The Angola malnutrition emergency, that MSF first raised on April 8 this year, has reduced when compared to the severe standards at its peak. However malnutrition, crude mortality rates, lack of access to healthcare and food insecurity all remain unacceptably high. MSF is treating 1,231 children in its 13 therapeutic feeding centers (TFCs) and another 10,229 children in its 21 supplementary feeding centers (SFCs) throughout the country.

In areas where MSF is working in 12 of the country's 18 provinces, the nutritional situation is now showing signs of becoming stabilized. The only provinces where MSF is not delivering medical assistance are Namibe, Cunene and Cabinda, Bengela, Cuanza Norte and Luanda. However MSF is present in 15 of the Angolan provinces.

The most striking exception to the improving conditions is still in Mavinga, in the south east, where there has been hundreds of fatalities in two UNITA receptions areas. MSF is continuing to respond with supplementary and therapeutic feeding. In addition, nutritional stress remains of concern to MSF in Huambo and Huila Provinces, where MSF is undertaking a blanket feeding prgramme to 22,600 children.

Measles outbreaks

Reports of measles outbreaks continue to confirm the extremely poor vaccination coverage countrywide. With the support of MSF, the Programa Alargado de Vacinacao (PAV) undertook a vaccination campaign in Mussende district, Cuanza Sul province, following several reported cases. In Luanda Sul Province, MSF reported an epidemic in Saurimo, with 253 cases and 16 deaths and responded with a vaccination campaign. A total of 42,000 people were vaccinated in Saurimo and another 6,000 in Dala. Another measles vaccination campaign was carried out in September in Uige Province where 1,321 children were vaccinated in Bungo. There have been other reports of small outbreaks, especially within mobile populations.

General health care unavailable

There remains concern that immediate health needs are not being met across the country. Outside the former security cordons, extending around former provincial capitals, little improvement has occurred in the provision of Government health care. To date, preventive healthcare is almost non-existent. Curative care at the primary level is, at the best, limited to infrequent and inadequate supplies of drugs. Referral services are similarly not in evidence.

The movement of people will massively strain coping mechanisms that have been built up in the past. As the malnutrition emergency recedes, lack of general healthcare comes more into focus. Crude mortality rates remain unacceptably high even when malnutrition is relatively controlled.

There is also great concern for the consequences of the rainy season which has already started in the north and which will cover the country by the end of October.

Food distribution

Although the World Food Program (WFP) state the number of beneficiaries has risen to approximately 1.9 million people, WFP has difficulties in conducting the regular monthly distributions required. Indeed, the monthly distribution cycle continues to take more than one month, bringing the consequent impact on food security. Logistical constraints, including lack of transport, poor roads and destroyed or damaged bridges and mines, continue to restrict distribution. These problems will be exacerbated as the rains set in, and little improvement in access for major deliveries or aid is expected until the beginning of next year at the earliest.

The latest major problem met by WFP was the blockage of food items in all the major Angolan ports due to the delay in government granting port clearance. More than 8,500 metric tons were blocked for more than a month at the three main ports in Luanda, Lobito and Namibe.