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.