Episode: "The Choice"

Angola: A Rapidly Developing Crisis

In this episode of Doctors Without Borders: Life in the Field, National Geographic film crews document a particularly difficult moment in the early stages of a devastating nutritional crisis that struck Angola in the spring and summer of 2002. A cease-fire had just brought the 27-year civil war in Angola to an end, opening up regions of the country in which people had been without access to food or medical aid. Although war caused the malnutrition and disease, peace in Angola allowed it to be seen and addressed for the first time by relief agencies – the result was an unsuspected and rapidly developing humanitarian emergency.

When volunteer Els Adams goes on a preliminary assessment visit to a government-run quartering area for former UNITA rebels, it is the first by any humanitarian aid worker to that particular area. She finds an overwhelming number of malnourished women and children – more than her truck can carry.

Els knows that an MSF truck will return to the area the next day, and the day after that. But without assistance from United Nations agencies or the Angolan government, which were slow to respond to the emergency, Els and MSF are forced to make difficult decisions regarding which patients to transfer back to MSF feeding centers, when so many lives are at stake. Unfortunately, during this stage of the crisis, the terrible scene that appears in this episode was happening daily, in many parts of the country.

Malnutrition and Lack of Medical Care: A Legacy of War

The starvation did not begin in spring 2002. Fighting in Angola’s civil war had resumed in November 1998 after an aborted peace agreement, and this new phase quickly became one of the cruelest periods of the conflict. Civilians caught in contested areas were specifically targeted; many were forced to fight, and their villages were burned along with their crops. They were subjected to systematic violence.

Tens of thousands were displaced from their homes time and again, either fleeing on their own or forced to flee by the warring parties. As the war raged on, they spent long years in the bush or captive in military encampments. MSF estimates that up to 500,000 people were trapped in these "gray areas."

Access of humanitarian aid workers to the areas where this was all happening was denied from November 1998 until early 2002, when the death of longtime rebel leader Jonas Savimbi paved the way for a cease-fire and subsequent peace agreement between the government and União Nacional para a Independência Total de Angola (UNITA) rebels. Starting in March, the gray areas opened up, revealing huge populations that had been isolated from food and medical care for three years.

Project Update:

Months after episode one was filmed in Malange province, the widespread malnutrition witnessed by MSF teams throughout Angola last year was brought largely under control. MSF’s supplementary and therapeutic feeding programs, a decent fall harvest, a late, but effective response from the international community, and revitalized commerce and trade all helped to mitigate the crisis in late 2002.

For many Angolans, however, these factors were too little and far too late – untold thousands lost their lives, and the repercussions of the nutritional crisis continue to be felt throughout the country.

In response to the remaining large-scale, serious health needs in Angola, MSF maintains an extremely strong presence in the country. As of June, 2003, more than 100 MSF volunteers and approximately 1,900 national staff members are currently working in 11 of 18 Angolan provinces. MSF is supervising or supporting 11 hospitals and 32 health posts, offering consultations to more than 28,000 people each month. In addition, MSF currently operates eight therapeutic and 15 supplementary feeding centers, treating 485 and 9,135 patients respectively. In early 2003, in the Huambo province, MSF performed a blanket food distribution to reach 21,000 children under five years of age.

The specter of malnutrition continues to haunt Angola, and will, until adequate money and resources are directed towards the problem by the Angolan government and the international community. In a country with a population of around 12 million inhabitants, of which an estimated 2.8 million are displaced, MSF remains extremely concerned about the lack of access to quality primary health care for many Angolans.

To read more about MSF in Angola, click here:
http://www.doctorswithoutborders.org/news/angola.shtml