Diary from the Angola famine
Monday 20 May
Not a very good start for the day. Alice, the critically ill ten-year old girl, who was brought in by her father yesterday, has died.
Alice arrived yesterday evening with her father. Marjan, one of our nurses, and I were still in the hospital, where Médecins sans Frontières (MSF) has a unit for seriously malnourished children. The father, wearing only rags, was barefoot and had nothing with him except his daughter. He had walked through the bush for four days with Alice on his back.
She was in an advanced stage of malnutrition; her whole body swollen with oedema. Her father and his family were kidnapped years ago by rebel movement Unita. On arrival he told us they had spent all that time as prisoners in the bush.
Last night he looked at Marjan and pleaded: "Please do everything to save Alice. She’s all I have left". His wife and his other five children had already lost their lives. From his rags he pulled out a photo of himself and his family. A young, healthy woman with six radiant children in their Sunday best.
This morning, Marjan and I are devastated when we hear that Alice hasn’t made it.
The father, wearing only rags, was barefoot and had nothing with him except his daughter. He had walked through the bush for four days with Alice on his back.
Now that the rebel leader Jonas Savimbi is dead and the peace process has started, more and more people are emerging from Unita army bases in the bush. Our feeding centre is being swamped with severely malnourished children. We decide to send a car to Cambondo, the arrival point of people who have sometimes been walking for days on end. My car is full of women and their malnourished children. I listen as they tell me, how they have been kidnapped - some at a very young age - by the rebels and ‘handed over’ to a Unita soldier.
"Couldn’t you choose your husband?" I ask. They laugh at my naivety.
One woman has buried her four-year-old along the road the day before. She describes it without any visible signs of emotion. They have been living on leaves and raw mandioc without salt or oil. They tell us about all the people who are still en route, some too ill and malnourished to walk.
When I get to the feeding centre I bring the women and children to Marjan who, together with the other nurses, starts weighing and measuring them and administering the first drops of milk and medication. In the first phase of the therapeutic feeding programme all the children get is milk that has been specially prepared for serious malnutrition cases. They get it eight times, spread over 24 hours. The quantity is based on the weight of the child.
I notice Marjan is looking tired.
Tuesday 21 May
Our feeding centre is becoming overcrowded and we get permission for another centre. Latrines need to be dug. We need a water tank and a kitchen.
A sleepless night. The effect of the increased workload is getting stronger and stronger. Our feeding centre is becoming overcrowded. I have been in touch with the MSF management team in the capital Luanda several times to tell them that we need a new feeding centre. I’m starting to lose patience. We, the field workers, see the growing need. Fortunately, they give me the go-ahead today and Luis, my Angolan logistician, and I start looking for suitable premises.
We find an old warehouse, strike a deal with the owner and start planning. Latrines need to be dug.
We need a water tank and a kitchen and mats to sleep on. We also need to work out requirements in terms of food and medical supplies, cooking utensils, crockery, registration wristbands, firewood, candles etc. Protocols and recipes need to be copied. And then, there is the staff of course: nurses, cooks, nutritional assistants, guards, a cleaner and a supervisor. We reckon that we need around three days.
When I get back to the MSF office about 40 people are waiting outside; they all want to talk to me. They have heard about the new feeding centre and are looking for work. I explain to them kindly but firmly that they can pass on their names to the secretary and that I really don’t have time to speak to each of them individually. It doesn’t seem to make much impression, so I flee inside. With Pocas, our office assistant, I go through the files of ex-employees at feeding centres and make an initial choice. I often trust her judgement.
Wednesday 22 May
At the entrance to the feeding centre I find a large group of seriously malnourished children, ill, scabious, some with ulcers, naked or in rags, often with a mother who looked just as bad.
It is a strange experience that MSF is about to open another feeding centre. Now, in the middle of the widespread euphoria about the - totally unexpected - peace process, we are starting to realise what went on in the bush during the years of war. The demobilisation of the Unita troops is part of the peace process. They are being concentrated with their families in special areas. There are two demobilisation camps in Malange Province. None of the aid organisations have been allowed in so far.
At three o’clock I receive a radio message asking me to go to the hospital right away. It sounds urgent so I jump into the car. At the entrance to the feeding centre I find a large group of seriously malnourished children, ill, scabious, some with ulcers, naked or in rags, often with a mother who looked just as bad. An army truck has brought them from demobilisation camps. The driver opened the flap and dropped them at the door of the already overcrowded feeding centre.
Our nurses have already started the registration procedure under the trees. I have to think fast. Our feeding centre is already bursting at the seams; there is no room for as much as a single additional child and our new centre is still to be organised. I tell the staff to prepare milk for the children and decide that we will have to open our new centre right away. Everyone starts rushing around. Cars ferry food and goods from the MSF warehouse. The staff is being warned that they have to start working immediately.
Don’t ask me how we manage it, but by six o’clock we take the first batch of children to the centre and at seven they are sitting drinking their milk.
The whole team, including the national staff, works throughout the evening. I am quite sure all of us collapsed, totally exhausted, into bed, plagued with dreams full of malnourished children. But we have our new feeding centre and I am proud of my team!
Thursday 23 May
Everybody is shaken by the stories and the suffering. These people only seem to be the survivors.
Everybody just keeps on rushing around. Nobody slept well. There is so much that still needs to be done to get the new feeding centre up and running. Today I don’t have time for a break. I am busy organising and arranging things, while Marjan screens the children individually. In the evening we stop for a bite to eat and to swap experiences. Everybody is shaken by the stories and the suffering. These people only seem to be the survivors. Again it is confirmed that just as many people are still in the bush, and in an even worse state. Help will come too late for them. And again, it transpires that almost all the mothers we spoke to have recently lost one or more children.
One woman tells me she lost four children in the month April. Her two remaining children are in bad shape and I doubt if they will make it. Another woman has buried her eighth and last child a few days ago. There are just no words for the suffering of these people.
Friday 24 May
I see children - whose eyes only a few days ago were closed by oedema - starting to look around again. There are few jobs are as rewarding as this.
Getting access to the demobilisation camps becomes more and more a priority. But this could be awkward as they are in military territory. However, everything starts moving when I am invited to a meeting at the military headquarters. The commanders of the government army and Unita are sitting together, in a brotherly manner. They invite us to visit the camps so that we can provide relief. We get the green light at all levels. It helps when the request comes from both sides.
The UN is, as yet, refusing to enter the demobilisation camps because the national government has not submitted a formal request for aid.
I drop by the feeding centre in the afternoon. I see children - whose eyes only a few days ago were closed by oedema - starting to look around again. There are few jobs are as rewarding as this, with such visible results. We cannot save them all but most of them will change gradually from sad, apathetic, sick children into lively and happy ones. I am sure that this is what is giving the team such energy and satisfaction.
Saturday 25 May
The children are waiting in a long row. I cannot believe my eyes. So many children, each one in a worse state than the next. Enough to fill a couple of trucks.
At 9 a.m. we leave for the demobilisation zone, about 50 kilometres away. We drive past some burnt-out remains of trucks. Only a few months ago it was impossible to drive here because of the risk of mines and ambushes. The last 15 kilometres take us right into the bush where we see people building huts from grass leaves and bits of plastic. These are the Unita soldiers and their families. We are officially welcomed by a delegation of ‘both parties’ who say they are in desperate need of our help. Children are dying every day. The army sends food for the troops but no-one cares for the women and children.
The children are waiting in a long row. I cannot believe my eyes. So many children, each one in a worse state than the next. Enough to fill a couple of trucks. I distribute notes to the children who need to be admitted to our feeding centre. While I am ditributing these notes, one child dies. I gave him a note only half an hour before.
Our lorry is filled to overflowing. We need to get back as soon as possible to pick up more children. We radio ahead that we are on our way, so the team is ready to take charge of the children. Also the new feeding centre is filling up.
In the evening I tuned in to the Dutch World Service. I hear reports of all the wrangling around the elections and the general sense of dissatisfection in the Netherlands. Sometimes the Netherlands seems very far away....