Angola 'grey zones' emergency - a dying population
Malnutrition witnessed by Médecins Sans Frontières (MSF) among people emerging from the war zones in Angola is among the worst seen in Africa in the past decade.
Following the cease-fire agreements signed on April 4, 2002, MSF could finally access the 'grey areas' of Angola - pockets of land that had been cut off all humanitarian aid since the conflict escalated in 1998 - and discovered dramatic mortality rates among the populations, well beyond the emergency threshold of one death per day in a population of 10,000 people (1/10,000/day).
In some areas, the number of deaths reaches catastrophic proportions:
- Chipindo: 4.5deaths/10,000/day and 6.1/10,000/day for children under-5.
- Chilembo: 5-10deaths/10,000/day
In an emergency situation, the Crude Mortality rate (CMR) is the most useful indicator as it measures the gravity of the situation and follows its evolution. Calculating mortality rates per 10,000-population/per day enables each situation to be compared against reference values.
The expected CMR in a developing country is in the order of 25/per1,000 population/per year. This reflects as 0.68/10,000/day. In emergencies it can rise above 1/10,000/day.
- The very high levels of malnutrition (including among the adults) combined with the very high mortality over the past months among the populations in various locations indicate pockets of a famine situation.
- We are at the beginning of the large-scale nutritional emergency as assessments are still being planned to many other locations and other areas still remain inaccessible (roads and bridges destroyed, risks of mines). We have information that in many of those locations there are still populations in an emergency situation.
- MSF is increasing the capacity of the feeding centres as more people are expected to arrive in search of food and assistance. Presently MSF has in total 3,600 beneficiaries in the therapeutic feeding centres (TFCs), located in Kuito (850 beneficiaries), Camacupa (500), Luena (300), Malange (400), Menongue (150), Caala (800), Chilembo (100), Chipindo (150), Uige (100), Matala (250).
In most of those locations MSF is also managing supplementary feeding centres (SFCs).
What is a therapeutic feeding centre? A therapeutic feeding centre (TFC) should provide the severely malnourished with their full nutritional requirements and medical care. They normally offer two levels of care. An intensive 24-hours care unit ensures the initial medical and nutritional treatment. Once complications are brought under control (one to seven days) the child can be transferred to the day unit, where he will continue to receive nutritional treatment and medical follow up. Each centre usually cares for 60-100 children.
What is a therapeutic feeding centre (TFC)? A therapeutic feeding centre - TFC - should provide the severely malnourished with their full nutritional requirements and medical care. They normally offer two levels of care. An intensive 24-hours care unit ensures the initial medical and nutritional treatment. Once complications are brought under control (1 to 7 days) the child can be transferred to the day unit, where he will continue to receive nutritional treatment and medical follow up. Each centre usually cares for 60-100 children.
- MSF believes that a major international relief effort (specifically reinforcement of the WFP food line capacity) is required to meet the scale of the emerging needs. The Angolan government should also mobilize the necessary resources to assist its populations.
The ongoing nutritional emergency in Angola is a direct result to populations in large areas of the country that have remained inaccessible for humanitarian assistance over the past years because negotiated access for humanitarian assistance was not pursued in the country. Linked to the political agendas and lack of interest to apply International Humanitarian Law (the right of access to populations for humanitarian organisations and right of assistance for populations in need).
This emergency is also a direct consequence of the military strategies of both parties involved in the conflict: residents were forcibly displaced; houses and villages were burned in order to gain control over the civilian population. The present large-scale nutritional emergency is directly linked to how the war was fought and the lack of access to assist populations.
Even in areas under government control, but inaccessible until recently for international humanitarian organisations, the population was not assisted by the authorities in spite of the very high mortality rate and malnutrition.
'Grey areas' in Angola:
- Chitembo (southern Bie province): latest data collected shows malnutrition rates of 26% global acute malnutrition and 9% severe malnutrition; figures which exceed the emergency threshold. These people are now being admitted to MSF’s therapeutic feeding centres (TFC’s) in Kuito (referred by MSF, 150 km further). The southern part of Bie province is one of the regions that had remained inaccessible for humanitarian assistance since the resumption of the war in ’98. This is the first time an international humanitarian organisation can access Chitembo since '98.
- Chilembo (Huambo province, south of Huambo town): A rapid nutritional survey conducted among 1,219 children under-10 years revealed 42% global malnutrition and 10% severe malnutrition. The number of deaths (5-10/10,000/day) is well above the emergency threshold (1/10,000/day). Population estimated at 6,000 people. TFC with 100 beneficiaries and SFC with 200. These figures confirm that also here the population is in an extremely serious condition and in urgent need of food and medical assistance. General Food Distribution (GFD) planned by ICRC, registration already started, distribution expected this week. [NOTE: ICRC has a limited capacity in terms of food and they are mainly focusing on Huambo province (complementary to WFP). ICRC registers people and distributes their food themselves.]
Measuring malnutrition rates
The prevalence rate of acute malnutrition in children under-five years of age is generally used as an indicator of this condition in the entire population, since this group is more sensitive to changes in the nutritional situation. It makes it possible to know whether there is a nutritional problem and, if so, how significant it is. The essential indicators for decision-making are the global malnutrition rate and the severe malnutrition rate. A global malnutrition rate below 5% is considered common in major parts of Africa and Asia; a rate between 5% and 10% should act as a warning. Malnutrition rates recorded by MSF teams in Angola over the past weeks are as high as 42%.
- Northern Huila province, bordering Chitembo municipality: reports of high numbers of populations in a very bad medical and nutritional situation.
- Chipindo: Catastrophic mortality rates of 4.5/10,000/day for children and 6.1/10,000/day for under-5. This high mortality rate is 'visible' as there are few children around and a lot of graves.
- In Bunjei, 116 km away from Caala, the level of severe malnutrition is 30%. Population of about 14,000 people but continues flux of new arrivals. SFC with about 800 beneficiaries (children and most vulnerable), blanket feeding for children under 10 years in place. It is impossible to set up TFC at the moment because of a lack of space and national medical staff as well as the risk of mines. For the past six weeks, the severely malnourished have been transferred from Bunjei to Caala.
- In Caala, 800 beneficiaries in the TFC: After the period in the TFC they stay in transit structure for a few days until they are transported back to Bunjei and given 15 days of food from the ICRC.
- Malange (Malange province): Sudden increase in the number of admissions to the TFC over the past 2-3 weeks. TFC structures are being expanded (400 beneficiaries present). The severely malnourished mainly come from former UNITA bases and the newly established 'quartering' areas (locations where UNITA soldiers and their relatives present themselves for future demobilisation and reintegration).
- Menongue (Cuando Cubango): Sudden increase in the number of admissions to the TFC over the past days. 150 beneficiaries (including adults), mainly coming from a quartering area north of Menongue, are admitted to the TFC.
MSF presence and development in Angola
These areas had been cut off from medical and food aid since 1998 when the civil war intensified and are only now becoming accessible because of the recent cease-fire agreements on April 4. MSf has been vocal on the situation, raising awareness on April 8, immedaitely after the people started to appar in areas where MSf were already active.
MSF is increasing its staff in order to better handle the developing emergency. With the reinforcements arriving in the next couple of weeks, there will be approximately 150 MSF international staff members present in Angola working alongside another 850 local staff.