International staff: 77
National staff: 400
Angola's decades-long, on-again, off-again civil war has had a devastating effect on the health and well-being of the population. Fighting between government forces and UNITA (UniÃ?£o Nacional para IndependÃ?ªncia Total de Angola) rebels, which began in 1975, has left the country with entire regions that are abandoned, countless mined roads, and a virtually nonexistent health system.
The people suffer from chronic malnutrition, sleeping sickness, malaria, preventable diseases such as measles and polio, and injuries caused by land mines and war. Up to a quarter of the country's 12 million people have been displaced during the course of the conflict. And, despite the country's natural wealth (from oil and diamonds), 60% of the population lives below the poverty line.
A peace agreement was signed in 1994, but the war flared up again in 1998. Control of the country remains divided between UNITA and the government (the MPLA, or Movimento Popular de LibertaÃ?§Ã?£o de Angola). Vast parts of the territory remain hidden behind a curtain of war and silence, inaccessible even to aid agencies such as MSF. The people of Angola have been living in this state of chronic emergency for over 25 years.
The Angolan public health system has all but disintegrated. MSF provides support to several hospitals and health clinics, and works to screen for and treat diseases such as sleeping sickness and pellagra. The organization has focused much of its work on treating and feeding many thousands of internally displaced persons (IDPs) and residents.
The combat against malnutrition
Widespread malnutrition has been one of the most vicious consequences of the Angolan war. MSF runs feeding programs in the cities of Huambo, Kaala, Kuito, Luena, Huige, Malange and Cangandala. A large part of the territory is accessible only by air.
From late 1998 on, renewed fighting between the government and UNITA forced MSF to suspend operations in Kuito and, later, Malange. The situation eased slightly in early 1999, and programs in Kuito were reopened, but it was only in late summer that MSF was able to return to Malange.
The government renewed its offensive against the rebels in September 1999, and the number of IDPs increased dramatically in some areas. This put additional pressure on the food supply, as people fled the fighting for regions already facing food shortages. Fighting in some areas eased in spring 2000, but large parts of the country remain inaccessible.
Many of MSF's nutrition programs have been ongoing for a year or more. Others are new, reflecting the continual pressure on the population. Responding to an alarming increase in malnutrition in Malange province in summer 1999, MSF opened eight therapeutic feeding centers. In early 2000, the nutritional situation improved, and the project was scaled down to three. The feeding program in Huambo opened in September 1999, and another in Huige in February 2000. Later that spring, the organization opened a small feeding program in the town of Cangandala.
In Kaala, where MSF had previously provided only emergency care, more permanent programs were launched in January 2000. These include four nutrition centers and drug procurement and support for all services in Kaala hospital. Until early this year, MSF supported nutrition programs run by the local health authorities in Benguela, Angola's second largest city.
Sleeping sickness and other diseases
Malnutrition is not the only health problem facing Angolans. MSF runs sleeping sickness programs in the towns of N'Dalatando and Golungo Alto. The organization screens for sleeping sickness with a mobile lab and supports in- and outpatient care at the hospital in N'Dalatando. As part of its hospital-based and nutrition work, MSF also treats pellagra, a rare vitamin B deficiency disease.
In October 1999, MSF brought to a close its support of the tuberculosis center at the Catholic hospital in Cubal.
Basic health services
The backbone of MSF's work in Angola is its support of various hospitals and health centers in several provinces. Teams often function as the primary staff at the hospitals in Kuito and Luena. In Kamaciuo, MSF opened a small health center and is assisting with the rehabilitation of some of the medical infrastructure.
In Menongué, MSF supports three health posts and the hospital. Three local medical professionals work for MSF in the municipal hospital in M'banza Congo. In October 1999, an MSF project supporting three health centers in Cazenga, a slum area of Luanda, was successfully handed over to the Ministry of Health after a ten-year intervention.
MSF has been working in Angola since 1983.