Bombina, fear going back to their homes. “Even if we want to go back to our villages, where are we going to shelter? We don’t know what we’re going to do,” she said.