Sub-Saharan Africa

Angola

Angola

During the reporting period, the Angolan government has begun new offensives against UNITA in the central highlands. The offensives have resulted in more people being displaced in Mexico, Huila and Bie Provinces. The shelling of the provincial capitals, however, has been reduced and the siege of Huambo has been lifted. These developments are likely to push the war into a new phase. It is probable that UNITA will revert to classic guerrilla tactics, so rendering a decisive victory on the part of the government unlikely. The war is set to continue for the foreseeable future (IRIN-SA-19/10/99, Oxford Analytica, 12/11/99).

Latest estimates put the total population of Angola at approximately 12.7 million. Approximately 3.7 million of these people may be categorised as “war-affected”. Since January 1998, over one million people have been confirmed as new IDPs (unconfirmed estimates are as high as 1,600,000), The distribution of the confirmed IDPs by province can be seen in the table below (IRIN -10/11/99; OCHA -11/99).

The number of registered IDPs by Province in Angola

Province	IDP Numbers
Bengo	34,832
Benguela	102,526
Bie	108,000
Cuando Cubango	55,032
Cuanda Norte	57,831
Cuanda Sul	41,547
Cuene	2,871
Huambo	194,000
Huila	87,943
Luanda	4,901
Luanda Norte	18,259
Luanda Sol	30,110
Malanje	134,724
Mexico	93,356
Namibe	6,409
Uige	83,393
Zaire	4,950

Access

There continues to be a lack of access, for humanitarian agencies and others, to areas outside government control. The situation of the people in these areas is unknown, but the availability of government-provided services, and in some areas, certain types of food is probably limited. The humanitarian community is considering extending the areas in which it has operated for several months, depending on localised security conditions. Contingency plans for the extension of activities to currently inaccessible populations are being drawn-up (OCHA - 26/11/99).

WFP targeted approximately 1,200,000 people in Angola for food assistance in November, of which 863,000 were IDPs. The largest individual programmes were in Malange and Huambo. The number of beneficiaries has increased every month during the reporting period (WFP - 08/10/99, 05/11/99).

There are indications that the populations from the provincial towns of newly secure government areas have started to cultivate fields and collect firewood within easy reach of the towns. They are not, however, moving permanently back to the countryside yet because of the risk of security incidents (OCHA-19/11/99; 26/11/99).

Land Mines

There has been an increase in the number of land mine incidents in the reporting period. The Angolan Mine Action Institute estimates that between six and seven million landmines are scattered throughout the country. The residual mines will continue to pose a threat for the local population and IDPs. Fear of mutilation or death continues to force farmers off productive land info urban centres, aggravating food shortages (OCHA-11/99).

Economy

The continuous shift of populations from rural to urban areas has changed the demography of the country from one predominantly rural-based to one in which around 60% of the population now live in urban centres. Consequent demand and lessening supply of all consumables has led to a rise in prices. As the prices have risen, however, the purchasing power of the kwanza has diminished at a steady state with periods of extreme inflation. On 9 October 1999, the Angolan parliament approved the introduction of a re-valued currency (OCHA -11/99, 12/11/99).

Malanje

Despite three months of uninterrupted food supplies to the formerly besieged city of Malanje, high prevalences of malnutrition are still reported. The population is currently estimated at 400,000, including at least 135,000 IDPs. There are currently 230,000 beneficiaries receiving food assistance (OCHA - 05/11/99). An MSF-H survey in mid-September estimated the prevalence of wasting and/or oedema in children aged 6-59 months at 21.5%, including 10.5% severe wasting and/or oedema (see annex). This result should be compared to other surveys in Malanje earlier this year and in 1997 (see table). Retrospective CMR for the period from April 1 to 30 September was estimated at 2.07/10,000/day; under-five mortality was estimated at 3.72/10,000/day.

Prevalence of acute malnutrition in Malanje

	Jun-97	Jan-99	Jun-99	Sep-99
Wasting and/or oedema	2.3	11.0	20-25	21.5
Severe wasting and/or oedema	0.4	4.5	5-7	10.5

MSF-H also undertook a rapid assessment of adult malnutrition in Malanje in October, having found cases in IDP camps around the city. The rapid assessment screened some 336 adults, and used a MUAC<18.5 cm to diagnose moderate malnutrition. A MUAC<18.5 cm and a clinical symptom or a MUAC<16.0 cm were used to diagnose severe malnutrition (see annex). Using these very low cutoffs for malnutrition, 21.4% of the adult population assessed were severely malnourished and a further 19% were moderately malnourished. Of the adult population, 5.6% were suffering from general oedema.

The percentages given above are not necessarily representative of the adult IDP population of Malanje, as many of the healthy people may have been in the fields and some very sick people may have been in hospital at the time of the survey. It was apparent, however, that the problem of malnutrition in adults was not a “social” one and that, although older persons and “social-cases” were malnourished, many younger adults were as well. This indicates the severity of the problem (MSF-H -16/10/99).

The level of oedema was very high. It was not possible to establish whether the oedema was caused by eating new, unsafe food (such as grass) due to a lack of normal food-stuffs or whether it was related to traditional healing methods. The therapeutic feeding centres in Malanje were not all equipped to deal with adult oedema (MSF-H -16/11/99).

Results from the rapid assessment of the adults indicated that 89% of the malnourished adults did not have ration cards. Reasons given for not having a ration card included: the inability to build a house due to weakness, no money to pay the village chief (through whom the current registration system is organised) and delays or mistakes in the registration process. The authors of the report recommend reorganising the current registration system.

Huambo

SCF-UK has completed the registration of residents and IDPs in the city and preliminary estimates suggest that there are some 200,000 food-insecure residents and IDPs in Huambo’s municipality (WFP - 29/10/99). WFP reports that a survey in September estimated that 17% of the under-five population were malnourished. (This survey is not available to the RNIS). It has been noted that over 50% of the children attending supplementary feeding programmes are residents (WFP - 08/10/99).

Agricultural assistance programmes aimed at promoting self-reliance in food continue. Some 41,000 families have received seeds for the lowland planting season, as well as seed protection rations (OCHA -19/11/99).

Huila Province

Tension in Huila province in late October resulted in major population displacements towards more secure areas, especially the cities and towns (WFP - 05/11/99). As a result, the nutritional situation in the southern province of Huila appears to be very poor, particularly for the newly arrived IDPs. ACH-Spain undertook rapid nutritional assessments of children in newly set up IDP camps in Vissaca and Chimpopia in October, the findings are summarised below. These results were not obtained from a survey based on the recognised weight-for-height nutritional index and hence may not reflect the precise prevalence of acute malnutrition in this area. Despite this, the authors of the report suggest that the very high prevalences of wasting recorded using MUAC reflect the severity of the situation and the requirement for immediate intervention (ACH - Spain - 10/99). There are currently an estimated 20,000 IDPs in Vissaca and Chimpopia camps (OCHA -26/11/99).

Results of Nutritional Assessments in Huila Province

	Vissaca	Chimpopia
Population	8,611	5,714
Moderate Malnutrition (MUAC 110-120 mm)	35.8%	7.4%
Severe malnutrition (MUAC<110mm)	23.4%	13.8%
Oedema	2.5%	0%
Diarrhoea (in two weeks prior to interview)	62.9%	21.2%
Dysentry (in two weeks prior to interview)	8.6%	8.5%
Measles Vaccination	4.9%	25.5%

In the remote town of Matala an MSF-Spain assessment estimated the rate of malnutrition at 30.8%, including 12.9% severe malnutrition using MUAC on a small sample of newly arrived IDPs (WFP - 05/11/99). At the time of the survey the IDP camps were very new and disorganised. A more recent report from WFP suggests that the situation may not be as severe as the results above suggest, particularly in Matala. ACH-Spain will conduct a further nutritional survey in this area in January (ACH-Spain -09/12/99; OCHA-19/11/99).

Bie Province

Since December 1998, three main waves of IDPs have arrived in Kuito due to the high levels of insecurity and military activity in Bie Province. Approximately 108,000 IDPs have been registered and verified (WFP -13/12/99).

MSF-B conducted a MUAC screening in November. The screening estimated that 3.5% of the new IDP children had a MUAC<110mm (severe wasting) and a further 1.7% were oedematous (MSF-B - 26/11/99).

The IDP population in Kuito is almost entirely dependent on the general ration provided by WFP, which is currently about 1800 Kcal/day. Agricultural land (half an hectare per person), seeds and tools have been made available to the IDPs, but even under optimal conditions the land will provide them with food for only a few months. The quality and quantity of the land is often poor and may be insecure due to mines. In addition there is a real fear of theft at harvest time (MSF-B-26/11/71).

The food security outlook for the resident population is also poor. Many traders’ activities have been reduced because of the war and the town’s consequent isolation (accessible only by air). Purchasing power has decreased due to inflation. The availability of certain basic products is limited and market prices for all products have increased. Residents do not currently receive the general ration, although the families of malnourished children attending the feeding centres are targeted (MSF-B - 26/11/71). Some residents receive food through community kitchen programmes (young children, older persons and the sick).

In November, there were around 500 severely malnourished children attending the therapeutic feeding centre and 5,000 moderately malnourished attending the supplementary feeding centres. Approximately 650 severely malnourished individuals are admitted to the TFC per month (2,500 for the SFC). Around 50% of the new admissions are residents, and up to a third are over-fives (MSF-B -11/26/99).

Between August and the end of November, approximately 616 cases of pellagra (niacin deficiency) were admitted to MSF-B’s supplementary feeding centre. The majority of the cases were IDPs (see graph). There has since been a targeted distribution of dried fish to families of children affected by pellagra through supplementary feeding centres (MSF-B -14/12/99; OCHA -19/11/99; WFP -13/12/99).

Number of Pellagra cases admitted in clinic in Kuito (from MSF-B)

Uige Province

IDP numbers have increased rapidly in the last four months as government forces recapture areas. There has been an increase in market prices (between 15-33% in one week) due to the increase in demand for basic products including beans and rice. An increasing number of both IDPs and residents are reported to be attending feeding centres. Reports suggest that the increase in the prevalence of malnutrition is mainly due to TB, poor hygiene and diarrhoea amongst the under-five IDP population (WFP - 22/10/99,29/10/99,03/12/99).

Benguela Province

ACH-Spain undertook a nutritional survey of IDPs in camps in Ganda, Benguela Province, in October (see annex). At the time of the survey there were an estimated 3,000 people in the camps. The prevalence of wasting and/or oedema was estimated at 21.1%, including 6.1% severe wasting and/or oedema. The prevalence of oedema was estimated at 3.2%. Measles vaccination was confirmed by card for 43.4% of the sample and a further 7.8% of mothers reported that their children had been vaccinated, although they did not have their cards (ACH-Spain-01/11/99).

Fifty-six percent of the children were reported to have had diarrhoea or dysentery in the 15 days prior to the survey. Overall hygiene and sanitary conditions were poor and water provision was inadequate. A shortage of basic household utensils, particularly those for cooking, water storage and transportation was reported (ACH-Spain -01/11/99),

OCHA has reported on a nutritional survey undertaken by CRS in Benguela city in August that estimated the prevalence of malnutrition in children aged 6-59 months at 3.4%. This result indicates that there was no nutritional emergency in young children. Other indicators, however, such as the prices of basic foodstuffs in the market, decreased trading between the interior and coastal regions and the approaching seasonal food shortage suggest that the situation needs to be monitored (OCHA -19/09/99).

Refugees

The Angolan government’s offensive against UNITA rebels in the south has created an outflow of refugees into Namibia. Refugee numbers in Namibia are projected to rise to at least 5,000 Difficult living conditions exacerbated by the rainy season have meant that many of the refugees have arrived in poor condition and require immediate medical, food and shelter assistance (IRIN-SA - 23/11/99; UNHCR-26/11/99).

Recommendations and Priorities:

· Targeting of vulnerable groups (including adults) must be improved, particularly among the resident population.

· Public health issues need to be addressed in order to decrease the prevalence of malnutrition in many areas. This should include improving water and sanitation in IDP camps in areas such as Uige and Huila.

· Step up de-mining activities in order to allow farmers back on to their land.

· Set up supplementary and therapeutic feeding programmes.

· Provide safe water to the camp population.

· Undertake a measles immunisation campaign in the camps.

· Conduct a full nutritional survey in order to more precisely establish the prevalence of malnutrition.

· Continue to adjust the quality of the general ration and include dried fish where pellagra may develop.

· Distribute a general ration and essential non-food items.

· Where appropriate, provide agricultural inputs.

· Establish a monitoring system through nutritional surveillance

· Strengthen the existing facilities for the treatment of malnourished children and provide a complementary ration to the accompanying adults.