Dzaleka records stronger vaccination, maternal healthcare, sanitation and internet access than the rest of Malawi, but serious gaps remain in water, employment, family planning and essential services.

A new report based on the 2024 Malawi Demographic and Health Survey has provided one of the most detailed comparisons yet between conditions in Dzaleka Refugee Camp and the rest of Malawi.

The report, Understanding the Health, Nutrition and Population Situation in Dzaleka Refugee Camp, was prepared by Malawi’s National Statistical Office and UNHCR, with technical and financial support from the World Bank–UNHCR Joint Data Center on Forced Displacement.

Dzaleka was fully included in the national survey rather than being studied through a separate assessment. Researchers used the same questionnaires, testing methods and sampling standards applied across Malawi, making it possible to compare the camp with the national population.

Data collection in Dzaleka took place between May and August 2024. Of the 720 households selected, 681 were successfully interviewed. The survey also interviewed 738 women aged 15 to 49 and 330 men aged 15 to 54. The findings therefore describe conditions measured in 2024 and should not be treated as a real-time account of conditions in 2026.

Water remains one of Dzaleka’s largest service gaps

Only 30 percent of Dzaleka residents had access to at least a basic drinking-water service. The remaining 70 percent relied on what the survey classified as a limited service.

By comparison, 73 percent of the population in the rest of Malawi had access to at least a basic drinking-water service. The report found that households outside Dzaleka were approximately two and a half times more likely to receive a basic service.

Sanitation presented a different picture. About 76 percent of Dzaleka residents had access to at least a basic sanitation service, compared with 40 percent in the rest of Malawi. Thirteen percent of the camp population used limited sanitation services, while 9 percent relied on unimproved facilities and approximately 3 percent had no facility or practised open defecation.

The findings show that progress in one area does not remove the need for investment in another. Access to toilets and sanitation facilities appears comparatively strong, while reliable access to drinking water remains a major concern.

Household conditions reveal pressure on children and essential services

Households in Dzaleka were larger than those in the rest of Malawi, with an average of 5.1 members compared with 4.2 nationally.

The survey also found that approximately 6 percent of children under 18 in Dzaleka had lost both parents, compared with about 2 percent in the rest of Malawi. This highlights the continuing need for child protection, family support and community-based care services.

One of the more positive findings was birth registration. Around 92 percent of children under five in Dzaleka had been registered, compared with 78 percent in the rest of Malawi.

With children making up a large share of the camp’s population, pressure remains high on schools, nutrition programmes, healthcare facilities and services supporting vulnerable families.

Vaccination and maternal healthcare show strong results

Nearly 80 percent of children aged 12 to 23 months in Dzaleka had received all basic vaccinations, compared with 67 percent in the rest of Malawi.

Seventy-four percent had received all vaccinations required under the national schedule, considerably higher than the 47 percent recorded among children of the same age in the rest of the country.

However, coverage of the human papillomavirus vaccine was much lower. Only 17 percent of girls and young women aged 15 to 17 had received two HPV vaccine doses in Dzaleka, compared with 31 percent in the rest of Malawi. Seventy-five percent had received no HPV vaccination.

Maternal healthcare indicators were also positive. Ninety-five percent of women received antenatal care from a skilled provider for their most recent birth, while 78 percent attended at least four antenatal appointments. The corresponding figure for four or more visits in the rest of Malawi was 62 percent.

Almost all recent births in Dzaleka took place in a health facility and were assisted by a skilled provider. Facility delivery reached 98 percent, while skilled attendance reached 99 percent.

Malaria testing produced another notable result. Only 0.4 percent of children under five tested positive for malaria in Dzaleka, compared with 23 percent in the rest of Malawi.

Child malnutrition remains a concern

The survey found that 38 percent of children under five in Dzaleka were stunted, meaning they were too short for their age. This was the same proportion recorded in the rest of Malawi.

One percent of children in Dzaleka were wasted, 7 percent were underweight and 5 percent were overweight. Although several of these indicators were slightly better than the national results, the high level of stunting points to continuing long-term nutritional challenges.

Anaemia affected 41 percent of children aged six to 59 months in Dzaleka, compared with 56 percent in the rest of Malawi. Among women aged 15 to 49, the prevalence of anaemia was approximately 35 percent in both populations.

These figures were collected before some of the major reductions in humanitarian funding reported during 2025. The report says reductions in food assistance, healthcare support and education funding have since increased pressure on already limited services.

Family-planning needs are significantly higher

Women in Dzaleka had an estimated fertility rate of 4.9 children per woman, compared with 3.7 in the rest of Malawi.

Among currently married women aged 15 to 49, approximately 37 percent were using any contraceptive method in Dzaleka, compared with 68 percent nationally. About 33 percent were using a modern method.

Twenty percent of married women in Dzaleka had an unmet need for family planning, almost twice the 11 percent recorded in the rest of Malawi.

The figures indicate a need for accessible reproductive-health information, a reliable supply of contraceptives and services that women can use voluntarily and confidentially.

Strong literacy and digital access have not translated into equal employment

Literacy among women aged 15 to 49 was similar in Dzaleka and the rest of Malawi, at 75 percent and 77 percent respectively.

Among men, literacy was recorded at 97 percent in Dzaleka, compared with 83 percent nationally. Internet use was also higher in the camp. Twenty-seven percent of women and 48 percent of men in Dzaleka had used the internet during the previous 12 months, compared with 15 percent of women and 27 percent of men in the rest of Malawi.

Despite these results, employment remained lower.

Among currently married people aged 15 to 49, 48 percent of women and 84 percent of men in Dzaleka had worked during the previous year. In the rest of Malawi, the figures were 65 percent for women and 93 percent for men.

The report connects these economic differences to restrictions affecting refugees’ movement and access to formal employment. It also notes that long-term residents continue to face limited opportunities for higher education, economic integration and other durable solutions.

Better data must lead to better decisions

The findings do not present Dzaleka as performing either entirely better or entirely worse than the rest of Malawi.

The camp has achieved comparatively strong results in childhood vaccination, antenatal care, facility delivery, sanitation, birth registration, literacy and malaria prevention. At the same time, residents face serious challenges involving drinking water, overcrowding, employment, family planning, HPV vaccination, nutrition and access to health insurance.

Including Dzaleka in a national survey is an important step because refugee communities are frequently left out of national statistics. The value of the data will now depend on whether government institutions, humanitarian organisations and development partners use it to direct funding and services towards the areas of greatest need.

Read the full report

This article is based on the report Understanding the Health, Nutrition and Population Situation in Dzaleka Refugee Camp, published by Malawi’s National Statistical Office and UNHCR, with support from the World Bank–UNHCR Joint Data Center on Forced Displacement.

Report overview: Malawi: Understanding the Health, Nutrition and Population Situation in Dzaleka Refugee Camp, 2024

Download the full report: Read or download the PDF report