Angola: An image of devastation begins to emerge


Angola is back in the headlines. The death of Jonas Savimbi in February this year, and the deterioration of Unita, has allowed prospects for peace in Angola - for years an impossibility - to resurface. A cease fire was signed on April 4

With the opening of zones previously inaccessible to humanitarian organisations, the devastating consequences of this 27-war on the health of the population are beginning to be seen. MSF is preparing for a medical and nutritional emergency.

Over the past few weeks, MSF teams in Kaala have been alerted to a significant number of malnourished children coming from the town of Bunjei (110 km in the South of Kaala, in the province of Huambo). This city, like many others, has been inaccessible to MSF for almost four years due to fighting in the region that made road transport impossible

Newcomers arrive in a deplorable state

Brigitte Vasset, an MSF doctor who returned to Kaala three weeks ago, was struck by the level of serious malnutrition found amongst these newcomers.

"Malnutrition is especially serious when it affects children between 0 and 5 years because they are the weakest and most vulnerable", said Dr Vasset "All the women we saw had at least two children who had to be treated in our therapeutic feeding centre because they were less than 70% of their standard weight. For one of the mothers, four of her children were put under intensive care. Many of them had lost a child in the last six months.

Malnutrition was also seen among a significant number of older children (up to 12 years) , as well as six adult women. "In one week, three of the 25 mothers examined were severely malnourished" said Dr Vasset. "When the adults suffer from malnutrition, that means the situation is extremely serious.

"Many mothers told of their children they had lost on the way to the feeding centre. The majority of these women were found alone. They tell us that their husband died or he was conscripted into one of the two armies. [Their children] died on the way here."

In Kaala, MSF is working in the hospital and a therapeutic feeding centre (TFC) - as well as two health stations located in the camps for the displaced in Cantao and Cassoko, just outside the city. Last month the TFC dealt with approximately 70 new children per week. But recently the number of malnourished arriving at the centre rose dramatically: 172 children and six adult women arriving from Bunjei and had to be dealt with in the TFC

The centre, originally intended for 150 children, received 400 children just two weeks ago. MSF will open an additional TFC to deal with the flow of malnourished people arriving from insecure areas controlled by either Unita or the government

As well as malnutrition, other serious medical problems such as measles, malaria and dysentery are seen among the children arriving from Bunjei. Six of the seven children hospitalized for measles in Kaala come from Bunjei.

"There was an epidemic of measles in Kaala, one year ago", said Dr Vasset. "We had carried out a vaccination campaign and the epidemic was suppressed. But MSF has not had access to cities like Bunjei since 1998" so there was no vaccination campaign there.

For the past four months, MSF has also been helping children in Kaala with tuberculosis, a disease often found in populations living in precarious situations. Of the 70 children in Kaala under care for tuberculosis, 86% of them are displaced.

Tales of death from a region strewn with coffins

People say they have left Bunjei because of the absence of food and the infectious diseases that have been steadily taking lives.
"'It is a place of death' one woman told me", said Dr Vasset.

"Another said 'there are fields strewn with coffins'."

In order to build a picture of the situation in the still inaccessible zones, the MSF teams in Kaala have started to collect accounts from the displaced.

Jervasia, 30 years, is the mother of six children. She left Bunjei after seeing two of her children die. Since she has arrived in Kaala, three of her children were placed in the TFC. Two of them died within an hour of each other.

Two of Filomena's children are receiving therapeutic care at the TFC. She does not remember her age. She left her village in the area of Chipindo after her husband died during an attack by the Government army. After walking in the forest for one day, she arrived in Bunjei with her four children; aged two, five, six and ten. She then managed to take a truck to Kaala. She said that, people in Bunjei were hungry and that 'many' had died of diseases.

To find food, it was necessary to move every day, under military escort, to look for 'cassava' in the abandoned fields. Filomena explained that people who are in Bunjei cannot leave because the roads are too dangerous and, often, because the people are too weak.

Delfina, 37, left Samboto, a Unita controlled area, in November 2001. She left at night, with her husband and four children aged 13, nine and three years and one at seven months. They walked for two days in the forest before they reached Bunjei. She explained they had taken the decision to leave because they were not hungry and they could live from their harvest of manioc and corn, but there was no security with the alternating attacks from either the Government army or Unita forces. Their seven month old child died from fever and convulsions two weeks ago in Bunjei. They took a truck to Kaala, because two their children had also fallen sick. Today both children cared for the in the TFC.

MSF prepares for emergency mission in Bunjei

As soon as MSF became aware of the alarming nutritional problems, an emergency team was sent to Ngove (located between Kaala and Bunjei) and then on to Bunjei to evaluate the situation faced by the inhabitants.

The team found that Ngove and Bunjei were ghost towns, the town centres completely deserted. Only the principle road, which crosses the centre is safe. Elsewhere the ground is strewn with mines.

In Bunjei, people have regrouped outside the downtown area. The emergency evaluation indicates a serious health and nutritional situation. MSF began emergency food distribution and nutritional assistance to aid the most vulnerable people.

MSF in Angola

MSF has been present in Angola since 1983. The 27-year of civil war has devastated the country, including the majority of medical infrastructures, leaving the civilian population in an extremely precarious situation.

Increasing insecurity in 1998 forced MSF to close many of its programs. Nevertheless, in November 2000, 11 programs were being run in nine of the 18 provinces in the country, by 80 expatriate staff and 850 national staff members.

Even today, the high state of insecurity, prevents transfer of materials by road, obliging MSF to transport medical and nutritional aid by air .

Due to extensive mining throughout the countryside and the constant risk of attack, MSF s not able to work throughout provinces or districts, and in some places is limited to working within a 30 kilometers perimeter (or sometimes even smaller)

The end of the war, which has displaced four million people - a third of the country's population - would mean the opening of the 'grey zones' that have been inaccessible to any humanitarian aid since 1998.

Taking into account the alarming state of health of the displaced that MSF has seen in Bunjei and Ngové, it is almost certain that an emergency situation will be encountered in many other areas that were previously inaccessible to aid agencies.