Médecins Sans Frontières (MSF) would like to thank the Singapore Mission and members of the Security Council for the opportunity to inform you about the humanitarian situation in Angola. At this briefing, we hope to bring to your attention what we believe are the major humanitarian issues that require urgent consideration

MSF has been working in Angola since 1983. Our activities in this country represent one of our organization's largest operations and are supported by 80 international volunteers and 850 national personnel. MSF works in 10 of Angola's 18 provinces, running primary health care services in displaced camps, nutritional programs, supporting hospitals and other health structures, and running surgical, sleeping sickness and tuberculosis programs. MSF also provides assistance to Angolan refugees in neighboring Zambia and the Democratic Republic of Congo. Our medical presence alongside the Angolan population, many of whom are directly affected by the war, provides us with a clear understanding of the scale of the humanitarian crisis in Angola and its causes.

MSF would like to remind you that the need for humanitarian action in Angola today is not just a logical consequence of the ongoing war. The underlying causes for the medical and nutritional emergencies that MSF confronts in Angola stem from the systematic disrespect of international humanitarian law and the failure of the Angolan Government and UNITA to meet their responsibilities towards populations living in areas under their control.

Today, we would like to address two fundamental concerns that have led to disastrous medical and humanitarian consequences in Angola:

• The lack of access to vulnerable civilians; and
• The forced displacement of populations

Lack of Humanitarian Access

It is a fundamental principle of international humanitarian law that, in situations of armed conflict, civilians are entitled to receive humanitarian assistance according to their needs, and that access to neutral and impartial humanitarian organizations should be facilitated to this end.

Before the resumption of the war at the end of 1998, MSF provided humanitarian assistance to Angolans in both Government and UNITA controlled areas. While the Government presently claims to control over ninety percent of the country, the conditions necessary for the provision of humanitarian assistance exist in few parts of the country like provincial capitals or other main Government-held towns. Since early 1999, hundred of thousands of Angolan civilians live in areas deprived of humanitarian assistance. These are zones where control is contested and fluid, UNITA held territory, or inaccessible areas under Government control. These civilians' plight, until very recently, has been ignored by the international community despite the acute emergency situation they experience. MSF has over the past year collected substantial medical and nutritional data confirming the acute emergency situation of some of these populations who manage to reach our health structures:

• During 2001, for example, approximately 50,000 displaced persons (IDPs) arrived in Camacupa (Bie Province). Most of the people came from areas under Government control that were inaccessible to humanitarian organizations, and where no medical or social assistance was provided. Many arrived in a state where they needed to be urgently admitted for medical and nutritional treatment in MSF's programs.
• In Huila province, since October 2001, approximately 17,000 IDPs arrived in displaced sites in Matala from Chipindo and Chicomba. These are two municipalities that have been inaccessible to humanitarian organizations since 1998. In November 2001, mortality rates among these displaced exceeded emergency thresholds reaching between 2.9 and 6.3 deaths per day for every 10,000 persons (and between 7.6 and 17 deaths per 10.000 persons per day for the under 5 years population). High rates of global acute malnutrition were recorded in February 2002 in these sites, reaching 19% among new arrivals.

There are several reasons why populations such as these have not benefited from the assistance of MSF and other humanitarian organizations since the resumption of the war in 1998. Increased insecurity and the changes in the type of warfare have certainly been a significant impediment. Another major factor, however, has been the politicization of access in the form of an unwillingness by the Angolan Government to facilitate it, and the lack of will by UNITA to make the presence of humanitarian organizations possible in areas where it operates. In addition, while it has been difficult to identify credible UNITA interlocutors, compliance with UN sanctions should not have affected the negotiation of access for humanitarian organizations. A major obstacle over the past years has been the lack of political will by all parties, including the Security Council, to actively support negotiated access to these populations.

From our experience and current field perspective, MSF believes that access can be substantially increased only with the consent of all parties to the conflict and not through militarized corridors. As a first and immediate step, MSF favors the negotiation of humanitarian access to specific locations throughout Angola, where acute humanitarian emergencies are ongoing or suspected .

Forced Displacement of Populations

The intentional and forced displacement of populations by UNITA and the Government of Angola, in furtherance of their military strategies, is taking place in many locations throughout the country.

UNITA has over the past years forced civilian populations to move with its troops in order to maintain a human and material support. This policy has been further expanded since the end of 1999, when UNITA increasingly lost control over territories and had to become more mobile, particularly in Moxico, Huambo and Bie provinces. Civilian populations remain continuously displaced under insecure conditions and with no access to healthcare or sufficient food. Gradually their health and nutritional situation deteriorates to the point where many, including adults, become severely malnourished. Patients arriving in our health centers have also reported alarming levels of mortality among the populations under UNITA control. Humanitarian organizations have absolutely no access to them.

In large parts of the country, Government forces have moved populations to isolate UNITA, cutting it off from the rural population which supplies it with food, labor, and potential recruits. In 2001, a large proportion of newly registered IDPs were displaced as a result of this increasingly widespread Government strategy, with dramatic consequences on the people's health and nutritional status. Families are obliged to find shelter in displaced sites where overcrowding, an absence of medical care, and a lack of food has led to the outbreak of epidemics and other major health problems. Many of these IDPs are concentrated and kept in locations where international humanitarian organizations cannot be present. In addition, Government authorities rarely provide any food assistance or health care following the displacement. Displaced populations no longer have access to their villages or fields to cultivate food. In most cases, these populations are only authorized to leave these locations once they have become seriously ill or severely malnourished, and then become dependant on international organizations.

• A large proportion of the 50,000 people who arrived in Camacupa (Bie Province) last year were displaced as a direct result of the Government's strategy. Many patients recounted how villages and houses were burned by Government forces to compel them to leave. A survey conducted in Camacupa's IDP camps indicates that mortality rates have reached emergency levels. Under five and crude mortality rates were recorded at 4.8 deaths per 10,000 children per day and 2.9 deaths per 10,000 persons per day, respectively. The results of a nutrition survey conducted in the same camps indicate severe and global malnutrition rates of 1.6 and 13.3 percent, respectively. Malnutrition levels were found to be highest among IDPs who have arrived since mid December 2001.
• In Huila Province, the level of displacement of populations in the north-eastern part of the province increased considerably during the second half of 2001 and continues today. According to IDP accounts, people are forced to leave their villages and are escorted on foot by Government armed forces to towns such as Caconda, Chipindo, Cuvango and Matala.
• Since the second half of 2001, in Moxico and Cuando-Cubango provinces, large numbers of people have been brought by Government army helicopters and trucks to Luena and Menongue. Although some of these people are in search of security and assistance in the provincial capitals, many patients in MSF programs explained how they were forced to leave their villages. In Luena, the admissions in the therapeutic feeding centers have increased considerably during the last two months.

Forced displacement justified under international law by "imperative military reasons" only applies to specific locations, a limited time and with the condition that assistance and security be provided to these populations by the authorities. The widespread and systematic forced displacement occurring in Angola and the failure to assure proper conditions for IDPs is responsible for devastating the health and nutritional status of large civilian populations.

Conclusion

While the Security Council has recently been briefed on the general mortality and nutritional indicators and the desperate plight of Angolan civilians, two critical factors contributing to this situation have not been raised. The first is the restricted access of international humanitarian assistance to people in need, and the second is the widespread forced displacement of civilian populations. Together, they are responsible for an unacceptable and largely preventable toll on the Angolan population. The parties at war, with the support of the international community should take whatever steps are necessary to negotiate, improve and secure humanitarian access, and to respect the right of populations in need to receive humanitarian assistance. Forced displacement of populations occurring throughout the country is a violation of international humanitarian law and should be halted immediately.