SOUTHERN AFRICA

Angola
Zambia

Angola

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

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

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

Nutrition Situation

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

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

Malange

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

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

	July 00	December 00
Acute malnut	3.1 (1.6-5.7)	5.3 (3.1-7.5)
Severe malnut	2.0 (0.9-4.2)	2.1 (0.8-3.3)
Crude mortality	0.9 (0.5-1.6)	1.52 (1.21-1.83)
Under-five mortality	1.3 (0.4-3.4)	3.35 (2.4-4.2)

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

Kuito, Bie Province

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

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

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

Results of MSF/Concern Surveys in Kuito town and camps

	Town	Camps
Proportion of IDPs	35%	100%
Acute malnut (<-2 z scores and/or oedema)	2.6 (1.1-4.1)	9.1 (6.7-11.4)
Severe malnut (<-3 z scores and/or oedema)	0.2 (0-0.5)	0.7(0.1-1.2)
CMR	1.4/10,000/day	1.5/10,000/day
Under-five mortality	2.3/10,000/day	3.2/10,000/day
Measles vaccination	80 %	66%

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

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

Benguela Province

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

Cuando Cubango Province

Menongue

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

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

Uige Province

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

Refugees

Angolan refugees in Namibia

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

Overall

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

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

Recommendations

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

From the MSF-Holland survey in Malange

· Continue targeted feeding programmes.

· Improve community outreach and screening of malnourished children

· Given the poor functioning of health surveillance systems the NGOs should monitor mortality trends closely to detect emerging epidemics.

· Improve coverage of measles immunization beyond 60%.

· Focus on the development of emergency preparedness.

· Close monitoring of the nutrition, agricultural and food economy situation is needed.

· IDPs arriving since December 1999 should be targeted for nutritional and health screening, vaccination and a full food ration.

· Keep the general ration fortified with niacin rich foods such as CSB, to address the problem of pellagra.

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

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

Zambia

In distinct contrast to its northern and western neighbours Zambia enjoys a stable political environment, despite suffering from economic decline. During 2000 Zambia has faced a mounting refugee crisis as the war in Angola between the UNITA rebels and the government coupled with the regional instability and conflict of the Great Lakes region, has sent thousands of refugees into the North and North West Provinces of the country.

Zambia currently has an estimated 225,000 refugees currently living within its borders, with 180,000 from Angola, 35,000 from DRC and another 10,500 from Burundi, Rwanda or Somalia. An estimated 80,000 of those currently have no access to land or markets and depend totally on food supplied by the WFP. Since June 2000 Zambia has seen a massive influx of some 40,000 refugees fleeing fighting in the Democratic Republic of the Congo and Angola. To cater for the influx of refugees the UNHCR has been obliged to open a new camp called Kala in the Kawambwa district in August, after the Mwange camp in Mporokoso reached full capacity and was closed to new comers. Preliminary results of a nutrition survey in Kala camp by MSF-H estimate the prevalence of acute malnutrition is 4.2%, with 1.2% severe malnutrition. No oedema was recorded (MSF-H, 7/3/01)

There is considerable concern at the increase in banditry along Zambia’s northern Luapula province bordering the DRC which has created a very unstable and insecure environment for the refugees (UNHCR 2001; WFP 23/02/01).

The influx of Angolan refugees picked up sharply in mid September 2000, as a result of clashes and bombing by Angolan Armed Forces in Moxico and Cuando Cubango provinces. By mid October well over 10,000 refugees had entered Zambia from Angola. The large influx of refugees has been accompanied by armed combatants which has dramatically increased the number of security incidents in the camps.

A recent offensive by rebels in the Democratic Republic of Congo’s Katanga province and the subsequent capture of Pweto, Moba and Malilo resulted in 15,000 people, in November and December alone, fleeing across the border into Zambia’s Luapula and Northern Provinces. Any escalation in hostilities could spark an immediate surge of thousands of people into Zambia. The RNIS does not have any nutritional information about the condition of the refugees (WFP 23/02/01).

Food security and resources

Zambia is not a high profile emergency and donor response has been slow. Many of the refugees currently located in Zambia are in six refugee camps that are currently facing the prospect of shortages in basic food commodities due to lack of funding. An IRIN South Africa report in March stressed that unless donors renew pledges there will be an expected 25 % cut in the general food rations. Given the food cuts and the reliance of the refugee population on food aid, there could be a deterioration in nutritional status

Overall

The increased numbers of refugees and the threatened cuts in the food pipeline as a result of funding constraints makes the overall food security situation and nutritional status of the refugees extremely precarious (Category II or III).

Recommendations

· Continue to closely monitor the nutritional status of the refugees to provide timely information in the event of a deterioration of the nutritional situation.

· Advocate for the provision of funds to UNHCR programmes to ensure the continued provision of quality assistance to the refugees.

· Try to encourage and facilitate some degree of independence through agricultural or income generating programmes in order to decrease the dependence of the refugee population on humanitarian food aid.