United Nations System
Standing Committee on Nutrition

Nutrition Information in Crisis Situations - Angola

NICS 16, March 2008

Huila province, largely affected by the war, has experienced relative stability over the past few years and as such, most relief services have slowly been discontinued. A recent random-sampled nutrition survey conducted by ACH-S in the remote municipality of Chipindo indicated a worrisome nutrition situation (ACH-S, 09/07). The results, while not significantly different from the last survey done in 2004, are much higher than those obtained in a 2003 survey (table 9). Under 5 mortality rates have also increased in comparison to previous surveys and the study authors suggest that poor access to adequate health care, lack of dietary diversity and the cessation of food aid in December 2006 have all contributed to the rise.

Table 9 Results of a nutrition and mortality survey, Angola, September 2007 (AAH-S, 09/07)

NICS 8, January 2006

Several surveys conducted in Kwanza Sul, Bie, Huambo and Benguela provinces during the lean season showed an average nutrition situation (figure 9), which was comparable to the situation within the same period in 2004 (CDRA, 04/05). Stunting was very high, varying from 45% to 52%, depending on the province.

Figure 9 Prevalence of acute malnutrition in parts of Kwanza Sul, Bie, Huambo and Benguela provinces (CDRA, 04/05)

NICS 7, August 2005

Angola is recovering from a 27-year civil war which ended in 2002.

As part of the Food Plus Initiative led by WFP, in collaboration with other agencies, a nutrition survey was conducted in Kuito municipality, Bieh province, in December 2004. The survey showed an average prevalence of acute malnutrition (table 8) (MOH/joint, 12/04). The mortality rates were under control (table 8). 14.3% of the women (15-49 years old) had chronic energy deficiency (BMI < 18.5) including 3.4% severe chronic energy deficiency (BMI< 16).

Table 8 Prevalence of acute malnutrition and mortality rates, Kuito municipality, Bieh province, Angola (MOH/CICH/WFP/MSF-B, 12/04)

Anaemia was a public health problem in both children and women (table 9).

Table 9 Prevalence of anaemia, Kuito municipality, Bieh province, Angola, December 2004 (MOH/CICH/WFP/MSF-B, 12/04)

Although only one case of clinical pellagra in children and two cases in women were detected during the survey (which was not designed to evaluate the prevalence of clinical signs of pellagra), niacin deficiency detected by biochemical analysis was significant. Moreover, the MSF-B pellagra clinic received a significant number of patients with clinical symptoms: about 800 patients were treated between January and August 2004.

NICS 4, November 2004

Since the peace accord in April 2002, about 274,000 refugees have returned home, of whom about 150,000 have been repatriated by UNHCR (IRIN, 15/11/04). However, programmes to support the resettlement are under funded. WFP food distribution programme was only 40% resourced as of October 2004 while FAO had a shortage of toolkits (IRIN, 16/11/04; WFP, 19/11/04). Bad road conditions and the presence of land mines continue to hamper access to part of the country.

The 2003/2004 cereal production was 9% higher than last year and 27% higher than the average five previous years, due particularly to an increased area being under cultivation (FAO/WFP, 06/08/04). Around 1.6 m people have been estimated in need of food aid between May 2004 and April 2005. The number of people categorized food insecure (mostly returnees arrived after the 2003 planting season) has decreased by 67%, compared to the previous year, while the number of people estimated moderately vulnerable and requiring food aid only during the hunger gap has increased by 29% (table 9).

According to various nutrition surveys, the nutrition situation is still average and mortality rates were under control (table 10). In Caconda and Ganda municipalities, the number of admissions to TFCs and SFCs were lower in 2004 than in 2003.

In Caconda municipality, the increase in the malnutrition rate when compared with January 2004 may be explained by the failure of the harvest due to heavy rains. Depending on the area, measles vaccination coverage and vitamin A coverage were average to low (table 10). The prevalence of anaemia was a significant public health problem in Caconda and Chipindo municipalities. According to measurements of iodine concentration in salt, only 48% of families consumed iodized salt in Caconda municipality, while 80.7% of households consumed iodized salt in Chipindo municipality. However, 9% and 22.2% of the iodized salt contained less than 15 ppm iodine, in Caconda and Chipindo, respectively, which is less than the recommended amount.

Table 9 People requiring food assistance between April 2004 and May 2005, Angola (FAO/WFP, 08/04)

Table 10 Results of nutrition surveys among children 6-59 months old, Angola, August-September 2004 (ACH-S, 08-09/04)

* According to cards and mothers' statements
** Hb < 11 g/dl

NICS 3, August 2004

Slow reconstruction process and lack of funding

Two years after the signing of the peace agreement, macro-economic indicators and transparency, especially regarding oil revenues, have improved, but the overall economic and infrastructure situation is still weak and funding to allow a smooth stabilisation of the country is lacking. The rate of inflation declined by 50% in 2003 and the GDP grew by about 3.5 % (IMF, 21/07/04). The number of people in need of food aid at the beginning of 2004 decreased by 33% compared to last year, but one million people were still estimated food insecure between November 2003 and April 2004, with returnees being the most vulnerable and making up 60% of the people in need of food aid (OCHA, 30/06/04). However, WFP has been experiencing food shortages for several months and therefore has reduced the rations distributed (see NICS 2). Only 24% of the WFP's return and resettlement programme was funded as of late July 2004, whilst UNHCR repatriation programmes from Namibia, Zambia and DRC resumed in May/June 2004 (UNHCR, 06/07/04). Unless new contributions are received, no distribution will be conducted during the hunger gap season, beginning in September (WFP, 30/07/04).

The 2003/2004 agricultural season has been doing well generally, with 90% of families cultivating more land compared to the previous year. However, adverse climatic conditions have jeopardised food security in the central highlands and in the south east (OCHA, 30/06/04).

Landmines are still an issue and limit the population's movement and access to lands (OCHA, 30/06/04).

The public health situation is of concern, with pipeline breaks in essential medicines in Moxico, Bie, Kuando Kubango, Huila, Benguela and Luanda Norte (OCHA, 30/06/04). The capacity of health staff is also still limited. Moreover, the lack of funding obliged NGOs to hand medical structures over to the MOH, despite a concern of lack of capacity. The same pattern is observed for nutrition centres (see below) (OCHA, 30/06/04).

Stable nutrition situation

Admissions to nutrition centres

The maps show the coverage of the TFCs and SFCs (UNICEF-A, 05/04). As of March 2004, there were 20 TFCs managed by 78 MOH

staffs trained in the management of severe malnutrition according to national protocols, and four TFCs managed by NGOs. In 2003/2004, twelve TFCs were handed over by NGOs to the MOH and one TFC was closed. During the same period, ten SFCs managed by NGOs closed, 18 were handed over to the MOH and 14 SFCs were opened by the MOH (UNICEF-A, 05/04). As of March 2004, there were 33 and 10 SFCs managed by the MOH and NGOs, respectively.

The number of children registered in the SFCs has been stable since July 2003, remaining around 10,000. On the other hand, the number of admissions to TFCs seems to have been lower in late 2003/beginning 2004 than in late 2002/beginning 2003. In particular, the number of admission has only slightly increased during the hunger-gap season, compared to previous years (figure 6). This may be explained either by a better food security situation or by the fact that the quality of care in the TFCs has decreased since mid-2003, discouraging people to bring their children to the centres. Indeed the rates of mortality and absconding have increased from less or around 10 % before mid-2003 to more than 10% with peaks at about 15% thereafter (UNICEF-A, 05/04). This may be partly explained by the decrease of the staff-patients ratio which is of 1:20-25 in TFCs managed by the MOH and which was probably higher when the TFCs were managed by NGOs.

Figure 6 Number of admission to therapeutic feeding centres, Angola (UNICEF-A, 05/04)

Child's growth monitoring

Child-growth monitoring is part of the National Nutrition Programme and aimed to be further developed (OCHA, 30/06/04). As of March 2004, 330 health facilities were running growth monitoring and 43% were providing regular and reliable reports (see map) (UNICEF-A, 05/04). According to these reports, 7% and 3.3% of the children who were measured were moderately and severely malnourished, respectively, in February 2004 (UNICEF-A, 05/04).

TFC coverage by municipality, Angola, May 2004 (UNICEF-A, 05/04)

SFC coverage by municipality, Angola, May 2004 (UNICEF-A, 05/04)

Growth monitoring coverage by municipality, Angola, May 2004 (UNICEF-A, 05/04)

Nutrition situation under-control in Balombo municipality, Benguela province

A random-sampled nutrition survey was undertaken in Balombo municipality in May 2004 (CRS, 05/04). 63% of the families interviewed were resident, whilst 37% were returnees (arrived after April 2002).

The results showed an acceptable nutrition situation, which has gradually improved since 2001 and was stable compared to 2003 (figure 7). Mortality rates were average (under-five mortality rate = 1.86/10,000/day, crude mortality rate = 0.72/10,000/day), but have decreased since March 2002, when under-five mortality rate and crude mortality rate were respectively 3.2/10,000/day and 1.4/10,000/day (see RNIS 36/37). The main presumed cause of under-five mortality was malaria (74%). Measles vaccination coverage for the 12-23 month olds was 17% according to cards and has not improved compared to 2003. Vitamin A distribution coverage was also low at 16%.

Figure 7, Prevalence of Acute Malnutrition Bolombo Municipality, Benguela Province, Angola, May 2004 (CRS, 05/04)

Overall

The nutrition situation remains stable with more and more nutrition centres handed over to the Ministry of Health, who plans to develop growth-monitoring and vitamin A distribution as part of the National Nutrition Programme.

NICS 2, May 2004

Owing to heavy rains, Huambo province and part of Huila province, especially Caconda municipality face reduction in maize production. Maize production is expected to be 35% below normal in Huambo, and 75% below normal in Caconda municipality. Although there are surpluses in other areas, bad transport conditions will hamper marketing surplus production (OCHA, 30/04/05; FEWS, 12/04/05).

About 1.3 million Angolans are in need of food aid, including returnees. However, WFP faces a high funding shortfall: only US$ 35 million of the US$ 253 million required had been received (WFP, 06/05/04). Rations had already been halved in April and May and are scheduled to be further reduced by June, unless WFP receives cash pledges. WFP is also experiencing a shortfall in feeding Angolan refugees in nearby countries and will face serious challenges to provide a food package to refugees who will return with the UNHCR repatriation programme due to resume in May-June (UNHCR, 21/05/04).

There were several reports of human rights violations when Congolese and people from other nationalities, considered to be illegal diamond miners, were expelled from Angola (MSF, 29/04/04; AI, 14/05/04). An estimated 80,000-100,000 people have been expelled to DRC over the last months in dire conditions. People have been held with no basic services available, have been forced to walk for more than 60 km with no water and food. There have been reports of rape and other human rights violations. People arrived mostly in Bandudu and Kasai Orientale province in DRC stripped of possessions and clothes. Most of those expelled were born in Angola and have no place to which they can return. Humanitarian agencies provide aid as far as possible (OCHA, 07/05/04). The government of Angola has recently announced a 45-day suspension of expulsions (IRIN, 20/05/04).

Stable nutrition situation and returnees more at risk, especially in inaccessible areas

According to several surveys received by NICS, the nutrition situation has not significantly improved since 2003 (ACH, 01/04-02/04; CRS, 04/04; MSF-S, 03/04). The same pattern is shown by the number of admissions to TFCs country wide (figure 8). Moreover, it seems that the number of admissions to TFC slightly increased in December 2003 compared to December 2002 in Benguela and Huila provinces (UNICEF-A, 02/04).

The only real improvement is seen in accessible areas of Caconda municipality (ACH, 01/04). This can be partly explained by the return of the IDPs to their area of origin: the population halved between June 2003 and January 2004 and in January 2004 the majority of the population was resident (91%), whilst in June 2003, more than half of the population was displaced people. On the other hand, screening conducted in areas where a lot of people returned, showed a more worrying situation, especially in areas not accessible to humanitarian agencies owing to poor road conditions and the presence of landmines: screening carried out during a food distribution found 166 acutely malnourished children of 927 children screened (17.9%) (ACH, 02/04). In Ganda and Cubal municipalities, 20% of the population was returnees.

Figure 8 Admissions to therapeutic feeding centres, Angola (UNCEF-A, 04/04)

Whilst mortality rates were under alert thresholds in Matala and Cubal municipality, they were high in IDP camps in Matala and in Caconda and Ganda municipalities (table 21). Measles vaccination and vitamin A distribution coverage was insufficient (table 21).

Table 21 Results of nutrition and mortality surveys, Angola

Overall

There has not been a noticeable improvement in the nutrition situation in Angola since 2003 (category II/III). This may be attributed to the fragile food security situation, especially for the returnees who represent a significant proportion of the population. Unfortunately, donors' and the government of Angola’s commitment to Angola's reconstruction is weak and far from sufficient to ensure a significant improvement of the situation.

Recommendations

From FEWS in Huambo province:

• Provide seeds
• Implement food aid programmes
• Increase nutrition surveillance

NICS 1, February 2004

The lack of infrastructure and basic services is one of the main constraints faced during this period of rehabilitation of the country. Donors’ commitment is average, partly because they are waiting for a greater transparency in public sector expenditure and for an intensification of the efforts of the government for reconstruction (IRIN, 15/10/03).

As of mid-December 2003, it was estimated that about 100,000 Angolan refugees had returned in 2003, of whom 70,000 benefited from the UNHCR’s repatriation programme (OCHA, 16/12/03). Around 250,000 Angolan refugees remain outside the country; 170,000 are expected to return in 2004 (OCHA, 16/12/03). According to government figures, around 3,400,000 IDPs have returned to their areas of origin, whilst about 800,000 remain displaced, of whom, 400,000 are expected to establish new livelihoods where they have settled (OCHA, 16/12/03).

Heavy rains during the current rainy season have had a negative effect on agricultural production in some areas and have greatly hampered the delivery of food aid, because of bad road conditions (OCHA, 25/01/04). WFP has been forced to cut rations to most beneficiaries owing to a break in the food pipeline and a limited access to parts of the country (IRIN, 03/02/04).

Precarious food security in central and south Angola

Preliminary results of the vulnerability analysis has estimated that 1.2 million people will be highly vulnerable to food insecurity in the first half of 2004 and that half a million people are food insecure and need immediate assistance (FEWS, 31/01/04).
People in the central and southern maize-based farming area are more prone to food insecurity than the population of the northern cassava-based farming area. In addition, the fate of returnees and recently displaced people is of concern.

Food insecurity in Caconda municipality, Cuando Cubango province

The nutrition situation in Caconda municipality has remained average over the past two years (see RNIS 43). A food security assessment was carried out in the municipality in December 2003 (ACH-S, 12/03). The study showed that people were experiencing food insecurity. The major constraint to food security was the area people were able to cultivate. As people had no more oxen and had a limited access to seeds, the area under cultivation was not enough to guaranty a sufficient harvest. Because of the food scarcity, people were eating green maize before it was ready to harvest, further limiting their food stock. The hunger-gap period was considered to have started four months earlier than in normal times. People who do not own fields, such as displaced people, are even more vulnerable as they have to borrow or rent land (against work in the owners’ fields or part of the harvest). This land is often not very fertile. The main coping mechanisms are daily work in others’ fields, consumption of wild food and selling of charcoal or firewood. The social cohesion seemed poor because of the years of conflict which have divided people; the displaced population and ex-UNITA soldiers are facing particular challenges.

The most important indicators of wealth, defined by the population, were the owning of oxen, ploughs, and of small livestock such as pigs or goats. Having dependants in town was also associated with a better status. According to the population, 70% to 84% of the households were classified as poor, depending on the area.

Recommendations

From the ACH-S survey in Caconda municipality, Cuando Cubango province

• Distribute oxen and ploughs, to improve capacities of agricultural production
• Implement food for work activities for repairing infrastructure
• Community-based activities should be started only after social cohesion has improved

RNIS 43, November 2003

About 35,000 refugees have been repatriated since the beginning of the voluntary repatriation programme, launched by UNHCR in June 2003; 15,000 refugees returned from Zambia, 17,000 from DRC and 3,000 from Namibia. It is also estimated that about 34,000 refugees returned home spontaneously in 2003 (UNHCR, 09/10/03). However, only half of the districts of return are opened to repatriation, the others being considered unsuitable for repatriation because of poor road conditions, land-mines and lack of basic social services (WFP, 10/10/03). WFP food distribution has increased over the last months, from 1.6 m in August 2003 to 1.8 m in September and 2.2 m in October (WFP, 10/10/03).

This is mainly due to seasonal factors, as food stock has begun to decline in some areas, and to the caseload of IDPs and returnees, and also to the distribution of seed protection rations to accompany distribution of seeds and tools. Major distributions of seeds and tools to 600,000 families are on-going to unable cultivation in the October-December period (FAO, 19/09/03). The FAO will also support rehabilitation of livestock. However, some humanitarian operations are under- funded; UNICEF has only received 20% of the funds required (OCHA, 21/10/03) and WFP has had to lower dramatically non-food and passenger air transport because of a severe lack of funds (WFP, 14/10/03). Due to transportation related delays of commodities, WFP will distribute a half ration of cereals for returning refugees and IDPs during November and December (WFP, 23/10/03).The average cost of the food basket was lower in July and August than the average in the four previous years. Commercial activity has developed in most of the provinces, although it has been limited in Moxico and Luanda Sul province because of poor road conditions. It is expected that commercial activity will decrease with the forthcoming rainy season (FEWS, 08/03). The nutrition situation seems to remain stable.

Caconda municipality, Cuando Cubango

A survey was carried out in accessible areas of Caconda and Cusse communities in June 2003 (ACH, 06/03). About 54% of the surveyed population were displaced people, 42% were residents and 4.4% were returnees, of whom 15% were former UNITA soldiers; the proportion of the different groups was about the same in December 2002. The nutrition situation was average and has not improved since December last year (see figure). On the other hand, mortality rates have dropped, compared to December 2002 (see figure), but the under- five mortality rate was still above an acceptable threshold. The decrease in mortality rates may be mainly attributed to better public health. The measles vaccination coverage was 88.8%, according to cards and mothers' statements. About 75% of the displaced people received food distribution the month prior to the survey, as well as 85% of the ex-UNITA soldiers. However, only 9% of the returnees and 1% of the resident populations received food distribution.

Ganda municipality, Benguela province

A random -sampled nutrition survey was undertaken in Ganda municipality in August 2003 (ACH, 08/03). The population surveyed comprised 78% of residents, 13% of displaced people and 7% of returnees. The nutrition situation was undercontrol and has remained stable since 2000 (see figure); mortality rates were still high (see figure). The measles vaccination coverage was estimated at 93.6% according to cards and mothers' statements. Only 16% of the displaced families and 13% of the returnees had received food distribution. Ganda municipality experiences bad water and sanitary conditions.

Overall

Despite a better harvest this year than in 2002, a high number of people are still in need of food aid. The nutrition situation is stable (category III).

RNIS 42, August 2003

Access to populations has recently improved due to the end of the rainy season and continuous demining efforts (see map). The number of people in critical need in inaccessible areas declined from 500,000 in January 2003 to less than 100,000 in mid-June (OCHA, 10/07/03). There has been concern about "reconstruction and development aid boycott" in Angola, with most of the humanitarian projects in all sectors being under-funded (ACTSA, 08/05/03). The fate of the child soldiers forcibly enrolled, mostly in the UNITA army, but also in the Angolan army, has raised concern because no specific programmes have been directed to them, either boys or girls (ACTSA, 08/05/03). Population movement IDPs and refugee returns A significant number of IDPs and refugees has returned home over the past months. However, about 2 m people remain displaced either internally or in nearby countries (see table).

Population movement, Angola, 2003

¹ OCHA, 10/07/03 ² UNHCR, 11/07/03

A voluntary repatriation project for Angolan refugees from DRC, Zambia and Namibia began in mid-June 2003 (UNHCR, 11/07/03). Five locations meet pre-conditions defined by UNHCR for organised return (they can be reached by road, the danger of landmine is relatively low and basic services are available): Cazombo, Moxico province, Menongue and Calundo, Cuando Cubango, Luau, Mexico province and Mbanza Congo, Zaire province.

The returnees, when back in Angola, will spent a few days in reception centres where they will receive mine-awareness training, HIV/AIDS information, medical care if needed and re-integration kits (food, construction kit and basic household assets) (UNHCR, 11/07/03). However, the return of the refugees to their area of origin may be difficult as transport from the transit centres is not yet assured and the capacity of the villages to absorb returnees is limited (MSF, 22/07/03).

UNITA ex-soldiers and family resettlement

The Quartering and Family Areas (QFA) were officially closed on the 19 June 2003 (GoA, 19/06/03); 375,000 persons were registered during the process. However, logistical problems have hampered a smooth return of these people to their area of origin (IRIN, 19/06/03). Some people have stayed near the QFAs, whilst others have remained in transit centres for more than the few days they were intended to stay, despite the transit centre not having the capacity to host people for a long stay (IRIN, 19/06/03). Moreover, demobilisation kits have not been delivered to all the families; this will not ease a return in optimal conditions.

Food security

The FAO/WFP crop and food supply assessment mission was carried out in May and June 2003 (FAO/WFP, 25/07/03). Overall, agricultural production is estimated to have increased compared to the production in 2002. Cereal and bean production are estimated to be 23% and 14% higher respectively than last year, and the cassava crop is slightly higher than in 2002. The good crop performance is attributed to good rainfall, an increase in the area under cultivation (14% higher than in 2001/2002) and distribution of agricultural inputs.

Livestock numbers sharply fell during the war, but re-stocking has restarted this year. Rearing is one of the major activities in the south and centre of the country. Many people have also regained access to natural resources such as fishing, hunting, honey and wild food collection.

Although cessation of hostilities has improved movement of goods in the country, poor road conditions hamper normal trade, especially for goods which are low in value and high in unit weight, like grains and roots. In general, prices are considered high for the purchasing power of the population.

It is estimated that 219,000 MTs of food aid will be required for 2003/2004, with 1.4 m people dependent on food aid (the same number as last year) (see tables).

Beneficiaries of food aid, Angola, 2003 (FAO/ WFP, 25/07/03)

¹ Displaced after 2001, and UNITA demobilised soldiers and their families who still reside in the QFAs or transit centres
² Ex-IDPs, ex-refugees, who resettled in areas which are not their areas of origin

WFP is intended to provide about 161,000 MTs of cereals to 1,027,500 people, whilst the remaining requirements should be met by other humanitarian agencies. It is hoped that people who have resettled in 2001/2002 will not need any further food distribution after the next harvest in 2004, whilst people who will return in 2003/2004 will require assistance at least until the 2005 harvest.

Regionally, good rains in Northern (where the main crop is roots) and Central region (where the main crop is maize) have led to good harvests, and, good pasture and fodder, for livestock in the Central region. In the Southern region, which is the least fertile of the country, Cunene and Kuando Kubango provinces have experienced poor rainfall leading to failure or complete loss of harvests. In Huila province, it is also estimated that crops will not last until the next harvest and that people will be in need of food aid. The other provinces were doing well. The highest number of returnees is estimated to be in Huambo, Bie and Benguela, and the highest number of IDPs in Kuando Kubango and Bie.

Provision of seeds and tools will be crucial for the next planting season, starting in October/ November. Agricultural inputs for 600,000 families have already been ordered, whilst inputs to cover 200,000 more families are still needed (OCHA, 10/07/03).

Pipelines

A national measles vaccination campaign was carried out in April/May 2003, targeting children between 9 months and 15 years old (OCHA, 10/07/03). Essential drug pipeline breaks have been reported and are expected to continue at least until September (OCHA, 10/07/03).

On the other hand, WFP food pipeline seems secured until the end of the year, except for beans which are expected to last only until December (OCHA, 10/07/03); beans are fundamental to prevent pellagra.

Benguela province, Ganda municipality

A random sampled nutrition survey was carried out in March 2003 in Ganda municipality (ACH, 03/03). Among the families surveyed, 68% were resident families, 20% were displaced (of whom 89% were displaced for more than one year) and 12% were returnees, who arrived less than one year ago.

The nutrition situation was under-control and has not significantly changed since mid 2000 (see figure). Admissions in SFC and TFC were, however, still significant at the beginning of the year: an average 1,000 children/month were admitted in SFC and 100 children/month were admitted in TFC.

The mortality rate was of concern, although it has decreased over the last years (see figure). The measles vaccination coverage was 40.6% according to cards and 72.4% according to cards and mothers' statement. About 27% of the children surveyed have received vitamin A.

It is striking that the prevalence of malnutrition is relatively low and yet mortality rates are high, suggesting that the main problem for people is the health environment. Major causes of under five year old deaths were diarrhoea and fever.

There is room for improvement in terms of safe water availability, sanitary conditions, health care and food security. The harvest is expected to be good and will help to improve the situation.

Cubal municipality

A random sampled nutrition survey was carried out in Cubal municipality in April 2003 (CRS/MINSA, 04/03). About 76% of the families surveyed were resident families; 4% were displaced and 19% were returnees. The malnutrition prevalence was undercontrol and was within the range of the results of previous surveys (see figure). Mortality rates were below alert levels but remained significant (underfive mortality rate = 1.52/10,000/day; crude mortality rate = 0.69/10,000/day). The main cause of under-five mortality was malaria (80% of the deaths). Measles vaccination for the 12-23 month olds was 68% according to cards. Vitamin A coverage was 5.4%.

Balombo municipality

A random sampled nutrition survey was undertaken in Balombo municipality in May 2003 (CRS, 05/03). Since April 2002, a number of new areas have been made accessible in the municipality. The present survey included the newly accessible areas. 64% of the families interviewed were resident families, whilst 31% were returnees. The IDPs represented only 5% of the sample. The results showed an acceptable nutrition situation, which has gradually improved since 2001 (see figure).

However, mortality rates were of concern (underfive mortality rate = 2.4/10,000/day, crude mortality rate = 0.9/10,000/day), but have decreased since March 2002, when under-five mortality rate and crude mortality rate were respectively 3.2/10,000/day and 1.4/10,000/day (see RNIS 36/37). The main causes of under-five mortality were malaria (44%) and diarrhoea (22%). Measles vaccination coverage for the 12-23 month olds was 18% according to cards.

Overall

The nutrition situation has stabilised in Benguela province, even in newly accessible areas (category III/IV), but mortality rates are still high. Provision of basic need services is an essential part of the country reconstruction and will be crucial, as will be the strengthening of food security, to ensure people's recovery from the war.

Recommendation and priorities

• In addition to sustaining food security, strengthen water availability, sanitation and health care to reduce mortality

RNIS 41, April 2003

The humanitarian situation has remained stable over the last months. Improvements have been reported in some areas, whilst the situation is still critical in others. The delivery of food aid and humanitarian assistance are still hampered by the presence of land mines and bad road conditions, which have been made worse by the rainy season. Bengo, Huila, Kuanza Norte and Sul, Luanda Sul and Malange provinces have been the most difficult to reach (WFP, 14/02/03). New WFP interventions have been planned in Nzoji and Soqueco in Malange province (WFP, 28/02/03; WFP, 07/03/03). Reconstruction of infrastructure, de-mining, provision of basic services and reintegration of UNITA ex-soldiers are especially challenging and will be crucial components of Angolan reconstruction following a 27 year war. There is more and more concern about the commitment of the Angola government to achieve these crucial projects. The International Crisis Group recommended that some of the oil money be directed to social services and public investments, and these should be considered as part of a peace building and conflict prevention strategy (ICG, 26/02/03). It is also observed that donor commitment to Angola will be influenced by the government's fiscal transparency and governance (OCHA, 03/02/03).

Food security and nutrition situation

A vulnerability assessment concluded that the highest concentration of food insecure population were in Bie and Huambo provinces. New IDPs, vulnerable residents in new accessible areas, returnees, and UNITA demobilised soldiers and their families are considered the most vulnerable (OCHA, 19/02/03). Seeds and tools were distributed during the planting season to some 600,000 families. However, tens of thousands of families did not receive sufficient seeds and tools, especially in Bengo, Benguela, Cunene, Huila, Kuando Kubango, Kwanza Sul, Moxico and Uige provinces (OCHA, 19/02/03).

The attempt to relocate UNITA soldiers and their families from the Quartering and Family Areas where they are settled, to their areas of origin before the planting season (November-December) has failed. Different factors have delayed the process: the number of ex-UNITA soldiers had been underestimated; there have been delays in distribution of resettlement packages (tools and basic non-food items), and rainy season has hampered transportation. It is now expected that the majority of ex- UNITA soldiers and family will not be able to plant before the next planting season in 2003 and will therefore be dependent on food aid for several more months.

The fate of often very young girls who were abducted by UNITA soldiers and are now considered as UNITA soldiers family members has raised concern (RI, 07/03/03). No direct assistance has been planned for them, although they have suffered from their abduction and living conditions and may wish to reintegrate into their families. Refugee International calls for special attention to them.

Kuando Kubango province

Cuito Kuanavale municipality

ACH-S conducted a nutrition survey in Cuito Kuanavale municipality (including the town, rural areas, and IDP camps) in November 2002. Among the families surveyed, 32% were displaced, of whom 23% arrived less than one year ago. The survey revealed that the situation is undercontrol: 6.7% of the 6-59 month olds were acutely malnourished, including 2.3% severely malnourished. The nutritional situation has remained undercontrol now over the past several years (see RNIS 38, 34). The food distribution coverage was very poor the month prior to the survey: only 8.6% of the recently displaced population (displaced less than one year) received food aid, whilst the other IDPs received no food. The measles vaccination coverage was 82% according to vaccination cards and mothers' statement, and was better than in the previous surveys (64% in May 2002 and 61% in June 2001).

Huila province

Caconda municipality

A nutrition survey was carried out by ACH-S in Caconda municipality in December 2002. The municipality has received a large number of IDPs over the last few years. Among the families surveyed, 60% were displaced (of whom 60% were displaced for more than one year), 38 % were resident families and 2% were returnees. The survey results showed an average nutrition situation, which has greatly improved since the beginning of 2002 (see graph).

Under-five mortality rate has also decreased over the past months but was still high (see graph). In addition, admissions to TFC have decreased since May 2002.

The measles vaccination coverage was 52.1 % according to cards and 71.3% according to cards and mothers' statement. About 80% of the households which had been displaced for more than one year, as well as 78% of the families which were displaced for less than one year, received food distribution the month prior to the survey. On the other hand, only 15% of the returnees received food distribution. The improvement of the nutrition situation may be attributed to the wide coverage of WFP distributions and better food availability in markets.

Trend in admission to therapeutic feeding centres

The number of therapeutic feeding centres decreased over the second semester of 2002 from 24 in August to 10 in December. The number of admissions to TFC has also decreased; in December 2002, the number of admissions was the lowest recorded since September 1999 (see graph). In December 2002, the highest numbers of admissions (around 350) were recorded in Benguela and Huambo provinces. The situation in the central area of Benguela seemed especially unstable.

Overall

The situation remained stable over the past few months (category II/III), and has greatly improved since mid-2002. The coming crops and dry season will probably also contribute to the improvement of the situation. Humanitarian aid and development programmes are however still fundamental to improving the living conditions of the population.

Recommendations and priorities

From the ACH-S survey in Kuito Kuanavale, Kuando Kubango

• Improve the coverage of the food distribution for the IDPs
• Implement food security programmes
• Implement nutritional surveillance through the health system

From the ACH-S survey in Caconda, Huila

• Support government and local NGOs in assisting vulnerable population
• Reactivate health posts
• Continue food distribution, at least until the next harvest

RNIS 40, Dec 2002

Delivery of humanitarian aid has been greatly hampered over the reporting period. The rainy season exacerbated the already poor transport conditions, which were due to the inadequate road infrastructure and presence of landmines. Food aid air drops were planned in order to reach inaccessible areas, where 40,000 people were isolated (OCHA, 10/01/03). As of December 2002, WFP estimated that between 2.1 and 2.4 m people might be in need of food aid until the next harvest in April/May 2002, but warned that a pipeline break might occur due to a lack of funds (WFP, 19/12/02). Seeds and tools were distributed to at least 300,000 families throughout the country before the 2002 September/October sowing season (FAO, 02/12/02).

IDP and refugee movements

As of December 2002, it was estimated that about 2.8 m people remained displaced, including 290,000 who settled in camps or transit centres, whilst between April and November 2002, 1.1 m returned to their areas of origin. Only 15% re-turned under an organised plan. It is estimated that only 30% returned to areas where living conditions were in accordance with the pre-conditions that should be met during the resettlement and return process, as defined by the Angolan government (OCHA, 19/12/02). About 39,000 ex-UNITA soldiers and family members were moved from the Quatering and Family Areas, where they were settled, to their areas of origin. It was intended that they be given land, the equivalent of US$ 100 and basic items such as blankets, seeds and tools. Some may also benefit from training. The World Bank is to provide Angola with US$ 100 m over three years to help with the re-integration programme (OCHA, 22/10/02). About 425,000 ex-UNITA soldiers and family members still remain in the QFAs (OCHA, 19/12/02). The fate of former rebel combatants will be a key factor in national stability. It seems that about 86,000 Angolan refugees spontaneously returned between January and November 2002; 61,300 have been registered (OCHA, 19/12/02). Organised repatriation by UNHCR will only begin at the end of the rainy season, in May/ June 2003 (UNHCR, 15/11/02).

Nutrition situation

Living conditions have stabilised in all except four of the 14 areas where acute needs were found dur- ing rapid assessment of critical needs (USAID, 31/10/02). MSF also reported that living conditions have generally improved over the past weeks, except in Mavinga, and in Huambo in Huila Provinces. Measles outbreaks and improving the coverage of measles vaccinations were particularly challenging (MSF , 13/11/02). A joint rapid assessment in Cassongue, Kuanza Sul province, found a serious situation which required urgent humanitarian interventions (WFP, 31/10/02). World Vision also reported high malnutrition rates in newly accessible areas in Huambo and Huila provinces (WV, 21/11/02). On the other hand, COSV reported a 60% reduction in malnutrition rates since July 2002, in Fazenda Santa Cruz and Mimbota, Bengo province (WFP, 10/01/03). Admissions to therapeutic and supplementary feeding centres have also decreased in Luena, Moxico province, probably as a result of development of income-generating activities and distribution of seed protection rations. MSF-B was planning to hand over the treatment of malnutrition to Luena central hospital (WFP, 25/10/02).

Luanda Norte

A nutrition survey was carried out by MSF-H in Cumbulo QFA, Xa-Muteba municipality, Luanda Norte Province, in October 2002 (MSF-H, 10/02). The camp hosted approximately 5,000 people. The prevalence of acute malnutrition was 3.9 %, including 0.9% of severe malnutrition, which indicated a satisfactory nutrition situation. However, the under-five mortality rate was very high at 5.5/10,000/day.

Kuando Kubango

Two nutrition surveys were carried out by MSF- CH/Epicentre in Mavinga Town and in Matungo and Capembe Quatering and Family Area (QFA), Kuando Kubango province, in November 2002 (MSF-CH, 11/02). Although the prevalence of mal- nutrition was average, the crude and under-five mortality rates were of concern, especially in Mavinga town (see table). Fever/malaria and diarrhoea were the two main causes of deaths. Measles vaccination coverage was good in the QFAs, but low in Mavinga town (see table). Most of the households surveyed in Mavinga town arrived in August and September 2002, whilst the population of QFAs arrived mostly in May and June 2002. The nutrition situation has improved notably since the last survey done in July 2002, when the prevalence of acute malnutrition was above 25% in the QFAs and above 12% in Mavinga town, both including high levels of severe mal- nutrition (see RNIS 39). MSF-CH has been running supplementary and therapeutic feeding centres.

Result of two surveys, Mavinga area, Kuando Kubango province, Angola, November 2002 (MSF-CH/ Epicentre, 11/02)

Trend in admission to therapeutic and supplementary feeding centres

The trend in admission to therapeutic feeding centres throughout Angola shows that the number of admissions in May 2002 was the highest recorded since the end of 1999 (see graph). The number of admissions rose from January 2002 until May 2002 and decreased thereafter. This pattern may be explained by different factors. At the beginning of 2002, population displacement increased as a result of renewed fighting and because of the Angolan army policy to move people within controlled areas. Following the April agreement between UNITA and the Angolan government, wider access to the population was possible. Improved humanitarian aid delivery may explain the drop in admissions since June 2002. The trend in admissions saw the same pattern in Hambo, Bie, Huila, Benguela, and Malanje. The highest number of admissions was reported in Bieh and Huambo Provinces, in May 2002.

Overall The nutrition situation seems to have greatly improved in some areas of Angola, probably because of the efforts to deliver massive humanitarian aid, but mortality rates remained high. People are still highly dependent on relief aid, which needs to continue to be delivered. Rehabilitation of infrastructure and de-mining are also crucial for the country re- construction.

Recommendations and priorities

From the MSF/Epicentre survey in Mavinga:

• Improve access to quality health services
• Urgently carry out a measles vaccination cam- paign in Mavinga town
• Implement and support active mortality and morbidity surveillance
• Improve access to potable water
• Continue existing nutrition programmes
• Monitor the general food distribution
• Update the population figures of Mavinga

From the MSF-H survey in Cumbulo QFA

• Implement curative and preventive health care
• Implement and support active mortality and morbidity surveillance

RNIS 39, October 2002

The situation in Angola is causing great concern amongst the humanitarian community. The almost complete destruction of infrastructure in certain areas caused by the 27 years of war is a major constraint to assisting the population. The destruction of health facilities and other basic infrastructure such as running water has created a large number of people in need of assistance when there is a lack of funds.

Since April 2002, when the war ended, more and more areas have become accessible and people have moved closer to places where humanitarian aid can be provided, leading to a rise in the population requiring assistance. Rapid assessments have been conducted in 28 locations in 12 provinces (OCHA, 09/02). About 60% of the country however remains unreachable due to landmines and poor infrastructure (OCHA, 09/02). Access to basic services is hampered by the poor condition of roads and airstrips, and very large numbers of landmines. Difficulties in accessing populations are even worse during the rainy season, which began in September. Needs are enormous, including infrastructure rehabilitation, de-mining, strengthening livelihoods, and emergency programmes to cover basic needs (OXFAM, 29/07/02; MSF, 05/08/02; IRIN, 02/08/02). An overall improvement in the situation can not be foreseen for at least 12-18 months by which time a majority of the displaced people and refugees should be resettled, the infrastructure should be repaired, and de-mining be undertaken. A successful agricultural season will also be required before the situation may improve significantly (OCHA, 28/08/02).

However, there have been improvement in some areas. Out of the 25 accessible areas where malnutrition rates were high in July, the situation improved in 14, although it remained precarious in other areas (OCHA, 26/09/02).

Funding

Operations in Angola remain largely under funded. In August 2002, it was estimated that the 2002 appeal by UN agencies and NGOs only helped gen-rate 47% of the required funding. Moreover, there are large funding discrepancies between sectors (see figure) (OCHA, 09/02). WFP’s needs were only 26% funded as of October 2002 (WFP, 01/10/02). Although the government of Angola has pledged US$ 140 M for Quartering and Family Areas, and resettlement for 2002, there are concerns that it is insufficiently committed to helping its people in need, particularly given the country’s US$ 9 billion GDP (RI, 13/08/02).

Funding gaps, Angola 1^st semester 2002 (from UNOCHA, 09/02)

IDP and refugee movements

It is estimated there are currently about 4.3 m IDPs in Angola, a significant rise since April 2002. However, only 1.3 m are registered by humanitarian organisations. There are an estimated 100,000 separated children throughout the country (USAID, 14/08/02). According to different sources, the estimated number of IDPs resettled in their area of origin varies between 300,000 and 450,000. The majority of them have returned to either Bengo, Bie, Hambo, or Malanje. About 90% of the IDPs have returned to their home land without receiving any form of assistance. The areas where they are resettling lack basic infrastructure, and humanitarian agencies are unable to cover all the needs (OCHA, 26/09/02).

WFP reported that returnees were receiving no help at the returnee transit point at Luau in Mexico Province, where basic services are urgently needed (WFP, 11/10/02).

Before the end of hostilities the number of refugees was estimated at about 470,000, scattered between Zambia, the DRC, Namibia and Congo. UNHCR is planing to provide repatriation assistance from early 2003. From February to August this year, about 9,500 refugees spontaneously returning from the DRC, were registered by UNHCR. More have probably returned without being registered. The influx of returnees seems to have decreased recently with only 650 returning in August compared to 1,500 per month in the previous months. UNHCR also registered 4,500 spontaneous returnees from Zambia, with a further 8,500 estimated non-registered (UNHCR, 13/08/02).

Food security situation

An overall cereal deficit of 468,000 Mts is expected for 2002-2003 despite a 22% increase in maize production and a 64% increase in cassava production because of better rain (SADC, 28/07/02).

The number of people in need of food distribution has grown from 1.3 to 1.9 M. WFP has begun to distribute food to the 41 Quartering and Family Area (QFA) settlements which together cater for about 300,000 former UNITA soldiers and their families although the government should have normally supplied them until October (WFP, 10/09/02). WFP has suspended its distribution programme in Huila, Cunene and in a central province of Malange because of landmines (OCHA, 13/09/02). Additionally, although it was planned to deliver a three month stock to populations in remote areas inaccessible during the rainy season, WFP’s pipeline was insufficient to achieve this (WFP, 10/09/02).

Nutrition situation

With the increased ability of both humanitarian agencies and the population to move around the country, several pockets of extreme poverty have been identified. The number of TFCs increased from 20 in March to 50 in June (UNSC, 15/08/02). The QFAs seem particularly at risk.

Kuando Kubango Province

Mavinga

MSF first obtained access to Mavinga in June 2002. About 7,000 people were living in Mavinga town while a further 40,000 were gathered in two QFAs. The local infrastructure had almost entirely been destroyed. MSF reported a very high rate of malnutrition in Matungo QFA with 25% acute malnutrition, including 8.9% severe, in a nutrition survey undertaken in July 2002. In Mavinga town, the rate of malnutrition was 12.4% including 5.6% with severe malnutrition (MSF, 08/08/02). As of September 2002, the situation remained highly precarious. About 10,000 people had come into Mavinga town from the QFAs where they were receiving no food. The water situation in the town was also very poor with no potable water available and cases of shigellosis were reported. Food supplies were also far from sufficient (MSF, 11/09/02).

Huambo Province

Bailundo

A nutrition survey carried out by Epicentre in June 2002 in Chiteta QFA revealed a malnutrition rate of 18%, including 5.9% severe malnutrition. The crude mortality rate and under-five mortality rate, over the past six months were respectively 2.5/10000/day and 5.7/10000/day, showing a very precarious situation (MSF, 01/07/02).

Moxico Province

Luena

MSF-B in collaboration with GOAL and MINSA carried out two nutritional surveys in Luena. One survey included Muacanhica and Muachimbo IDP camps and the transit centre; the other was done in Chicala Quartering and Family Area. Before the cease-fire agreement, Luena was a government-controlled area, which has received many displaced, particularly since January 2002. The Angolan Army has been bringing them from other parts of the province at the rate of about 1,500 persons a month, making the proper settlement of the IDPs difficult to ensure. A further three QFAs have been implemented in the area since the beginning of April.

The results of the nutritional and retrospective mortality surveys are shown in the table below. In July 2002, the rates of malnutrition and mortality in the QFAs were far above the emergency threshold, whilst the nutritional status in the camps was slightly better but still of concern. The population in both areas surveyed had very high death rates, particularly before their arrival in the settlements. Although the mortality rates then dropped somewhat they remained elevated. It was noticed that very few cases with oedema were recorded during the survey although 40 % of the new admissions to TFCs in June 2002 had oedema.

In the IDP camps, new arrivals were receiving a 90 % ration for one month and then were given the same ration as the IDPs who had arrived earlier (70 % ration). About 5 % of the families reported having received no food. Although attempting some agricultural activities, the population is still almost totally reliant on food distribution. Cases of bloody diarrhoea resulting from poor access to safe drinking water and poor sanitation were also reported.

At the time of the survey, humanitarian organisations were only able to access Chicala QFA for the previous few weeks. Food was provided by the Angolan government (99 % of the families reported to have received food). WFP also started to give additional food to mothers and children at the end of June. Sanitary conditions seemed to be poor, and the health facilities lacked essential drugs.

The measles vaccination coverage in both places was below the 85 % necessary to avoid measles outbreaks.

Results of two nutritional surveys in Luena, Moxico province, Angola, MSF-B, July 2002

a Deaths recorded from 22-02-2002 to 26-06-2002

b Deaths recorded from 22-02-2002 to 17-04-2002 or to the date of arrival in the camps, corresponding to the period prior to their arrival at the quartering and family areas or camps

c Deaths recorded from 26-06-2002 to 18-08-2002, corresponding to the period after their arrival at the quartering and family areas or camps

Overall Populations in the newly accessible areas, and in the QFAs are both at high risk (category I). The situation may worsen further during the rainy season, when access is hampered. Needs are huge both in terms of emergency programmes to provide basic services, but also in terms of de-mining, infrastructure rehabilitation, and support for population resettlement.

Recommendations and priorities

From the MSF-B survey in Luena

Quartering and Family Areas:

• Continue the food distribution
• Increase measles vaccination coverage
• Provide support to health facilities

IDP camps:

• Continue the food distribution,
• Distribute seeds and tools for planting
• Increase measles vaccination coverage

From the RNIS

• Support NGOs and United Nations funding
• Support both emergency and longer term programmes

RNIS 38, July 2002

Angola currently has one of the worst humanitarian outlooks in the world. The country has been suffering from a protracted conflict between the government and forces of the National Union for the Total Independence of Angola (UNITA), that has gone on for almost 30 years. The conflict has resulted in the massive displacement of population, largely as a result of direct tactics on behalf of both the government and UNITA. The continued displacement and the acute insecurity in most of the country has systematically prevented people from accessing their land and being able to practice farming. The situation has been further exacerbated by the collapse of the economy in many areas and the abysmal state of the infrastructure. The result has been a great degree of vulnerability and catastrophic humanitarian conditions.

The situation in Angola took a dramatic turn in February 2002 with the death of the UNITA leader, Jonas Savimbi. With the death of Savimbi, UNITA appear to have lost the will to continue the conflict and a cease fire was duly announced, unilaterally, by both UNITA and the government in March 2002 and a Memorandum of Understanding agreement signed in April 2002. The MOU called for the full implementation of the Lusaka peace accords of 1994, which made provision for the full demobilisation and reintegration of UNITA soldiers, originally estimated to number around 50,000 with a further 300,000 family dependants. The peace agreement appears to be holding and critically has allowed access to the huge areas of the country that had been totally inaccessible to the humanitarian community, which has revealed the true extent of the extraordinarily serious humanitarian disaster in the country.

The humanitarian situation

The sudden peace process and the cessation of violence between the warring parties has brought about unprecedented changes to the Angolan context. Until 1 April 2002, 80 % of the country was totally inaccessible to humanitarian agencies and, as new areas become accessible and are investigated, the full extent of the humanitarian crisis is becoming apparent. It is estimated that over 4.3 million people from a total population of approximately 12 million, are displaced, with 1,340,000 being officially registered in various camps around the country. The case load of IDPs grew significantly in the months leading up to the April peace agreement and UNOCHA estimate that between November 2001 and March 2002, 50,000 people were displaced a month (UNOCHA 18/06/02). The humanitarian community was serving the emergency needs of around 1.9 million people at the time of the peace agreement in April 2002 and this number has grown considerably since April, with current UN estimates indicating that there are now 3 million people being targeted for assistance, or about one quarter of the country’s population (UNSC 17/07/02).

A key feature of the current situation is the emergence of particular groups of vulnerable people. The first is the old case load of IDPs that are located in the areas formerly accessible to humanitarian agencies, many of them in and directly around provincial capitals. Many of these are long term IDPs and many, although largely dependant on aid, have established a variety of coping mechanisms. The second group is those, largely IDPs, who live in the newly accessible areas. The reporting period has seen major efforts to reach these new areas and there are confirmed reports of up-wards of 800,000 highly vulnerable people in these areas. Rapid assessments have shown that the humanitarian situation is critical, with the most affected areas being those with the worst history of insecurity and where agricultural fields were destroyed during military operations. This resulted in large amounts of people being in a desperately impoverished condition and suffering from desperately poor food insecurity (UNOCHA 18/06/02). The third group with critical needs is the demobilised UNITA soldiers and their family attendants, which number 82,185 and 220,264 people respectively (USAID 12/06/02). The official policy regarding the UNITA troops and their families has been to quarter them in 34 Family Reception Areas (FRAs) locate throughout the country. The condition of many of the UNITA in the camps is extremely poor as they have been living for years deep in the country and have suffered from the effects of the sanctions imposed on UNITA by the international community. Despite promises by the Angolan government that they had the capacity to address the needs of those demobilising, the response appears to have been slow and woefully inadequate. Concern has been expressed that without urgent assistance the ex soldiers will tire of waiting and return to their weapons once more as a way of obtaining desperately needed food (UNOCHA 19/07/02). The fourth group consists of returning refugees and IDPs who have and will chose to permanently resettle or go back to their areas of origin. UNOCHA estimates that up to 500,000 IDPs and 80,000 refugees could resettle or return by the end of this year (UNOCHA 18/06/02; 24/06/02). Returns are likely to increase substantially in the future as areas become suitable for returns to take place. This will decrease the case load, which is nevertheless likely to remain high for the immediate future.

With increased access to areas, the humanitarian community has been able to conduct more and more assessments in the newly opened areas and it is becoming clear that the situation is extremely serious in many areas. Some of the worst affected areas identified thus far are Bie, Huambo, Huila, Kuando Kubango, Kuanza Norte, Lunda Sul and Uige Provinces (UNOCHA 24/06/02). Assessments have routinely shown that people are arriving in distribution centres in desperately poor condition after literally years without sufficient access to adequate food or health services. As a result levels of malnutrition and mortality rates have been found to be significantly above established emergency thresholds and indicative of a truly desperate situation. The needs, particularly of the newly accessible populations, have been found to be critical and people are dying in large numbers.

The ability of the humanitarian community to address the critical needs is still constrained by a mixture of factors. The security situation is hugely improved as a result of the cease fire and the demobilisation of UNITA troops suggests that a return to war is not likely. However, much of the country remains very heavily mined and this continues to have an impact on humanitarian assistance by leaving large areas insecure. The provinces of Bie, Huila, Huambo, Lunda Sul, Bengo, Kuando Kubango and Kwanza Norte are particularly badly effected. The mine threat is hampering attempts to move aid around the country to areas with high needs. The 30 year war has also rendered the road and transportation network largely impassable, leaving 40-50 % of all humanitarian assistance efforts relying on air transport. However, the poor state of many of the airstrips has limited the size and number of aircraft that can use them (USAID 12/06/02). This is having the effect of greatly increasing the cost of delivering aid to much of the country.

Given the current severity of the situation, the increase in beneficiary numbers and the greatly increased humanitarian needs, it is alarming to note that the UN Consolidated Inter-Agency Appeal (CAP) has so far met with a very poor response from the international donor community, despite the emergency having been branded as the worst crisis in the world at present. As of 1 July 2002, only one third of the CAP target of 232,768,666 US dollars had been met. WFP have also announced on 19 July 2002 that they had received less than 10 % of their required budget and are facing critical pipeline breaks in December. This is extremely concerning and is likely to result in the reduction of rations to vulnerable populations that are in dire need of assistance.

Bie Province

The situation in Bie province continues to be extremely critical. The number of displaced in the established centres of Kuito and Camacupa is close to 200,000 people and IDP numbers continue to increase. WFP announced that another 19,000 people arrived in Camacupa, Kuito and Kunhinga at the beginning of May 2002 (WFP 03/03/02). Many of the new arrivals are reported to be in extremely poor condition and MSF have opened up another Therapeutic Feeding Centre (TFC) in response (WFP 10/05/02). Rates of malnutrition in the camps are reported to be high but stable as a result of the great humanitarian response. However, it is concerning to note that there are reports of another outbreak of pellagra, a deficiency of niacin. The area has suffered pellagra outbreaks for the past few years, which is highly indicative of the poor quality diet that is being consumed by IDPs. Pellagra is associated with increased morbidity, and ultimately mortality, and an improvement to the general ration is urgently required.

The peace agreement has allowed humanitarian agencies to access other areas in the province and assessments have revealed very acute needs. MSF conducted a rapid assessment in Chitembo and Cuemba that revealed a prevalence of acute malnutrition that was significantly above emergency thresholds and rates of mortality that were up to 3 times higher than emergency thresholds. The assessments resulted in the initial transportation of more than 45 malnourished children to TFCs in Kuito and concluded that the humanitarian community was a year too late (MSF 14/06/02). Other areas of concern are Gamba, M’Dele and Nharea, where assessments have indicated very serious situations. Bie also has a UNITA FRA at Ndele and assessments have indicated that the number of cases of malnutrition is on the rise, even after the arrival of emergency aid (UNOCHA 02/07/02). The number of returnees has also increased as a result of the improved situation and WFP has reported that 19,500 have returned to Cuemba, with a further 10,000 returning home from Kuito and Camacup (WFP 21/06/02). Despite the increased access to areas in Bie, the security situation remains precarious, as was highlighted by the recent detonation of a mine by a WFP truck on the road from Kuito to Ndele. The road has subsequently been closed for further assessment but this incident indicates the dangers still present in the area. The RNIS has not received any recent full survey reports but rapid assessments continue to indicate that the overall situation is extremely precarious.

Benguela Province

The situation in Benguela remains mixed. Humanitarian agencies have remained active in areas with long standing IDP populations but the delivery of aid has been difficult as a result of poor roads and the destruction of important bridges, such as that over the river Cavaco, which links Lobito to the main town of Benguela. The good security of the area has meant that there are four Family Reception Areas (FRAs) with more than 30,000 UNITA soldiers and family members. ACF-SP conducted nutritional surveys of the displaced and non displaced populations in the municipality of Ganda in June 2002, as follow up to previous surveys in the area (see the table below for data).

Table of ACF-SP survey in Ganda, Benguela Province

The surveys indicated that the prevalence of acute malnutrition are below emergency thresholds and have not significantly changed since the last survey conducted in November 2001 (see RNIS 36/37). However, it is concerning to note that the mortality rates are slightly above emergency thresholds, suggesting that the humanitarian situation is far from under control. The results also compare to those from the previous survey and suggest that the real problem for both the IDPs and the resident population is a health problem.

Huila Province

The humanitarian situation in Huila province is extremely poor with over 170,000 IDPs in various camps and towns. There are reports of new IDPs arriving and the improved security has allowed access to increasing numbers of places such as Bunjej, Chipindo and Galangue. Bunjej, as reported in RNIS 36/37, has an extremely poor humanitarian situation with assessments indicating extraordinarily high rates of both malnutrition and mortality. There are currently estimated to be in excess of 15,000 IDPs and a further 22,000 local people in the town and more are reportedly arriving (ASA 01/05/02). Chipindo camp has an estimated 18,000 IDPs with another 10,000 expected when food is available (WFP 17/05/02). The situation is again extremely poor with many children currently registered in selective feeding programmes. WFP has been conducting food distributions to the population in these areas but has been hampered by the very poor roads which are slowing down the delivery of aid. The town of Galangue, 47 Km to the south of Bunjej, was assessed in May 2002 and has revealed rates of mortality as high as 5 times the emergency thresholds, and many of the dead are children under the age of five. Assessments have also revealed very high rates of acute malnutrition and indicate the extent of the critical needs of the IDP population.

Caconda

Caconda is 240 Km from the provincial capital of Huila province, Lubango. The town is on a major transit route from the north to the south and has received a large number of displaced over the years. Until very recently, the town had a security perimeter around it of 10 km, which severely restricted the movement of both the residents and the IDPs and severely restricted access to farm land. The town contains about 20,471 and the displaced camps 25,195 (ACF-SP 05/02). ACF-SP conducted a nutrition survey amongst both the resident and the IDP population (see table below for data). The surveys show that that there is a significant difference between the estimated acute malnutrition amongst the resident and IDP populations. The estimated prevalence amongst the resident population lies below emergency thresholds whilst that of the IDP population lies above the emergency threshold. However, it should be noted that there is no significant difference between the observed prevalence of severe malnutrition. The estimated mortality rates are all above emergency thresholds with that of the under-five IDP population being 4 times the emergency threshold (ACF-SP 05/02). The results indicate a precarious situation, particularly vis a vis the mortality rates, although the survey makes the point that the situation appears to have improved since the last surveys were conducted at the beginning of the year (see RNIS 36/37).

Table of ACF-SP survey in Caconda, Huila Province

The situation remains alarming but the survey explains the improvement as being a result of a decrease in the number of displaced arriving in the area and that IDPs are now being resettled in camps, relieving some of the overcrowding. There has also been an increase in the coverage of food aid. However, it is also noted that the purchasing power of IDPs is extremely poor and that the price of staples is beyond the reach of most IDP families (ACF-SP 05/02). It is also noted that for the past two years the harvests have been too poor to maintain household food security, which has substantially increased dependence on humanitarian food distributions.

Kuando Kubango Province

The situation in Kuando Kubango province is extremely mixed with large differences between some of the long term IDP populations and some of the newly accessible areas. Assessments in the Mavinga area, which lies 300 Km from the town of Menongue, have revealed a very poor humanitarian situation as a result of a prolonged period of isolation, poor access to water and no previous access to aid. Accessing the region has proved extremely difficult as roads between Menongue and Mavinga have been heavily mined. The only way of reaching the town has been by aircraft. The assessments have revealed a population, including IDPs, of about 64,700 people (WFP 19/07/02) and levels of malnutrition greatly elevated from emergency thresholds. This has resulted in many people being admitted to TFCs and WFP establishing an urgently required general food distribution to meet the critical needs of the population. It is likely that this mirrors other sites in the province that are yet to be accessed.

Kuito, Kuanavale

Kuito Kuanavale is on the road from Menongue to Mavinga and historically has been extremely isolated and insecure. The situation has changed considerably as a result of the peace accord and the reporting period has seen no reports of insecurity in the area. The reported population of the area is 26,395 (ACF-SP 06/02). The town contains a sizeable IDP population with many coming from Mavinga, however the good security situation has meant that there has been a considerable drop in the number of new arrivals to the town. ACF-SP conducted a survey in the town in June 2002 and showed an estimated prevalence of acute malnutrition of 5.5 % (W/Ht < -2 Z scores and/oedema), which included 1.3 % of severe malnutrition (W/Ht < -3 Z scores and/oedema). The Crude Mortality Rate was 0.94/10,000/day and the under-five mortality was 2.36/10,000/day (ACF-SP 06/02). The results indicate that the nutrition situation is under control, with prevalence being under emergency thresholds, and has remained stable when compared to past surveys. However, the mortality rates are cause for concern. The CMR is fractionally under the emergency threshold of 1/10,000/day and the under-five mortality is over the emergency threshold of 2/10,000/day. These rates indicate that there is cause for concern and that the humanitarian situation is far from being acceptable. The survey indicates that one of the chief problems in the town is the very poor access to safe water and to adequate sanitation. This greatly increases the risk of disease transmission and may go some way towards explaining the high observed mortality. The survey also notes that the harvest has been poor, resulting in inadequate food stocks, and that the coverage of food aid is poor with the ration being below recommended levels. The situation remains precarious and although the new found security will hopefully allow the situation to improve, the possibility of a deterioration must not be overlooked.

Overall

The reporting period has seen the consolidation of the peace accords. There have been almost no reports of insecurity and the likelihood of a return to war would appear to be small. The main groups of concern are the new IDPs who are growing in numbers as previously inaccessible areas are opening up to humanitarian organisations. They are considered to be extremely vulnerable (category I) and very high rates of mortality and malnutrition have been observed. Other groups of concern are the demobilised UNITA soldiers and their family attendants who are in very poor condition (category I). The needs of the old IDP community are very mixed with some areas of high needs and others where the needs are less, however they still remain extremely vulnerable (category II).

Recommendations

From the ACF-SP survey in Ganda, Benguela Province, June 2002

• Continue the General Food Distribution to the IDPs and to the vulnerable groups from the resident population.
• Improve access to medical services.
• Conduct health education programmes focusing on primary health care and public health.
• Improve anti-malarial programmes in the area.
• Improve access to water and sanitation facilities.

From the ACF-SP survey from Caconda, Huila Province, May 2002

• Increase routine vaccination services.
• Increase the amount of trained health staff from the MoH.
• Screen all new IDPs for health and nutrition status.
• Increase access to water and sanitation facilities.
• Distribute urgently needed agricultural inputs.

From the ACF-SP survey in Kuito Kuanavale, Kuando Kubango Province, June 2002

• Improve nutritional screening of children under five.
• Improve access to water and sanitation facilities.
• Promote food security through the dissemination of agricultural inputs.
• Reinforce health education programmes.

RNIS 36/37, April 2002

Angola has been suffering from a protracted conflict, between the government and forces of the National Union for the Total Independence of Angola (UNITA), which has been ongoing for almost 30 years. An attempt at peace was made in 1994 with the signing of the Lusaka peace accords by the government and UNITA, however conflict continued and all out war resumed in 1998 (NRC 04/04/02). The toll on the population and the country has been enormous and has served to create a humanitarian crisis of quite staggering proportions. The total population of the country is 12 million and current estimates suggest that a quarter of the population have been displaced.

Many have argued that displacement, much of it forced, has been one of the predominant tactics in the war, with areas having been deliberately cleansed of people to remove potential subsistence base for armed units (MSF 05/03/02). The majority of those affected have been rural populations who have been displaced from their lands and means of subsistence. Many families have become separated and the proportion of female headed households is very high. Some IDPs have made their way to regional centres, where international agencies have been able to work, and have received assistance. For the remainder, they have often been forced to live in hiding in the hills and forests, with little or nothing to sustain them other than what they have been able to forage. The insecurity and the large amount of land mines in the country have restricted access to cultivable land and seriously affected food availability. Furthermore the collapse of livelihoods and the economy has resulted in grinding poverty. As a result, many have been left unemployed and the possibility of alternative income generating activities is poor. The situation has been further exacerbated by the almost total lack of infrastructure, including access to basic health care, clean water and sanitation. The result has been a deteriorating humanitarian situation witnessed by rates of acute malnutrition, morbidity and mortality that have all been above emergency thresholds.

Events in Angola took a dramatic turn in February 2002 with the death of Jonas Savimbi, the head of the UNITA rebel movement. Savimbi was widely seen as the driving force behind UNITA and his death has paved the way for direct talks between the remaining UNITA leadership and the government. The negotiated peace received a considerable impetus 14 March 2002 when the government announced a cease fire (GoA 13/04/02). The cease fire was officially recognised by both UNITA and the government at the end of March and an agreement signed at the beginning of April 2002 (ASA 09/04/02). The peace agreement is of enormous significance because it offers an end to a conflict that is at the heart of the poor humanitarian situation in the country. The agreement includes a plan to demobilise up to 50,000 UNITA soldiers who are currently still in the bush. This will require an enormous amount of commitment on behalf of the government and the international community to ensure that the fighters are effectively demobilised and reintegrated into society. The period after the signing of the agreement has generally seen a decline in the number of reported security incidents and has led to the hope of an improved situation. However, it is very early to tell whether events herald a total end to conflict in the country or not

The humanitarian situation

Despite the dramatic political changes that have taken place in the country, the humanitarian situation remains desperate. The total estimated figure for IDPs in the country has risen to 4.29 million with 1.4 million of these registered by humanitarian organisations (UN OCHA 31/03/02). This is one of the highest figures for internal displacement in the world. The reason for the increased displacement is the escalation of violence that took place during 2001. In January 2002 alone there were an estimated 49,400 displaced in direct comparison to July 2001 when there were 12,383 (UN OCHA 31/01/02). By the middle of April, the number had risen to 139,500 (UN OCHA 15/04/02). If the current trend continues it is estimated that around 300,000 people will become newly displaced during the next 6 months, which would bring the total number of displaced to approximately 4.6 million people (UN OCHA 07/03/02). Areas particularly affected are Moxico, Bie, Huila, Bengo, Malange, Huambo and Benguela.

The newly signed peace is having an effect on the overall security situation and many new areas of the country are becoming accessible to humanitarian agencies. For years, one of the chief problems for the relief community has been its inability to reach populations that were in critical need of assistance due to insecurity and poor infrastructure. One of the foremost features of the past months has been an incredible influx of people to municipal towns in the hope of accessing relief assistance. Many of these people are arriving in very poor condition and agencies are reporting that they simply do not have the capacity to deal with the rising needs. There is a shortage of land, housing, water and sanitation and food supplies and selective feeding programmes in many areas are already beyond capacity. As a result, many new arrivals are living in sub standard conditions without access to basic shelter or services.

The vulnerability of IDPs is enormous and many have been living for very extended periods in the bush without real access to food, water or medicines. Much of the male population have either died, as a result of conflict, or have been subscripted into armed forces. As a result, many of the new arrivals are women, children and the elderly, all of whom represent vulnerable groups. It is clear from various reports and assessments that there has been substantial mortality amongst the displaced population and rates are emerging that are well above emergency thresholds. There have also been reports of greatly elevated prevalences of acute malnutrition and disease and it is alarming to note that this is occurring at a time when humanitarian resources are at their most stretched.

The improved security has resulted in a general improvement in access to affected populations and this will have important implications for the ability of the humanitarian community to meet emergency needs. Until relatively recently, most humanitarian relief supplies were delivered by air due to the acute insecurity of the roads. WFP has announced that since the cease fire it has been able to shift the emphasis away from costly air transport to the road network (NRC 04/04/02). However, the presence of mines and the very poor state of much of the road infrastructure will continue to hamper access and road transportation in many areas. Furthermore, air deliveries are also constrained in a number of places by the poor condition of runaways, which are badly in need of rehabilitation.

The general food security situation of the displaced population is extremely poor and, as new areas open up and the numbers of displaced continues to grow, it is likely that the overall situation will appear to deteriorate as the highest needs are amongst the newest displaced and in newly opened areas. As a result, a very substantial humanitarian intervention is required to prevent further loss of life. Areas of apparent critical need remain the provinces of Bie, Moxico, Huambo, Huila and Benguela.

Bie Province

The situation in Bie province continues to be extremely critical. The number of displaced has increased, with new arrivals reaching the area in increasingly poor condition. In the first two weeks of April 2002, it was reported that 6,610 people arrived in Kuito, Camacupa and Cunhinga. This influx over a two week period is larger than the 5,807 IDPs registered for the whole of the month of March 2002(UN OCHA 15/04/02). This has brought the total number of IDPs in the province to over 206,000 people. However, in January 2002, 21,500 newly arrived IDPs remained unregistered. This has placed extreme pressure on the existing resources in the province and over stretched registration systems. It is reported that new arrivals in some areas reported to be waiting up to three weeks before they receive assistance (UN OCHA 07/03/02). Reports indicate that there are high levels of malnutrition amongst the displaced population and mortality rates are above emergency thresholds.

The security situation, for the moment, appears to have improved and this is facilitating the arrival of many more people in to the area. Due to poor infrastructure it is still proving very difficult to transport humanitarian supplies and reports once again stress the poor condition of the airstrip in Kuito, which has impeded the delivery of adequate assistance for more than 22 months.

Camacupa

Camacupa is situated Northeast of Kuito, with a total number of IDPs as of 15 January 2002 of 50,587, although this will have increased considerably since that time (UN OCHA 24/01/02). The influx of IDPs has greatly stretched the ability of the humanitarian community to meet the needs of all those requiring assistance and many of the camps have reached full capacity. The Afeina II camp was opened in February 2002 and had reached full capacity, with an estimated 18,000 people, by the second week of March (UN OCHA 15/03/02). New sites are now being sought and as a result of the increased demand, the capacity of the therapeutic feeding centre (TFC) in Camacupa was increased from 250 to 400 to meet the increased needs.

In July 2001 MSF conducted a nutrition survey in the camps and found an estimated prevalence of acute malnutrition of 12.5 % (W/Ht <- 2 Z scores and/or oedema), which included 1.7 % of severe acute malnutrition (W/Ht < -2 Z scores and/or oedema). The survey also indicated that the CMR was 1.8/10,000/day and the under-five mortality was 3.8/10,000/day (MSF 08/01). The data indicates that the nutrition and health situation of IDPs is extremely poor and is a result of a chronically poor diet and very little access to food sources or medical care. It is also important to note the previous high prevalence of pellagra, which is a deficiency of niacin, pyridoxine, riboflavin and tryptophan. This evidence of micronutrient deficiency is highly indicative of a very poor quality diet and is concerning because it is associated with increased mortality and morbidity. According to nutrition surveys conducted in December 2001, the rate of acute malnutrition is 13 %, with a higher observed rate amongst the newer arrivals, where figures of 28 % have been measured. The CMR is 2.9/10,000/day and the under-five mortality is 4.8/10,000/day (UN OCHA 31/01/02). Selective feeding programmes are operating at full capacity and seasonal rains in December 2001 increased the risk of water borne diseases. It is also apparent that many of the new arrivals have not received measles vaccination and so the risk of a measles epidemic is of great concern (UN OCHA 24/02/02). The situation is extremely concerning and reinforces the vulnerability of the population in this area and the need for concerted emergency interventions.

Benguela

The situation in Benguela is extremely mixed. As of January 2002 it was reported that there were 95,698 registered IDPs in the province with a reported 419,239. Many areas of the province have been inaccessible to humanitarian assistance due to poor security. As the security situation has changed there have been reports of many new IDPs arriving in towns such as Culango, where more than 3,000 arrived in January and February 2002. There are also reports of large influxes of IDPs to Bocoio town who are without adequate shelter, clothing and food. (UN OCHA 28/02/02). The needs and conditions of the IDPs vary enormously with the newer IDPs showing both the highest needs and vulnerabilities.

ACF-SP conducted a nutrition survey in the town and IDP camps in and around Ganda, in November 2001. The town is situated to the south east of the province and contains approximately 5,300 IDPs who fled insecurity in the surrounding area. The town is more or less an enclave and both the residents and the IDPs have very little access to the surrounding area, greatly constraining their access to cultivable land. They have received an intermittent general food distribution. The survey investigated the prevalence of malnutrition in the displaced and non-displaced communities and found that prevalences did not differ markedly and were not elevated above emergency thresholds (see table below). This did not of itself indicate a concerning situation. However, the survey rates of both the crude and under-five mortality were above emergency thresholds and highly indicative of an extremely poor health situation. This is a result of a poor food security situation and the lack of access to good water, sanitation and primary health care (ACF-SP 11/01).

Table of ACF-SP survey in Ganda, Benguela Province (ACF-SP 11/01)

It is striking that the prevalences of malnutrition are relatively low and yet the mortality rates are alarmingly high, suggesting that the main problem for the population is the health environment. It is also interesting to note that the risk appears to apply equally to the displaced and non displaced and is probably a result of being confined to the same environment with little opportunity to move beyond the security perimeter.

Catholic Relief Service (CRS) conducted a nutrition survey on both resident and IDP children under five years of age in the town of Balombo in March 2002. The survey found an estimated prevalence of malnutrition of 11 % (W/Ht < -2 Z scores and/or oedema), which included 1.3 % of severe malnutrition (W/Ht < -3 Z scores and/or oedema). The survey also found a crude mortality rate of 1.4/10,000/day and an under-five mortality rate of 3.2/10,000/day. The results indicate that the situation for both IDPs and residents in the town is extremely precarious and, although not statistically significant, observations indicated that the condition of newly arrived IDPs was worse than that of the residents and the longer term IDP population. It is alarming to note that the mortality rates are elevated above emergency thresholds indicating a very poor situation. The reasons for this are believed to be acute food insecurity, the poor conditions within the town and the lack of access to adequate medical care (CRS 03/02).

Huila Province

The general situation in Huila province is extremely poor with an estimated 164,000 IDPs as of March 2002. There are estimated to be 1,000 new IDPs arriving in centres such as Caconda and Matala each week, placing pressure on the already limited resources of the area (UN OCHA 07/03/02). As the security situation has improved and the area opened up to humanitarian agencies, some areas of very acute needs have been highlighted. In particular, the situation in Bunjej has been confirmed as a disaster. MSF has conducted some assessments in the area and found mortality rates of between 4 and 6/10,000/day and a prevalence of acute malnutrition greatly in excess of emergency thresholds. This is indicative of a very serious humanitarian situation and has arisen as a result of the insecurity of the area and the inability of people to access even the simplest of subsistence needs. Similar situations have been found in other areas of the province and are indicative of the immense needs and vulnerability of much of the population (UN OCHA 31/03/02).

Caconda

ACF-Spain conducted a nutritional survey in the town and IDP camps of Caconda, in January 2002.

The area has been considered to be extremely vulnerable for some time as a result of poor food security and an increasing number of IDPs. The results of the surveys (see table below) indicate that the humanitarian situation in Caconda is critical and effects both the displaced and the non displaced populations.

Table of ACF-SP survey in Caconda, Huila Province

The prevalence of acute malnutrition in both incidences is above emergency thresholds and is very highly elevated in the case of the IDPs, illustrating that their nutritional status is extremely poor. The survey also indicates that the mortality rates for both groups are also above emergency thresholds and, in the case of the displaced population, is almost four times the emergency cut-offs for both CMR and under-five mortality. This is extremely concerning as it represents a huge mortality over the three months prior to the survey. One of the major causes of this mortality was an epidemic of measles in late 2001, with other causes being fever, diarrhoea and malnutrition (ACF-SP 01/02). The survey reports that the spread of disease has been greatly facilitated by over crowding and a greatly reduced access to medical care. It was also noted that the food situation is extremely poor as a result of reduced general rations and a lack of land and agricultural inputs. The situation can be considered to be very alarming.

Kuanza Sul

The province of Kuanza Sul is in the west of the country above the provinces of Huambo and Benguela. The province has suffered from poor insecurity and contains a number of IDPs, particularly in Wako Kungo where the numbers are reported as having reached 13,000 in February 2002 (UN OCHA 15/02/02). ACF-Spain conducted a nutrition survey in the municipality of Sumbe in December 2001 to determine the prevalence of acute malnutrition amongst IDP and non displaced children under five years of age. The survey indicated an estimated prevalence of acute malnutrition of 3.4 % (W/Ht < - 2 Z scores and/or oedema), which included 1.2 % of severe acute malnutrition (W/Ht < - 3 Z scores and/or oedema). The survey also estimated a crude mortality rate of 0.9/10,000/day and an under-five mortality rate of 4.1/10,000/day (ACF-SP 12/01). The prevalence of acute malnutrition is not high and of itself is not indicative of an emergency situation. However, the mortality rates are elevated with the CMR just below the emergency cut-off of 1/10,000/day and the under-five mortality above the emergency cut off of 4/10,000/day. The mortality rates indicate that the situation in the municipality is extremely poor and the causes would appear to be the very poor public health environment. The survey notes that the number of IDPs has placed great pressure on housing and that as a result houses and shelters are built very close together with no room given to the construction of latrines. This has led to a very poor hygiene situation where infections are very easily spread (ACF-SP 12/01). Both the IDPs and the non-displaced population remain vulnerable and, although the nutritional status was not deemed to be severe, the risk of further declines, particularly with the arrival of new IDPs, is large.

Lunda Sul

The situation in Lunda Sul is variable with areas of great need emerging as the security situation allows for increased access to needy populations. In March 2002, UN OCHA reported that the areas of Alto Chicapa, Xassengue, Cucumbi and Cacolo were experiencing critical shortages of food and medicines (UN OCHA 15/03/02). Many of these IDPs are reported to be making their way to the town of Saurimo where various camps and reception centres have been established. In Saurimo itself, the number of IDPs is growing and there are reports of increasing cases of diarrhoea among both children and adults. This has been linked to inadequate access to clean water and the consumption of seeds that have been treated with chemicals for conservation purposes (UN OCHA 28/02/02).

ACF-Spain conducted a nutrition survey on children under five years of age amongst the displaced and resident communities in Saurimo during January 2002. The results indicated that the prevalence of acute malnutrition did not, in itself, indicate a problem of public health significance. The prevalence appeared to be higher in the IDP population but the results were not statistically significant. However, the survey also showed that the mortality rates in both groups were above emergency thresholds, indicating that the overall situation for the population was extremely poor (see table below).

Table of ACF-SP survey in Saurimo, Lunda Sul

The reasons for the high mortality rates were given as being the poor access of the population to potable water. It was noted that most people were relying on contaminated water from rivers and lakes. It was also noted that access to curative health services was extremely poor. The health and hygiene situation was exacerbated by overcrowding in the camps which facilitated the spread of infectious diseases such as diarrhoea and fevers. The population is assumed to be at great risk of further nutritional decline as a result of the further influx of new IDPs (ACF-SP 01/02).

Moxico Province

Moxico has been the sight of much insecurity over the reporting period and was the province where Jonas Savimbi, the leader of UNITA, was killed in February 2002. The provincial city of Luena has been particularly badly affected by a huge influx of IDPs that have placed enormous pressures on the existing poor infrastructure. It has also been reported that the poor condition of the airstrip has made the delivery of emergency aid all the more difficult. In February 2002, it was estimated that the total number of IDPs in Luena was 89,000 (IRIN 12/02/02), however this figure is likely to have grown considerably.

Reports indicate that many of the IDPs have arrived at the town in military helicopters and the government has been accused of depopulating the surrounding countryside in an attempt to remove the subsistence base from the UNITA rebels known to be in the area. The problem has been that the sheer number of IDPs has simply overrun the resources of the town and of the humanitarian agencies ability to deal with the influx. Many of the new arrivals are women and children who are reported to be in critical condition. Both the supplementary and therapeutic feeding programmes have exceeded their capacity (UN OCHA 31/01/02). The government of Angola has reported that another 50,000 people could arrive in the town over the next few weeks (UN OCHA 07/03/02). The RNIS does not have any recent nutritional surveys from the town but it is reported that a nutritional screening in February 2002 indicated extremely high rates of acute malnutrition. The population should be assumed to be in very poor condition and at risk of further nutritional decline.

Overall

The reporting period has seen some major political changes in Angola but these have yet to have an affect on the critical humanitarian situation. Insecurity appears to be reduced, although it continues in some areas, and the presence of large numbers of landmines will continue to constrain access and ensure that many areas are regarded as insecure for some time to come. There has been a great increase in the number of IDPs, all with very acute humanitarian needs. The increase has surpassed the humanitarian community s ability to cope with the numbers of people and the depths of their needs. In terms of vulnerability, it is evident that the new IDPs are at greatest risk (category I) with some of the resident population and older IDP communities being at marginally reduced risk (category II).

Recommendations

From the MSF survey in Camacupa, Bie Province

• Continue general food distributions for all displaced to include a fortified blended food such as CSB.
• Improve access to primary health care and vaccination coverage.
• Improve shelters with plastic sheeting to protect against the rainy season.

From the ACF-SP survey in Ganda town, Benguela Province

• Continue the general food distribution to the population.
• Tackle the problem of diarrhoea and malaria through education and community teams.

From the CRS survey in Balombo, Benguela Province

• Expand the capacity of the Supplementary Feeding Centre.
• Extend the Therapeutic Feeding Centre to include a 24 hour facility.
• Give particular support to the newly arrived IDPs.

From the ACF-SP survey in Caconda, Huila Province

• Improve the general food distribution to 2100 Kcals/day with appropriate coverage and targeting.
• Increase the capacity of the existing selective feeding centres.
• Improve the access and availability of water and sanitation services.
• Support the local health facility and conduct essential vaccination programmes.

From the ACF-SP nutrition survey in the Municipality of Sumbe, Kuanza Sul

• Establish a system of home visits in order to detect vulnerable children.
• Conduct nutrition and hygiene education programmes for mothers of vulnerable children.
• Support breast feeding in the community.

From the ACF-SP nutrition survey in Saurimo, Lunda Sul

• Improve access to potable water and sanitation.
• Implement a therapeutic feeding centre in the provincial hospital.
• Improve the system of registration for newly arrived IDPs.

RNIS 35, October 2001

The reporting period has seen a further deterioration in the humanitarian situation in Angola as a result of an escalation in violence between UNITA rebels and government troops. The violence of recent months has been characterised by increasing attacks by UNITA on civilian targets including towns, villages, IDP camps and various transport routes, as well as an increase in military attacks by government forces. Whilst much of the country is reported to be insecure, fighting has been focused on Bengo, Bie, Huambo, Huila, Luanda Sul, Malanje and Moxico provinces, which are considered to be the political heartland of the country (OCHA 26/09/01).

The insecurity has huge implications for the humanitarian situation. At the end of September, OCHA estimated that 3.1 million people, or almost a quarter of the entire population, were displaced from their places of origin. Of this number, 1.23 million people have been confirmed by humanitarian agencies and are currently receiving assistance, with 384,400 having been displaced since the beginning of the year (OCHA 30/09/01). The number of those being displaced has grown enormously over the reporting period, clearly indicating the increase in military activity. In July, OCHA reported that 12,383 people were displaced (OCHA 31/07/01). This increased to 20,985 during the month of August (OCHA 31/08/01) and reached an annual high of 61,395 in September (30/09/01). The enormous increase in displacement is very concerning because it is placing enormous pressure on an already over stretched humanitarian system. WFP have reported that they are having great difficulty in funding their programs in the country, despite recent donations, and that there are likely to be critical shortfalls of sugar in December. This will affect supplementary and therapeutic rations used in the many selective feeding programs in the country. In November, WFP announced that it was not reaching all of its target beneficiaries and had frequently resorted to reducing ration sizes (WFP 02/11/01). WFP is currently assisting 820,000 people instead of the planned 1,040,000.

The IDP population remains extremely vulnerable as a result of ongoing and increased levels of insecurity. Many are driven from their lands by fighting, often for the second, third or fourth time, and chose to try and reach towns which have a WFP presence in order to be assured of some kind of humanitarian assistance. However, the journey to these centres is often long and arduous and humanitarian agencies frequently see people arriving in camps and transit sites in a desperately poor condition. Many have spent many weeks in the open deprived of adequate food, water, shelter or health (SCF 13/08/01). One of the greatest problems for the humanitarian community remains access to these vulnerable populations. The insecurity in much of the country ensures that many areas remain inaccessible to humanitarian agencies and the needs and conditions of the populations in these areas remain largely unknown but is assumed to be very high.

In areas where access is possible it is often restricted to key cities and a narrow area or security perimeter around them. In a bid to increase access to vulnerable populations the UN Security Council recently called on the warring parties in the country to provide humanitarian “safe corridors”. UNITA responded by announcing that it could not guarantee the safety of humanitarian workers without a bilateral cease-fire (IRIN 18/10/01). As a result, travel between areas is very hazardous and agencies often rely on air transport to supply the needs of their projects. Air transport has been limited by funding constraints on WFP’s special operations and by the extremely poor condition of many of the runaways. Those particularly affected are in Kuito in Bie province and in Uige. Both airstrips supply very high numbers of IDPs (OCHA 30/09/01; WFP 02/11/01).

As a result of the continued increase in the number of IDPs and the deteriorating security situation, it is increasingly difficult to resettle IDPs due to a lack of available secure land. Returnees are also constrained by the huge number of land mines in and around many areas. Angola is officially the most heavily mined country in the world. There is also a chronic lack of construction material and access to basic amenities such as water, sanitation and health care is largely missing. As a result, only 67,000 out of a planned 500,000 people have been resettled by September of this year (OCHA 12/10/01)

The general food security outlook for the country and for IDPs in particular, is extremely poor. Many IDPs are almost totally dependent on food assistance to meet their nutritional needs and have little opportunity to find income or alternative food sources. It is very difficult to know the nutritional situation in many areas as a result of the lack of access. However, it appears that malnutrition rates have stabilised in areas where humanitarian access has been good. There is concern that the resurgence of increased insecurity will affect levels of malnutrition by adversely impacting on the general humanitarian situation.

Malange

The security situation remains extremely precarious with reports of attacks occurring in various parts of the province. OCHA have also reported that access to some areas has been constrained by a lack of fuel, which has impeded the delivery of aid and other activities, particularly de-mining (OCHA 31/07/01). As a result of rises in insecurity the province has also seen a substantial increase displacement with 1,183 people reported in September alone (OCHA 30/09/01).

MSF-H conducted a nutrition survey in Cangandala in August 2001. The municipality lies to the south of the provincial capital, Malange and has seen a continuous increase in the number of IDPs arriving, most of whom appear to have come from the neighbouring province of Kwanza Sul. Security in Cangandala has been reasonable as it falls within the security perimeter around Malange. However, attacks have occurred and access by humanitarian staff is possible only with strict security precautions. The IDPs have received WFP food rations but these were cut to a half ration in August for IDPs who had arrived before October 2000 and for returned residents. The survey determined that the general availability of food in the area had been reasonable. The survey revealed an estimated prevalence of acute malnutrition (W/Ht <-2 Z scores and/or oedema) of 3.5% including 0.2% of severe malnutrition (W/Ht <-3 Z scores and/or oedema) (MSF 08/01). The results indicate that there is not a significant problem of acute malnutrition amongst the IDP population and, furthermore, that the results are very similar to the survey conducted in February 2001 (see RNIS # 32/33), indicating that the situation appears to be quite stable despite the increase in IDP numbers. The low rates of acute malnutrition are further corroborated by the Crude Mortality Rate (CMR) of 0.57/10,000/day and the underfive mortality rate of 1.17/10,000/day. The mortality rates are both below alert thresholds and indicate that the situation is well under control. The low levels of malnutrition and mortality are attributed to the provision of a regular general ration, the relatively good level of security, certainly in comparison to other areas, and the good access to medical care (MSF 08/01).

Bie Province

The security situation in Bie province continues to be extremely poor with reports of heavy fighting between government troops and UNITA and the continued, large-scale displacement of population. Many of the displaced have headed for Kuito and Camacupa, in the hope of obtaining humanitarian assistance. During September it is estimated that 13,117 people were displaced in the province. The nutritional situation has been extremely poor but recent reports indicate that levels of malnutrition are greatly reduced, attributed largely to the scale of the response to the emergency in Camacupa and Kuito, which has averted a possible disaster (SCF 13/08/01).

Camacupa

Earlier in the year, the situation in Camacupa was reported to be very poor with high rates of acute malnutrition and mortality. The scale of the humanitarian response has brought the situation under control but reports indicate that there are still large numbers of IDPs arriving in the camps. In general, access to the area has been good, although it is reported that the road from Kuito toCamacupa was closed for a couple of weeks following an attack on a private vehicle on September 19^th (OCHA 30/09/01). However, food distributions continue to take place and the food security of the IDPs is relatively good, although SCF reports that income levels amongst the IDPs are very poor. This is because the opportunity to generate income and supplement their diets is poor with markets tending to be saturated with goods typically used for income generation such as charcoal and firewood (SCF 13/08/01). The RNIS has not received any recent surveys but it is reported in a WFP emergency report that a recent MSF-B nutrition survey revealed that malnutrition rates had dropped from the high rates observed earlier in the year (WFP 28/09/01). However, the situation still remains extremely precarious and OCHA reports that mortality rates amongst the IDP population remains unacceptably high (OCHA 31/08/01).

Kuito

The situation in Kuito remains extremely precarious as numbers of IDPs arriving to the town continue to grow. Many of the IDPs are arriving in very poor condition and are heavily reliant on humanitarian assistance to meet their needs. A recent SCF food security assessment indicated that 93% of the very poorest group defined in the town were residing in camps. The assessment also showed that the price of food, particularly staple foods, was increasing in the markets, but that general food availability was good. With the majority of the IDPs being classified as very poor, the issue becomes one of food access rather than availability. This is because the majority find it very hard to generate money with which to purchase food (SCF 13/08/01). The RNIS also notes with concern that the numbers of cases of pellagra (niacin deficiency) appear to be increasing. This is strongly indicative of the consumption of a very poor quality diet and is most likely a result of lack of access to foods other than food aid. The presence of pellagra in the population is an indication that the population is in nutritional crisis and it is very concerning to note that there appears to be a high degree of reliance on food assistance. It is extremely likely that in its absence the prevalence of acute malnutrition and mortality would increase significantly.

Cuando Kubango Province

As in other areas of the country, security is very precarious in Cuando Kubango and this continues to impact on the humanitarian situation of the displaced and local populations. The RNIS has no new nutritional information for Kuito Cuanavale but there are reports that the poor insecurity and the state of the road system have impeded the delivery of food aid in some cases. The last survey indicated that the situation was not critical and it is unlikely that the situation has deteriorated dramatically, although the IDPs should be considered as being extremely vulnerable.

Menongue

In July 2001, ACH conducted a nutrition and mortality survey in the municipality of Mengongue. The survey was conducted on a population of IDP and local children and revealed an estimated prevalence of acute malnutrition (W/Ht < -2 Z scores and/or oedema) of 4.7% including 1.2% of severe malnutrition (W/Ht < -3 Z scores and/or oedema). The survey also measured Crude Mortality and estimated a rate of 1.23/10,000/day and an under-five mortality of 3.17/10,00/day. The results indicate that levels of acute malnutrition are not above alert thresholds. However, the mortality rates are slightly elevated and indicate that the population is still quite vulnerable (ACH 07/01).

Refugees

The conflict in Angola has prevented large numbers of refugees from seeking asylum with Angola but the wars in the neighbouring country of DRC have driven an estimated 11,830 people into the country (OCHA 12/10/01). The RNIS does not have any information on the condition of the refugees, but it is known that they have access to humanitarian assistance and their condition is not thought to be critical. The conflict within Angola continues to force Angolans to flee across the border, mostly into the neighbouring countries of Namibia and Zambia. Namibia has a reported caseload of 30,380 Angolan refugees (UNHCR 26/10/01) and it has been increasing steadily as a result of the continued fighting. As a result, Namibia has imposed a dusk to dawn curfew on the border with Angola in an attempt to control the movement of armed rebels into Namibia. However, there are concerns that this will prevent genuine refugees from seeking asylum as many chose to travel at night in order to avoid militias who might prevent them leaving for safety (UNHCR 26/10/01).

Overall

The situation in Angola remains extremely precarious as a result of an increase in both rebel and government activity that has seen heavy fighting in many areas. The insecurity continues to displace enormous numbers of people and severely disrupt their livelihoods. As a result, IDPs often find themselves without any form of resources and suffering from extended periods of privation that leave them in a very poor physical state. Many are unable to cope with their situation without external assistance. The issue of access to these vulnerable populations remains extremely problematic and many areas of the country are simply not accessible to humanitarian agencies. In those areas where access is possible, it is often for limited periods and only in select areas around government held towns. As a result, there is a lack of information on the conditions of IDPs in inaccessible areas (category V). However, it can be assumed that they remain at very high risk. In areas where access is not a problem the condition of IDPs appears to be stable (category III) but the condition of IDPs in areas that suffer from intermittent and limited access is poor (category II).

Recommendations

• Insure full support for the Global Appeals to prevent food pipeline breaks to populations

From the ACH survey in Menongue (ACH 07/01)

• Improve the general ration for all IDPs

From the MSF-H survey in Cangandala (MSF-H 08/01)

• Ensure the close monitoring of the food security situation
• Continue the selective feeding to serve as an early warning device for a worsening situation
• Improve emergency capacity to be prepared for large influxes of IDPs

RNIS 34, July 2001

The reporting period has seen the continuation of violence between the UNITA rebels and the government of Angola. The government still retains control over provincial and municipal centres with rebels occupying areas around the provincial centres and much of the rural hinterland. Much of the fighting is fuelled by often illicit revenue from oil and diamonds and as a result is particularly centred on districts such as Bie, Huambo, Huila, Malanje, Moxico and Luanda Sol, districts that are rich in these natural resources.

It is worth noting that whilst the government claims it controls 90% of Angolan territory, the areas and populations that are actually accessible to humanitarian agencies remain extremely limited (MSF 02/07/01). At the end of May, OCHA estimated that almost a quarter of the population, an estimated 3.1 million people, have been displaced as a result of the fighting since the renewal of hostilities in 1998. Of this number, 1.2 million IDPs have been confirmed by humanitarian organisations with an estimated 237,000 having been displaced since the beginning of 2001 (OCHA 20/06/01). Considerable numbers of people remain in inaccessible areas in conditions that are largely unknown. Recent estimates by OCHA have reported that as many as 500,000 people remain inaccessible but in need of urgent assistance (USAID 09/07/01).

In areas accessible to humanitarian agencies, IDPs have tended to collect in urban areas that are generally under government control, such as Malange, Kuito and Humabo. This is largely because many of the rural areas are heavily insecure and farming practices are frequently interrupted by security incidents. During the last several months, new influxes of displaced populations have reported for a number of urban locations including Kuito, Malange and Lobito. The urban areas offer some hope of security as well as access to the possibility of humanitarian assistance. However, the obvious lack of access to land in these urban locations limits their opportunities for food production resulting in affected populations becoming heavily reliant on food assistance. The heavy insecurity and the almost total dereliction of the road infrastructure have meant that access to many areas, for the humanitarian community, continues to be almost totally dependent on air transport from Luanda. The reporting period saw a considerable set back to the supply of humanitarian relief, with two separate attacks on WFP aircraft during the first two weeks of June (WFP 22/06/01). The attacks resulted in all passenger and cargo flights being stopped nationwide for a week. This represented a very significant set back for the humanitarian effort, since 60% of all deliveries of humanitarian aid are transported by air. WFP have also expressed concern at the poor state of airstrips in some areas of the country, particularly Kuito in Bie province, where humanitarian needs are currently described as extremely high (WFP 22/06/01).

An FAO/WFP Crop and Food Supply Assessment Mission conducted in June has estimated that cereal production for the 2000/2001 agricultural year is fifteen percent higher in comparison to last year. The report indicates that the increase is largely a result of good progress in the allocation of land to IDPs in secure areas, increased access to populations as well as timely distributions of relatively larger quantities of seeds and tools. In addition, weather conditions were generally favourable last year, particularly in the main cereal growing areas in the central and southern provinces such as Huambo and Huila. Prices of maize are currently stable or declining in some markets with the arrival of the new crop. By contrast, yields of maize, beans and groundnuts that were planted in the northern provinces were severely affected by the prolonged dry spell in December/ January. As a result of disruption in trade activities, there are therefore large differences in cereal prices in the markets in the central and northern provinces. The report estimated that 218,000 IDPs were active in farming during the 2000/01 season (FAO/WFP 19/06/01) - this figure representing only a small proportion (approximately 8%) of the total displaced population. Therefore, as a result of continuing influx of displaced due to ongoing insecurity in rural areas, lack of access to land in urban areas and an inability to plant on allocated land areas, a large majority of the displaced population will continue to rely on food assistance. The report also observed that food security in much of the population is closely linked to good access to land and to other resources such as grazing and forest products as well as the ability to access markets for trade (FAO/WFP 19/06/01).

Acute malnutrition rates in rural Angolan populations characteristically show a seasonal pattern with highest levels of malnutrition occurring during the lean season from January to April. Levels of malnutrition are expected to show a decrease from June onwards when the main harvests are expected and are normally at their lowest in September. Obviously, displacement and consequent lack of access to harvests as well as exposure to poor health environments in over-crowded displaced camps, will significantly distort these seasonal patterns of malnutrition.

Malange

The RNIS has not received any new nutritional surveys during the reporting period but the last surveys received indicated relatively satisfactory rates of acute malnutrition although the crude and under five mortality rates were above emergency thresholds (See RNIS 32 and 33). In general the security situation in areas accessible to humanitarian workers has been fairly stable. However, many of the outlying areas remain insecure and have hampered attempts to resettle about 50,000 IDPs to the Lau, Quissol and Cambondua areas. The resettlement has also been constrained by a lack of fuel that has negatively affected de-mining activities (UNICEF 30/06/01). In addition, water and sanitation systems are not in place, agricultural lands have not been demarcated and there are no health and educational facilities - factors that are likely to delay resettlement schemes (IRIN-SA, 20/07/01). In general the nutrition situation is thought to be stable but WFP reports that the situation is worrying in Cangandala municipality where Concern World-wide has noted that admissions to their SFC from the 17^th to the 23^rd of June have risen by 87% compared to the previous month (WFP 06/07/01). The increase in admissions is most likely as a result of new IDPs, the majority of which are arriving from Kwanza Sul Province (IRIN SA 20/07/01).

Bie Province

The situation has continued to deteriorate in the province with insecurity continuing to cause significant displacement into the towns of Kuito and Camacupa (80km from Kuito). OCHA estimates that a further 15-20,000 IDPs from Kuemba municipality may arrive in Camacupa and Kuito over the following months (IRIN-SA 20/07/01).

Camacupa

In July IRIN reported that about 200,000 people are living in camps around Camacupa and the humanitarian agencies are bracing themselves for the arrival of up to 20,000 more in the following months (IRIN-SA 27/07/01). In March MSF-B conducted nutritional screening, using MUAC, on children in the camps in Camacupa and showed a prevalence of 28% acute malnutrition with 11% severe malnutrition. A retrospective mortality survey from the same period indicated a crude mortality of 3/10,000/day and an under five mortality of 5.4/10,000/day (MSF 31/05/01) The RNIS does not have access to the methodology used for the mortality figures but it is assumed to be from routine surveillance. The results of other screenings amongst the displaced populations indicated very alarming rates of both acute and severe malnutrition. The high prevalence of reported malnutrition is likely to be a result of the fact that displaced populations travelled long distances with little food. The high mortality rates may be linked to underlying respiratory infections associated with extreme cold at night (OCHA 13/06/01).

On the 13^th of July WFP delivered food to 14,211 people in camps in Camacupa covering only half of the food requirements for the increasing number of people arriving into the town. These newly displaced are reported to have poor nutritional status (WFP, 20/07/01). Consequently, in addition to the newly established Therapeutic Feeding Centre, humanitarian agencies have established a plan to substantially scale up assistance to the population, including; conduct nutritional surveys to verify the nutritional situation, preposition emergency food stocks and distribute Vitamin B to address the potential pellagra outbreak (IRIN-SA 20/07/01).

Kuito

The upsurge in insecurity over the course of 2001 has seen the arrival of 52,161 new IDPs in Kuito, with 8000 arriving in the month of May alone. Current estimates of total numbers of IDPs in Kuito are for 160,000 people in fifteen camps. Reports indicate a deteriorating situation with new arrivals carrying very little in the way of basic survival items and are in need of immediate assistance (OCHA 13/07/01). Mortality rates at the Therapeutic Feeding Centres (TFC) that have been set up in the town have already reached alarming levels. The TFC at the Kuito hospital recorded a mortality rate of 24% during the first two weeks of June although this fell to 14% in the following week (OCHA 13/07/01).

MSF-B conducted a nutrition survey in the camps in Kuito in July. The RNIS does not have access to the full survey report but the survey estimates 13% acute malnutrition (W/Ht <-2 Z-Scores and/ or oedema) including 2.3% severe acute malnutrition (W/Ht < -3 Z-Scores and/or oedema) (MSF 13/07/01). This indicates the poor nutritional status of the IDPs. It is also concerning to note that agencies have been reporting high numbers of cases of pellagra (niacin deficiency), with a total of 783 cases reported since April (UNICEF 30/06/01). An outbreak of pellagra in the population suggests strongly that that the access and availability of food has been very poor for at least the last six months. It is extremely worrying that the number of pellagra cases continues to increase in Kuito, since the first reported cases were reported in August 1999 (see RNIS 29).

The future food security for Camacupa and Kuito remains critical because the number of IDPs continues to rise in the face of a potentially decreased humanitarian capacity. Kuito is heavily dependent on the transport of supplies by air and given that the runaway is in extremely poor condition - which has significantly reduced both the number and size of the planes able to land - the potential for meeting the humanitarian needs, including food deliveries, remains precarious (OCHA 13/06/01).

Benguela Province

The security situation in Benguela Province continues to be precarious with reports of continued population displacement. ACH conducted nutritional surveys amongst displaced and non-displaced populations in Ganda town, in May 2001. The surveys indicated a prevalence of 9.5% and 10.1% acute malnutrition (W/Ht < -2 Z-Scores and/or oedema) in the displaced camps and the non-displaced population respectively. Further-more, the figures for acute malnutrition included 1.1% of severe acute malnutrition (W/Ht < -3 Z-Scores and/or oedema) in both surveys. The report also indicates a crude mortality rate of 1.28/10,000/day and 1.41/10,000/day with an under five mortality rate of 3.11/10,000/day and 2,1/10,000/day respectively. The respective measles vaccination coverage was 46.6% for the displaced and 57.2% for the non-displaced, and was calculated from both health card and mother/carer report (ACH 05/01).

The prevalence of malnutrition is not highly elevated but does suggest that the nutrition situation remains precarious. Furthermore, the results confirm that the nutritional situation has deteriorated since the last survey in November 2000 where the prevalence of acute malnutrition (W/ Ht) was reported to be 5.8% acute and 0.6% severe malnutrition (ACH 05/01). The RNIS does not have access to the November report but the methodology is assumed to be the same. The reported mortality rates (see above) are higher than emergency thresholds, particularly the crude mortality (CMR), suggesting that an usually large proportion of the reported mortality is from people over five years of age.

Potential reasons for the deterioration in the nutritional situation include; the relative isolation of Ganda town and trading opportunities limited as a result of poor road infrastructure. Insecurity of the surrounding areas is a serious problem that has prevented people from accessing land or other resources (ACH 05/01). In relation to the problem of land access, the Government has been requested by humanitarian agencies to increase security guarantees, access and protection to IDPs and to achieve a more timely distribution of arable land to the displaced population (WFP, 20/07/01) Losses of some maize harvests had been reported as a result of flooding in some parts of the Province (FAO, 19/06/01).

Cuando Kubango Province

Cuito Cuanavale

The reporting period has seen a continuation of insecurity and the displacement of people, particularly from the Mavinga areas. Reports indicate that there are approximately 6,000 IDPs in the reception camps of Cambambi and Mulumbei. ACH undertook a nutrition survey of children from 6 to 59 months amongst IDPs and resident Barrios in Cuito Cuanavale Municipality in June 2001. The prevalence of acute malnutrition was estimated to be 6.0% (W/Ht -2 Z-scores and/or oedema) including 1.9% severe (W/Ht -3 Z-scores and/or oedema). The prevalence of acute malnutrition has remained very similar to the last survey in May 2000 (see RNIS 31) indicating that the nutritional situation is stable. The survey also reported a CMR of 1.6/10,000/day and an under five mortality of 4.1/10,000/day. These mortality rates are both higher than emergency cut offs, suggesting a public health problem in the area. The measles vaccination coverage for IDPs present in the area for less than a year was low at 41.6%. Based on the findings of the report, the general food ration, which provides 1.500 kcal/ person/day, is below the recommended minimum requirement. Therefore, an inadequate food ration, high mortality rates and ongoing population displacement justifies continued nutritional interventions (ACH 13/06/01) as well as ongoing nutritional surveillance of the population.

Uige Province

The security situation in Uige has remained precarious with a major UNITA assault on the city on June 26^th. The assault was thwarted by the Angolan army but it resulted in the evacuation of humanitarian personnel from the city. The current situation is more secure and staff have started to return to the city. OCHA estimate that there are currently 42,000 people relying on food distributions to survive (OCHA 01/07/01). MSF-Spain conducted a survey in the city in March and found an estimated prevalence of acute malnutrition of 5.2% (W/Ht -2 Z-scores and/or oedema) including 0.8% severe malnutrition (W/Ht -3 Z-scores and/or oedema). The RNIS has not seen the final report but the figures are comparable with a survey conducted in October 2000 (see RNIS 32 and 33) and indicate that the situation is stable (MSF-Sp 17/07/01; WFP 22/06/01).

Refugees

Ongoing civil war in Angola continues to force people to seek more secure areas across the border in neighbouring countries. Current estimates indicate that there are 430,781 Angolan refugees with 199,086 in Zambia, 179,550 in DRC, 18,515 in RoC and 28,889 in Namibia (USAID 09/07/01). The RNIS does not have any new nutrition information on Angolan refugees.

Overall

The overall humanitarian situation in Angola remains precarious with continued insecurity leading to ongoing population displacement. The continued insecurity has heightened the vulnerability of affected populations, particularly the displaced, and has limited humanitarian access. Based on the limited number of nutrition surveys that have recently been conducted, the nutrition outlook appears mixed; many areas do not show increases in prevalence of malnutrition (as expected during this time of the year) while a few isolated ‘pockets’ of populations are at increased risk showing concomitant increases in prevalence of acute malnutrition. One important factor is related to the volatile nature of the situation. Populations are unpredictably forced to move from rural areas and humanitarian agencies face difficulties in accessing these populations in a timely manner. With further insecurity incidents, it is expected that more isolated pockets of population will require assistance. A second determining factor appears to be the challenge for humanitarian agencies to maintain a regular and sufficient supply of humanitarian assistance to these populations. In areas where access is not reported to be a problem, such as Huambo and Lobito, the IDPs can be considered to be Category III, whilst in Camacupa and Kuito, where the continued supply of assistance is posing considerable problems, the IDPs are considered to be Category I. Further-more, the internally displaced populations, who have no access to land for agriculture and are entirely reliant on the ration, are considered to be in Category II given the fragility of the food pipeline. However, it is also evident that a large number of people are in areas inaccessible to humanitarian relief and their condition is currently unknown (Category V).

Recommendations

From a Needs Assessment mission in Bie Province in June (OCHA 13/07/01)

• Increase the delivery of food through the hiring of additional aircraft and repairing existing runaways
• Preposition emergency food stocks in strategic locations
• Ensure a full food basket and distribute vitamin B to curb the pellagra outbreak
• Ensure the timely delivery of seeds and tools and access to agricultural land for the forthcoming planting season.

From the ACH Ganda Survey in Buengela Province (ACH 05/01)

• Continue the food distribution and reinforce selective feeding activities
• Intensify the outreach activity
• Conduct a nutritional causal analysis

From the ACH Nutritional Survey in Cuito Cuanavale in Cuando Kubango Province

• Strengthen the food ration to 2100 Kcal/ person/day
• Ensure the allocation of land to IDPs in time for the next farming cycle
• Initiate health education programmes and training in the health structures

RNIS 32/33, April 2001

A renewal of violence between government forces and the UNITA rebels in 1998 has resulted in huge displacement of people, particularly from rural areas to provincial towns with the worst affected districts being Bie, Huambo, Huila, Malanje, Moxico and Luanda Sol. which has escalated as a result of. The government has claimed significant successes in destroying UNITA’s conventional war capacities during the past year. As a result, UNITA rebels have switched to guerrilla warfare tactics. This has left much of the rural hinterland of the country insecure, preventing people from accessing agricultural land and hindering humanitarian access to populations in need of assistance (UN 2001; UNICEF 05/02/01).

The total number of IDPs since the escalation of fighting in 1998 is estimated to be in excess of 3 million people (UN 2001; UNICEF 05/02/01). The number of displaced has increased steadily with an estimated 457,000 people displaced in 2000, and another 82,000 between January and March 2001.

Humanitarian access remains extremely difficult, given the inaccessibility of certain areas where it is estimated there are as many as 525,000 people. At least six major road corridors were opened in 2000 but remain insecure as a result of ambushes. The wide use of mines also restricts humanitarian programmes. Air transportation remains the only reliable means of access and transportation and poor infrastructure has meant that certain airports are only open to special types of aircraft (IRIN-SA 12/04/01; UN 2001)

Nutrition Situation

The FAO Food Supply Situation in Sub Saharan Africa has indicated that the total area planted is reduced as a result of continued insecurity and a series of natural disasters including heavy flooding in the southern provinces of Benguela and Namibe. The province of Cunene in the south has also suffered severe drought. The south may be the worst affected area with between 40-80 % of agricultural production lost in Menongue and between 60-100 % in Kuito Kuanavale. Agricultural productivity and thus food security, is expected to be down as a result of lack of access to good quality land, depressed market demand, insecurity, insufficient inputs and poor technical assistance. Few income-generating opportunities and a loss of productive and household assets are likely to reduce purchasing power. The shortfall in funding pledges with only 60 % of pledges received by mid March 2001 has led to a one third reduction in the number of beneficiaries from 1.5 to 1 million and to cuts in the ration distributed (FAO 04/01; IRIN 21/02/01; UN 2001).

In general, the results of nutrition surveys indicate that the prevalence of malnutrition has decreased in most areas from rates of acute malnutrition of around 30 % in 1999 to rates of around 10 % by the end of 2000. However, the situation remains extremely precarious and rates are expected to climb again during the pre harvest hunger gap. The highest malnutrition rates are currently found in newly accessible areas and amongst the populations most recently displaced. (UN 2001).

Malange

Melange has an estimated 131,931 IDPs in a mixture of transit centres, camps, resident communities and resettled areas. The province has suffered from continued insecurity over the past year but a series of nutrition surveys by MSF-Holland indicates that the nutritional situation is not critical. MSF conducted two surveys in Malange town in July and December 2000. The city has remained quiet for a number of months but the situation is extremely insecure in the surrounding areas and a steady flow of IDPs have been coming into the city. The prevalence rates of acute malnutrition are estimated as 3.1 % and 5.3 % for July and December, including 2% and 2.1% severe malnutrition respectively. Although these figures appear satisfactory, it should bestressed that a large part of the population is receiving general food rations. In addition the prevalence of nutritional oedema was 1.4%, which cause for concern. CMR was estimated at 1.5/10,000/day and under five mortality at 3.3/10,000/day - both above accepted emergency thresholds. Given the relative stability of the food situation and the absence of high morbidities, MSF suggest these mortality rates are the result of a combination of factors, including extremely poor basic health services, the poor health environment and possibly a ‘hidden’ meningitis epidemic (MSF-H 12/00). More than 75% of the sample were residents, who tended to have a better nutritional status than the IDPs, although small sample size of the latter prevents statistical comparisons.

Table of survey results from MSF-H surveys in Malange town

MSF also conducted a survey in Cangandala municipality south of Malange town (but still within the security perimeter). The municipality is populated by returnees most of whom have returned at the end of 1999, and a steady flow of IDPs from the Mussende area in Kwanza Sul Province to the south. Current estimates are of a total population of 30,000 with about 50 % being IDPs. MSF report that the majority of the population is destitute and rely to a large extent on the general food distribution (returnees and IDPs alike). The prevalence of acute malnutrition was estimated at 2.4 %, and 0.4 % severe. The CMR was 0.68/10,000/day (approximately two times normal) and the under five rate 1.61/10,000/day (MSF-H 02/01).

Kuito, Bie Province

The deterioration of the security situation in Bie and the surrounding areas has resulted in a massive influx of IDPs into Bie province and particularly into the town of Kuito. The population of Kuito is estimated to be around 111,444 people with 82,500 IDPs being counted by the MSF teams in and around the town in October 2000. Current estimates put the total number of IDPs in Bie at 123,041 people (MSF-H 11/00; UN 2001).

The security situation has restricted access to land around Kuito to within a 20 km boundary. Late rains and poor soil fertility have resulted in poor crop yields. MSF-B and Concern have conducted nutritional surveys amongst the resident population of Kuito, the capital of Bie province, and in the surrounding camps in November 2000 (see graph).

Graph of nutrition survey results from March 99 to Nov 2000 in Kuito and Camps - Acute and severe malnutrition in Kuito town and camps

Results of MSF/Concern Surveys in Kuito town and camps

The results indicate that despite an overall decrease in levels of malnutrition since 1999, the nutritional status in the camps is significantly worse than the town. No such difference was apparent in June. Worryingly, the survey notes that IDPs show a low rate of malnutrition on arrival and only become malnourished after some time in Kuito indicating the poor conditions under which they are living (MSF-H 11/00).

Kuito has suffered repeated outbreaks of pellagra (niacin deficiency) with the first being recorded between June 99 and April 2000. During this period the daily ration distributed to IDPs provided a daily niacin intake below recommended daily intakes. A resurgence in the disease was noted in May 2000. The previous outbreak affected mostly IDPs whilst the most recent outbreak comprised 65 % resident cases. An explanation could be that only 9 % of cases had access to the WFP food distribution strongly suggesting that the inclusion of fortified CSB in the general ration may have prevented the disease (MSF-H 11/00).

Benguela Province

The most recent survey available to the RNIS (see RNIS 31) indicate that the nutritional situation had improved dramatically. Overall estimates of IDPs in the province are 73,425 persons. The RNIS does not have any new nutritional information.

Cuando Cubango Province

Menongue

The population of Menongue is estimated to be 135,200 including about 22,000 IDPs who have arrived since December 1998. ACH undertook a nutrition survey in April 2000 on children between the ages of 6-59 months and found that the nutritional status of both the town and camp populations was acceptable. A recent follow-up survey in December 2000 (see graph below) indicates a deterioration in the nutritional situation particularly in the camp populations with rates having risen significantly from April figures. The intermittent rainfall throughout the country has particularly affected Menongue and Cuito Canavale and is responsible for the slump in agricultural production that may have had an affect on nutritional status. Other reasons could be the huge influx of IDPs that has taken place over the past year and the continued insecurity of the region that has severely impacted on the socio-economic life of the area (MSF-H 11/00).

The ACH survey recorded a CMR of 0.66/10,000/day and an under five mortality rate of 2.5/10,000/day amongst the camp populations and a CMR of 0.67/10,000/day with an under five mortality rate of 2.1/10,000/day amongst the town populations. These figures indicate that the under five mortality rate is alarming but neither are significantly different from the figures obtained in April. In contrast the measles vaccination coverage seems to have improved with 77.7 % of children between 9-59 months in the camps and 78.2 % of children in the towns, having received vaccinations.

Uige Province

Uige has suffered from insecurity over the past year and from a large influx of IDPs. Current estimates of IDPs numbers are 97,486 persons. MSF Spain conducted a nutrition survey in October 2000 on children between 6-59 months, which indicated an estimated prevalence of acute malnutrition of 5.9 % and 0.6 % of severe malnutrition including 0.3 % oedema. The survey also indicated a higher rate of acute malnutrition in the displaced population as opposed to the resident population although the difference had reduced from an earlier survey in May 2000 (see RNIS 31). The CMR amongst the displaced population was estimated at 0.52/10,000/day and the under five mortality rate was 0.42/10,000/day. Both the anthropometric results and the mortality figures indicate that the situation is not critical with all indicators falling below established emergency thresholds (MSF-SP 10/00).

Refugees

Angolan refugees in Namibia

Fighting along the Namibian border has intensified over the past year, causing a flood of refugees to cross into Namibia and in particular to Osire camp. The RNIS does not have any information of the nutritional status of Angolan refugees in Namibia. However 15,935 were recorded in October 2000 and the figure had risen to 19,000 in February. The refugees are receiving food rations via the Red Cross (WFP 23/02/01).

Overall

The nutrition situation would appear generally to have improved although prevalences, particularly of moderate acute malnutrition, have risen particularly among the displaced. Improvements in the nutritional situation and the generally low rates of severe malnutrition must in part be attributable to international relief efforts.

The insecurity coupled with natural disasters continue to adversely undermine the food security of the population and reports indicate a continuing influx of IDPs from rural areas to provincial towns. All indicators point towards a high degree of reliance on international food aid and a break in the WFP food aid pipeline could well lead to a rapid deterioration in the situation particularly for those displaced. The population is considered to be moderate to high risk (categories II and III) and it is likely that pockets of high risk exist in areas that are currently inaccessible to international agencies.

Recommendations

Continue to closely monitor the nutritional situation, given the widespread dependence on general food distribution particularly by IDPs.

From the MSF-Holland survey in Malange

• Continue targeted feeding programmes.
• Improve community outreach and screening of malnourished children
• Given the poor functioning of health surveillance systems the NGOs should monitor mortality trends closely to detect emerging epidemics.
• Improve coverage of measles immunization beyond 60%.

From the MSF/Concern survey in Kuito, Bie Province

• Focus on the development of emergency preparedness.
• Close monitoring of the nutrition, agricultural and food economy situation is needed.
• IDPs arriving since December 1999 should be targeted for nutritional and health screening, vaccination and a full food ration.
• Keep the general ration fortified with niacin rich foods such as CSB, to address the problem of pellagra.

From the ACH survey in Kuando Kubango

• Maintain a general food ration for vulnerable populations and the newly displaced.

From the MSF-Spain survey in Uige

• Continue therapeutic feeding activities with emphasis on supporting local structures.
• Create an active nutritional surveillance programme.
• Conduct vaccination programmes in previously unvaccinated zones.
• Conduct health and hygiene training.
• Repeat the nutritional survey in three to four months.

RNIS 31, July 2000

The prospects for peace in Angola seem remote. The current crisis, which began in December 1998, continues despite calls for peace from international, religious and grassroots groups. Fighting between government and UNITA forces has been reported in most provinces during the reporting period and consequently the long-term humanitarian situation has not improved significantly. According to the OCHA database, approximately 2.5 million persons have been displaced since December 1998. Of these, more than one million people have been officially registered as IDPs by a UN agency or NGO. The IDPs are currently settled in 120 locations of which 36 remain inaccessible to the international community (OCHA - 18/06/00).

Guerrilla activities persist in many parts of the country, perpetuating the prevailing insecurity among the population and considerably reducing the amount of humanitarian assistance that can be delivered by road. As a result most relief is delivered by airlifts, which are extremely expensive.

Nutritional Situation

An FAO/WFP Crop and Food Supply Assessment Mission to Angola in April indicated that cereal production is about 5% lower than last year, due mainly to unfavourable rain patterns, reduced access to land, and shortages of essential inputs. The mission, which visited every province where food aid is distributed, estimated that some 1.86 million people will require food aid in 2000-20001. The mission noted that although Angola used to be self-sufficient in major food crops, and even a net exporter of staples, the impact of the protracted civil war has reduced the country's total cereal production to less than 40% of the country's total requirement. This was felt to underscore the acute food insecurity of the populations, IDPs and residents alike (FAO/WFP - 17/05/00).

In general, the results of nutritional surveys recently conducted indicate that the prevalence of acute malnutrition has decreased in most areas. This improvement is in part due to the maize harvest in April/May, and a general fall in prices in most provincial capitals as well as improved targeting of food aid to vulnerable groups. The nutritional situation of areas outside government control, which are inaccessible to the humanitarian community, is unknown. This seasonal improvement is likely to be short-term. Land distribution schemes have only been partially successful, income-generating opportunities remain restricted and the limited harvest will all contribute to continuing vulnerability, especially for the displaced populations. Until the IDPs are better able to integrate into the local economies (by giving them access to fertile land), and the resident population able to cultivate without fear and freely market their produce, this situation will continue (FAO/WFP - 17/05/00).

WFP has reported that food stocks for Angola are very low. Despite recent pledges, donor contributions have amounted to less than 40% of the projected requirements. As a result of the shortages, WFP may have to reduce food distributions in many locations (IRIN-SA - 14/07/00; OCHA-04/06/00).

Malange

In May, MSF-H closed two therapeutic feeding centres in Malange town due to the improvements in the nutritional 04/06/00).

Kuito, Bie Province

The nutritional situation of the population living in Kuito town and its surrounding camps has improved. The population of the town and its suburban barrios is estimated at 111,500 and the population of Kunje town (about 5km from Kuito) and its suburban barrios at 19,200. There are also some 56,000 registered IDPs living in and around the town, the majority of these live in camps, but some also live outside camps. Two main waves of IDPs have been registered - December 1998 and September 1999 - corresponding to high levels of military activities in the province, and new arrivals were still being registered. The Government is encouraging the population to return to their places of origin, but this is not always possible because of the security problems.

MSF-B/Concern conducted two surveys of children aged 6-59 months in the area - one in the camps and one among the non-camp population of Kuito and Kunje - in June (see annex). Some IDPs were included in the non-camp population. It was not possible to include newly arrived IDPs who did not have a house or a shelter. The prevalence of acute malnutrition has decreased since December 1999, especially for the camp population (see graph). Previously, the rates of malnutrition were significantly higher in the camps (RNIS 30). Currently, no significant differences in the prevalence of acute malnutrition were found between the camp and non-camp populations. There was also no significant difference in the prevalence of malnutrition between the IDPs who arrived after December 1999 and those who arrived before. However, the majority of children being treated in the Therapeutic Feeding Centre in Kuito were recent arrivals, indicating that these people, who may be without a house or shelter, are the most nutritionally vulnerable (MSF-B/Concern - 6/00).

The prevalence of malnutrition (defined using z scores and/or oedema) in Kuito town and camps

The improvement in nutritional status was attributed to the maize harvest in April, the opening of roads into the city which resulted in more food in the markets, more regular food distributions by WFP, and seed and tool distributions for the IDP's vegetable gardens. An FAO/WFP analysis of the April harvest, however, reported that the yields were below those achieved in 1999, and that there would not be sufficient food to cover the population's needs for the rest of the year. There are also logistical constraints to providing food to this population. In particular, access to the city by road is unreliable due to security constraints and the airstrip needs major repair work (during which time it will be shut) (MSF-B/Concern - 6/00).

The table below summarises some of the surveys' other findings. Mortality rates remained worryingly high, and were attributed to seasonal increases as a result of malaria. Such high rates clearly indicate the inadequacy of anti-malaria programmes and treatment through health structures. The health structures were reported to be overloaded prior to the survey. The majority of the registered families received their food ration in June (80% in town and 98% in camps). The number of registered beneficiaries may have been underestimated if the households expected some benefit from a positive answer. A delay in the registration of newly arrived households was noted, this may explain some of their increased vulnerability to malnutrition (MSF - B/Concern - 6/00).

Results of surveys in Kuito town and camps

WFP has reported that more cases of pellagra (caused by niacin deficiency) have been registered in Kuito (WFP - 25/05/00). An outbreak of pellagra was reported between August and November 1999 (see RNIS 29). WFP responded to the problem by providing niacin rich food supplements for the cases identified and also their families. MSF-B/ICRC distributed vitamin B complex tablets to all women over 15 years old in December. The RNIS does not have any information on the severity of the current outbreak.

Ganda, Benguela Province

An ACM nutritional survey was conducted among children aged 6-59 months in the displaced camps in Ganda, Benguela Province in February as a follow-up to surveys in October 1999 and February 2000 (see annex). At the time of the February survey, the population of Ganda was estimated at about 36,000 residents and 3,000 IDPs in official camps and a further 6,300 IDPs living in the town either with host families or in rented accommodation. (ACH - 02/00). The most recent survey found that the prevalence of acute malnutrition had decreased dramatically (see graph) (ACH - 06/00). No further information is currently available.

The prevalence of malnutrition (defined using z scores and/or oedema) in Ganda, Benguela Province

Cuando Cubango Province

Menongue

The population of Menongue is estimated at 131,500 including some 50,000 IDPs most of who have arrived since December 1998. ACH undertook a nutritional survey of children aged 6-59 months living in the camps and in the town (see annex). Both the nutritional status and the mortality rates of the town population were satisfactory. The nutritional status of the camp population was also acceptable. Sixty-eight percent of the families living in the camps had received a food distribution from WFP prior to the survey (ACH - 05/00a).

Results of surveys in Menongue town and camps

Cuito Canavale

ACH conducted a nutritional survey of children aged 6-59 months in Cuito Canavale province of Cuando Cubango in late May (see annex). The population of Cutio Canavale is estimated at 20,500 including some 5,000 IDPs. The prevalence of acute malnutrition was estimated at 6% and 1.1% severe acute malnutrition. Oedema as recorded in 0.2% of the sample. These rates represent an improvement in the nutritional situation. The risk of malnutrition was higher among the displaced than the residents. CMR was estimated at 1.22/10,000/day and under-five mortality at 1.85/10,000/day. Vaccination coverage was low at 37.3% (ACH-05/00b).

Moxico Province

There are an estimated 75,000 IDPs living in six camps in Moxico Province. WFP is reducing its food distributions in this area based on the findings of the recent FAO/WFP assessment, but NGOs have expressed concern over these plans. Food stocks are low and hence expensive, and the rates of malnutrition increased in May (OCHA - 19/06/00).

Huila Province

The number of IDPs in Huila Province has increased to an estimated 246,000 IDPs, including 176,000 people who have been displaced since December 1998. The increase is due to insecurity in the south of Huambo Province. Reports of serious humanitarian situation in Caconda, where 1,200 displaced people have recently arrived and are without assistance, have been received (OCHA - 18/06/00).

Huambo

An FAO/WFP/MINDARS delegation visited Huambo, Caala and Longonjo in late April to verify food and nutrition needs. The mission reported that, due to heavy rains, less food had been harvested this year than in previous years. Harvesting took place earlier due to hunger and to prevent theft. Rates of malnutrition are reported to have increased in some areas, but decreased in others (this report is not available to the RNIS) (OCHA 23/05/00).

In April, ICRC halted its general food distributions in Huambo in response to the harvest; they will restart their programme in September. ICRC stressed that although the nutritional situation in Huambo had improved in places, the situation is still very fragile and could deteriorate rapidly in the event of further population displacements, increased insecurity, poor climate or post-harvest looting. They noted that the displaced population was more generally more vulnerable than the residents (ICRC - 20/06/00). IDPs have continued to enter Huambo Province during the reporting period (OCHA - 18/06/00).

Uige Province

UNHCR has begun a relief operation in Uige Province. An estimated 150,000 people are displaced in the Province (UNHCR - 27/06/00). MSF-S undertook a nutritional survey of both resident and displaced children aged 6-59 months in Uige Province in May (see annex). The prevalence of acute malnutrition was estimated at 6.8%, including 0.6% severe acute malnutrition. The rate of acute malnutrition was significantly higher in the IDP group than the resident group, indicating that the displaced are more vulnerable. This was because the IDPs were not receiving a general food distribution and the supplementary food provided to them was insufficient to prevent their nutritional status from deteriorating (MSF-S - 06/00).

Refugees

Congolese refugees

UNHCR is planning the repatriation of at least 1,850 Congolese refugees in Angola, some of who have been in exile for more than 20 years. In all, there are an estimated 11,000 Congolese still living in Angola. Most of these people are assisted in the Viana camp near Luanda (UNHCR - 26/05/00). There is no information on the nutritional situation of these refugees, which is assumed to be satisfactory.

Angolan refugees in Namibia

The fighting along the Namibian border has intensified. As a result, an estimated 1,120 Angolan refugees arrived at Osire camp in Namibia in June, bringing the total number of registered refugees at the camp to approximately 11,950. WFP plans to provide food assistance to these refugees in a new EMOP, which allows for 14,000 people, which will start in August (IRN-SA - 14/07/00).

Overall, in the short-term at least, the nutritional situation in Angola has improved, following the recent harvest. In addition the situation of the IDPs is now similar to that of town residents in most areas where the humanitarian community has had access, which reflects a significant improvement and must in part be attributable to international relief efforts. However, the national food situation remains extremely precarious as Angola is dependent on food imports, notably food aid, for at least 60% of its requirements (in contrast to self-sufficiency prior to the conflict). This suggests that current improvements cannot be sustained without substantial international aid or return to peace and extensive rehabilitation. The population is therefore considered at moderate to high risk (category III and II). A serious break in the WFP pipeline would lead to a rapid deterioration in the situation, particularly of IDPs.

Recommendations and priorities:

•  Provide funds to WFP and other agencies assisting the Angolan population.

From the FAO/WFP Crop and Food Supply Assessment

• In more secure areas, support rural development programmes that will begin to contribute to more sustainable livelihoods for farming communities.

From the surveys in Kuito, Bie Province (MSF-B/Concern - 6/00):

• Continue to support displaced populations.
• Adapt nutritional structures to the lower prevalence of malnutrition, but continue active case finding and surveillance.
• Target new arrivals for nutritional and health screenings, vaccinations, food and non-food items. Improve the registration system.

From the survey in Ganda, Benguela Province (ACH - 06/00):

• Continue the nutritional programmes in the area, including the general food distribution.
• Re-evaluate the nutritional situation at the end of the year.

From the surveys in Menongue and Cuito Canavale, Cuando Cubango Province (ACH-05/00a, 05/00b):

• Integrate the therapeutic and supplementary feeding programmes into the local health structures.
• Continue to monitor the nutritional situation regularly.
• Improve the measles immunisation rates.

From the survey in Uige (MSF-S - 06/00):

• Advocate for the provision of a general food distribution to the displaced populations.
• Continue with the supplementary and therapeutic feeding programmes.
• Continue to monitor the nutritional situation through surveillance activities and further surveys.

RNIS 30, March 2000

The prospects for peace in Angola seem remote. The country has been in a state of civil war since, and even before its independence. The humanitarian situation has not improved significantly during the reporting period: fighting between government and UNITA forces has intensified in some areas. Latest estimates suggest that 3.7 million people of Angola’s population of 12.7 million may be categorised as “war-affected”. Since January 1998, more than 1 million people have been confirmed as new IDPs (unconfirmed estimates are as high as 1.6 million). There has been an increase in the influx of Angolan refugees into Zambia and Namibia due to insecurity in the border regions since the start of the year (IOM - 28/03/00; WFP -30/03/00a).

Access and funding

Security conditions continue to be one of the major constraints for the delivery of humanitarian assistance activities: most relief aid is still delivered by airlifts which are extremely costly. WFP targeted some 1.13 million people for food assistance in March 2000, the majority of who are in the Provinces of Malange (240,3000), Huambo (206,000), Bie (200,300) and Huila (121,100) (WFP -30/03/00a). There continues to be a lack of access, for humanitarian agencies and others, to areas outside government control.

WFP has recently issued an alert that without substantial new donor pledges the Angola programme could face serious difficulties as of July. Serious pipeline breaks are foreseen (WFP - 30/03/00b).

Malange Province

The nutritional situation in Malange city has improved dramatically, according to a survey by MSF-H in January 2000 (see annex). Extremely high prevalences of malnutrition had been recorded in Malange in September 1999 (see RNIS 29). According to this survey report the population of Malange city is only 180,000, which is less than half previous estimates of 400,000 (MSF-H - 01/00).

MSF-H also undertook a nutritional survey in Lombe, a village 23 km east of the city (population 8,000) (see annex). Both Lombe and Malange have long been centres to which displaced people come, as they are perceived as relatively safe areas. The worsening situation in March 1999 forced more people to come to Lombe. The renewed conflict has halted or interrupted resettlement efforts, and relief programmes, in the form of dry ration distribution, have only recently started in Lombe. Examples of other nutrition programmes include the distribution of cooked free meals for children as well as sick adults by a Catholic mission, a ‘kitchen’ project focusing on lactating mothers, and a small food-for-work project. The results of the nutrition surveys can be seen in the table below (MSF-H-01/00).

Results of surveys in Malange and Lombe

The decrease in malnutrition in Malange city is partially attributed to the restoration of WFP’s general ration in August. The agency had been unable to deliver food to the community for five months during the siege (in the survey 74% of households reported receiving food from WFP, which is a great improvement compared to November when it was reported that 89% of malnourished adults did not have ration cards). There has also been an increase in goods available for sale in the city’s markets because of improved access by road. In addition, many NGOs have been operating feeding centres and programmes in the city during the past nine months, although the coverage was reported to be relatively poor (between 20 to 25%) (MSF-H- 01/00).

The prevalence of malnutrition was considerably higher in Lombe than in Malange, particularly for adults. This was attributed to the lack of a general ration distribution in Lombe. In addition, there are fewer supplementary feeding centres in Lombe and no therapeutic feeding programmes at all (MSF-H-01/00).

In Malange local residents had a significantly lower prevalence of malnutrition than IDPs (adults and children). This was not true for Lombe, possibly because the general circumstances of residents, particularly income opportunities for residents are as poor as those for the displaced (see graph). In Malange, a significant association (p<0.05) was found between children who drank water from unprotected wells and malnutrition. In Lombe, children who drank water from the river were more likely to be malnourished (MSF-H-01/00).

The prevalence of malnutrition (defined by z-scores or the BMI and/or oedema) in Malange and Lombe among residents and displaced

Kuito, Bie Province

The nutritional situation of IDPs in camps in Kuito and in neighbouring Kunje, Bie Province, is precarious. The population of Kuito town and its suburban barrios has been estimated at 130,000 and the population of Kunje town and its suburban barrios at 25,000. About 110,000 IDPs were registered at the time of an MSF-B/ICRC survey in December 1999. Two main waves of IDPs have been registered - December 1998 and September 1999 -corresponding to high levels of military activities in the province, and new arrivals were still being registered. The surveys of children aged 6-59 months in the towns and the I DP camps recorded a deterioration in nutritional status since March 1999 (see annex). Mortality rates remained elevated in both resident and displaced groups (MSF-B/ICRC-12/99).

Results of surveys in Kuito, Bie Province

The authors of the surveys suggested that the relatively higher prevalence of acute malnutrition in the camps was due to limited access to food as well as poor sanitation and health facilities. Only 23% of all the families interviewed (in town and the camps) reported having received a general food distribution in December, although a much higher proportion received food in November. WFP food deliveries were severely constrained during December due to the closure of the airport for almost two weeks. For general distribution, the current planned ration is 1,800/KCal/day and is targeted at IDPs and vulnerable categories of residents including children under five, disabled persons, and lactating and pregnant women. Since November 1999, families with malnourished children and families with pellagra (niacin deficiency) cases are also included. According to the survey only 42% of IDPs reported having access to general food rations. Access to community kitchens programmes where meals are distributed was even lower (approximately 5%). Coverage of the MSF-B feeding programmes were also low at 27% in town and 34% in the camps. Anecdotal reports suggest that an increasing number of older adults and children are becoming malnourished (MSF-B/ICRC -12/99).

RNIS 29 reported on an outbreak of pellagra in Kuito between August and November 1999. WFP has since supplied niacin rich food supplements (blended food) for the cases identified and also their families. The general ration, however, currently contains only 8-10 mg/person/day of niacin compared to the recommended daily allowance of 15-20 mg/person/day (WFP/MSF-B/ICRC/UNICEF -01/2000). A 30 day supply of vitamin B complex tablets was distributed to all women of 15 years and over in December by MSF. The MSF-B/ICRC survey estimated that 86% of women in the town and 90% of women in the I DP camps had received the tablets. However, compliance rates were relatively low for a variety of reasons, including misinformation and suspicions about the purpose or side effects of the tablets. Cases of pellagra are being treated through the supplementary feeding centres (MSF-B/ICRC-12/99).

Matala, Huila Province

The nutritional situation of the IDPs in Matala, Huila Province has improved since October 1999 according to two ACH surveys conducted in January (see annex). In October a rapid nutritional assessment using MUAC had estimated extremely high prevalences of malnutrition. The recent surveys were conducted on children aged 6-59 months from both newly arrived displaced groups (defined as those who had arrived after August 1999, population approximately 15,000) and more established displaced groups (those who had arrived before July 1999, population approximately 35,000) (ACH - 01/00).

Results of surveys from Matala, Huila Province

The most significant difference between the two groups was the alarmingly high under-five mortality rate among the newly-arrived IDP group. This was largely due to a diarrhoea epidemic that accounted for 92% of all reported deaths in this age group. In stark contrast the prevalence of malnutrition was similar for both groups, although slightly lower among the more established IDPs. A large proportion of this group have access to land and have managed to establish vegetable gardens. In contrast, the newly arrived group of IDPs are more dependent on the ration provided by WFP, as they do not yet have access to land (ACH - 01/00). New IDPs have continued to arrive in Matala during the reporting period (OCHA - 20/02/00).

Ganda, Benguela Province

Two ACH nutritional surveys were conducted among children aged 6-59 months in Ganda, Benguela Province in February as a follow-up to a survey in October 1999 (see annex). At the time of the survey, the population of Ganda was estimated at about 36,000 residents - 3,000 IDPs in official camps and a further 6,300 IDPs living in the town either with host families or in rented accommodation. There have also been reports of a further 1-2,000 displaced people arriving in the area (ACH - 02/00; OCHA -20/02/00).

The prevalence of malnutrition (defined using z-scores and/or oedema) in Ganda, Benguela Province

The prevalence of acute malnutrition was extremely high among the IDPs in the official sites (see graph). Mortality rates for the IDP population (calculated by grave counting in the cemeteries around the displaced sites) were also elevated - CMR was estimated at 3.1/10,000/day and under-five mortality at 4.1/10,000/days. The IDPs in Ganda have very limited opportunities for self-reliance, their main source of income is from working on the residents’ farms but this work is infrequent and poorly paid. The displaced are able to plant on very limited plots around the campsites, but this activity does not produce enough food for the majority of households. Residents are also suffering as both agricultural production and economic activities in the area have been limited by insecurity. A limited number of animals are still owned by the residents (ACH - 02/00).

Huambo

SCF-UK/WFP/MINARS are verifying beneficiaries in Huambo. WFP plans to undertake a general food distribution in April, focusing on the IDP population. The situation will be reviewed in the next three months when the availability of food locally should improve after the harvest. Previous reports have suggested that both the resident and displaced populations have poor nutritional status. The nutritional situation is still reported to be of concern (WFP-30/03/00a).

According to WFP, a nutritional survey in Caala in November estimated the prevalence of acute malnutrition at 23.3% and severe acute malnutrition at 5.8% (WFP -13/01/00). This survey is currently unavailable to the RNIS. ICRC assisted some 16,000 IDPs in Caala in January-March. An estimated 2-3,000 new IDPs have arrived during the reporting period (WFP - 30/03/00a).

Angolan refugees in Namibia

Fighting has intensified in recent months along the Angolan border with Namibia and in other areas of the province of Kuando Kubango. UNHCR and WFP are currently assisting some 11,000 Angolan refugees in Osire camp, Namibia, about 230 km north of the capital Windhoek (IRINSA 28/02/00; WFP - 30/03/00a). There is no information on the nutritional situation of these refugees.

Overall, the nutritional situation appears to be quite variable from the surveys described above. Populations to which the international humanitarian community has recently gained access have generally experienced improvement in their nutritional situation (category II or III). Generally the nutritional situation for the IDPs living in official sites in Kuito, Bie Province, and Ganda, Benguela Province is worse than that of adjacent town residents (who include IDPs resident in towns) (category I), although in some smaller towns or villages like Lombe, Malange province the situation is similar for both IDPs and longer-term residents. In Matala the impact of non-nutritionally related causes of mortality are evident. The nutritional situation of the refugees in Namibia is unknown (category V).

Recommendations and priorities:

• Support WFP’s programme in Angola to avoid pipeline breaks from July onwards.
• Maintain humanitarian assistance to the IDPs, particularly those in official camps or sites.
• Improve public health - a continued priority.
• Obtain information about the nutritional situation in UNITA controlled areas, and the need for humanitarian assistance.

From the MSF-H surveys in Malange and Lombe:

• Improve the general food distribution to the IDPs in Malange to ensure in particular that the IDPs and malnourished adults are not excluded.
• Start a general food distribution in Lombe targeted equally at IDPs and residents.
• Start a therapeutic feeding centre in Lombe.
• Improve coverage of all selective feeding programmes in both Malange and Lombe, through active case finding.
• Investigate water sources in both Malange and Lombe to assess the links with malnutrition.
• Investigate the source of livelihood and food security of people in Malange and Lombe.

From the MSF-B/ICRC surveys in Kuito:

• Improve access to safe water and essential health care facilities in order to reduce the high mortality rates.
• Improve coverage of the selective feeding programmes through screening and active case-finding, and investigate delays in discharging recovered children.
• Initiate food basket monitoring and continuing to reinforce nutritional surveillance.

For the pellagra outbreak:

• Supply the IDPs with foods rich in niacin and other B vitamins (preferably groundnuts, otherwise corn soya blend)
• Investigate whether or not residents are also suffering from other micronutrient deficiencies.
• Investigate the feasibility of setting-up local maize fortification schemes as a more long-term solution

From the ACH survey in Matala, Huila Province:

• Continue to supply food assistance, and increase this if possible.
• Support food security through appropriate agricultural and income-generating activities.
• Establish a nutritional surveillance system in the camps for the longer-term displaced.
• Improve the measles immunisation rate for this group.
• Strengthen the provision of safe water for the newly displaced.

From the ACH survey in Ganda:

• Provide a general ration, shelter, essential kitchen and other non-food items to all IDP households in the official sites for three months.
• Continue nutritional surveillance through the health centres.
• Strengthen active case finding.

RNIS 29, December 1999

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

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

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

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.

From the survey in Huila:

• 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.

Kuito, Bie Province:

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

IDP camps in Ganda:

• 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.

Overall, high prevalences of malnutrition continue to be reported among IDPs (and residents) in Huambo and Malange (category I). In the areas recently affected by conflict, including Bie and Huila, the nutritional situation of the IDPs has deteriorated and they may be at high risk (category II). The remainder of the IDP population are probably at moderate nutritional risk (category III).

RNIS 28, September 1999

The humanitarian situation in the country has not improved significantly during the reporting period. Continued warfare, including the shelling of cities, laying of landmines and other security incidents, have led to the displacement of one million people since the beginning of this year (total displaced 1.7 million). The situation of the displaced is exacerbated by widespread road closures which severely restrict access and the delivery of humanitarian resources. In addition, the conflict has also constrained the movement of people and goods, and prevented surpluses in some provinces from reaching the deficit areas. Not all areas are equally affected and the nutritional situation is variable. Reports from the northern provinces indicate a reasonable harvest and fair accessibility to crops. The nutritional situation in the central highland provinces, however, is generally thought to very poor and high prevalences of malnutrition are currently being recorded in both resident and displaced populations (UNICEF - 07/99).

The prospects for peace in Angola seem remote; the country has been in a state of civil war since, and even before, its independence. The current crisis, which is the most severe since the Lusaka Peace Protocol was signed in 1994, began in December 1998 when the government launched a major offensive against UNITA. The international community largely holds UNITA responsible for the collapse of the peace process and is trying to tighten sanctions against the organisation. In particular, they are trying to tighten sanctions on diamonds - it is estimated that UNITA earned US $200 million from trading diamonds in 1998 alone (IRIN-SA 08/06/99; UNHCR -11/06/99).

Humanitarian assistance is currently focused on the IDPs within the besieged cities of Huambo, Kuito and Malange. The residents of these cities are also facing difficulties accessing food. Their harvest reserves have been consumed by the army and/or IDPs and labour opportunities are extremely limited due to the war. Thus prevalences of malnutrition are rising in this group (WFP - 08/09/99).

WFP were able to meet approximately 60% of the estimated needs in July. An improvement in the pipeline has meant distribution levels have increased more recently. WFP has expanded its EMOP to provide assistance to 900,000 people until December 1999. In September, 867,00 beneficiaries received WFP food (OCHA - 23/07/99, 24/08/99; WFP - 20/08/99, 20/09/99).

1998/99 Cereal production and food security

Food security is obviously tenuous given the resumption of the civil war and major population displacements. However, satellite imagery and field reports indicated that seasonal rainfall was generally good. National production of cereals in 1998/99 was projected to be 10% below production from 1997/98 as a result of disruption caused by renewed warfare and large population displacements. Although, non-cereals, particularly cassava, grown in northern and central areas are thought to compensate to some extent for this shortfall (FEWS-30/07/99).

Huambo

The very poor situation in Huambo reported in RNIS 27 has not improved significantly, despite humanitarian airlifts to the city since early July. The nutritional situation remains critical and an increased number of residents are being admitted to feeding centres. The airlifts have allowed WFP to re-establish its provincial stocks. However, the airport has been frequently closed because of security incidents, suspending humanitarian deliveries (IRIN-SA - 03/08/99; OCHA - 09/07/99, 16/07/99, 23/07/99, 12/09/99; WFP - 16/07/99).

Food is available in the markets, but is extremely expensive. The government has tried to ease the problem of food supply by distributing land before the planting season in September, and ICRC are providing limited quantities of seeds and tools. These initiatives are handicapped by the lack of secure farm land, as UNITA forces are based just 30 km from the city. Crucially, whatever the harvest yield, it will not be available until December (IRIN-SA -03/08/99; OCHA - 12/09/99).

Malange

Malange has been under siege for a prolonged period of time and as a result international NGOs and the UN have only recently been able to obtain access to the area. Shelling continues sporadically. A Ministry of Health survey conducted in late June/early July estimated the prevalence of acute wasting and/or oedema, at approximately 20-25% and severe wasting and/or oedema was estimated at 5-7% (see Annex). Note that the survey methodology employed is unknown (WFP - 08/09/99).

Reports from WFP, MSF-H and World Vision confirm that the nutritional situation in Malange is grave. Anecdotal reports indicate that mortality from nutrition-related diseases is high. There are now an estimated 49,000 IDP families (196,000 people) in the city. WFP have begun to provide food assistance in the reporting period, although there is no general food distribution for residents, but registration of vulnerable residents is underway. There are over 1,500 children in the MSF-H therapeutic feeding centres, and selective feeding is generally considered a priority. The number of community kitchens has also increased, they are now assisting over 60,600 persons (IRIN - 14/9/99; IRIN-SA - 30/07/99; MSF-H - 29/07/99; OCHA - 12/09/99; WFP -16/07/99, 03/09/99, 07/09/99).

More recently, the road from Luanda to Malange has been opened and WFP food convoys have been able to reach the city. Transportation between WFP warehouses and distribution points in Malange is difficult, as there are very few commercial transporters left within the city. The increase in food assistance has led to a decrease in market prices, however should the roads be closed again the situation will deteriorate rapidly (WFP - 27/08/99, 08/09/99).

Plans are underway to resettle the IDP families on land within a security perimeter around the city before the next planting season. The amount of land set aside, however, is insufficient and efforts continue to identify more land. There are also insufficient non-food items for the resettlement programmes (OCHA - 24/08/99, 12/09/99).

Kuito, Bie Province

The bombardment of Kuito (estimated population 250,000 of which 72,000 are IDPs) continues sporadically. Heavy fighting in early September in the areas surrounding the city has resulted in non-essential staff being relocated (WFP - 13/09/99). The nutritional situation has deteriorated rapidly in the past four months. In a survey undertaken in March 1999, MSF-B estimated the prevalence of acute wasting at 4.3% among children under five years. This had risen to 12.7% by mid-July. Severe wasting was estimated at 3.5% in July, including 2.7% oedema (see Annex). There has been a concomitant increase in the attendance figures at supplementary and therapeutic feeding centres (Epicentre/MSF-B - 28/07/99).

The authors of the survey suggest that the nutritional situation in Kuito will deteriorate further. Reasons given for this include the poor coverage of the general food distributions provided - only 33.6% of households in the sample received food at the last distribution or from community kitchens (approximately 25,000 of the most "at risk" people received food at the end of June and July). In addition, the coverage of the feeding programmes was low at 13.2% for supplementary feeding centre and 14.3% for the therapeutic centre.

High mortality rates were recorded in both the general population and the under-fives (CMR 2.2/10,000/day; U5MR 3.3/10,000/day). CMR was more than double the level usually defined as a "serious situation". It is probable that the high CMR is not due to the nutritional situation alone and that other public health problems need to be identified and controlled. For example, measles immunisation coverage was low, at 33.5%. The rainy season is approaching which will increase the risk of a series of medical problems including diarrhoea, acute respiratory infections and malaria.

Approximately 14,000 families have planted in lowland fields under WFP-supported agricultural resettlement activities in the Kuito area. If security conditions permit more families will join them (WFP - 13/09/99).

Cuito Canavale

A brief visit to assess the food and nutritional situation of the population in an IDP camp in Cuito Canavale was made by ACF-S in mid-June. The main findings of the assessment included a lack of purchasing power and cash income among most of the displaced population who do not have access to land. The market contained only a limited selection of foods. Most of the families existed on a day-to-day basis, buying food only one day at a time. In addition, the environmental and public health conditions were reported to be very poor (ACH-S - 18/06/99).

Uige

There have been reports of increased fighting in Uige, and of further population displacements. An unknown number of people have been killed. Reception centres for the approximately 10,000 IDPs have been set-up. The nutritional situation in Uige was reported to be under control in the latest UNICEF report, but may begin to deteriorate if the security situation worsens. The road corridor between Lubango and Benguela province and Menongue in Kuando Kubango province remains closed and market prices are extremely high (OCHA - 12/09/99; UNICEF - 07/99; WFP - 13/09/99, 27/08/99).

Overall, the situation for many Angolan IDPs remains critical, particularly in the three besieged cities. High prevalences of malnutrition have been recorded in these cities, and although humanitarian efforts to provide assistance are underway, the situation could deteriorate further if security conditions become worse (category I). Unknown numbers of residents in these cities are considered at high risk. The situation in the rest of the country is generally considered to be better and it is assumed that the IDPs who are provided with assistance by WFP in these areas remain at moderate risk (category IIb). The nutritional situation of the remaining IDPs is unknown (category III).

Priorities and recommendations:

• Support negotiations for a peace agreement in Angola through diplomacy and economic pressure.
• Supply funds to support humanitarian operations in Angola. The UN 1999 appeal for Angola has been revised upwards from approximately US $66.6 million to US $106 million. The WFP EMOP for Angola currently has a 34% shortfall of the requirements (WFP - 03/09/99).
• Include vulnerable residents in food distributions in the affected areas.
• Support the agricultural resettlement programme for IDPs in the besieged cities of Malange, Huambo and Kuito.

Recommendations from WFP in Malange:

• Expand therapeutic and supplementary feeding centres which are still considered a priority for assistance.

Recommendations from the survey in Kuito include:

• Increase the coverage of the general food distributions to encompass all vulnerable groups in both the resident and the displaced populations. Assess the content and quality of the rations provided through regular food monitoring programmes.
• Increase the capacity of the supplementary and therapeutic feeding centre programmes.
• Conduct an active case search for all malnourished children. Refer all malnourished children to the feeding programmes.
• Organise a mass vaccination campaign against measles targeting all children aged 6-59 months as soon as possible.
• Implement a surveillance system for mortality and priority diseases.
• Assess public health problems.
• Conduct a further anthropometric survey after the rainy season, and also a food security study. This should assist in the identification of the most vulnerable groups.

Recommendations from the report on Cuito Canavale include:

• Monitor the nutritional situation, using routinely collected data from health centres.
• Re-visit the region as soon as security conditions permit, and undertake a food security and anthropometric survey in order to assess the nutritional situation further, and identify vulnerable groups within the population.

RNIS 27, July 1999

The humanitarian crisis in Angola has become extremely severe. Following the collapse of the peace process and renewed warfare in late 1998, an estimated 1.7 million people have now been displaced from their homes out of a total population of 13 million. Approximately 900,000 of these people have been displaced since December last year. Insecurity has been experienced in virtually all provinces but the provinces of Bie, Huambo, Malange, Kuanza Sul, Moxico, Benguela and Huila have been most severely affected. Huambo, Malange and Kuito are virtually besieged. In addition, landmines are being laid down by both the Angolan armed forces and the UNITA rebel movement which are causing more accidents and deaths amongst civilians (FAO/WFP - 16/06/99; IRIN-SA - 02/06/99; OCHA - 02/06/99, 11/06/99, 01/07/99; WFP - 04/99, 05/99).

The prospects for peace in Angola seem remote, the country has been at the centre of a civil war since, and even before, its independence. The current crisis, which is the most severe since the Lusaka Peace Protocol was signed in 1994, began in December 1998 when the government launched a major offensive against UNITA. The government seems committed to end the conflict by military means and has stated that "Angola had to wage war in order to achieve peace". The international community largely holds UNITA responsible for - the collapse of the peace process and is trying to tighten sanctions against the organisation. In particular, they are trying to tighten sanctions on diamonds - it is estimated that UNITA earned US $200 million from trading diamonds in 1998 alone (IRIN-SA 08/06/99; UNHCR- 11/06/99).

The conflict has seriously disrupted food security and hence negatively affected the nutritional situation. Despite good climatic conditions for this year's harvest, and no dramatic reductions in planting, significantly reduced yields are anticipated in many areas due to the abandonment of fields. Looting of crops before they have reached maturity has also been a problem. In addition, the closure of most roads in the conflict-affected areas will prevent surpluses in some provinces from reaching deficit areas. Thus urban areas will face food deficits and farmers will have difficulties marketing their crops. Very few of the IDPs will have any harvest at all this season. The food security situation is reported to be satisfactory only in the south-western parts of the country, where security is stable (FAO/WFP - 16/06/99; OCHA - 01/07/99).

Access to IDPs and others in need

Large-scale movements of the population began from rural areas to municipalities and later to provincial capitals. Many of the IDPs arrived in the urban areas in very poor condition and with only small supplies of food. However, obtaining access to the IDPs and other vulnerable groups found in the towns and cities of Angola is becoming increasingly difficult for humanitarian agencies, particularly in the Central Highlands. The strategic roads around many of these cities have been cut off by UNITA for months and ambushes on the remaining roads have increased. Logistical capacities for food assistance are very much dependent on the local security situation. Whereas WFP was previously able to deliver food assistance by road to over 200 destinations, the resurgence of the conflict has resulted in the number of locations accessed by road diminishing to less than 50. Frequent attacks, fluctuating road tariffs and the scarcity of fuel in some provinces have all led to increased costs of transport and decreased capacity. Air deliveries are also hindered by poor security situations. Factors such as inadequate aircraft ground support operators, poor maintenance and repair of airstrips and very high insurance costs all contribute to increased transport costs. Taking into account all these factors, the internal transport and storage costs for WFP have risen from US$ 219/tonne in 1998 to US$ 330/tonne (FAO/WFP -16/06/99).

It is clear from preliminary surveys and reports carried out in some of these cities that the rates of undernutrition are increasing and will continue to do so unless food and other forms of assistance are provided. The small supplies of food which were brought with the IDPs following their displacement are now largely exhausted and these populations are becoming increasingly dependent on humanitarian assistance. Food security for the resident population is also expected to deteriorate in the coming months as they compete with the IDPs for the same resources. In many cases, the children of residents are reportedly brought to the feeding centres in equal proportion to the children of the IDPs (WFP - 05/07/99).

Huambo

An SCF-UK/Concern/MOH survey undertaken in Huambo city in May recorded exceptionally high levels of malnutrition for this area (see Annex), exceeding all previously reported results since 1994. The prevalence of acute wasting among children under five years of age was 14.5%, with 1.3% severe wasting (compared with 3.7% acute, and 0.1% severe reported in April 1995). The prevalence of oedema was 2.2%. The current prevalence rates indicate that an estimated 11,700 children are malnourished and need supplementary or therapeutic feeding (based on a conservative estimate, the population is 350,000 including an estimated 70,000 children under-five). At the time the survey report was published the capacity of the feeding centres was just 2,800, i.e.: the number of facilities were totally inadequate. An unknown number of adults and children older than five years old may also be malnourished.

Reduced access to agricultural land as a result of insecurity was suggested as a main factor explaining the very poor nutritional status seen in this survey, but similarly high levels of malnutrition were found among resident and displaced groups - that is in groups with and without access to land. This was probably because of the increased strain on resident households due to greater numbers of household members (displaced persons). In addition, local food production has been reduced due to insecurity and in some areas the staple food (maize) was harvested earlier than normal resulting in food reserves being used up already. Food is available in the markets, but most of the population is unable to afford it as prices have tripled since the same period last year. Shortages of salt, oil, sugar, fish, meat, flour and soap have been reported. Insecurity on the roads outside the city make it dangerous for the population to buy (or sell) goods outside of Huambo.

The nutritional outlook for Huambo's population is very poor. Future harvests will be reduced due to low seed conservation. WFP's on-going operation, which will end in August, was not planned to cater for the very much increased needs currently described and the food for the new operation starting in September has not yet arrived. Usual coping strategies are restricted due to insecurity (e.g.: the collection of firewood). In addition, the politico-military situation is still very fragile in this area and could deteriorate even further (CONCERN -06/99; SCF-05/05/99, 09/06/99; OCHA - 11/06/99, 01/07/99, WFP - 05/07/99).

Kuito, Bie Province

A joint WFP/UNDP/UCAH mission to Kuito, in Bie province, in late April described the humanitarian situation of the approximately 45,000 registered IDPs in the area as very poor, but not yet critical (WFP -04/99). A more recent report from MSF-B, however, suggests that the situation is now very serious. In the first week of June there were more than 500 beneficiaries in their Therapeutic Feeding Centre - an increase of more than 400% in the past few months. There are also an estimated 1,500 people in the Supplementary Feeding Centre. It is estimated that 61,000 newly displaced people have come to the city since December and the total population of the city is currently estimated to be 220,000 (MSF-B - 04/06/99; OCHA - 01/07/99). As in many of the other besieged cities, fuel shortages are a major hindrance to the delivery of humanitarian assistance (OCHA - 11/06/99).

Malanje

Malanje has been the scene of sporadic shelling for nearly four months, and the Province Hospital has registered more than 1,000 deaths since the beginning of the year. The city is has registered more than 100,000 IDPs. Emergency food distributions have been temporarily halted because of continual bombardment and attacks on the Malanje-Luanda road. Food stocks are currently being targeted only to children, pregnant women, elderly people, the disabled and the sick (WFP - 02/05/99, SCF - 05/05/99; IRIN-SA - 07/06/99, 08/06/99). Security conditions have prevented a nutritional survey being undertaken in the city in the past few months, but given that acute undernutrition was measured at 11% in January of this year (see RNIS 26) and that the city has practically been under permanent siege status since this time it is feared that the prevalences of undernutrition will be high (OCHA - 17/06/99).

Moxico

In Moxico province, the insecurity continues to force the displacement of the population from war affected rural areas into Luena. Fields in the periphery of Luena are also difficult to access because of the security conditions, which has reduced the supply of food to the town Thus food insecurity also affects the local population, some of whom have had to resort to posing as IDPs in order to obtain humanitarian assistance. (OCHA-11/06/99).

The condition of some 19,000 recent arrivals in Kuito Kuanavale from areas in Moxico was reported to be particularly extreme, with evidence of severe malnutrition in both adults and children. In addition to food aid, these people - who have been cut off from the rest of Angola for up to 10 to 15 years because of the civil war and hence can speak no language other than their own local dialect - desperately need medicine and clothing: many of them are wearing clothing made out of tree-bark (OCHA - 02/06/99).

Kwanze Norte

World vision has recently reported the results of three nutritional surveys undertaken in two localities of Kwanza Norte Province (see Annex and graph). It can be seen that the prevalence of malnutrition is relatively high. A further report suggests that the prevalence of wasting may be even higher in Samba Caju district (up to 43%), but the study methodology is not know and hence the results are not shown. The NGO reports that most of the new IDPs arriving at the camps in Kwane Norte are from Malang and most need immediate attention. The majority of the children are undernourished and are suffering from diarrhoeal diseases, malaria, acute respiratory tract infections or other illnesses. World Vision has been running a therapeutic feeding centre in Cazengo since April, but new arrivals from insecure areas are frequently arriving in very poor condition, hence the high prevalence of malnutrition. The main constraint of programmes in these areas is funding (WV - 23/06/99).

Benguela

A recent Angolan Red Cross nutritional survey reported 13% acute and 3% severe wasting and/or oedema in Chongorio, while in Caimbambo acute wasting and/or oedema was estimated at 19% and severe wasting and/or oedema at 2%. Depending on the availability of WFP stocks, food assistance will be given to the most vulnerable (OCHA -24/06/99).

Other areas

A report from a recent UNICEF meeting suggests that in some areas of the country such as Zaire and Uige there are no evident signs of a nutritional problem. In these areas there is much better access to crops and/or the humanitarian agencies are able to deliver some assistance to the communities. Although, the most recent report from Zaire Province states that there is a shortage of health facilities and medical equipment in this area (OCHA - 22/06/99, 01/07/99).

An emergency vaccination campaign against polio is currently being undertaken by UNICEF and the national health authorities. The latest figures indicate that 958 cases (almost all are children under five years) have now been reported with 84 deaths (SCF - 22/06/99). Most of the cases are in the slum areas around Luanda, although some have been reported in Benguela (OCHA - 28/04/99). Over a million children have been vaccinated and the campaign continues. An outbreak of meningitis amongst young adults has also been established in the province of Kuando Kubango (OCHA - 07/05/99), although an immunisation campaign appears to have brought this under control.

Overall, the situation in Angola is critical in many areas, although in other areas the situation is not as severe. The numbers of people involved are difficult to estimate (note that only IDPs are shown in summary tables, although the resident population is also at great risk). The 462,000 IDPs in the cities in the central highland provinces are at high risk (category IIa), although the IDPs in Huambo (175,000) are known to have very high rates wasting and are therefore classified as category I (these numbers are from UCAH - WFP, 05/0799). IDPs in other areas are probably at moderate risk (category IIb).

Priorities and recommendations:

• Funds are urgently needed to support humanitarian operations in Angola. At the time of going to press the appeal for Angola was only 29% funded (OCHA - 01/07/99). The funds are required to charter additional cargo aircraft to transport desperately needed food and medicines to the war-affected cities. Low levels of emergency food stocks are reported in several areas. Breaks in the food aid pipeline breaks are expected in the next few months.
• Support the Government of Angola's commitment to the temporary resettlement of IDPs on productive agricultural land
• Expand the capacity of supplementary and therapeutic feeding programmes and distribute a regular general ration distribution programme in order to make the selective feeding effective.

Recommendations from the CONCERN/SCF/MOH survey in Huambo

• Increase the number of targeted feeding programmes (supplementary and therapeutic)
• Ensure close collaboration between targeted programmes and soup-kitchens, providing referrals
• Elaborate a nutritional/agricultural educational programme highlighting alternative possibilities of food cultivation and preparation with currently available foods. This programme should target the most vulnerable families.
• Provide agricultural and food interventions for the most vulnerable families where possible.

RNIS 26, March 1999

Angola is currently experiencing its most severe political and humanitarian crisis since the signing of the UN brokered Lusaka Protocol Peace Accord in 1994. Fighting between UNITA and government forces has intensified since December 1998, particularly in the central highlands and northern provinces. This has resulted in fresh waves of population displacements and has aggravated an already precarious food situation in several parts of the country. The number of confirmed IDPs has increased dramatically since December from 350,000 to over 650,000, although the actual number of IDPs (including non-confirmed persons) may be as high as 882,000 (OCHA - 17/03/99).

The latest breakdown of confirmed IDPs in the most affected provinces are as follows (OCHA - 17/03/99):

Of particular concern are those IDPs in Malanje, Huambo and Kuito where UNITA forces have besieged the cities. The government occupied town of Malanje, which accomodates at least 130,000 IDPs, who have fled fighting in the surrounding countryside, has been the site of heavy shelling by UNITA for some weeks. The shelling frequently prevents people gathering at meeting points to receive what relief is available. WFP has managed, however, to provide assistance to the IDPs periodically - during breaks in the shelling - which has resulted in a drop in prices at the only food market still open (IRIN-SA - 19/02/99; OCHA - 19/03/99).

A survey in Malange town in January 1999, found the prevalence of wasting in children aged 6-59 months to be 11.0%; severe wasting was at 4.5% (see Annex I(1a)). These levels are much higher than those reported in comparable surveys in Malange in June 1997 and July 1996, when wasting was measured at 2.3% and 3.6% respectively. Furthermore, the current situation may deteriorate as access to food is increasingly limited due to security constraints (WFP - 05/02/99).

The situation in Huambo and its environs is also of grave concern. Reports suggest a precarious public health situation as well as food shortages and inflation in market prices (OCHA - 17/03/99, CONCERN - 10/02/99). An SCF-UK survey in January among children of displaced families (SCF-UK - 19/03/99) recorded a prevalence of 14.7% wasting and 7.3% severe wasting (see Annex I(1b)). In response to these findings, four supplementary feeding centres have been opened by NGOs in Huambo and the opening of a therapeutic feeding centre is planned. In February, WFP - with the assistance of SCF-UK - was able to provide assistance to some 54,000 beneficiaries of which 44,500 were IDPs.

Poor public health conditions in over-crowded cities have increased the risk of a rise in morbidity, particularly measles, malaria and tuberculosis. Reports of a growing number of people contracting tuberculosis in Kuito have been received (IRIN-SA - 08/02/99).

A major obstacle to the provision of humanitarian assistance to Angolans in UNITA controlled areas is the issue of safe access. In December and January there was heavy fighting in the northern Zaire province capital, M'banza Congo, which at one point was controlled by UNITA. The humanitarian community was unable to enter the city during this period and there are reports that the local hospital was ransacked and equipment looted or destroyed (IRIN-SA - 19/02/99). Access for humanitarian workers may become even more difficult in the absence of MONUA (the UN Observer Mission in Angola), who plan to withdraw from the country completely by the end of March (Reuters - 19/03/99). Furthermore, the downscaling of MONUA has brought the UN Mine Action Programme to a virtual halt and there are reports of new mines being laid (IRIN-SA - 19/02/99).

Given the extreme insecurity on the country's roads, WFP must currently deliver 80-90% of its aid by air compared to 20% six months ago (WFP - 15/02/99). This can only greatly reduce WFP's capacity to deliver food assistance. This is partly due to the much greater costs ($20 million has been requested for air transport costs in the most recent appeal) and more limited capacity of air transport compared with road transport, and also because of airport closures, such as those experienced in Huambo and Kuito restrict access (IRIN-SA -31/12/98). Shortage of funding for transportation costs is threatening to cause delays in deliveries of emergency assistance to IDPs and affected communities even when goods are available in the country (OCHA - 19/03/99). After the crash of two aircraft in the service of MONUA, all UN flights were temporarily suspended for part of January, however, humanitarian flights operated by WFP have recommenced to some destinations in the country (OCHA - 14/01/99). In spite of these difficulties, in March WFP plans to distribute food to 700,000 beneficiaries, of which 480,000 are IDPs (OCHA - 17/03/99).

The food security outlook for Angola has become increasingly bleak. The latest satellite images indicate that the 1998/99 rainy season has been favourable so far. However, there is little hope that this will translate into increased production as intense fighting is taking place in the major crop growing areas of the centre (Huambo and Bie provinces) and extending to the north and the east. As a result many farmers have abandoned their land. Also, widespread insecurity, new laying of land mines and severely damaged infrastructure are curtailing normal trading and are hampering the distribution of seeds, tools and other agricultural inputs. Consequently, the 1999 crop is expected to be below the output in recent years. The Harare-based Southern African Development Community's Early Warning System estimates that the maize output is likely to fall by 25%. The country must rely heavily on food assistance to meet its basic food needs (FAO - 18/02/99; OCHA - 19/03/99).

New Angolan Refugees

According to UNHCR reports, 75,000 people have crossed from Angola into DRC since December. Many of this new wave of refugees entered DRC through the border post at Luvo from Zaire province which has been the site of intensive fighting. Reports have also indicated that there are an estimated 8,000 recent Angolan arrivals in Congo-Brazzaville (UNHCR - 17/03/99). In addition, UNHCR reports that more than 1,200 people have fled to Zambia since June 1998 (WFP - 12/2/99).

Overall, the IDPs in the cities which are besieged by UNITA are considered to be at high nutritional risk (category IIa), those in other areas are considered to be at moderate nutritional risk (category IIb).

Recommendations and Priorities:

• The main issue to be addressed is the safe and secure access of humanitarian assistance to affected areas and populations, which can only be achieved through dialogue between UNITA and the government of Angola.
• Funding is required for the revised UN Consolidated Appeal for Angola (January 1999). In particular, funds are required for the increased costs of food and non-food items for displaced persons and their hosts, and the air transportation to deliver these goods.
• UNICEF has appealed for more money to allow for a larger vaccination campaign and WHO has requested extra funds to continue its early warning information network (IRIN-SA - 29/01/99).

RNIS 25, October 1998

RNIS 25 was devoted to reviewing some of the changes in emergency response over the last five years. We will first highlight situations where wasting was brought rapidly under control. We will then look at some of the factors that have led to less than optimal results, followed by what has been accomplished to improve response over the last five years. We conclude with some ideas for future improvements in the RNIS Reports that could even further enhance communication, stimulate thought, and promote improvement.

RNIS 24, June 1998

A twenty year long conflict in Angola led to widescale displacement and disruption of farming activities. The conflict ended with the signing of the Lusaka peace accords in November 1994. However, many people remain in need of humanitarian assistance due largely to continued insecurity and the presence of landmines. The war has left the country's infrastructure in ruins and although security and access to the country had improved greatly, recent reports of increasing insecurity and banditry are giving cause for concern. For example, the security situation in Benguela, Huila, Malange and Uige provinces is described as serious and has restricted UN and NGO humanitarian and rehabilitation efforts. There has also been some remining of roads [FAO 20/05/98, IRIN 08/05/98, WFP 12/06/98].

A recommendation to extend the mandate of the UN Observer Mission in Angola for two months has recently been approved. Most troops will be withdrawn by July 1st 1998, with a small number remaining in the country until the end of 1998 [IRIN 30/04/98].

Cereal Production in Angola over time

taken from: FAO/WFO Crop and Food Supply Assessment Mission to Angola, 20 May 1998. A recent assessment of expected crop yields in Angola predicted an increase in production at a national level although there will be deficit areas, e.g. the south and south/west. Improved supplies of seeds and tools were noted in most provinces so that cultivation has increased in areas where IDPs have land allocations and where returnees have resettled. However, problems such as insecurity, poor roads, a lack of functioning markets and landmines mean it will be almost impossible to move crops from surplus to deficit areas [FAO 20/05/98]. It is estimated that 750,000 people currently require emergency assistance, a 25% reduction compared to 1997. The most important factors influencing the decrease has been the successful resettlement of around 60-80,000 people in 1997/8. Good harvests have also been a contributing factor. This 750,000 includes internally displaced people, returnees and demobilised soldiers. In addition, food assistance will be required to assist the rehabilitation process. Although levels of wasting appear to be generally low in the country (about 5% - see RNIS 22, 23), food insecurity is widespread due to a number of factors. These vary by population group and region, but generally include:

· lack of access to agricultural lands and inputs; · low purchasing power due to high inflation and stagnant incomes; · poor infrastructure; · inaccessibility of some areas [FAO 20/05/98]. Some IDPs are returning home. For example, 13,000 people returned to their villages of origin in Bengo Province. However, the deteriorating security situation in some areas has led to the postponement of plans for the return of internally displaced populations and refugees. For example, increased insecurity has discouraged the planned return of many IDPs in Cubal, which was home to the largest concentration of IDPs in Angola. Furthermore, the security situation is leading to fresh population displacements; 4,000 new IDPs arrived in Longonjo, Huambo Province in April. Since that time, a number of people have started to return home. The problem of security has meant that transport of humanitarian aid has to be organised in convoys [CRS 27/05/98, FAO 20/05/98, OCHA 27/04/98]. There are approximately 260,000 Angolans living as refugees in Congo-Brazzaville, Democratic People's Republic of Congo, Namibia and Zambia. About 10,000 people have returned to Angola so far in 1998. It is hoped that the rate of return will increase with the end of the rains in May. UNHCR is concentrating on some 200 quick impact projects in the heavily war-damaged southern and eastern provinces. These are rapid projects which aim to improve the infrastructure in areas of return, such as construction of roads or community centres [UNHCR 08/05/98].

Overall, the population in need of humanitarian assistance is not currently thought to be at heightened nutritional risk (category IIc in Table 1), but if the security situation continues to deteriorate, that is likely to change.

On-going interventions: Assuming that the security situation improves, programmes such as those outlined in the UN Consolidated Appeal and highlighted in the last RNIS Report to address some of the underlying causes of food insecurity should continue or be taken up. These include:

• a continued emphasis on demining;
• rebuilding the health infrastructure and improving the water supply;
• rebuilding of the market system and roads to allow for food to be re-distributed from surplus to deficit areas;
• ensuring adequate access to agricultural inputs before the next planting season, due to begin in September/October in some areas, along with support of activities designed to ensure adequate supplies of appropriate seeds;
• a focus on increased agricultural production through training in and support for appropriate agricultural techniques, such as animal traction.

Specifically, there is a small shortfall of food pledges for 1998. Approximately 85% of requirements are either available as carry-over stocks or have been pledged. There is a need to strengthen government crop monitoring and agricultural statistical systems in order to obtain better estimates of production. This would allow for more accurate estimates of food aid requirements. Urgent funding is required to maintain UNHCR's operational capacity to assist in the repatriation process.

RNIS 23, March 1998

A twenty year long conflict in Angola ended with the signing of the Lusaka peace accords in November 1994. Since that time, there has been a slow consolidation of the peace process, including demobilisation of soldiers and gradual return of refugees and internally displaced people to their places of origin. The war has left the country's infrastructure in ruins. Decimation of health systems and an enormous number of mines remain major areas of concern. The security situation in the country has recently been tense, with reports of banditry and armed clashes in some areas interrupting humanitarian activities and causing further displacements. There has also been tension associated with the incomplete disarmament of UNITA soldiers. However, a recent announcement that demobilisation will be completed before the end of March has somewhat eased these tensions [IRIN 07-09/03/98, OCHA-a Jan-Dec 98, WFP 09/01/98].

It is currently estimated that 900,000 people will continue to need emergency assistance in 1998, although that number is likely to slowly decrease over the year as people return home. This population is comprised of 820,000 long-term displaced and 80,000 recently displaced people. There are a further 300,000 unregistered internally displaced people (IDPs) who are not currently receiving assistance (not included in Table 1). There are a number of especially vulnerable groups, such as traumatised children, street children and orphans under age soldiers, war disabled, elderly and female headed households that require special assistance efforts. In addition, there are likely to be some refugee returnees, mainly from the Democratic Republic of Congo and Zambia, who will require support upon their return [OCHA-a Jan-Dec 98].

Malnutrition over time in Menongue, Angola

from: Enquete Nutritionnelle, Menongue, 8-10 octobre 1997 Accion contre la Hambre As Angola became increasingly accessible to humanitarian agencies, high levels of wasting were often found in previously cut-off locations. However, where access could be maintained, conditions were rapidly brought under control. For example, a survey carried out in October 1997 in Menongue, Kuando-Kubango Province found 5.0% wasting with 0.7% severe wasting. Oedema was measured at 0.7% (see Annex I 1a). The city had originally been cut of for nine months in 1992-3 but had since received aid in the form of general rations, therapeutic feeding and soup kitchens. Wasting levels over time are shown in the graph [ACH 10/10/97]. A recently launched United Nations Consolidated Inter-Agency Appeal for Angola sets out some priorities for 1998. These include meeting arising and existing basic emergency needs, prioritising vulnerable groups, and maintaining support to a coordinated and phased approach to re-settlement and re-integration of displaced, returnees, demobilised soldiers and their families. As the peace process consolidates, the main focus during the year will shift from emergency to developmental programmes. The Office for the co-ordination of Humanitarian Affairs will divest itself of humanitarian coordination responsibilities in 1998 and as a result, an increasingly active role in coordinating and managing humanitarian programmes by the Government will be required. It is, however, recognised that the retention of capacity to respond to emergencies is essential. To this end, an Emergency Response Unit (ERU) will be established to allow for a coordinated emergency preparedness and response capacity among UN agencies. Specifically, the ERU will help to maintain the ability to respond to emergencies through coordinated situation assessments, identification of priority groups, implementation of joint operations and resource sharing [OCHA-a Jan-Dec 1998].

Overall, the population requiring assistance in Angola is not currently considered to be at heightened nutritional risk (category IIc in Table 1).

On-going interventions

There are a number of specific needs outlined in the Consolidated Appeal which, when met, are likely to have a positive effect on the nutrition and food security situation of the affected population.

Some of these include:

• demining of secondary and tertiary roads to allow access to more remote areas;
• re-establishment and rehabilitation of local health systems, including the control of communicable disease like measles, and TB;
• support for improved infant feeding practices, including the promotion of exclusive breastfeeding;
• promotion of food security through the supply of seeds and tools to returning refugees, IDPs and affected farmers;
• improvement of water supplies and sanitation facilities - only 32% of Angolans have access to clean water, and only 40% access to sanitation facilities.

RNIS 22, December 1997

A twenty year long conflict in Angola ended with the signing of the Lusaka Protocol in November 1994. The conflict left the country in ruins - the health care system was not functioning, and large tracts of land were infested with landmines. Hundreds of thousands of people were displaced either inside the country or as refugees in neighbouring countries. Serious insecurity was reported over the following years, but in early 1997, the peace process seemed firmly established. This was. underscored by the swearing in of the Government of National Unity and Reconciliation and the initiation of many rehabilitation programmes.

However, since August 1997, the security situation in the country has deteriorated once again with numerous incidents being reported. For example, an ambush in Benguela province led to the death of six people from the UN Observer Mission for Angola (MONUA) and the German demining NGO Saint Barbara Foundation. There have also been reports of a serious deterioration in security in Huila province. Because of the uncertain security situation, UN agencies and NGOs appear reluctant to continue to pour their resources into rehabilitation programmes for fear that these might be interrupted in the event that the insecurity escalates into a much larger emergency. Therefore, such programmes have been dramatically scaled down and contingency planning initiated, especially with regard to vulnerable populations in UNITA controlled territory [IRIN 25/09/97].

There remain at least 662,000 displaced and war-affected people requiring food aid in Angola. In addition, there are 315,000 people being assisted as part of the demobilisation programme. Approximately 117,000 people have returned spontaneously to Angola from neighbouring countries in 1997. However, violence in some areas is leading to fresh population displacements. For example, recent insecurity in Benguela province has caused the displacement of up to 9,000 people. The area, is currently only accessible by helicopter, and assistance will be provided following an assessment of needs [IRIN 06/11/97, OXFAM-a 23/10/97, WFP 14/10/97, 17/10/97, 31/10/97].

The last RNIS report included information on newly displaced people in N'Zaji. At that time, wasting was measured at 10% with over 4.3% severe wasting. Since September, the number of displaced people has increased and was estimated at almost 11,000 in mid-October. Most of these people are housed with friends and family in the town, but there are over 1,000 in a camp outside of the town. There are growing concerns about the town's capacity to continue to receive such a large influx of displaced persons [WFP 17/10/97].

Over 3,800 spontaneously returning Angolan refugees from nearby countries were registered during the month of September. There are now approximately 2,100 Burundi and Rwandan refugees in Luau, Mexico province. These refugees are arriving from the Democratic Republic of Congo (DRC) [WFP 17/10/97].

Demining in Angola is continuing in many areas. Initially, efforts were focused on clearing main logistical corridors to transport humanitarian aid by road. Now, secondary roads are being cleared in many areas to allow for the resettlement of displaced people, and implementation of rehabilitation and development projects. Cleared areas have also meant safer firewood collection and access to new water sources [WFP 31/10/97].

Overall, the affected population can be considered to be at moderate risk (category IIb in Table 1) due to continued dependence on humanitarian aid, and an apparently deteriorating security situation.

Ongoing interventions: The consolidated appeal for Angola was launched early in 1997, covering the period January-December 1997. As of mid-October, many needs outlined in the appeal remained underfunded, and only 32% of the overall funding required had been pledged or contributed. Earlier RNIS reports have flagged the need to rehabilitate the health care system and more specifically to ensure an adequate supply of essential drugs. To date, funding for such projects has not been forthcoming. These, and other funding needs must be urgently met.

The present situation in N'Zaji is likely to be similar to situations where other large numbers of returnees have concentrated. There appears to be a need to determine how to foster greater self-reliance amongst returnees and how best to support host families that are assisting returnees until the latter achieve greater self-reliance. Food security assessments of areas where there are large numbers of returnees should be regularly conducted,

RNIS 21, September 1997

The signing of the Lusaka Protocol in November 1994 began a process of reconciliation and reconstruction to end the twenty year conflict that had left the country's infrastructure in ruins, and the countryside infested with landmines. Hundreds of thousands of people had been displaced within Angola or to neighbouring countries. A United Nations peace-keeping force was established to oversee the implementation of the peace agreement. Over the next two and a half years, much was accomplished in terms of opening land transport routes in the country, landmine clearance, demobilisation of soldiers, return of internally displaced people and rebuilding health infrastructure.

However, there has recently been an upsurge in conflict between government forces and UNITA rebels who still control some eastern areas of the country. The destabilisation arose following the return of both Angolan government troops and UNITA rebels from former Zaire. This is the most serious threat to the peace process witnessed to date, and some fear conflict escalation. In response, the United Nations has decided to establish an observer mission that will take over from the existing peace keeping force [DHA 30/06/97, JRS 01/07/97, USAID 15/07/97].

Lawlessness, exacerbated by severe economic conditions is said to prevail in most of the country. Furthermore, the opening of roads for peacekeeping and humanitarian purposes is hindered by thousands of land mines, numerous destroyed bridges and a lack of security in many parts of the country side. The demobilisation process that was originally scheduled to be completed in six months is now in its twenty second month.

This renewed fighting has led to fresh population displacements and disrupted resettlement programmes. For example, there are reports of population movements in Lunda Sul and Lunda Norte. Reports of newly displaced people arriving in N'Zaji, Lunda Norte in June showed 10.1% wasting with 3.6% severe wasting (see Annex I (1a)). Emergency food aid was rapidly airlifted in to the camps. Since the survey, people have continued to arrive and the displaced population is now estimated at 9,500 [CWS 04/09/97, MSF-H 17/07/97, WFP 04/07/97, 05/09/97].

In Malange, a recent survey showed 2.3% wasting with 0.4% severe wasting (see Annex I (1b)). This is comparable to a survey carried out in July 1996, when wasting was measured at 3.8%. However, an influx of internally displaced people fleeing violence in UNITA held areas continues [DHA 30/06/97, WFP 22/08/97].

There are reports of a measles outbreak in Ambaca, Kwanza Norte province, which is still under UNITA control, and that children are dying everyday. As one report reveals:

'Ambaca had been cut off from the outside world by the civil war, and most of the children and adults there were malnourished. They have no seeds or tools; and although the area is very fertile, they grow only cassava, which has little nutritional value.'[WV 12/08/97].

By the end of August, the outbreak was reportedly under control after an intensive immunisation programme [WV 03/09/97].

There are also reports of the arrival of Rwandan and Burundi refugees from the Democratic Republic of Congo (DRC). Approximately 1,600 refugees are in Luau in Moxico Province, and a rapid assessment revealed 34% wasting with 11% severe wasting (see Annex I (1c)). A health post has been opened and therapeutic feeding has begun. In addition, the water supply has been increased, and sanitation facilities have improved [WFP 08/08/97].

Despite the increase in insecurity, almost 4,000 spontaneous returnees were registered in May 1997, and 3.000 in July [DHA 30/06/97, WFP 05/09/97].

Cereal production is forecast at 14% lower than last years good harvest while other crops, particularly roots and tubers are estimated to be normal. Food aid is currently needed for at least 942,000 internally displaced and war-affected people, vulnerable groups, returnees and demobilised soldiers and their families [DHA 30/06/97, FAO 12/05/97]. This number could be higher, depending on the extent of population displacement caused by the recent fighting in the eastern parts of the country.

Overall, those in N'Zaji, Lunda Norte along with the Rwandan and Burundi refugees in Luau are at heightened risk due to elevated levels of wasting (category I in Table 1). The remainder of the population requiring emergency assistance can be considered to be at moderate risk (category IIb in Table 1) due to the recent upsurge in violence.

Ongoing Interventions: Access remains a problem in some areas. When these areas become accessible, emergency conditions are often revealed to exist. Agencies require resources to respond rapidly to this type of situation. Trypanosomiasis prevention efforts are continuing and need support. Measles immunisation activities must continue throughout the country. There is also a need for additional funding for the refugee repatriation operation.

Specifically, in Ambaca, Kwanza Norte province there is an urgent need for seeds and agricultural inputs to help the population diversify their existing cassava based diet. Emergency feeding programmes need to be set up for Rwandan and Burundi refugees arriving in Luau, Moxico province, amongst whom wasting rates are reportedly extremely high.

RNIS 20, June 1997

As peace in Angola slowly consolidates, epitomised by the swearing in of the Government of National Unity and Reconciliation, the focus of humanitarian aid programmes is shifting from emergency assistance to development and reconstruction. The mandate of the peacekeeping force has been extended by the UN Security council until the end of June 1997. Much has been accomplished in recent times including:

• the provision of food aid to 1.2 million people;
• the provision of seeds and tools to 500,000 families;
• expansion of humanitarian activities, including immunisation programmes, to large sections of the population;
• continuation of the demobilisation process.

However, many of these programmes will need to continue in order to ensure an enduring peace and a successful end to the long-standing humanitarian crisis [UN 1997, WFP 18/04/97].

It is estimated that 977,000 war-affected or displaced people, and demobilised soldiers will require humanitarian assistance in 1997. This assistance will be in the form of food aid for vulnerable groups, as well as for ex-combatants and their families. The goals of the programme will be to facilitate the process of return and reintegration into society. Therefore, assistance must be carefully targeted once people return home. Large-scale resettlement programmes are already scheduled to begin in June in Huila province [UN 1997, IOM 28/04/97, WFP 02/05/97],

Despite a generally calm situation in the country, some areas are reporting insecurity. For example, areas of Benguela province have been virtually deserted due to attacks on villages with large numbers fleeing to Cubal town. There are now an estimated 200,000 IDPs in the province. IDPs are also arriving in Malange from areas north of Lombe city. This population movement is however believed to be due to the increase in free movement in UNITA areas. A most recent report indicates that the Angolan army has moved into north-western areas over the past week to take back territory under the control of the former rebel group UNITA. A number of fatalities occurred during the fighting and there are fears that the fragile peace accord between the government and former rebels could be threatened by this action. There are reports that up to 3,000 people are newly displaced in the northeast [DHA 30/03/97, IRIN 27/05/97, 06/06/97].

Reports indicate drought-related crop damage in many coastal districts and absence of rain in Cuanza Norte Province; in eastern provinces, better rainfall has led to higher production. Data used for comparison purposes is known to be incomplete, however best estimates are that while production has increased for many crops, yields remain far below domestic needs. The provision of seeds and tools has led to an increase in areas under cultivation; however shortages of fertilizers, hand tools and animals are constraints to increasing production [DHA 30/03/97, FAO 12/05/97].

The above-mentioned problems are not thought to be adversely affecting the stable and adequate nutritional status of the population. This was reflected in a recent assessment in the Kuito/Cunningha regions where all children registered in an agricultural rehabilitation programme were weighed and measured. Among this group there was an improvement in nutritional status compared to results of an earlier assessment conducted in August 1996 [CONCERN 19/05/97].

A recent survey in Luena, Moxico province, showed 4.4% wasting, with 1.0% severe wasting among a centre for returnees. Oedema was measured at 0.6% (see Annex I (la)). Measles immunisation coverage, as confirmed by a vaccination card, was 38.8%. Among the resident population, wasting was measured at 6.6% with 1.2% severe wasting. Oedema was measured at 1.2% (see Annex I (1b)). Measles immunisation coverage, as confirmed by a vaccination card, was 48.2% [MSF-B 20/04/97].

Food stocks were reportedly low in mid-April with maize, CSB, pulses, oil and sugar stocks expected to run out shortly. Shortages could seriously affect the programmes for demobilisation and for the displaced and war affected [WFP 14/03/97].

Overall, the affected population in Angola is not currently thought to be at heightened nutritional risk (category IIc in Table 1).

How could external agencies help? A recently launched United Nations Consolidated Appeal for Angola highlights much of the work that needs to be done in Angola. The overall objective of programmes is to build up capacity in country so that national institutions can take full control of the rehabilitation and reconstruction efforts. Specific activities include:

• strengthening the health information system;
• provision of seeds and tools for returnees, along with fertilizers;
• restoration of primary health care structures;
• provision of essential drugs;
• training of health workers.

Low food stocks as of mid-April could jeopardise assistance to soldiers and the war-affected population. The survey s from Moxico province indicates a need to improve measles immunisation coverage in the area. This could be a more generalised situation that needs attention in Angola.

RNIS 19, March 1997

As peace slowly returns to Angola, more and more refugees and displaced persons are expected to return to their homes during 1997. Approximately 980,000 displaced and war affected people, and demobilised soldiers currently require humanitarian assistance. The decrease in numbers since the previous RNIS report is due to the increasing self-sufficiency of large numbers of returnees and war affected population groups. The de-mining process is gathering pace thereby allowing return of displaced populations to former homes in areas such as Quincunzo and Caje. Security incidents, although few and far between, are still being reported. Only recently, SCF closed its Quibaxe office in Bengo province after repeated armed attacks on their warehouse, and fighting has been reported in Cauingolo and Cubal [WFP 10/02/97, WFP 24/01/97, 14/02/97, 28/02/97]. There are no new nutritional data on this population. Throughout 1996, a pattern emerged whereby rapidly improving nutritional status was observed following interventions in areas which had previously been cut-off from humanitarian assistance due to insecurity. The continually improving access to the countryside and freedom of movement of people and goods would indicate that the improving nutritional situation seen in 1996 will continue [DHA 31/01/97].

However, in some areas such as Cuanze Norte, Bengo and Luanda, local authorities and NGOs are concerned that irregular rainfall will result in poor maize production in the first quarter of the 1996-7 agricultural season. Furthermore, food security of some populations will also be adversely affected by the late delivery of seeds and tools at the end of last year before the planting season [DHA 31/01/97].

The focus of humanitarian agency activities during 1997 will be on rehabilitation and resettlement. Efforts will also be increased to better target food assistance. One initiative to strengthen this process has been the creation of a "vulnerability Analysis and Mapping Unit" which will work with government, NGOs and donors to collect and analyse data to identify areas of food insecurity and beneficiaries in need of assistance [WFP 24/01/97].

The main diseases reported by agencies continue to be malaria, tuberculosis and trypanosomiasis [DHA 31/01/97].

Overall, this population is not considered to be at heightened nutritional risk (category IIc in Table 1).

How could external agencies help? The improved security situation in Angola has allowed for greater access to the countryside and many needs noted in earlier RNIS reports are now being addressed. For example, programmes to immunise women and children against tetanus, polio, measles and meningitis have begun. However, more support is needed to fight trypanosorniasis, including improved vector control.

RNIS 18, December 1996

There are approximately 1.37 million war affected and/or internally displaced people in Angola, although this number is likely to gradually decline as more families return home. For example, it is estimated that in the past year 45,000 internally displaced people have left Saurano, Lunda Sul, to return to their home communities within the government controlled areas. Over 5,000 refugees returned home in October 1996 [DHA 07/10/96, 10/11/96].

In recent months the focus of humanitarian activities has been upon rehabilitation of village infrastructure to encourage the return of internally displaced people country wide. Several bridges have been rehabilitated and roads have been declared open thereby facilitating the free movement of people and goods throughout the country. It is now estimated that 75% of food transported since early 1996 has been by road, rather than air transport which is significantly more expensive [DHA 07/10/96, 10/11/96].

The nutritional situation in the country appears to be generally stable. For example, a recent survey in the areas around Kuito (excluding Kuito town) showed 9.7% wasting and/or oedema with 1.9% severe wasting and/or oedema (see Annex I (1a)). These results compare favourably with those from last year when wasting and/or oedema was measured at 28% [DHA 10/11/96]. The implementing agency recommended continuing health interventions to reduce prevalence of disease which is believed to be a significant contributing factor to current levels of wasting. Another example of an improving nutritional situation comes from Uige city where a 2% prevalence of wasting was found within a 15 mile radius (see Annex I (1b)). These results have led to a decision to phase down therapeutic feeding in Uige hospital [DHA 10/11/96].

However, there are still concerns over the food security of demobilised soldiers. Due to the prolongation of the quartering process, food stocks earmarked for soldiers and their families have been close to depletion. Urgent appeals to donors for more food pledges have been made [WFP 08/11/96].

Numerous initiatives in the health sector prevail in Angola with widespread support for immunisation campaigns and restoration of health infrastructure. However, periodic outbreaks of disease continue to be reported. For example, a measles epidemic was reported in an inaccessible area of Malango province killing 111 children. Immunisation to prevent the spread of the epidemic is underway [DHA 10/11/96]. In Huila province, a recent meningitis outbreak killed 30 people. Essential drug kits and chlororamphenicol were immediately distributed to local health posts.

Overall, this population is not currently considered to be at heightened nutritional risk (category IIc in Table 1)

Haw could external agencies help? As peace continues to hold, the extension of projects designed to encourage internally displaced people to return home, such as provision of seeds and tools, and rehabilitation of villages infrastructure are essential. Equally important is the process of demobilisation of soldiers. As this programme is taking longer than anticipated, food resources are dangerously low and need to be replenished immediately in order to avoid the type of nutritional crisis affecting families of former combatants described in earlier RNIS reports.

The task of rehabilitating the health infrastructure in country will require long-term commitment from donors although there are short-term priorities which still need to be addressed. Immunisation coverage, in particular and noted in earlier RNIS reports as inadequate, remains a problems in some areas. Efforts of the mobile immunisation teams therefore need to be supported, and in some cases enhanced.

RNIS 17, September 1996

Apart from a few cease fire violations, the security situation in Angola has remained calm, and the construction of new bridges and reopening of roads are improving the free movement of people and goods. There are now only a few areas in Angola, such as Luena, where there is no road access and humanitarian aid must be delivered by air. The nutritional situation of the approximately 1.37 million people affected by the Angolan conflict and its aftermath appears to be adequate and stable with the exception of some newly accessible areas, where levels of wasting are quite high. The anticipated large scale return of internally displaced people has still not occurred, and is cause for concern as the planting season ends in the August-September period. Attempts to promote self-sufficiency are further thwarted by limited trading opportunities in many areas. An estimated 325,000 Angolan refugees are still residing in neighbouring Congo, Namibia, Zaire and Zambia [DHA 04/08/96, USAID 01/07/96].

The high levels of wasting often found in newly accessible populations are quickly reduced once emergency feeding programmes have been established. For example, a recent survey in Malange measured wasting and/or oedema at 3.8% (see Annex I (la)). This shows an improvement in the situation since April 1996 when wasting and/or oedema was measured at 8.1%. The survey team recommended the continuation of targeted feeding programmes, and the establishment of a food security system to detect any changes in household food security [WFP 09/08/96].

Emergency general ration provision and therapeutic feeding have been urgently recommended for the population of Samba Caju, Kwanza Norte, where a recent survey showed 17.5% wasting and/or oedema with 6.8% severe wasting and/or oedema (see Annex I (1b)). Unfortunately, shortages of powdered milk are delaying the opening of therapeutic feeding centres. Indeed, throughout the country, many therapeutic feeding programmes are hampered by a lack of powdered milk² [DHA 23/06/96, WFP 12/07/96].

² A policy on the acceptance, distribution and use of milk products in feeding programmes in refugee settings has been put out by UNHCR. In this policy, it is clearly stated that milk products should ‘be used under strict control and in hygienic conditions, e.g. in a supervised environment for on-the-spot consumption.’ (from: Policy for Acceptance, Distribution and Use of Milk Products in Refugee Feeding Programmes, UNHCR, 1989.) A survey carried out in Caala showed 9.0% wasting and/or oedema with 1.0% severe wasting and/or oedema (see Annex I (1c)). This was considered to be a somewhat precarious nutritional situation as this is the period just after the harvest when food is relatively plentiful. Furthermore, only one third of the malnourished children are receiving assistance from the nutritional centre, and immunization coverage here again was low [CONCERN May 96]. In contrast, a recent survey in Kuito, Bie Province showed 5.1% wasting and/or oedema with 0.4% severe wasting and/or oedema (see Annex 1 (1d)). Although this showed a generally adequate nutritional situation, only about one third of malnourished children were enrolled in feeding programmes. Immunization coverage, which has been highlighted in earlier RNIS reports as a problem, was low [CONCERN 15/06/96].

Overall, the affected population in Angola can be considered to be at moderate nutritional risk (category IIb in Table 1) due to continued dependence on emergency food aid. There are pockets of high risk (for example Samba Caju, mentioned above); however census data for these populations are not currently available.

How could external agencies help? Numerous rehabilitation and resettlement programmes are underway and addressing many needs such as those noted in the June RNIS report. For example, there are resettlement projects in Kwanza Sul, Bengo and Moxico Provinces which include support to communities in the form of seeds and tools provision, immunization campaigns, supplying essential drugs to local hospitals and the continuation of supplementary feeding rations [DHA 23/06/96. WFP 21/07/96].

The June RNIS report also described the need for general ration and targeted feeding programmes in newly accessible areas where levels of wasting are found to be high. The need for programmes which aim to control communicable diseases such as trypanosomiasis, a disease whose prevalence has been increasing, was highlighted as well. In many areas where these needs have been identified, interventions are underway. For example, a number of mobile teams to combat trypanosomiasis have been established [DHA 30/06/96].

Generally, continued support for returning internally displaced people, affected host communities, and demobilised soldiers will be necessary. This support may be temporary general rations and/or targeted feeding programmes, provision of seeds and tools for agricultural production, or rebuilding community infrastructure. Also, a generalised lack of powdered milk throughout the country for therapeutic feeding programmes is becoming critical. As only a small quantity is needed for therapeutic feeding programmes, this should be relatively easy to obtain.

More specifically, recent surveys show low immunisation coverage, along with low coverage of selective feeding centres in Caala and Kuito. Programmes to improve these would be likely to positively affect the nutritional status of these populations.

RNIS 16, June 1996

Since the signing of the Lusaka peace agreements in November 1994, security has largely remained stable in Angola allowing the opening up of new roads and an expansion of humanitarian assistance delivery. However, the use of these new routes has revealed populations in small villages and communes in urgent need of health care, food aid and basic household supplies. Moreover, many areas have remained inaccessible by road, and even by air, primarily for military reasons, so that large numbers of people still remain isolated.

A recent FAO/WFP Crop and Food Supply Assessment Mission concluded that 1,375,000 people will require emergency food aid from April 1996 to March 1997. This number included 804,000 war affected and displaced people, 100,000 returnees from neighbouring countries, 170,000 vulnerable persons, 301,000 disarmed and demobilised soldiers and 270,000 beneficiaries involved in rehabilitation activities. [FAO 23/05/96]. As the next planting season approaches, increased efforts are being made to resettle the internally displaced to allow this population an opportunity to re-establish agricultural production [DHA 07/05/96].

A recent assessment of the output of foodcrops in Angola projected an overall increase in production of 84% compared to last year due to a variety of factors including, the provision of seeds and tools, and adequate rainfall. However, there are wide regional disparities. For example, the harvest on the Central Planalto is not expected to provide for more than half subsistence needs [ICRC 30/05/96]. Overall, food security remains poor because of a lack of purchasing power, a lack of infrastructure, and the still restricted movement of traders [FAO 23/05/96].

Some recent population displacements have been noted, and appear to be related to theft and vandalism of crops. For example, in Benguela province, displaced people were arriving in Chongoroi, reportedly fleeing loss of crops, and newly displaced people arriving in Cutembo were reportedly in extremely vulnerable nutritional condition. Food aid has been delivered to these newly displaced people. Extensive vandalism against crops has also been reported in Malange [DHA 07/05/96, WFP 24/05/96].

Recent evidence in some areas points to a deteriorating nutritional and health situation. For example, a survey in Masseca, Kuando Kubango showed a relatively low level of wasting and/or oedema (4.5%), but a high (3.6%) level of severe wasting and/or oedema (see Annex I (la)). The survey team recommended targeted supplementary feeding to the most vulnerable groups in conjunction with an assessment of the crop situation as a basis for future seed and tool allocations [DHA 29/04/96].

In Jamba, Kuando Kubango, wasting and/or oedema was measured at 11.2% with 3.1 % severe wasting and/or oedema (see Annex I (1b)). Measures including supplementary, therapeutic and school feeding are being reinforced in response to these findings [DHA 29/04/96, 07/05/96, WFP 24/05/96].

A nutritional survey in Malange measured wasting and/or oedema at 8.1% with 1.1% severe wasting and/or oedema (see Annex I (1c)). This shows a marked deterioration in nutritional status compared to a survey carried out in October 1995 when wasting and/or oedema was measured at only 1.8%. This deterioration is largely attributed to destruction of up to 70% of crops by vandalism and the gradual reduction in food aid since January 1996 in response to prospects of a good harvest [CONCERN 25/04/96]. As a result of these findings, general rations of maize, pulses and oil will now be targeted between May and July to approximately 95,000 people including all those under 15 years of age, the elderly, the handicapped and other vulnerable groups [WFP 10/05/96].

There have also been reports of increasing numbers of malnourished people being seen in therapeutic feeding at Kuito hospital. This has been attributed to the poor harvest and sharp increases in food prices [WFP 07/06/96]. In contrast NGOs have closed down selective feeding centres in Huambo city due to evidence of improved nutritional conditions [DHA 27/05/96].

A nutritional survey in Golungo Alto, Kwanza Norte province found 6.8% wasting with 0.1% severe wasting (see Annex I (Id)). This shows substantial improvement compared to a survey conducted last October which found 20.4% wasting with 12% severe wasting [DHA 03/06/96].

High levels of wasting have recently been recorded amongst families of demobilised UNITA soldiers. In response to reports of malnutrition among family members of the quartered troops, nutritional assessments were undertaken in four of the quartering areas. The assessments showed levels of wasting and/or oedema ranging from 13.2% -20% with severe wasting and/or oedema varying from 1.4% - 8% (see Annex I (1e-h)). Selective feeding programmes are now being planned to improve overall food security of these families [DHA 29/04/96, 07/05/96]. The quartering process is likely to continue until October 1996 but food stocks are now reportedly inadequate to meet needs. Sugar is most urgently needed but stocks of beans and rice are also reportedly low [WFP 26/04/96]. Reports at the end of May indicate that the general ration has been doubled to address these nutritional problems [DHA 27/05/96].

In many areas such as Zaire province and Menongue, a continued lack of basic health services has been identified as a major factor contributing to persistent high levels of wasting. While substantive health interventions are being under-taken in many areas, e.g. immunisation campaigns in Malange, the urgent need to improve immunisation coverage and general health service provision is recognised in many areas of the country [DHA 22/04/96, UN-a Jan-Dec 96, WFP 12/04/96].

Overall, recent information points to an improvement in nutritional status in many accessible areas throughout Angola. Nevertheless, certain population groups have deteriorating nutritional status, and can be considered to be at moderate nutritional risk (category IIb in Table 1) probably due to crop losses and reductions in food distributions. Pockets of very high wasting, such as those revealed in the surveys in some of the quartering areas (category I in Table 1), are likely to exist in Angola.

How could external agencies help? There are still highly vulnerable populations in Angola and recent survey data suggest that in some areas nutritional status is deteriorating. Requests made to establish and reinforce relief activities, especially targeted feeding programmes and in some cases the reintroduction of a general rations, where vulnerable populations are identified, need support. At this point in time, the families of quartered soldiers are at substantial nutritional risk and stocks of sugar, rice and beans need to be replenished in order to continue feeding this population group.

The recently launched United Nations Consolidated Appeal for Angola identifies certain priority areas for strengthening relief and rehabilitation initiatives nationally. These include support to continue the rapid assessment of the nutritional status of newly accessible populations.

In line with priorities outlined in the April RNIS report, the following needs continue to be important:

• restoration of basic health services in newly accessible areas to provide preventive and basic curative measures, including immunisation;
• prevention and control of communicable diseases with emphasis on malaria, trypanosomiasis, meningitis and cholera;
• targeted feeding programmes have been extended recently to other areas where nutritional survey results have indicated a need. Further extensions are likely to be needed, requiring external resources;
• increased immunisation coverage was also highlighted in an earlier RNIS report. Final preparations are now being made to immunise over 80% of children and women of child bearing age in the newly accessible northern region.

RNIS 15, April 1996

Apart from a few minor incidents, the security situation throughout Angola has remained calm in recent weeks. Food availability in many areas is gradually improving as a result of the recent good harvest and increased access, particularly by overland transport, to populations requiring food aid. On average over 60% of relief item transport is now by road. However, political constraints have delayed the de-mining process in certain areas, thereby preventing the use of some key transport routes.

Reasonable harvests have led to the cessation of food assistance in areas such as Kwanza Norte and Gonguembo. The phasing out of general rations is also planned in numerous other areas where the nutritional situation appears to have improved. Programmes to re-integrate formerly displaced populations, involving support for agricultural rehabilitation activities, have been continuing successfully in many locations. Emergency assistance is now being provided to approximately 1 million internally displaced or war affected people and demobilised soldiers and their families [UNHCR 1995-7, WFP 17/11/96, 22/03/96].

It appears that levels of wasting decline rapidly in those areas where humanitarian agencies now have improved access. For example, overland humanitarian relief deliveries to Moxico Province began in mid-November 1995 at a time when prevalence of wasting was very high. Now, the most recent survey indicates a 6% prevalence of wasting and/or oedema with 1.4% severe wasting and/or oedema (see Annex I (1a)) [UNHAA-a 04/03/96, USAID 01/03/96].

In Kwanza None Province, where many relief agencies have recently been working, a nutritional survey in Gonguembo showed 7% wasting and/or oedema with 1% severe wasting and/or oedema (see Annex I (1b)). Another survey in N'Dalatando showed 5% wasting and/or oedema with 2.2% severe wasting and/or oedema (see Annex I (1c)). [UNHAA 04/03/96, WFP 08/03/96]. In contrast to these encouraging results, a recent survey in Lucala, Kwanza Norte province revealed 17.1% wasting with 6.1% severe wasting (see Anne I (1d)). The survey team recommended an urgent intervention in health and nutrition amongst the population [UNHAA-a 25/03/96].

A survey in Calandula, Malange Province, showed 9% wasting and/or oedema with 3.1% severe wasting and/or oedema (see Annex I (1e)). This elevated level of wasting is attributed to a combination of health problems, poor dietary practices, and poor food security due to theft of the current harvest [UNHAA-a 04/03/96, WFP 08/03/96].

In Menongue, Kuando Kubango Province, a recent survey showed 9.3% wasting and/or oedema with 3.1% wasting and/or oedema (see Annex I (1f)). In light of these somewhat elevated levels of wasting, it was recommended to continue food aid distribution, along with seeds and tools [UNHAA-a 25/03/96].

A recurrent problem identified by agencies working in Angola is that vaccination coverage and health service provision is poor. For example, shortage of drugs for the treatment of trypanosomiasis is threatening the continuation of all programme to combat the disease which is particularly prevalent in the north of Angola while a recent UNICEF mission in Kwanza Sul indicated a severe lack of drugs in the province [UNHAA-a 11/03/96].

Overall, the affected population in Angola appears to be more food secure as a result of the recent harvest and levels of wasting declining in many accessible areas (category IIc in Table 1). It is likely, however, that some pockets of malnutrition exist in areas which are not yet accessible to outside assistance.

How could external agencies help? Now that the country is moving from an emergency phase to a more protracted rehabilitation phase, humanitarian agencies are involved in a variety of sectors and may need support for numerous activities. An imminent consolidated appeal to be issued by UN/DHA in April will specify which activities need resourcing. Priorities may include:

• · continuing the restoration of health services to deal with major health problems i.e. malaria, diarrhoea, ARI, trypanosomiasis;
• targeted feeding programmes;
• · mass immunisation campaigns, mainly for measles.

More specific needs include:

• · drugs for the treatment of trypanosomiasis, which is prevalent in northern Angola;
• drugs to treat common illnesses in Kwanza Sul;
• improved delivery of health services in Calandula, Malange Province where high morbidity levels are thought to be contributing to elevated levels of wasting.

The long term need for immunisation programmes and improved health care delivery are now beginning to be addressed in Angola (see RNIS #14). The food pipeline for edible vegetable oil has been ensured (see RNIS #13).

RNIS 14, February 1996

The security situation has remained generally calm in Angola since mid-December, although periodic problems with security clearances have led to delays in food deliveries in the northern part of the country. The process of registering newly accessible populations for general ration distribution has been continuing. In spite of the fact that food is increasingly being delivered by road, agencies are still dependent on light aircraft for access to many populations. WFP have recently requested further donor support for the essential light aircraft operation which is presently under-funded. Increased confidence in an enduring peace is leading to the expectation that demobilisation of soldiers will begin soon and that voluntary repatriation from neighbouring countries (e.g. Zambia and Zaire) will continue and pick up speed in 1996. Organised repatriation is planned to begin in May 1996 in order that refugees can return before the planting season commences in October [UNHCR 1995-97, WFP 12/01/96].

Emergency assistance is currently being provided to approximately 1.4 million internally displaced people, returnees and/or war-affected people. It is anticipated that the number of beneficiaries will decrease to one million by March 19% as increasing numbers of families attain self-sufficiency [UNHCR 1995-97, WFP 22/12/95, 12/01/96]. Most recent nutritional surveys show an adequate nutritional status amongst populations in easily accessible areas. For example, a survey in Benguela city (with an estimated 300,000 population of residents and displaced) found only 4.4% levels of wasting and/or oedema with 1.6% severe wasting and/or oedema (see Annex 1 1(a)). However, measles immunisation coverage was low at 44.3%. These results compare favourably with a survey conducted in 1993 when levels of wasting were recorded at above 10% [MSF-F Nov 95].

A survey implemented in Kwanza Sul province showed 4.8% wasting and/or oedema with 3% severe wasting and/or oedema. In Kwanza Norte province, a survey in two areas also found relatively low levels of wasting of 4.9% and 2% (see Annex 1 1(b-c)). General food distributions in these areas are continuing [UNCAH 28/01/96].

In contrast, a recent survey in the city of Golungo Alto (population estimated to be 10,400) in Kwanza Norte province found far higher levels of wasting. The city is not served by a tarmac road and consequently becomes difficult to reach during the rainy season. The survey recorded levels of wasting and/or oedema of 20.4% with 12.3% severe wasting and/or oedema. Oedema rates alone were measured at 10.1% (see Annex 1 1(d)). These very high rates are all the more worrying in light of the fact that there had been a dry ration distributed for the three months prior to this survey. Since this survey, a feeding centre has been opened. Measles immunisation coverage was low at 47.6% [UNCAH 28/01/96, WV 27/10/95].

A recent survey in the district of Mavinga (estimated population 80,000) which is currently only accessible by air as the roads are so heavily mined, found the prevalence of wasting and/or oedema to be 7.6% with 1% severe wasting and/or oedema (see Annex 1 1(e)). The crude mortality rate was 0.43/10,000/day and the under-five mortality rate was 1.6/10,000/day. Both these rates are slightly above normal. These results show an overall deterioration compared to survey results from September 1994 which showed only 3.2% wasting (using MUAC). The deterioration is attributed to continuous bad harvests since 1992, labour shortages as the working populations migrates to neighbouring provinces for work and an absence of selective feeding programmes in 1995 [AICF 06/11/95].

A survey conducted in Balombo, Benguela province found 14% wasting with 4.3% severe wasting (using MUAC, see Annex 1 1(f)). A simultaneous household survey identified a large number of cases of diarrhoea suggesting a strong correlation with the elevated levels of wasting. The water supply in the area will be investigated [UNCAH 28/01/96]. A survey conducted in M'banza Congo town showed 14% wasting and/or oedema with 3.4% severe wasting (see Annex 1 1(g)) [MSF-H 13/02/96].

Overall, the population of Golungo Alto is in category I in Table 1 due to elevated levels of wasting. The remaining affected population is probably at moderate nutritional risk (category IIb in Table 1) due to continued dependence on food aid.

How could external agencies help? In general in the country there is a need for:

• increased funding for the light aircraft programme which is essential to the delivery and monitoring of emergency assistance;
• large-scale funding to restore health infrastructure in the country as more areas become accessible;
• expanded nutritional surveillance capacity to monitor these newly accessible areas;
• donor pledges of CSB and salt are needed to maintain this years food aid pipeline.

Some specific needs can be identified by area:

• In Benguela, a measles immunisation campaign, and the continuation of selective feeding programmes which have helped bring down rates of wasting;
• In Golungo Alto, support for selective feeding programmes where rates of wasting are extremely high and measles immunisation programmes;
• In Mavinga, distribution of farm tools and seeds, and better provision of primary health care services.

RNIS 13, December 1995

The overall security situation in Angola remains calm and the first practical steps towards registering UNITA fighters in Angola’s demobilisation and reintegration programme are underway [WHO 15/11/95]. Emergency assistance is still being provided to approximately 1.4 million internally displaced people, returnees and/or war-affected people and agreement has recently been reached with donors to provide for the food needs of an average of one million people each month from March 1996 until March 1997. It is anticipated that this food will assist the transition from widespread emergency food assistance to more targeted developmental reconstruction and rehabilitation activities [WFP 20/10/93, 3/11/95, 17/11/95].

The relative calm in Angola is allowing increased deliveries of food aid by road thereby reducing the overall cost of transport. Only 22% of transport was by air in the first week of November. As the country is entering the pre-harvest hungry season it is important that current food delivery schedules be maintained. There are some areas where relief deliveries remain problematic. In certain cases this is due to logistical difficulties such as poor runways in Caconda in Huila province, while in other areas, for example in Cabir in northern Huila province, insecurity is preventing access. Nevertheless, population access is generally improving with the needs of formerly inaccessible towns and cities being increasingly met [WFP 20/10/93, 3/11/95, 17/11/95].

The nutritional situation appears to be adequate in areas where relief supplies are being maintained. For example, a recent survey in Malange measured wasting and/or oedema at 1.8% with severe wasting and/or oedema at 0.2% (see Annex 1 (1a)). These low levels of wasting in Malange have now been maintained for the last year and appear to reflect high levels of access to safe farm land and sources of income which supplement the general ration. Less than three percent of children surveyed were consuming an inadequate diet. Nevertheless, the population is still believed to be dependant on the existing level of general ration provision. It is feared that any decrease in the food supply could lead to an increase in mine accidents as people might be forced to farm unsafe areas [CONCERN 17/10/95, WHO 15/11/95].

Another example of improved nutritional status is in Cafunfo, Luanda Norte Province. In April 1995, when the area first became accessible, levels of wasting were as high as 20% (see RNIS #11). Emergency general ration provision and therapeutic feeding were immediately implemented. A follow up survey in July 1995 showed only 2.8% wasting with 0.6% severe wasting (see Annex 1 (1b)). No cases of oedema were seen and measles immunisation coverage was recorded at 72.7%. This marked improvement is believed to reflect a combination of factors including, previous mortality of children under five years old, food relief, renewal of the diamond business and improved supplies of food by traders [AICF 11/07/95].

However, in areas that are newly accessible or where access is difficult, malnutrition is often still a serious problem. In Matala for instance, wasting and/or oedema were measured at 15.4% with 6.7% severe wasting and/or oedema among the displaced and resident population (see Annex 1 (1c)). Only the former are currently receiving food aid [WFP 10/11/95]. Preliminary results from a recent survey in Galungo Alto showed 20.4% wasting and/or oedema and 12% severe wasting and/or oedema (see Annex 1 (1d)). It was noted that road access has been difficult since the onset of the rains [WV Oct 95].

WFP are facing funding shortages for their light aircraft which are essential for transporting personnel to areas that remain inaccessible by road in both government and UNITA held areas. A rupture in the food pipeline is creating expectations of a shortage of oil in the food basket during November and December [WFP 3/11/95].

Overall, the majority of the 1.4 million people dependant on food aid in Angola could be considered to be at moderate nutritional risk (category IIb in Table 1). The pre-harvest “hungry” season may exacerbate vulnerability amongst particular groups, e.g. those inaccessible to relief supplies or not in receipt of any general ration support.

How could external agencies help? Priorities include increased funding for aircraft transportation in Angola and ensuring adequate pledges to address the current vegetable oil shortage in the general ration pipeline. Nutritional surveys in newly accessible areas are important, with contingency resources held over in order to be able to respond to identified needs. There may also be a need to provide general rations to resident populations where these are hosting large numbers of displaced as in Matala town.

RNIS 12, October 1995

The overall situation in Angola continues to improve. Although an estimated 1.4 million internally displaced people, returnees and/or war affected people still require emergency assistance it is reported that many of the displaced are now returning home for the planting season beginning in September. It was planned to distribute seeds and tools to over 700,000 farmers in preparation for planting [WFP 11/08/95-22/09/95].

The much improved security situation is reducing dependence on expensive air transport of relief items, although banditry and landmines are still constraining expansion of relief programmes to some areas. At the end of August 1995 less than 30% of transport was by air because many roads which were closed, such as the one between Huambo and Menongue, now considered open. The demobilisation of soldiers is continuing [WFP 11/08/95- 02/10/95]. However, deterioration in land fertility due to over-use of safe farming areas in recent years, poor road infrastructure, land mines and occasional security incidents are still major constraints to agricultural production. As a result, the international community recognises the need to give urgent priority to rebuilding the devastated agricultural infrastructure and support services. NGO-managed food-for-work projects involving some 20,000 people are being implemented to re-build schools, health posts, latrines and irrigation canals and to re-open farmland and access roads [WFP 11/08/95-22/09/95, FAO Jul 95].

There is very little recent nutritional information available. One survey conducted in Caconda in Huila Province in August found 14.7% levels of wasting with 2.7% severe wasting (see Annex I (la)). Unfortunately, proposals for emergency feeding arising from this survey cannot be implemented due to the poor security situation in the area [WFP 25/08/95].

There are anecdotal reports of very high levels of wasting among the displaced populations surrounding cities, especially along the coast (i.e. Lobota, Benguera) [ICRC 10/10/95].

Overall, most of the 1.4 million Angolans currently receiving emergency assistance can be considered to be at moderate nutritional risk due to their dependence on food aid, although food security will most likely improve following the next harvest. However, significant levels of wasting may still exist in certain inaccessible parts of the country, particularly where insecurity is a factor, but accurate numbers of people affected are not available.

How can external agencies help? Continued support for the recovery of agricultural production is needed. As new areas become accessible, nutritional surveys would be very useful to facilitate situation analysis, assessment of needs, and targeting services to improve nutrition.

RNIS 11, July 1995

With the signing of the peace accord on May the 6th and the partitioning of government and UNITA troops, the country has remained generally calm. Improvements in security have therefore made it increasingly possible to determine relief needs in formerly inaccessible areas and to dispatch assistance where appropriate. It has been reported that many of the displaced are beginning to return home. Large numbers of displaced people returned from Kuito and Kunje to their former homes in Bie province at the end of June and the displaced camp in Kunje, which held over 8,000 people, is now almost empty. In contrast the continuing lack of security outside of Luena in Moxico Province makes the return of the displaced to their nearby homes impossible. It is expected that repatriation of some of the approximately 300,000 Angolan refugees, mainly residing in neighbouring Zaire and Zambia, may soon take place. Food is being pre-positioned in the northern border ares of Zaire and Uige provinces for such an eventuality. The majority of these refugees are expected to return spontaneously [DHA 23/03/95, UNHCR 14/06/95].

However, a recent crop assessment mission in April/May forecast only a marginal increase in the harvest over last years poor output, leaving approximately 1.4 million people dependant on food aid over the next year. It is estimated that up to 2.2 million people require some form of food or non-food aid support during 1995/96. This number comprises the displaced (approximately 1.3 million) and war affected, returnees, and demobilised soldiers. The main constraints on agricultural production have been sporadic fighting, massive displacement of farmers and the existence of millions of landmines. There has also been a shortage of complementary agricultural inputs such as fertilizer [DHA 23/03/95, FAO 29/05/95, WFP 16/06/95, WFP 30/06/95].

The relative peace in the country has led to an increase in the amount of humanitarian aid that is being delivered by road rather than airlifted, thereby reducing transport costs. However, it is still envisaged that in the coming months air transport will continue to play an important role. In mid-June the first WFP road convoy carrying relief supplies to Malange departed from Luanda and at the end of the month a road convoy had successfully supplied Huambo and Kuito with relief items. WFP has also conducted a road assessment from Kuito to Menongue in order to determine the possibility of future convoys of relief supplies to this isolated city [DHA 23/03/95, FAO 29/05/95, UNHCR 14/06/95, WFP 16/06/95, WFP 30/06/95].

In general, the nutritional situation in accessible areas appears to be improving although these populations are still believed to be heavily reliant on food aid. For example, a survey completed in N’Dalatando (estimated population 75,000) found wasting rates between 2.3-5.5% with 0-1.1% severe wasting (see Annex I (1a)). This is an improvement over an earlier survey in November 1994 which found 26.5%-33.1% wasting with 9.1-13.5% severe wasting. Much of this dramatic reduction in levels of wasting has been attributed to the regular provision of a general ration and establishment of selective feeding programmes [Concern 94/95]. However, the dependence of the population on external support is a matter of concern and they are likely to be vulnerable to disruptions in food aid supply until agricultural production has improved and increased economic self-sufficiency achieved.

A survey conducted in Soyo, Zaire Province (estimated population 30,000) found 5.4% wasting and 0.8% severe wasting (see Annex 1 (1b)). These relatively normal levels of wasting are not mirrored by crude mortality rates of 1.5/10,000/day (5x normal) and an under five mortality rate of 4.3/10,000/day [MSF-H Jun 95]. A recent nutritional survey in Jamba indicated normal levels of wasting and, as a result, the general ration was reduced to half rations in early June [WFP 30/06/95]. A survey in Dondo in Cuanza None province in July found overall wasting rates of only 5.5% with 1% severe wasting (see Annex I (1c)) [WFP 16/07/95].

In contrast to these results, a survey carried out in Cafunfo, Lunda None (estimated population 10,000) in April/May found a catastrophic nutrition situation. The government controlled town has effectively been under siege conditions for the past year with surrounding areas controlled by UNITA forces. Market availability of food has therefore been extremely limited. Wasting was measured at 29.2% with severe wasting at 20.9% indicating an extreme emergency (see Annex I (1d)). Many cases of malnutrition were also noted among older children and adults. The crude mortality rate was 8.3/10,000/day (about 20x normal) and the under five mortality rate was 10.3/10,000/day [AICF 04/05/95]. A general ration programme was started in mid-May 1995 [WFP 19/05/95].

Overall, most of the affected population in Angola can be considered to be at moderate nutritional risk due to their dependence on food aid (category IIb in Table 1). However, conditions should improve quickly as populations become more accessible to delivery of humanitarian relief by road. Known exceptions are Cafunfo where the population are at high risk (category 1 in Table 1) and it is likely that other pockets of “famine” exist in formerly besieged areas which have yet to be properly assessed.

How could external agencies help? As the situation in Angola gradually improves, caution needs to be exercised in planning reductions in general ration provision. Nutritional surveillances should be established to ensure that withdrawal of emergency food aid does not lead to any marked decline in nutritional status. Efforts to de-mine large tracts of land and provide agricultural inputs to returnees should be given maximum priority and agencies should gear up for the possible return of large numbers of Angolan refugees.

RNIS 10, April 1995

The total number of people in need of humanitarian assistance in Angola remains at 3.2 million. The cease-fire is generally holding, although there have been security incidents affecting aid agencies in Benguela Province, and accounts of fighting and a seriously deteriorating security situation in parts of Bie Province. The much predicted large-scale return to land has not occurred as in many areas safety cannot be guaranteed. Indeed, many NGOs continue to report the arrival of displaced persons who urgently require food assistance. For example, in N’Dalatando 5,000 new arrivals were reported during March. In Malange there are daily arrivals from nearby Cacuso and internally displaced people are arriving daily in Menongue and Kuito. The virtual ceasefire has, however, allowed a much improved relief capacity with road convoys of aid occurring and rebuilding of crucial road and bridge infrastructure [WFP 10/03/95, WFP 25/03/95].

Nutritional and food security information on affected populations is still patchy although, with some exceptions, most surveys in 1995 have indicated levels of wasting below 10%. Subject to the results of the coming harvest, some agencies are planning to phase out general ration distributions. There are however, still numerous reports of large numbers of people in desperate need of food aid. For example, one recent assessment found 21,000 people in need of immediate food assistance in UNITA controlled Quibala town, which recently became accessible. Additional relief requirements have also been identified in Huambo and resumption of full general rations (rations had recently been cut to half) have been reported as necessary in Cubal given the loss of the maize crop [WFP 25/03/95, WFP 07/04/95].

A survey conducted in Luena, Moxico province in December 1994 where an estimated displaced population of 57,000 people were receiving a general ration, found wasting levels of 13,5% with 3.4% severe wasting (see Annex 1 (1a)). A high percentage (2.6%) of severe wasting occurred with oedema. These results show a deterioration in nutritional status since March 1994 when a survey found only 7.1 % wasting. There was no significant difference in wasting rates between the displaced and resident population. This deterioration was believed to reflect numerous factors including poor general ration deliveries, the fact that many displaced were not registered for the general ration distribution, and that December is a pre-harvest “hungry season” month [MSF-B Dec 94].

More recent information from Luena is that wasting levels have continued to rise and are currently as high as 20.3% (see Annex 1 (1b)). Several measures to improve the food distribution system have been taken as a result of this. These include automatic referral of families with malnourished children for enrolment on the general ration programme, opening 20 feeding kitchens serving all children under five years old, ex-camp residents and displaced persons identified as food insecure [WFP 07/04/95].

A survey in Huambo in January recorded levels of wasting of 7.9%(see Annex 1 (1c)). The most recent survey in Malange (in April) found wasting rates of only 2.8% (see Annex 1 (1d)) which is similar to results obtained at the beginning of the year. However, agency staff have reported that there are undoubtedly pockets throughout the country where high levels of wasting exist and where surveys have yet to be undertaken. For example, UNITA have reported alarming levels of malnutrition in Cuando Cubando province and have requested an immediate assessment by UN agencies [CONCERN 21/04/95].

There are concerns amongst some agency staff that plans to reduce general ration allocations may not be properly informed by rigorous needs assessment and that where rations are reduced careful monitoring must be established in order to detect any early signs of an adverse effect upon nutritional status [CONCERN 21/04/95].

An FAO/WFP Food Assessment Mission is due to visit Angola at the end of April to assess food aid needs following the harvest. Currently, further pledges of maize, pulses, vegetable oil and CSB are needed to meet projected 1995 emergency food aid requirements for Angola [WFP 25/03/95].

Overall, the population of Luena is known to be at high risk with elevated levels of wasting (category I in Table 1). The remaining population in Angola dependant on humanitarian aid is considered to be at moderate risk (category IIb Table 1).

How could external agencies help? There is a need for further donor pledges of maize, pulses, oil and CSB as well as money for non-food items such as transport for the Angola humanitarian programme. Furthermore, it is vital that planned ration reductions are only implemented on the basis of assessments and targeting criteria which encompass appraisal of food security and self-reliance. Also, reductions should only be considered where there is sufficient nutritional surveillance to ensure that any early signs of nutritional deterioration can be responded to with a resumption of full ration allocations.

RNIS 9, February 1995

Estimates of the numbers of people needing humanitarian assistance remain at 3.2 million. The current drought in most of the Southern Africa region is not reported to be affecting Angola and the forecast is for one of the better agricultural seasons in recent years [DHA Dec 94, WFP 13/01/95].

Assessment missions continue at an increased pace throughout the country as security improves and more and more of the country opens up following the peace agreement signed in November 1994 and the decision by the UN to send in peace-keeping forces. Initial findings are that the situation had deteriorated in areas that were cut off from food aid for long periods. For example, in Jamba an assessment team found an urgent need to distribute food to children under five years old, women and other vulnerable groups, while in Lucala the team found “deplorable health conditions despite plentiful locally produced food” [UNSC 08/02/95, WFP 27/01/94].

Food distributions by air and road to previously inaccessible locations have been continuing. For example, general dry food distributions were re-initiated in Huambo in December, In Dondo, approximately 60,000 people are receiving a general radon, and it is believed that many of the displaced are beginning to return to their homes. In N’dalantando, 47,000 people are receiving a general ration [WV 07/01/95].

In Malange (estimated population 180,000), where food has consistently been available over the past few months, a recent nutritional survey indicated a much improved situation. Wasting was measured at 2.8% with 0.9% severe wasting (see Annex 1 (8a)). This indicates a dramatic improvement since September 1994 when the city had been cut off from relief supplies for several months and rates of wasting were measured at 15.3% with 4.8% severe wasting. The crude mortality rate for December was still elevated at 1.7/10,000/day (6 x normal) and the under five mortality rate was 2.7/10.000/day [Concern/MSF-H Dec 94].

It is reported that the rapid decrease in rates of wasting in Malange is directly related to the resumption of the general food distribution in September 1994 and that this indicates a considerable reliance on external aid by the population. Since external aid remains a major source of food for the population, there are fears that any reduction in food aid would result in an almost immediate deterioration in the nutritional status of the population. If, as has been suggested, the ration in Malange is to be reduced, it may be advisable to monitor the situation very closely in order to detect any early signs of deteriorating nutritional status. The results of the survey are not felt to accurately reflect the nutritional status of the adult population for whom there is believed to be a continuing need for selective feeding especially amongst the elderly. [Concern/MSF-H Dec 94].

A cholera outbreak was reported in January in Cubal with 100 cases identified by January 10th. By the end of the month more than 700 people had reportedly been affected [WFP 13/01/95, WFP 27/01/95].

Overall, the population can be considered to be at moderate risk due to a high degree of dependance on external food aid (category IIb in Table 1)

How could external agencies help? As the food security and nutritional situation in Angola gradually improves and levels of emergency food aid are reduced, there is a need to closely monitor any impact of food aid reduction on nutritional status. Given that large sections of the population may remain highly dependent on food aid for some considerable time, nutritional monitoring systems should be established before food aid reductions are implemented. Also, further pledges of maize, vegetable oil and CSB are needed to cover the planned food delivery targets up until June 1995.

RNIS 8, December 1994

The estimated number of people in need of food and non-food relief supplies remains at 3.2 million. In spite of earlier agreement between UNITA and the GOA in Lusaka on the time-tabling of a cease-fire, subsequent disarmament and de-mobilization, fighting continued in most of the country up until the signing of the truce on 20th of November. Nevertheless, humanitarian flights continued, with some interruptions to all destinations, (including Kuito), throughout October. Access to Kuito had previously been extremely limited [WV 04/11/94].

In order to avoid a gap in the food pipeline between January and March 1995 there is a pressing need for donors to contribute more vegetable oil and blended foods [WFP 16/12/94].

Nutritional information from areas affected by the conflict gives cause for concern. A survey carried out in July in Mucoso displaced persons camp (8,100) near Dondo in Kwanza Norte Province found that 16.5% of children were wasted and 3.7% were severely wasted (see annex 1 (8a)). Statistically, these results show no improvement from rates of 21.4% wasting in February. This situation is thought to reflect the fact that between March and June food convoys could not reach Dondo\Mucoso due to fighting. Furthermore, at the end of May and early June a cholera epidemic broke out (735 reported cases) in the camp and in neighbouring Dondo. In the same period, hundreds of displaced persons started arriving from N'dalatando following the recapture of this large city by government forces. Many of the new arrivals were malnourished. Immunization rates are equally worrying with only 42% of children vaccinated against measles in Mucoso camp [WV Jul 94].

A more recent survey in N'dalatando found 29% wasting with 12% severe wasting (see Annex 1(8b)). Emergency food distributions have begun in the area. Other survey results from the provinces of Huila, Cunene, and Namibe show levels of wasting ranging from 6% in Namibe city to 37% in Matala (see Annex 1(8c,d)) [WFP 21/11/94].

Overall, the populations in Malange, Kuito and Huambo are considered to be at high risk (category IIa in Table 1) with a tendency toward improvement with the increased food supply. The population of Musco is probably also at high risk (category IIa in Table 1) due to low rates of measles immunization. The remainder of the affected population can be considered to be at moderate risk (category IIb in Table 1).

How could external agencies help? Angola presents a major opportunity at present for external agencies to provide effective assistance. This follows the recently-signed peace accord, with better access to major towns, a number of which are now in government hands. Thus committing resources now, both food and non-food, might be particularly effective in rehabilitation and prevention of future malnutrition. Donors need to urgently pledge more vegetable oil and blended foods for 1995. There are also needs to increase immunization coverage for the displaced e.g. in Mucoso camp in Dondo.

RNIS 7, October 1994

The estimated number of people in Angola in need of food and non-food aid remains at 3.2 million. Agreement between the government of Angola and UNITA was finally reached in August at the Lusaka peace talks, although the agreement is not yet signed. This agreement in conjunction with a general reduction in hostilities has resulted in resumption of relief flights to most cities [DHA 20/07/94, WFP 5/08/94, WFP 10/7/94].

Consequently, the first regular relief deliveries since mid-May finally arrived in Huambo and Malange in August. In September limited relief flights also began to Kuito, which had been cut-off from outside assistance for over three months. Regular flights to Menongue were also re-started [WFP 12/08/94, WFP 26/08/94, WFP 9/09/94]. In spite of these encouraging signs, fighting has increased in certain areas such as in the northern province of Lunda Norte bordering Zaire where approximately 3,000 people are reported to be fleeing to the outskirts of Saurimo. Increasing hostilities have also been reported in NDalatando, Kuanza Norte province [WFP 9/09/94, WFP 19/09/94].

Now that many cities are accessible again, the effects of the break in assistance are being assessed. For example, preliminary results from a survey conducted in Malange (estimated population 250,000) in early September 1994 found levels of wasting of 15% and severe wasting of 5% (see Annex 1 (8a)). This represents a sharp increase in levels of wasting, which had decreased steadily before the most recent break in assistance from 34% in November 1993 to 6.6.% in early May 1994. It is feared that similar nutritional deterioration will be found in cities such as Huambo and Kuito when nutritional surveys are under-taken [MSF-H 3/09/94].

A nutrition survey carried out in mid-July in Dondo measured the prevalence of wasting at 7.7% with 2.5% severe wasting (see Annex 1 (8b)). These relatively low levels of wasting were attributed to the success of NGO operated feeding programmes [DHA 7/08/94].

Outbreaks of meningitis have been confirmed in Huila province and measles in Saurimo. As a result, agencies such as UNICEF have given urgent priority to the procurement of cold chain equipment, and have requested more funds for the purchase of vaccines and related equipment [DHA 7/08/94].

The main planting season in Angola is September and every effort was being made to register beneficiaries eligible to receive agricultural packs of seeds and tools and to pre-position these inputs. However, with the increased access to many major cities there may well be conflict between the need to deliver food and these agricultural items. Furthermore, there are reports that the timely distributions of seeds are were jeopardized by the refusal of UNITA to grant flight security clearances for Bie and Benguela [WFP 26/09/94].

Improved access to the cities resulting from the agreement at the Lusaka peace talks gives ground for guarded optimism. The nutritional situation in the country has probably deteriorated in those cities and areas which have been cut off from assistance until recently. The survey in Malange showed levels of wasting indicative of a critical situation (category I in Table 1). Reports indicate that populations in Huambo and Kuito are likely to be amongst those at risk (category IIa in Table 1) and the rest of the population is likely to be at moderate risk (category IIb in Table 1).

How could external agencies help? Continued funds for air transport will be needed, with the eventual transfer to ground transport. Nutritional surveys in newly accessible cities are necessary to assess any change in the situation. Pledges for all basic commodities are needed to avoid any gaps in the food pipeline. It may be useful to consider stockpiling some supplies in cities in anticipation of possible future inaccessibility.

RNIS 6, August 1994

Estimates of the overall numbers affected by the continuing Angolan civil war and in need of both food and non-food aid items remain at 3.2 million people [DHA 20/07/94]. Fighting intensified throughout Angola in May and June so that in mid-June WFP air operations were completely grounded after UNITA refused to clear routine flight plans. Government media reported that Kuito and Kunje were captured and that many were killed in the fighting. Huambo and Malange were also bombed and mortared throughout May and June [DHA 3/07/94, DHA 10/07/94].

The cessation of relief supplies to non-government controlled areas in June meant that food stocks in key WFP bases reached very low levels. In Kuito there were reports that food stocks had been depleted in June and that very few medical supplies were left [WFP 10/06/94].

The break in assistance to Malange, Cubal, Kuito and Huambo had very serious consequences with alarming reports daily of increases in malnutrition among children and associated illness. The lack of food in Malange, for example, is said to be increasing tensions between the growing displaced population and the resident population. UN and NGO who were withdrawn from Malange have confirmed "that people are beginning to starve". Food stocks in the city are all but depleted - many selective feeding programmes which have been operating in the absence of a general ration, will have food to continue only until the first or second week of August [DHA 31/07/94].

By the end of July, humanitarian flights had received clearance to all destinations except Malange and Kuito, where the overall situation is reportedly deteriorating. Reports from Huambo are that the number of admissions into feeding centres has increased and that living conditions are declining [DHA 31/07/94].

Cholera had been reported in the area of N'dalantando, Dondo and Mocuso [WV 17/06/94], while meningitis had been reported in Kunene so preparations for a mass immunisation programme were under way [DHA 3/07/94, DHA 10/07/94].

The level of insecurity in and around these towns prevented international NGO staff from conducting rigorous nutritional and health assessments. It has, however, been speculated that the interruption to food relief supplies will have forced many civilians out into heavily mined areas to search for food and that many casualties will have resulted. It is estimated that Angola has between 10 and 20 million mines.

Overall, there are few details on the nutritional status of the affected populations in Angola, but those cities that were cut off from aid during June can be considered to be in a critical nutritional state (category IIa in Table 1). The remainder of the war affected population in Angola is thought to be at moderate risk (category IIb in Table 1).

How could external agencies help? As the only means of supplying adequate quantities of relief commodities to besieged population in large towns is via airdrops, funding commitments must be maintained to ensure that this expensive form of delivery continues. Any interruptions in supply due to funding constraints will have a rapid nutritional impact on large numbers of food aid dependent people.

RNIS 5, June 1994

It is estimated that the total number of people needing food and non-food aid has remained at 3.2 million [DHA Dec 93]. An FAO/WFP food and crop assessment mission in April estimated that emergency food aid will be required for 2.2 million people between April 1994-March 1995 [FAO Mar/Apr 94].

Since April, the civil war in Angola has continued unabated. There have been reports throughout April and May of concerted fighting around Malanje town, Kuito, Huambo town and province, Kwanza-South Benguela and Kwanza North. Major provincial capital cities are still effectively under siege, although with some interruptions, international agencies continue to fly in massive amounts of food aid. Up to 900 tons a week are being flown into Huambo by WFP with an estimated population of 400,000 people largely dependent on food aid.

In spite of these efforts, limited infrastructure and logistical capacity as well as periodic interruptions to supply caused by insecurity, have meant mat thousands of Angolans are still at considerable risk. There is little recent nutritional or mortality survey data, but a number of anecdotal/qualitative reports are cause for concern. Following a visit in April by the UN under-secretary for humanitarian affairs, a statement was made that the situation in Kuito was "one of the worst in the world", while a UN joint assessment mission to Tchindgenje and Balombo in Huambo province at the end of April found a "very grave situation".

In April, an airlift began into Cubal in Benguela province where an estimated 100,000 displaced people were reported to be in need of food aid [WFP 9/05/94].

Although the nutritional situation in Malange (estimated population 200,000) is reported to be improving, crude mortality rates in April were measured at 1.3/10,000/day (4 x normal). The under-live mortality rate was 0.4/10,000/day. A nutrition survey conducted in May measured wasting at 6.6% with severe wasting at 1.3% (see Annex I 8a). This is a considerable improvement over levels of wasting measured in October 1993 (37%) and February (11.1%) in large part due to WFP's success in airlifting food. However, anecdotal reports are now arriving of pellagra in Melange [MSF-H 7/05/94, MSF-H 23/05/94].

How could external agencies help? The international community is providing effective support and this needs to continue. Large scale relief and rehabilitation measures may be required when the most affected populations (e.g Kuito and Huambo) become accessible, when security improves; donor contingency planning may be needed. Insecurity necessitating airlifting remains a constraint, requiring special funding. There is also an urgent need for data on nutritional and health status from these large urban centres. Currently, the majority of data are anecdotal reports. Measures to support such data collection should be supported where possible.

RNIS 4, April 1994

It is estimated that 3,200,000 people in Angola currently require assistance [UN/DHA Dec.93]. WFP's forward planning figure is to feed 2.06 million for the entire year (i.e. 2.06 million person-years of food will be required) [WFP 23/02/94]. The civil war in Angola is continuing, although access for humanitarian aid is improving. After a temporary suspension in early February, relief flights to Huambo and Cuito have now resumed. However, shelling of Melanje recommenced at the beginning of March, while Menonge came under heavy attack one week later causing the evacuation of international relief staff. Apart from these incidents, relief operations have continued normally to most other destinations over the past two months with priority being given to Huambo, Cuito and Melanje. Meanwhile peace talks were held in Lusaka but eventually broke down at the end of March. Although the cities tend to be government controlled, UNITA controls much of the countryside and supplying the cities is difficult.

In spite of this agencies will continue to airlift food to major cities which have borne the brunt of the civil war. Many of these cities have large displaced populations who are known to have suffered high rates of conflict, malnutrition and disease related mortality. Apart from sporadic interruptions due to insecurity, food deliveries by relief agencies have gradually improved. While there are only data from Melanje which demonstrate an improved nutritional status, it is probable that other cities show similar improvement. Two recent surveys which may be typical of other areas are described below.

Melanje had suffered severe food shortages since mid 1993 due to the continued fighting between the NPLA and UNITA forces. A significant proportion of the cities' food demands was from large displaced populations entering the city as refugees from surrounding municipalities. In February a nutrition survey in Melanje (population estimated at 240,000) indicated a wasting level of 11.2% and severe wasting of 2.2%. (see Annex I 8a). This compares favourably with data in October 1993 which recorded wasting levels of 34% with 19% severe wasting. Crude mortality rates in February of 1.0/10,000/day and an under-five mortality rate of 1.7/10,000/day are still very high; these include war related deaths. These rates are similar to those reported in January (1.3/10,000/day). In February the average ration receipt was 1,720 kcals/person/day, marginally adequate on average. Melanje will continue to be heavily dependent on food supplies in the coming months so that it can be expected that any interruptions to food supplies from outside will very quickly precipitate another nutritional crisis [MSF-H 29/03/94].

In order to determine the need for emergency selective feeding a nutritional survey was conducted in Ombadja district, in the province of Cunene in December 1993. The low levels of wasting found, 4.8% with 1.1% severe wasting, led to the decision not to open feeding centres in the area (see Annex I 8b) [AICF 10/12/93].

How could external agencies help? Requirements depend on the security situation, and especially the effect on logistics. Delivering food fast enough by air, the main available route, to the cities, is proving very difficult, as well as expensive. Food in the pipeline seems currently not the main constraint, although supplies of medicine may be. Lack of information remains an important constraint, and as feasible surveys of nutrition conditions, immunization coverage, etc. would be most desirable, especially in the cities that have been cut off. If and when the security situation improves, repair to infrastructure will be important to facilitate relief efforts.

RNIS 3, February 1994

Following a resumption of the Angolan civil war in October 1992, access by humanitarian aid agencies to much of Angola was restricted. However, recent political initiatives have considerably improved access, and allowed better assessment of the needs of Angola's war and drought affected populations. It is now estimated that 3.2 million people are in need of some type of assistance - food or non-food aid. [DHA 10/12/93] WFP is now airlifting food to 14 major cities and will begin delivery to coastal cities by sea. [WFP 7/1/94] Unfortunately, even the steady increase in delivery capacity (20 fold since July) cannot meet the current needs in Angola. WFP estimates that the tonnage required (almost 30,000 MT) exceed current delivery rates by a factor of two. The humanitarian needs in some of the besieged provincial capitals are acute and the normal pre-harvest "hungry" season (until March) is beginning. This already serious situation could, therefore, deteriorate rapidly. [DHA 10/12/93]

Aid agencies recognise the importance of diminishing reliance on air transport as capacities in Melange and Luanda airports are insufficient. Thus, agreement between the government and UNITA on the use of main roads must be reached. [Statement at Brussels 18 Jan, 1994] However, Angola is now one of the most heavily mined countries in the world This will obviously constrain initiatives to increase resource flows by road as well as the population's ability to return to subsistence agriculture. [DHA 10/12/93]

The most recent WFP emergency food assessment mission found that fighting over the last six months has substantially increased the numbers of internally displaced. The current figure has grown to 951,000 from initial estimates of 344,000. The mission also reported that many populations particularly in besieged cities urgently require therapeutic and supplementary feeding facilities with associated health care provision.

There is still limited hard data available although numerous nutritional surveys are planned or are under way. A survey in January showed crude mortality rates in Melange of 1.3/10000/day (four times normal) and that the water supply is adequate (see Annex I (8a) for details). [MSFH 25/1/94] This is an improvement since October/November when crude mortality rates ranged between 2.8-5.7/10,000/day (up to twenty times normal) and reflects the improved food supply since January. However, the fate of over 20,000 orphans and unaccompanied children is of particular concern as these children cannot be discharged from therapeutic and supplementary feeding as the basic ration is still inadequate. This, therefore, overburdens the selective feeding programme and prevents deserving new cases from being enrolled.

Reports from Huambo alarmingly show 36-48% wasting using MUAC for height (see Annex I (8b) for details). This was Angola's second largest city yet now has a population reduced from 500,000 to 150,000. There is a small harvest at the end of January, but the main harvest will not be ready until March. The prospects for this main harvest are good, but the intervening period will most likely be very difficult [ICRC 27/1/94]

Eye-witness accounts from Kuito and Menongue in January describe a "catastrophic nutritional and medical situation". [ICRC 20/1/94] Reports of intensified fighting around Kuito have led to government threats to block aid flights into UNITA held towns. [BBC 11/2/94]

Most recently there have been reports of heavy fighting in the municipality of Libolo while a WFP/World Vision convoy containing food and non-food items was stopped at Catete (Bengo). There are also concerns that delayed shipments out of the US and improved access and accelerated deliveries within Angola have created a food pipeline gap in the emergency operation between March and May. [WFP 28/1/94]

Overall the situation is out of control. As access to transport possibilities improve, in more secure areas the situation could probably come slowly under control, unless security problems hamper the work. The populations of Huambo and Melange, estimated at 560,000, are suffering very high malnutrition and mortality rates (category I in Table 2). The remaining 2,640,000 are at considerable risk: it is reported that about half the required food is now being delivered to the country, but encountering huge distribution problems, so roughly 1,000,000 people are probably at high risk (category IIa in Table 2).

RNIS 2, December 1993

Following the resumption of Angola's civil war in October 1992, information in October 1993 (RNIS report #1) indicated that up to two million conflict and drought affected people may be at serious risk of starvation and disease related mortality, but that lack of access to much of the country (CARE Angola estimate 80%) has prevented the collection of data to verify the impact of this emergency. Current planning figures used by WFP for emergency food aid programming are 344,000 displaced persons, 112,000 returnees, 1,251,000 conflict affected and 256,000 drought affected people -- a total of 1,963,000 people.

During October military attacks continued throughout the country. Aid priority was given to the city of Benguela which, along with Malange, demonstrated some of the most appalling humanitarian conditions in the accessible cities of Angola. By mid-October UNITA had authorized the UN to fly humanitarian aid to a number of destinations in UNITA controlled areas. Assessment missions were duly scheduled for Huambo and Kuito. Humanitarian aid has thus resumed to a number of areas and cities that had not been accessible for several months.

There is still however, a paucity of recent data on the impact of this war/drought induced emergency. Preliminary results of a WFP nutrition survey in Malange (11 October 1993) found 20% prevalence of severe wasting amongst children under five years of age and an overall rate of 34% wasting. An earlier MSF nutritional survey in the Municipality of Benguela in September only found 10.3% wasting and a crude mortality rate of 0.8/10,000/day (3 x normal). However, MSF caution against an over-optimistic assessment of the situation in Benguela as these data may not be properly representative and also because the food aid receipts are well below acceptable levels (less than 1,000 kcal/caput/day). Furthermore, coverage of the general ration distribution is extremely limited (65% of target population) as is coverage of supplementary and therapeutic feeding programmes (15% of the estimated number of malnourished children). There is also grave concern over the vaccination status of the population and the high level of measles related mortality. MSF caution that the situation could deteriorate quickly and dramatically.

There are currently at least six large urban populations where access has until recently been extremely limited and where nutritional and health crisis conditions may well be present. These are: Kuito, Huambo, Menongue, Luena, Malange (definitely in crisis) and Saurimo. There are no reliable population data for these cities.

Anecdotal reports suggest that since the siege of Kuito began in January 1993 20,000 people have died from wounds, disease and starvation. Other reports claim that one third of the population have died from starvation.

Elsewhere food distributions have improved greatly since June when the number of general ration beneficiaries was 230,000. In October 1,240,000 people received a general ration. Very approximately, these rations have supplied, at an aggregate level, 70% of caloric needs. As with other current emergency programmes, pulses (e.g. beans) have been in short supply. Pledges have been made but not received. There has also been an on-going shortage of cash funds for the UN implemented emergency feeding programme which has affected transport, non-food items and logistical support.

At least 173,000 people in Angola are currently estimated to be in crisis (Table 2, column I) as based on the survey from Malange, while an unknown number may be in crisis in those towns which have been under prolonged siege. As we have no "hard" data on this population we have indicated in Table 2 that there are a further 1,789,020 internally displaced and war-affected people, some of whom may be in crisis or at high risk (Table 2, column III). In the short-term, as information from formerly besieged towns becomes available from the current round of UN and NGO needs-assessments, we may learn of crises similar to those currently seen in Malange. However, providing UNITA continue to allow humanitarian aid into previously inaccessible cities then the situation could continue to improve. The rainy season has begun and crops have been planted. Harvesting will not be for several months (usually April). Therefore much of the needed food will have to come from the international community.

RNIS 1, October 1993

The results of the multiparty elections in September 1992 were rejected by one of the major parties and Angola's civil war was resumed in October 1992. Since that time most of the country, including Luanda (see Map 8), has seen heavy fighting. Several large urban provincial centres have been completely surrounded and cut-off from food supplies. Others such as Luanda have had to host large numbers of newly displaced people (90,000).

An FAO/WHO Special Alert on 20/4/93 estimated cereal import requirements of 435,000 tons for 1993/94, citing the combined affects of the conflict and drought. WFP estimate that the total food assistance requirement for the coming 12 months is for a case-load of 1,963,000 conflict and drought affected persons. Other reports speak of about two million seriously at risk. However, the physical limitations on moving food around in the country due to mined roads, destroyed bridges and damaged airfields, mean that for the next 12 months at least, the maximum logistics capacity of the (UN and NGO) agencies in the Angola emergency operation is just over 70% of net requirements.

Ad hoc reports from relief agency and hospital staff and journalists indicate the existence of many cases of severe wasting and related mortality and villages surviving on wild famine foods. However, there are very few rigorous data and numbers severely affected are unknown. It is estimated that about 600,000 people are at risk (category IIa in Table 2). There is an urgent need for more information. A survey carried out in Porto Quipiri/Boa Vista in August 1993 showed total wasting 41%, of which severe was 15%.

From the scattered reports available, it seems that there is reason to fear a major famine may be underway. Towns such as Cuito (see Map 8) have been under siege and without food supplies for many months, and no one is clear as to what is happening. Some relief agencies fear tens of thousands may now be starving, and hundreds of thousands already malnourished and at imminent risk if the conflict continues.