MSF staff in Angola have been working in one of the worst malnutrition crises seen in Africa in the past ten years. Since the cease fire in early April between the Government of Angola and UNITA forces, some of the populations that had been previously unreachable by MSF are now accessible. The condition of the population has been appalling.

Papid assessments have shown that severe malnutrition is the norm and global malnutrition is affecting over 30% of the population assessed. In some areas, malnutrition has reached 40% of the entire population. Rates of severe malnutrition and mortality are registering at eight to ten times higher than the emergency threshold.

MSF response has been immediate but has also been confronted by an overwhelming demand and a failure of the international community and agencies to react effectively to the disaster.

With the lack of international attention to the ongoing disaster, MSF has maintained an unprecedented public profile to the situation. In the first six weeks following the cease fire, MSF more than doubled its therapeutic feeding centres (TFCs) from 11 to 23, giving essential care to the most vulnerable populations.

Patients in the TFCs are given care for an average of four weeks and over 4,000 children are in the facilities at any one time. Once they leave, they are transferred to a supplementary feeding centre (SFC) to be sure they do not relapse back into a severe malnutrition state.

Another 21 supplementary feeding centres were opened after the cease fire, providing care to a total of over 10,000 people at any one time. Two months later, there has been a slight decrease in the numbers of people attending some of the facilities, but the numbers being cared for currently remain high.

Needs throughout the rest of the country are unknown but MSF believes the situation shall be as bad, if not worse than, the regions where MSF is already working. Thousands of people have already died of neglect and malnutrition and hundreds of thousands of people in the country are either suffering severe malnutrition or are on the brink.

Estimates are that 500,000 people are in need of immediate assistance. Many of those in the worst state are too weak to walk and MSF has been moving deeper into the countryside to find vulnerable populations. In virtually every pocket of people MSF staff has come across, rapid assessments have shown extremely high numbers of severely malnourished.

The situation has also been present on both sides of the conflict. There are 35 Quartering and Family Areas (QFAs) where UNITA soldiers and their families have been asked to gather and receive assistance. Initially it was thought the armed forces would have been in a better state of health. By the end of May, over 210,000 soldiers and family members had gathered in the QFAs.

MSF had visited 12 of the sites, with a total population of 95,000 and rapid assessments showed levels of mortality and malnutrition that were alarming. The malnutrition crisis is overwhelming, enormous and widespread, affecting each and every area of the country and every sector of the population.

An MSF Head of Mission, Erwin van den Borght said in an interview in May "this will be the situation for the next six to twelve months". Prior to the cease fire, MSF was working in ten of the country's 18 provinces.

That situation remains the same today. However MSF is covering a larger percentage of the country and have been able to offer care to thousands more people. But as MSF extends its reach into the country, staff are finding expansion is confronted by three pressing realties. First, the overwhelming need throughout the country.

There appears to be not one area of the country where aid is not needed. People are suffering enormously high rates of malnutrition and mortality. As MSF workers expand their efforts and move deeper into the country, they quickly come across new pockets of people, most of whom are in need, many in severe conditions.

As aid reaches deeper, the situation has remained the same - urgent need is required. Second has been a destroyed infrastructure.

Roads are in a terrible state of neglect and disrepair. Most of the bridges were destroyed during the 27 years of conflict. Prior to the cease fire, transport was only possible by air, and that was restrictive due to safety of flight and available areas to land. Today, although the country is open, there is often no direct physical access to large parts of the country.

Third is the residue of the conflict. Many of the areas are heavily mined making movement into new regions difficult. MSF is continually doing exploratory missions into the country, looking for new population pockets and bringing immediate aid to the people. Over 180 expat staff and over 2,000 national staff members are active in the country.