Refugee Nutrition Information System - Angola
The nutritional situation in the country is variable. In the northern provinces (Zaire, Uige, Bengo, Kuanza Norte, Luanda Norte and Luanda Sol) the prevalences of malnutrition are not "excessive". This is due to a reasonable harvest, fair accessibility to crops, and continuing assistance from the humanitarian community (UNICEF - 07/99). The nutritional situation in the Central highland provinces, however, is generally very poor. High prevalences of malnutrition are currently being recorded in both resident and displaced populations.
The civilian population of the besieged cities of Huambo, Malange and Kuito continue to be shelled sporadically. The insecurity and shortages in available resources continue to hinder humanitarian assistance activities, which are restricted to accessible areas and a limited number of beneficiaries. WFP is urgently seeking US $5 million to charter additional aircraft to transport food supplies to those cities which are not reachable by land routes (WFP - 16/07/99).
The very poor situation in Huambo reported in RNIS 27 has reportedly not improved, despite humanitarian airlifts to the city in early July. The flights allowed WFP to re-establish provincial stocks. However, the airport has been closed frequently because of security incidents, suspending humanitarian deliveries (IRIN-SA - 03/08/99; OCHA - 09/07/99, 16/07/99, 23/07/99; WFP - 16/07/99).
Food is available in the markets, but is extremely expensive. The government has tried to ease the problem of food supply by distributing land ahead of the planting season in September, and ICRC are providing limited quantities of seeds and tools. These initiatives are handicapped by the lack of secure farm land, as UNITA forces are based just 30km from the city. Crucially, whatever the size of the harvest it will not be available until December (IRIN-SA - 03/08/99).
Malange has been under siege for a prolonged period of time and as a result international NGOs and the UN have only recently been able to obtain access to the area. The situation has been described as desperate. A Ministry of Health survey conducted in late June/early July estimated the prevalence of acute wasting (<-2z scores and/or oedema) at 31% (MSF-H - 02/08/99). Severe malnutrition (<-3z scores and/or oedema) was estimated at 15.9%. Note that the survey methodology employed is unknown.
Reports from WFP, MSF-H and World Vision confirm that the nutritional situation in Malange is very grave. There is no general food distribution for the estimated 130,000 IDPs, or for the residents. "Minimal" food supplies are reaching the most vulnerable only. Although food is available in the markets, it is very expensive and much of the population cannot afford it. Anecdotal reports indicate that mortality from nutrition-related diseases is high (IRIN-SA - 30/07/99; MSF-H - 29/07/99; WFP - 16/07/99).
Kuito, Bie Province
The nutritional situation in Kuito, Bie Province (estimated population 250,000 of which 100,000 are IDPs), has rapidly deteriorated in the past four months (Epicentre - 28/07/99). In a survey undertaken in March 1999, MSF-B estimated the prevalence of acute wasting (<-2z scores and/or oedema) at 4.3%. This had risen to 13.8% (including 2.7% oedema) by mid-July. Severe wasting (<-3z scores and/or oedema) was estimated at 3.5% in July. There has been a concomitant increase in the attendance figures at supplementary and therapeutic feeding centres.
The authors of the survey suggest that the nutritional situation in Kuito will deteriorate further. Reasons given for this include the poor coverage of the general food distributions provided by WFP - approximately 25,000 of the most "at risk" people received food at the end of June and July. Only 33.6% of the households surveyed had received food at the end of June. In addition, the coverage of the feeding programmes was low at 13.2% for supplementary feeding centre and 14.3% for the therapeutic centre.
High mortality rates were recorded in both the general population and the under-fives. CMR was more than double the level usually defined as a "serious situation". It is probable that the high CMR is not due to the nutritional situation alone and that other medical problems need to be identified and controlled. For example, measles immunisation coverage was low, at 33.5%. The rainy season is approaching which will increase the risk of a series of medical problems including diarrhoea, acute respiratory infections and malaria.
A brief visit to assess the food and nutritional situation of the population in an IDP camp in Cuito Canavale was made by ACF-F in mid-June (ACF- S - 18/06/99). The main findings of the assessment included a lack of purchasing power and economic income amongst most of the displaced population who do not have access to land. The market contained only a limited selection of foods. Most of the families existed on a day-to-day basis, buying food only one day at a time. In addition, the environmental and public health conditions were reported to be very poor.
Recommendations and Priorities:
Supply funds to support humanitarian operations in Angola. At the time of going to press the UN 1999 appeal for Angola has been revised upwards from approximately US $66.6 million to US $106 million (OCHA - 07/99).
Recommendations from the survey in Kuito include:
Increase the coverage of the general food distributions to encompass all vulnerable groups in both the resident and the displaced populations. Assess the content and quality of the rations provided through regular food monitoring programmes.
Increase the capacity of the supplementary and therapeutic feeding centre programmes.
Conduct an active case search for all malnourished children. Refer all malnourished children to the feeding programmes.
Organise a mass vaccination campaign against measles targeting all children aged 6-59 months as soon as possible.
Analyse existing mortality and morbidity data in order to identify major public health problems in the area.
Implement a surveillance system for mortality and priority diseases.
Conduct a further anthropometrical survey after the rainy season, and also a food security study. This should enable the identification of the most vulnerable groups.
Recommendations from the report on Cuito Canavale include
Follow the nutritional situation, using regular information from the health centre in the area.
Re-visit the region as soon as security conditions permit, and undertake a food security and anthropometric survey in order to assess the nutritional situation further, and identify vulnerable groups within the population.