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MSF in Angola, 2003
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MSF has been working in Angola since 1983.
"We want to go home. The war made us flee, but if the war is over, why should we stay here? We want to return to our land. For that we are waiting for the government orders. When the government fixes the bridges, we'll be able to go back by car. But to go back, we need pots, medicine, food, schools for the children, and we don't know if the government is going to help us. We also aren't sure about whether this is really the end of the war... But with or without our doubts, we're going back. When the other displaced people in Congo find out that we've already gone back, they're going to come back too. We'll all be together there, the people who were captured too. We're family."
MSF heard his story several days after he rode a bicycle from Democratic Republic of the Congo to Saurimo in Angola's Lunda Sul province, looking for people from his village who might have found refuge there In one man's words are reflected the uncertainties, difficulties and dreams of post-war Angola. During years of conflict, people here were abandoned to the "scorched earth" strategy of war. In early 2002, hundreds of thousands of starving people were suddenly revealed after cessation of hostilities opened up large parts of the country that had hitherto been inaccessible to humanitarian workers; yet political maneuvering linked to the peace process seemed to supercede obligations to provide them assistance. Many people died for want of food and care, even though the war was over. Now people are trying to go home, rebuild their lives and care for their children. It is not easy, and in many parts of the country emergency relief is still very much needed. MSF, present in the country since 1983, expanded its activities dramatically during the height of the nutritional crisis following the April 2002 ceasefire, and now continues to provide essential medical and nutritional aid in 14 of the country's 18 provinces.
Continued complicated crisis
By the end of 2002, Angola's widespread nutritional emergency was finally under control, but the difficulties for Angola's people had not ended. Official rhetoric by the Angolan government and international agencies that the country has begun the transition to development is in stark contrast to the needs across the country. The medical infrastructure of Angola was completely destroyed during the war and many people have been without care for years. Children received no vaccinations for more than four years and the potential for dangerous outbreaks of disease is high. In some places, MSF teams reported that children who had been treated months before in therapeutic feeding centers were once again being readmitted with acute malnutrition due to continued problems with emergency relief.
The Mavinga example
The case of Mavinga town in Cuando Cubango province illustrates the health impact of failing to meet emergency needs, even months after the nutritional crisis had peaked. In August 2002, thousands of people were still gathered in "reception sites" in Cuando Cubango awaiting assistance. When food distributions being carried out by the World Food Program were halted for several weeks after a mine was discovered on the airstrip used to fly in supplies, people poured out of the camps toward Mavinga, a town nearly 50km away. "We saw thousands of people start walking in single file down the road carrying bundles on their heads," remembers Thomas Grien, an MSF Epicentre epidemiologist working in the area at the time. The massive flow was mostly made up of people who were ill and malnourished. "The gravity of the situation and the lack of food is so severe that our teams even saw handicapped people, with prostheses and crutches, start to walk the 50km which separates them from Mavinga," commented Fred Meylan, MSF Head of Mission in Angola. In November 2002, MSF released an epidemiological report showing that, even as late as October 2002, global and under-five mortality rates remained above emergency thresholds in Mavinga town and in Quartering and Family Areas (QFAs, resettlement camps for ex-UNITA soldiers and their dependents) in nearby Matungo and Capembe.
Despite the promise brought by peace, resettlement and repatriation remain complicated and preparations minimal. Thousands of villages have been completely destroyed, and many people have nowhere to go. International aid, insufficient even during the most acute post-war months, is now intermittent, and many Angolans continue to be dependent on food aid. "The vast majority of displaced have not received any seeds to plant," explains Thierry Allafort-Duverger, head of MSF's emergency team. "Their survival depends entirely on the assistance given to them." To make matters worse, destroyed roads and bridges and the ever-present danger of landmines makes access a persistent problem. "Not only does the poor quality of the transport routes hamper our work, especially in the rainy season," says Kostas Moschochoritis, an operational coordinator. "Nine to twelve million landmines are still littering Angola. That is more than one landmine per person." A mine accident 36km from Mavinga took the lives of six MSF national staff members and one child traveling in an MSF vehicle in November 2002.
The failure of "coherent" humanitarian action
During the nutrition emergency of 2002, the mechanisms of international assistance failed the Angolan people. At that time and throughout the last year, MSF has sought to call attention to the way in which political concerns for the outcome of peace distorted the provision of humanitarian aid to many of Angola's most vulnerable people.
Humanitarian action is guided by three core principles: impartiality, independence and neutrality. As an emergency humanitarian organization, part of MSF's mission is to speak out when these principles are violated. Only through adherence to these principles can need-based humanitarian aid be assured. When political concerns are included in decisions about emergency relief, these basic tenets are compromised, and the mechanism fails. In Angola, this meant that response to the nutritional emergency was hindered by concerns about establishing peace. In December 2002, MSF presented its analysis of this to the United Nations Secretary-General. In November 2002 MSF also released several collections of temoignage documenting the stories of many people cared for by MSF staff in Angola.
Essential medical care in 14 provinces MSF teams continue to bring essential medical care to the people in Bengo, Bie, Cuando Cubando, Cuanza Sul, Huambo, Huila, Kwanza Sul, Lunda Norte, Lunda Sul, Malange, Menongue, Moxico, Uige and Zaire provinces, supporting hospitals and health posts, traveling to isolated communities and conducting mobile clinics. Some teams provide assistance to those who are being repatriated or relocated, while other projects focus on specific vulnerable groups such as children and people living with HIV/AIDS. Teams also fight infectious diseases, vaccinating thousands of children and providing care for those with diseases such as tuberculosis, malaria and sleeping sickness.