Angola : Devastating nutritional emergency revealed as war ends

After 27 years of civil war, peace seemed finally to come to Angola in early 2002. The death of long-time rebel leader Jonas Savimbi in February paved the way for a ceasefire and subsequent peace agreement between the government and the UniÃ?£o Nacional para a IndependÃ?ªncia Total de Angola (UNITA) rebels. With the unexpected peace, however, a veil began to lift on hitherto inaccessible areas, revealing a devastating landscape peopled with hundreds of thousands of civilians who had been scorned and manipulated by both sides and deprived of humanitarian assistance for over three years. People emerged from these previously inaccessible "grey areas" - UNITA territory or inaccessible government regions, where control had been contested and fluid, and humanitarian assistance prevented - starving, shrunken, burying their children one by one. The human catastrophe was compounded by the slowness of the Angolan government, the United Nations and many aid agencies and organizations to respond to the horrifying conditions when they began to become apparent. MSF, already working in eleven of the country's 18 provinces, saw immediate increases in the numbers of children admitted to its feeding centers, and began working around the clock to increase capacity and try to gain access to previously unreachable areas. After urgent calls for widespread action failed, MSF condemned the Angolan government and international responses as "shamefully slow and shockingly insufficient" and urged that more be done to prevent the deaths of thousands of people. The starvation did not begin in spring 2002. Fighting in Angola's civil war resumed in November 1998 after an aborted peace agreement, and this new phase quickly became one of the cruelest periods in an already cruel conflict. Civilians caught in contested areas were specifically targeted and made hostages to the strategies of war. They were turned into slaves, forced to fight; their villages were burned along with their crops; they were taken by warring parties and used as "resources" to help win the war. They were subjected to systematic violence. Many were displaced from their homes time and again, either fleeing on the own or forced by the warring parties. Some reached provincial capitals; others spent long years in the bush or captive in military encampments. MSF estimates that up to 500,000 people were trapped in the "grey areas." Access of humanitarian aid workers to the areas where this was all happening was denied from November 1998 until March 2002. In November 2000 and again in November 2001, MSF had issued reports detailing conditions in Angola, based on testimonies of people in camps for the displaced and hospitals where MSF was working. And in early March, before the consequences of Savimbi's death began to be felt, MSF had gone before the United Nations Security Council to condemn to the "politicization of access" to people in need and the devastating health consequences of forced displacement of civilians. Rapid assessments conducted by MSF revealed mortality rates well above emergency levels in most places evaluated. As of summer 2002, an in-depth evaluation of the situation in several areas was underway by Epicentre, MSF's epidemiological research center. As the scope of the nutritional crisis was revealed, MSF stepped up operations, rapidly increasing the number of feeding centers for both severe and moderate cases. Often it was a race to set up facilities to accept the truckloads of sick and starving children who were arriving from the bush (see excerpts of one MSF volunteer's diary, page 44). By July 2002, MSF was providing therapeutic (for severe cases) or supplementary nutritional treatment to 14,000 children at any one time in 44 feeding centers spread across 11 provinces. The relief operation became MSF's largest mission worldwide during 2002. MSF continued to discover pockets of severe malnutrition throughout summer 2002. And while admissions to some facilities had begun to drop, MSF remained concerned about the situation in regions that, despite the peace agreement, had remained inaccessible to MSF and other organizations because of bad roads, lack of bridges, landmines. MSF was also worried that displaced people might be rushed back to their places of origin without the return being entirely voluntary, and without facilities and safety being verified. Ongoing MSF activities already underway prior to the emergency work of spring and summer 2002 include running primary health care services for displaced people in camps and within several provincial capitals and towns, supporting hospitals and other health facilities, and treating the malnourished. MSF also provides care for sleeping sickness and tuberculosis patients, and has worked to improve surgery and maternity care in several provincial hospitals. These medical activities targeted both residents and displaced people, and were ongoing in the provinces of Bengo, Bie, Cuando Cubango, Huambo, Huila, Lunda Sul, Malange, Moxico, Uige and Zaire, and the capital Luanda. During the nutritional crisis, work was expanded to previously inaccessible areas of these provinces and also to the province of Lunda Norte. MSF has been working in Angola since 1983. International staff: 190 National staff: 2,000