|Refugee Nutrition Information System (RNIS), No. 27 - Report on the Nutrition Situation of Refugee and Displaced Populations (UNSSCN, 1999, 78 p.)|
The humanitarian crisis in Angola has become extremely severe. Following the collapse of the peace process and renewed warfare in late 1998, an estimated 1.7 million people have now been displaced from their homes out of a total population of 13 million. Approximately 900,000 of these people have been displaced since December last year. Insecurity has been experienced in virtually all provinces but the provinces of Bie, Huambo, Malange, Kuanza Sul, Moxico, Benguela and Huila have been most severely affected. Huambo, Malange and Kuito are virtually besieged. In addition, landmines are being laid down by both the Angolan armed forces and the UNITA rebel movement which are causing more accidents and deaths amongst civilians (FAO/WFP - 16/06/99; IRIN-SA - 02/06/99; OCHA - 02/06/99, 11/06/99, 01/07/99; WFP - 04/99, 05/99).
The prospects for peace in Angola seem remote, the country has been at the centre of a civil war since, and even before, its independence. The current crisis, which is the most severe since the Lusaka Peace Protocol was signed in 1994, began in December 1998 when the government launched a major offensive against UNITA. The government seems committed to end the conflict by military means and has stated that "Angola had to wage war in order to achieve peace". The international community largely holds UNITA responsible for - the collapse of the peace process and is trying to tighten sanctions against the organisation. In particular, they are trying to tighten sanctions on diamonds - it is estimated that UNITA earned US $200 million from trading diamonds in 1998 alone (IRIN-SA 08/06/99; UNHCR- 11/06/99).
The conflict has seriously disrupted food security and hence negatively affected the nutritional situation. Despite good climatic conditions for this year's harvest, and no dramatic reductions in planting, significantly reduced yields are anticipated in many areas due to the abandonment of fields. Looting of crops before they have reached maturity has also been a problem. In addition, the closure of most roads in the conflict-affected areas will prevent surpluses in some provinces from reaching deficit areas. Thus urban areas will face food deficits and farmers will have difficulties marketing their crops. Very few of the IDPs will have any harvest at all this season. The food security situation is reported to be satisfactory only in the south-western parts of the country, where security is stable (FAO/WFP - 16/06/99; OCHA - 01/07/99).
Access to IDPs and others in need
Large-scale movements of the population began from rural areas to municipalities and later to provincial capitals. Many of the IDPs arrived in the urban areas in very poor condition and with only small supplies of food. However, obtaining access to the IDPs and other vulnerable groups found in the towns and cities of Angola is becoming increasingly difficult for humanitarian agencies, particularly in the Central Highlands. The strategic roads around many of these cities have been cut off by UNITA for months and ambushes on the remaining roads have increased. Logistical capacities for food assistance are very much dependent on the local security situation. Whereas WFP was previously able to deliver food assistance by road to over 200 destinations, the resurgence of the conflict has resulted in the number of locations accessed by road diminishing to less than 50. Frequent attacks, fluctuating road tariffs and the scarcity of fuel in some provinces have all led to increased costs of transport and decreased capacity. Air deliveries are also hindered by poor security situations. Factors such as inadequate aircraft ground support operators, poor maintenance and repair of airstrips and very high insurance costs all contribute to increased transport costs. Taking into account all these factors, the internal transport and storage costs for WFP have risen from US$ 219/tonne in 1998 to US$ 330/tonne (FAO/WFP -16/06/99).
It is clear from preliminary surveys and reports carried out in some of these cities that the rates of undernutrition are increasing and will continue to do so unless food and other forms of assistance are provided. The small supplies of food which were brought with the IDPs following their displacement are now largely exhausted and these populations are becoming increasingly dependent on humanitarian assistance. Food security for the resident population is also expected to deteriorate in the coming months as they compete with the IDPs for the same resources. In many cases, the children of residents are reportedly brought to the feeding centres in equal proportion to the children of the IDPs (WFP - 05/07/99).
An SCF-UK/Concern/MOH survey undertaken in Huambo city in May recorded exceptionally high levels of malnutrition for this area (see Annex), exceeding all previously reported results since 1994. The prevalence of acute wasting among children under five years of age was 14.5%, with 1.3% severe wasting (compared with 3.7% acute, and 0.1% severe reported in April 1995). The prevalence of oedema was 2.2%. The current prevalence rates indicate that an estimated 11,700 children are malnourished and need supplementary or therapeutic feeding (based on a conservative estimate, the population is 350,000 including an estimated 70,000 children under-five). At the time the survey report was published the capacity of the feeding centres was just 2,800, i.e.: the number of facilities were totally inadequate. An unknown number of adults and children older than five years old may also be malnourished.
Reduced access to agricultural land as a result of insecurity was suggested as a main factor explaining the very poor nutritional status seen in this survey, but similarly high levels of malnutrition were found among resident and displaced groups - that is in groups with and without access to land. This was probably because of the increased strain on resident households due to greater numbers of household members (displaced persons). In addition, local food production has been reduced due to insecurity and in some areas the staple food (maize) was harvested earlier than normal resulting in food reserves being used up already. Food is available in the markets, but most of the population is unable to afford it as prices have tripled since the same period last year. Shortages of salt, oil, sugar, fish, meat, flour and soap have been reported. Insecurity on the roads outside the city make it dangerous for the population to buy (or sell) goods outside of Huambo.
The nutritional outlook for Huambo's population is very poor. Future harvests will be reduced due to low seed conservation. WFP's on-going operation, which will end in August, was not planned to cater for the very much increased needs currently described and the food for the new operation starting in September has not yet arrived. Usual coping strategies are restricted due to insecurity (e.g.: the collection of firewood). In addition, the politico-military situation is still very fragile in this area and could deteriorate even further (CONCERN -06/99; SCF-05/05/99, 09/06/99; OCHA - 11/06/99, 01/07/99, WFP - 05/07/99).
Kuito, Bie Province
A joint WFP/UNDP/UCAH mission to Kuito, in Bie province, in late April described the humanitarian situation of the approximately 45,000 registered IDPs in the area as very poor, but not yet critical (WFP -04/99). A more recent report from MSF-B, however, suggests that the situation is now very serious. In the first week of June there were more than 500 beneficiaries in their Therapeutic Feeding Centre - an increase of more than 400% in the past few months. There are also an estimated 1,500 people in the Supplementary Feeding Centre. It is estimated that 61,000 newly displaced people have come to the city since December and the total population of the city is currently estimated to be 220,000 (MSF-B - 04/06/99; OCHA - 01/07/99). As in many of the other besieged cities, fuel shortages are a major hindrance to the delivery of humanitarian assistance (OCHA - 11/06/99).
Malanje has been the scene of sporadic shelling for nearly four months, and the Province Hospital has registered more than 1,000 deaths since the beginning of the year. The city is has registered more than 100,000 IDPs. Emergency food distributions have been temporarily halted because of continual bombardment and attacks on the Malanje-Luanda road. Food stocks are currently being targeted only to children, pregnant women, elderly people, the disabled and the sick (WFP - 02/05/99, SCF - 05/05/99; IRIN-SA - 07/06/99, 08/06/99). Security conditions have prevented a nutritional survey being undertaken in the city in the past few months, but given that acute undernutrition was measured at 11% in January of this year (see RNIS 26) and that the city has practically been under permanent siege status since this time it is feared that the prevalences of undernutrition will be high (OCHA - 17/06/99).
In Moxico province, the insecurity continues to force the displacement of the population from war affected rural areas into Luena. Fields in the periphery of Luena are also difficult to access because of the security conditions, which has reduced the supply of food to the town Thus food insecurity also affects the local population, some of whom have had to resort to posing as IDPs in order to obtain humanitarian assistance. (OCHA-11/06/99).
The condition of some 19,000 recent arrivals in Kuito Kuanavale from areas in Moxico was reported to be particularly extreme, with evidence of severe malnutrition in both adults and children. In addition to food aid, these people - who have been cut off from the rest of Angola for up to 10 to 15 years because of the civil war and hence can speak no language other than their own local dialect - desperately need medicine and clothing: many of them are wearing clothing made out of tree-bark (OCHA - 02/06/99).
World vision has recently reported the results of three nutritional surveys undertaken in two localities of Kwanza Norte Province (see Annex and graph). It can be seen that the prevalence of malnutrition is relatively high. A further report suggests that the prevalence of wasting may be even higher in Samba Caju district (up to 43%), but the study methodology is not know and hence the results are not shown. The NGO reports that most of the new IDPs arriving at the camps in Kwane Norte are from Malang and most need immediate attention. The majority of the children are undernourished and are suffering from diarrhoeal diseases, malaria, acute respiratory tract infections or other illnesses. World Vision has been running a therapeutic feeding centre in Cazengo since April, but new arrivals from insecure areas are frequently arriving in very poor condition, hence the high prevalence of malnutrition. The main constraint of programmes in these areas is funding (WV - 23/06/99).
A recent Angolan Red Cross nutritional survey reported 13% acute and 3% severe wasting and/or oedema in Chongorio, while in Caimbambo acute wasting and/or oedema was estimated at 19% and severe wasting and/or oedema at 2%. Depending on the availability of WFP stocks, food assistance will be given to the most vulnerable (OCHA -24/06/99).
A report from a recent UNICEF meeting suggests that in some areas of the country such as Zaire and Uige there are no evident signs of a nutritional problem. In these areas there is much better access to crops and/or the humanitarian agencies are able to deliver some assistance to the communities. Although, the most recent report from Zaire Province states that there is a shortage of health facilities and medical equipment in this area (OCHA - 22/06/99, 01/07/99).
An emergency vaccination campaign against polio is currently being undertaken by UNICEF and the national health authorities. The latest figures indicate that 958 cases (almost all are children under five years) have now been reported with 84 deaths (SCF - 22/06/99). Most of the cases are in the slum areas around Luanda, although some have been reported in Benguela (OCHA - 28/04/99). Over a million children have been vaccinated and the campaign continues. An outbreak of meningitis amongst young adults has also been established in the province of Kuando Kubango (OCHA - 07/05/99), although an immunisation campaign appears to have brought this under control.
Overall, the situation in Angola is critical in many areas, although in other areas the situation is not as severe. The numbers of people involved are difficult to estimate (note that only IDPs are shown in summary tables, although the resident population is also at great risk). The 462,000 IDPs in the cities in the central highland provinces are at high risk (category IIa), although the IDPs in Huambo (175,000) are known to have very high rates wasting and are therefore classified as category I (these numbers are from UCAH - WFP, 05/0799). IDPs in other areas are probably at moderate risk (category IIb).
Priorities and recommendations:
· Funds are urgently needed to support humanitarian operations in Angola. At the time of going to press the appeal for Angola was only 29% funded (OCHA - 01/07/99). The funds are required to charter additional cargo aircraft to transport desperately needed food and medicines to the war-affected cities. Low levels of emergency food stocks are reported in several areas. Breaks in the food aid pipeline breaks are expected in the next few months.
· Support the Government of Angola's commitment to the temporary resettlement of IDPs on productive agricultural land
· Expand the capacity of supplementary and therapeutic feeding programmes and distribute a regular general ration distribution programme in order to make the selective feeding effective.
Recommendations from the CONCERN/SCF/MOH survey in Huambo
· Increase the number of targeted feeding programmes (supplementary and therapeutic)
· Ensure close collaboration between targeted programmes and soup-kitchens, providing referrals
· Elaborate a nutritional/agricultural educational programme highlighting alternative possibilities of food cultivation and preparation with currently available foods. This programme should target the most vulnerable families.
· Provide agricultural and food interventions for the most vulnerable families where possible.