Devastating nutritional emergency revealed as war ends
International staff: 190
National staff: 2000
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After 27 years of civil war, peace seemed finally to come
to Angola in early 2002. The death of long-time rebel leader
Jonas Savimbi in February paved the way for a ceasefire and
subsequent peace agreement between the government and
the União Nacional para a Independência Total de Angola
(UNITA) rebels.
With the unexpected peace, however, a veil began to lift on
hitherto inaccessible areas, revealing a devastating landscape
peopled with hundreds of thousands of civilians who had
been scorned and manipulated by both sides and deprived of
humanitarian assistance for over three years. People emerged
from these previously inaccessible "grey areas" – UNITA territory
or inaccessible government regions, where control had been
contested and fluid, and humanitarian assistance prevented –
starving, shrunken, burying their children one by one.
The human catastrophe was compounded by the slowness of
the Angolan government, the United Nations and many aid
agencies and organizations to respond to the horrifying conditions
when they began to become apparent. MSF, already working
in eleven of the country's 18 provinces, saw immediate
increases in the numbers of children admitted to its feeding centers,
and began working around the clock to increase capacity
and try to gain access to previously unreachable areas. After
urgent calls for widespread action failed, MSF condemned the
Angolan government and international responses as "shamefully
slow and shockingly insufficient" and urged that more be
done to prevent the deaths of thousands of people.
The starvation did not begin in spring 2002. Fighting in
Angola's civil war resumed in November 1998 after an aborted
peace agreement, and this new phase quickly became one of
the cruelest periods in an already cruel conflict. Civilians
caught in contested areas were specifically targeted and made
hostages to the strategies of war. They were turned into slaves,
forced to fight; their villages were burned along with their crops;
they were taken by warring parties and used as "resources" to
help win the war. They were subjected to systematic violence.
Many were displaced from their homes time and again, either
fleeing on the own or forced by the warring parties. Some
reached provincial capitals; others spent long years in the
bush or captive in military encampments. MSF estimates that
up to 500,000 people were trapped in the "grey areas."
Access of humanitarian aid workers to the areas where this was all happening was denied from November 1998 until March 2002.
In November 2000 and again in November 2001, MSF had
issued reports detailing conditions in Angola, based on testimonies
of people in camps for the displaced and hospitals
where MSF was working. And in early March, before the consequences
of Savimbi's death began to be felt, MSF had gone
before the United Nations Security Council to condemn to the
"politicization of access" to people in need and the devastating
health consequences of forced displacement of civilians.
Rapid assessments conducted by MSF revealed mortality
rates well above emergency levels in most places evaluated.
As of summer 2002, an in-depth evaluation of the situation
in several areas was underway by Epicentre, MSF's epidemiological
research center.
As the scope of the nutritional crisis was revealed, MSF
stepped up operations, rapidly increasing the number of feeding centers for both severe and moderate cases. Often it was
a race to set up facilities to accept the truckloads of sick and starving
children who were arriving from the bush. Click here for excerpts of
one MSF volunteer's diary. By July 2002, MSF was providing
therapeutic (for severe cases) or supplementary nutritional
treatment to 14,000 children at any one time in 44 feeding
centers spread across 11 provinces. The relief operation
became MSF's largest mission worldwide during 2002.
MSF continued to discover pockets of severe malnutrition
throughout summer 2002. And while admissions to some
facilities had begun to drop, MSF remained concerned about
the situation in regions that, despite the peace agreement,
had remained inaccessible to MSF and other organizations
because of bad roads, lack of bridges, landmines. MSF was also
worried that displaced people might be rushed back to their
places of origin without the return being entirely voluntary,
and without facilities and safety being verified.
Ongoing MSF activities already underway prior to the emergency
work of spring and summer 2002 include running primary
health care services for displaced people in camps and
within several provincial capitals and towns, supporting hospitals
and other health facilities, and treating the malnourished.
MSF also provides care for sleeping sickness and tuberculosis
patients, and has worked to improve surgery and maternity care
in several provincial hospitals. These medical activities targeted
both residents and displaced people, and were ongoing
in the provinces of Bengo, Bie, Cuando Cubango, Huambo,
Huila, Lunda Sul, Malange, Moxico, Uige and Zaire, and the capital
Luanda. During the nutritional crisis, work was expanded
to previously inaccessible areas of these provinces and also to
the province of Lunda Norte.
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