Three important developments took place in Mozambique's Cabo Delgado province in a period of less than six weeks, all with a significant future impact on human lives. 

First, in mid-March the U.S. designated an armed opposition group operating in Cabo Delgado as a "terrorist" organization and sent military advisors to train the Mozambique army in counter-terrorism measures.

A fortnight later, the town of Palma – close to a multi-billion-dollar gas project run by the French company Total – was attacked by an armed group in a high profile and brutal assault that killed a still undetermined number of people and displaced at least 30,000.

In early April, Southern African Development Community (SADC) countries condemned the terrorist attacks in strongest terms, and affirmed that "such heinous attacks cannot be allowed to continue without a proportionate regional response." SADC deployed a "technical mission" to Mozambique that has recommended the deployment of 3,000 regional troops.

Much of this recent attention on Cabo Delgado was fueled by the claims of the opposition groups linked to the Islamic State (IS) and the killing of foreigners in the attack on Palma. 

While the conflict has been going on since 2017, it has received very little political attention regionally or internationally – except those interested in Mozambique's gas reserves or private military contracts.

Much less attention has been given to the growing number of displaced people – now over 700,000 – and the critical humanitarian crisis facing the province. 

Cabo Delgado might not be a forgotten conflict, but it certainly is a neglected humanitarian crisis. And now, with SADC attention and the Mozambican government's international backers fixed almost exclusively on "fighting terrorism," the solutions being proposed may once again overlook the urgent need to save lives, and alleviate the suffering of scores of conflict-affected communities.

Hundreds of thousands of people have fled the violence and insecurity, ending up living in overcrowded camps or being hosted by local communities with already limited resources.

People have experienced significant trauma: a decapitated husband, a kidnapped wife, a son or daughter from whom they have no news. 

Many walk for days to find safety after hiding in the bush, often without food and water. Others remain in locations humanitarian actors cannot reach due to ongoing insecurity. 

While the reasons for this conflict might be multifaceted and complex, the consequences of the violence are strikingly simple: fear, insecurity and a lack of access to the basic needs for survival, including food, water, shelter and urgent healthcare.

Meanwhile, significant restrictions are placed on the humanitarian response due to ongoing insecurity and bureaucratic hurdles impeding importation of certain supplies and the issuing of visas for additional humanitarian workers.

Having recently returned from Cabo Delgado, I have seen first-hand how the scale of the humanitarian response in no way matches needs. 

What does seem set to escalate is regionally supported and internationally funded counter-terrorism operation that could further impact an already vulnerable population.

In many conflicts, from Syria to Iraq and Afghanistan, I have seen how counter-terrorism operations can generate additional humanitarian needs while limiting the ability of humanitarian workers to respond.

Firstly, by designating a group as "terrorist," we often see this pushing the groups further underground, making dialogue with them for humanitarian access more complex.

While states can claim that they "don't negotiate with terrorists," humanitarian workers are compelled to provide humanitarian aid impartially and to negotiate with any group that controls territory or that can harm our patients and staff.

Many aid organizations shy away from this in places where a group has been designated as "terrorist" out of fear of falling foul of counter-terrorism legislation.

For Médecins Sans Frontières/Doctors Without Borders (MSF), successfully providing impartial medical care requires reserving a space for dialogue and building trust in the fact that our presence in a conflict is for the sole purpose of saving lives and alleviating suffering. 

In counter-terrorism wars around the world, we often see civilian casualties being justified due to the presence of "terrorists" among a civilian population.

Entire communities can be considered as "hostile," leading to a loosening of the rules of engagement for combat forces.

It is in these situations we often see hospitals destroyed and entire villages razed to the ground in attacks that fail to distinguish between military and civilian targets.

Communities are often trapped between indiscriminate violence by armed groups and the counter-terrorism response from the state. 

The current focus on "terrorism" clearly serves the political and economic interests of those intervening in Mozambique. However, it must not come at the expense of saving lives and alleviating the immense local suffering.

Jonathan Whittall is MSF Director of Analysis. 

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