Malawi’s referral hospitals in gradual collapse

Being referred to a “referral hospital” in Malawi should mean better care. But for thousands of patients, it means longer waits, cancelled treatment and risk.

Across the country’s four main public referral facilities of Kamuzu Central Hospital, Queen Elizabeth Central Hospital (QECH), Mzuzu Central Hospital (MCH) and Zomba Central Hospital (ZCH), the infrastructure is collapsing.

It is not just leaking roofs and cracked floors. Critical machines have been down for years, elevators stand idle, and theatres sometimes run in darkness when the national grid fails. Nurses deliver babies by torchlight; doctors send patients back to districts because CT scanners or dialysis machines have broken down.

Sometimes, health workers are forced to choose between unsafe care and no care at all, said a doctor at QECH during one of our visits for this story.

Jobe: Shortages result in delayed diagnosis

For patients, the equipment gaps plus personnel shortages in hospitals can mean month-long waits for treatment.

On July 23, 2026 at KCH, Hallos Tembo from Ntchisi had spent nearly two months in a ward with a broken leg to get the specialised treatment he required.

“Every day I hope my name will be called,” he said. “I have seen other people getting treated. But whenever I ask the authorities, I am always told the specialist doctor is outside the country.”

Next to him, George Khwesi from Salima had waited more than two months for back surgery. “My hope is in the pending surgical operation,” he said.

Kamuzu University of Health Sciences lecturer Dr Lucy Kazembe, who also works as a medical doctor at QECH, said the bottleneck isn’t just surgeons.

“The challenge is not only the number of surgeons. We also need more anaesthetists, theatre nurses, intensive care beds, operating theatres, physiotherapists and reliable supplies of medicines and surgical equipment,” said Kazembe, associate professor of health systems and policy.

About one in every three Malawians requires surgical consultation or intervention in their lifetime—yet the country performs only a fraction of the required operations.”

For Justin Jafali from Chiradzulu, who was referred to QECH, hopes that his four-year-old daughter will be assisted are fading. On July 19, 2026, he told us that his daughter was supposed to undergo a procedure that would ascertain if she has cancer.

Jafali’s daughter was among 15 patients whose operation was cancelled, with some patients indicating they had been referred from districts of Chikwawa and Mulanje.

Together with Jafali’s daughter, they had spent nearly three weeks at the facility.

QECH director Dr Patrick Kamalo said the facility regularly postpones planned surgeries whenever emergency cases requiring immediate intervention are brought to the hospital.

“In emergencies, we attend to people whose lives are in immediate danger,” he said.

Sadly, Kamalo said once an operation is cancelled, patients cannot simply be accommodated on the next day’s theatre list because the schedules are already full.

Malawi has one of the lowest surgeon densities worldwide, with some estimates putting at 75 surgeons—of which 50 percent are general surgeons—for a population of 21.7 million, across all public, private and Christian Health Association of Malawi facilities.

This translates to approximately 0.35 surgeons per 100 000 people, far below the World Health Organisation’s recommended 20 surgeons per 100 000 population.

Malawi, with 21 district hospitals with operating theatres, has no permanently stationed surgeon at any of these facilities, according to the College of Surgeons of East, Central and Southern Africa. This is regardless of the fact that Malawi performs between 289 and 747 surgical procedures per 100 000 people, compared to more than 5 000 people in many high-income and developed countries.

As a result, 35 percent of Malawi’s population live with a condition requiring surgical care, according to doctors Bernhard and Lydia Widmann (Surgeon and Intensive Care Nurse) who at the time of writing had been based at Malawi’s Nkhoma Hospital since 2022.

They wrote this in an article for Swiss Knife— a publication of the Swiss College of Surgeons—titled Surgical Care in Rural Africa published in June 2024.

Dark wards, broken machines, no water

At QECH, the pressure starts at registration. By mid-morning, only nine wooden benches serve hundreds. Most stand a few metres away. Toilets had no running water. Cleaners carried buckets from drums to flush.

Staff said the hospital had gone two days without water. Power cuts stop care entirely. The battery backup only covers the ICU. In radiology, X-rays halt when electricity goes.

The department’s main analogue X-ray machine has been out since 2022 with what staff call “minor faults.”

A second unit is also down. That leaves one digital machine, which broke down three times last month. When it fails, staff revert to an older Carestream unit that takes 20-30 minutes per patient.

“When electricity goes off, scanning must stop completely,” one radiographer said. Patients with fractures, chest infections and abdominal pain wait.

Dr Kamalo confirmed the strain: the hospital has no ambulance, while eight broken ambulances sit at the Blantyre District Health Office. He also said “forex shortages have led to scarcity of some essential medicines and consumables.”

Staff said the hospital is running with about 40 per cent fewer nurses and 60 per cent fewer doctors than required.

At Mzuzu Central Hospital, buildings look better after renovations four years ago. But demand outstrips space. One X-ray machine handles 95 patients a day.

There has been no functional CT scanner since last year, so patients are referred to KCH. “Repairs are handled centrally because the hospital has no budget to fix such specialised equipment,” a worker said.

While the buildings at both Zomba Central Hospital and QECH seem old and in dilapidated condition, the paying wards give a contrasting view; they are well maintained and look new.

Some other wards that were refurbished by corporate partners also give a new look.

But while allaying bed space challenges at ZCH, spokesperson for the facility Fredson Kambeni said maintenance is ongoing.

Health and Rights Education Programme executive director Maziko Matemba said when central hospitals operate with broken equipment and failing structures, the consequences extend far beyond operational inconvenience.

On his part, Malawi Health Equity Network executive director George Jobe said the situation reflects longstanding health system challenges that affect both patients and healthcare workers.

But by the time of publishing this story, KCH spokesperson Winnie Yotamu and Mzuzu Central Hospital spokesperson Blessed Kondowe were yet to respond to our questionnaires sent to them in July amid constant reminders.

On the other hand, both Minister of Health and Sanitation Madalitso Baloyi and spokesperson Benedicto Mbewe also did not respond to our questionnaires sent in July.

Reporting by Lloyd Chitsulo, Kondwani Nyondo, Andrew Viano and Allan Nyasulu