Angola Nutritional Emergency Fact Sheet
May 6, 2002
What is Mortality Rate?
In an emergency situation, the Crude Mortality Rate (CMR) is the most useful indicator as it accurately measures the gravity of the situation and can be used to trace its evolution. Calculating mortality rates per 10,000 people per day enables each situation to be compared against consistent reference values.
The expected CMR in a developing country is in the range of 25 deaths per 1,000 people per year, i.e. 0.68/10,000/day, but in emergencies it can rise above 1/10,000/day.
What is a TFC?
A therapeutic feeding center (TFC) should provide the severely malnourished with their full nutritional requirements and medical care. They normally offer two levels of care. An intensive 24-hour care unit ensures the initial medical and nutritional treatment. Once complications are brought under control (usually within 1-7 days), the child can be transferred to the day unit, where he or she will continue to receive nutritional treatment and medical follow-up. Each center usually cares for 60-100 children.
What is an SFC?
In a supplementary feeding center or program (SFC), a high quality food is provided to supplement the daily diet. The SFC provides standard care for large groups, in contrast to the individual attention provided in the TFCs. In a "targeted" program, high quality food is provided to those who are moderately malnourished to prevent a worsening of their condition. The patients are normally children under five. A "blanket feeding program" will instead provide all members of vulnerable groups (all children under five, pregnant and lactating women, and the elderly) with food supplements. Such action is taken when the general food supply is inadequate and it is a temporary measure, until the general food supply is restored. The objective is to prevent an increase in malnutrition and mortality rates.
What is a "Normal" Malnutrition Rate?
The prevalence rate of acute malnutrition in children under five years of age is generally used as an indicator of malnutrition in the entire population, since this group is more sensitive to changes in the nutritional situation. Under-five malnutrition rates make it possible to know whether there is a nutritional problem, and, if so, how significant it is. Other essential indicators for decision-making are the global malnutrition rate and the severe malnutrition rate. A global malnutrition rate below 5% is considered common in major parts of Africa and Asia; a rate between 5% and 10% should act as a warning. Malnutrition rates recorded by MSF teams in Angola during the past weeks have been as high as 42%.
Malnutrition witnessed by MSF among people emerging from the war zones in Angola is among the worst seen in Africa in the past decade. "We have seen hardly any little children under five. Lots of them had already died," said Mercedes Tataï, MSF's Medical Emergency Coordinator in Chipindo. "A whole hill has been covered with fresh graves since September."
Following the cease-fire agreements signed on April 4th, MSF could finally access the "gray areas" of Angola, which had been cut off from all humanitarian aid since 1998. MSF discovered dramatic mortality rates among the populations, well beyond the emergency threshold of 1 to 2 deaths per day within a population of 10,000 people.
In some areas, the mortality rate reaches catastrophic proportions:
Chipindo: 4.5/10,000 people/day and 6.1/10,000 people/day for children under 5
Chilembo: 5-10/10,000 people/day
- Very high levels of malnutrition (including among adults), combined with a very high mortality rate among certain populations over the past months, indicate pockets of famine.
- The beginning of a large-scale nutritional emergency, as assessments of many locations are still in the planning stages and other areas remain inaccessible to humanitarian organizations (roads and bridges destroyed, risks of mines). MSF has information to indicate that in many of these locations there are still populations in an emergency situation.
- MSF is increasing the capacity of the feeding centers as more people are expected to arrive in search of food and assistance. Presently MSF is treating in total 3,600 patients in the therapeutic feeding centers (TFCs), located in Kuito (850 patients), Camacupa (500), Luena (300), Malange (400), Menongue (150), Caala (800), Chilembo (100), Chipindo (150), Uige (100), Matala (250). In most of these locations MSF is also operating supplementary feeding centers (SFCs).
- MSF believes that a major international relief effort—specifically, reinforcement of the UN's World Food Program (WFP) food line capacity—is required to meet the scale of the emerging needs. The Angolan government should also mobilize the necessary resources to assist its populations.
- The ongoing nutritional emergency in Angola is a direct result of the fact that populations in large areas of the country remained inaccessible to humanitarian assistance over the past years because negotiated access to humanitarian assistance was not pursued in the country. This can be attributed to internal political agendas and a lack of interest in applying International Humanitarian Law (which ensures humanitarian organizations' right of access and right of assistance to populations in need).
- This emergency is also a direct consequence of the military strategies of both parties involved in the conflict: because a main objective of the belligerent groups was control over the civilian population, residents were forcibly displaced and their houses and villages were burned. The present large-scale nutritional emergency is therefore not an unavoidable consequence of the conflict but directly attributable to how the war was fought and a refusal of access to populations in need.
- Even in areas under government control—but inaccessible until recently to international humanitarian organizations—the civilian population was not assisted by the authorities in spite of a very high mortality rate and malnutrition.
WHERE (Angola's "gray areas"):
Provinces of Angola in which MSF is working as of May 6, 2002
Chitembo: The latest data collected shows malnutrition rates of 26% global acute malnutrition and 9% severe malnutrition—figures that exceed the emergency threshold. People in Chitembo are now being admitted to MSF's therapeutic feeding centers in Kuito (referred by MSF, 150 km further). The southern part of Bie province is one of the regions that had remained inaccessible for humanitarian assistance since the resumption of the war in 1998. This is the first time an international humanitarian organization has accessed Chitembo since 1998.
Bunjei: In Bunjei, 116 km away from Caala, the level of severe malnutrition is 30%. Bunjei has a population of about 14,000 people but receives a continuous flux of new arrivals. MSF is managing an SFC in Bunjei with about 800 patients (children and most vulnerable), with blanket feeding in place for children under ten years of age. It is impossible to set up a TFC at the moment because physical space and national medical staff are lacking and there is a high risk of mines. For the past six weeks the severely malnourished have been transferred from Bunjei to Caala.
Caala: In Caala, MSF is operating a TFC with 800 patients. After release from the TFC they stay in transit structure for a few days until they are transported back to Bunjei to receive fifteen days of food from ICRC.
Chilembo (south of Huambo town): A rapid nutritional survey conducted among 1,219 children under ten years of age revealed 42% global malnutrition and 10% severe malnutrition. The number of deaths (5-10/ 10,000/day) is well above the emergency threshold (1/10,000/day). The population is estimated at 6,000 people. MSF is operating a TFC in the region with 100 patients and an SFC with 200. These figures confirm that the population here is in an extremely serious condition and in urgent need of food and medical assistance. The International Committee of the Red Cross (ICRC) has planned a General Food Distribution (GFD) program in Chilembo, for which registration has already started and distribution activities are expected to begin this week. [NOTE: ICRC has a limited capacity in terms of food distribution, and they are mainly focusing on Huambo province (complementary to WFP activities in the area). ICRC registers people and distributes their food themselves.]
Northern Huila province (bordering Chitembo municipality): Reports of populations in very bad medical and nutritional condition.
Chipindo: Catastrophic mortality rates of 4.5/10,000/day for children and 6.1/10,000/day for children under five. This high mortality rate is visible, as there are few children around and a high number of graves.
Malanje: There has been a sudden increase in the number of admissions to the TFC over the past 2-3 weeks. The facility currently accommodates 400, but is under expansion. The severely malnourished come primarily from former UNITA bases and newly established quartering areas (locations where UNITA soldiers and their relatives go to be reintegrated with the civilian population).
CUANDO CUBANGO PROVINCE
Menongue: There has been a sudden increase in the number of admissions to the TFC over the past days. 150 patients (including adults) coming primarily from a quartering area north of Menongue are currently served by the TFC.
- These areas had been cut off from medical and food aid since 1998, when the civil war intensified, and are only now becoming accessible because of the recent cease-fire agreement (April 4th).
Note: MSF is also working in the provinces of Zaire and Lunda Sul. With the reinforcements that will arrive in the coming 1-2 weeks there will be about 150 MSF international staff members present in Angola, in addition to some 850 local staff.