The initial September assessment trip was planned in advance and MSF brought bikes by car to the river edge. Alongside the banks are men with canoes, offering their services to ferry people and goods across. The bikes and two staff members crossed the river in these dug-out canoes.

Once across the river, the road to Mussende is nearly perfect. The extended isolation due to the bridges being destoyed has meant the road has been ignored by troops and so the ride in was relatively easy.

Since then, MSF has delivered a vehicle to the region via the long alternative road route - an 18 hour journey - and the vehicle is now permanently stationed there. Each week, the teams on either side of the bridge appear, good are shipped across and then taken to Mussende. Today the entire journey, canoes included, is just four hours.

Bicycles are also widespread there because many of the paths are not big enough for a car. As well, the roads are suspected of being mined so access is often only on foot or by bicycle. MSF frequently uses bicycles in Malange to do vaccinations in communities without access by road.

Any travel in Angola has its inherent dangers. In late November 2002, an MSF vehicle transpoorting medical staff from both MSF teams and the ministry of Health, was destroyed by a landmine, killing seven and wounding six others. They were travelling on a road that had been frequently used in the past. 

Mussende is a small, isolated town, in the Cuanza Sul Province in northern Angola, located 134 kilometres from Malange, the provincial capital of Malange province. Mussende municipality has a population of approximately 10,000, while over 35,000 people live in the total surrounding area. Mussende was completely destroyed during the war, its isolation is so complete MSF team could only access the village the first time with a combination of cars, canoes and bicycles. The three main access roads to the town have been all but useless as all the bridges along the routes that cross the immense Cuanza River were destroyed during the 27 year long war, preventing almost all vehicle access.

Car, canoes, bikes

MSF's first entry in September came after a two-hour drive from Malange to the Cuanza river, then canoes to cross the Cuanza River - at a point almost 250m wide - and then on bicycle to ride another 85kms to the town. There were just two national staff members on this first trip, and they carried only personal gear such as sleeping mats and mosquito net.

It took MSF two days to reach Mussende by bike stopping often to assess the needs of the populations living in the four villages along the route. Finally in Mussende, they were able to assess the population there and try to arrange some sort of transport method for a larger team to enter.

Seven months after the cease fire was declared on April 4, this would be the first entry by an international organisation in years and MSF remains the only organisation active. Mussende is not the exception inside Angola as a place with no international assistance. There still remain many other areas throughout the country that have not been reached - by either MSF or other organisations - since the end of the war.

Fortunately the populations were not in as bad a condition as the team had feared. The greatest concern was for the people in the Reception Areas (previously called Quartering and Family Areas), where UNITA soldiers and their families live, because of what MSF had seen in the Reception Areas in Malange. However, although this group was vulnerable and needed assistance, they were not in very poor condition.

Critical phase

At the moment, the MSF team has one doctor and nurse permanently based in Mussende. The people feel very isolated there and just the fact that MSF is on the ground there and visibly doing work is re-assuring the people.

It is critical time for MSF to be in places like Mussende. The area is entering a transitional new phase of peace and the population still remains very vulnerable. After years of instability, Internally Displaced Persons (IDPs) have slowly started returning to the Mussende area to re-build their communities. In the coming months, the population will grow considerably and shall bring added stress to the health care system and food resources.

The Cambale Reception Area children are also at risk of a nutritional crisis if intervention does not increase soon. MSF is providing weekly dry food distribution in the Cambale Reception Area where 10,000 ex-Unita soldiers still live with their families, 7 km outside Mussende town. 141 children under-5 are currently benefiting from MSF aid in Cambale. This activity is the only consistent food aid and the only nutritional intervention reaching the people in the Cambale Reception Area. It is the only Reception Area in Angola that is not getting regular or semi-regular food aid.

Each week the teams bring about 500 kgs of goods from Malange to the river. The bridge is still unusable and so they use canoes to transport supplies and staff across to the other side.
MSF has also started a weekly dry food distribution in the town to assist especially vulnerable children aged under-5. Although the food crisis has stabilised somewhat, some cases of severe malnutrition can still be found in town. These children are sent to a Therapeutic Feeding Centre in Malange.