Owing to the renewed conflict, malnutrition is widespread once again and MSF is focusing on providing nutritional assistance to resident and displaced populations in many provinces.

MSF is running feeding programmes in several Angolan cities which were cut off during the worst of the fighting in 1999 and where food shortages have lead to serious health problems. These became evident when aid agencies' access improved in the autumn of 1999.

There is currently 16% global malnutrition among the displaced in Kuito, Bie province. MSF teams are providing assistance to 5,000 patients in the supplementary feeding centre and 500 in the therapeutic feeding centre for severe cases of malnutrition.

All aid has to be flown in to this enclave which has a population of 250,000, half of whom are displaced. MSF is concerned by the increasing numbers of older children and adults presenting signs of malnutrition. This is the result of long-term food shortages. It is much more difficult to treat adults with malnutrition than children. Moreover, there are more than 700 cases of pellagra (an illness brought on by a lack of vitamin B) in Kuito.

MSF already came across this when working with Mozambican refugees in Malawi several years ago. Vitamin supplements are being distributed by MSF to the population and MSF has been lobbying the World Food Programme (WFP) to include corn soya blend (CSB) or groundnuts in the general food distributions.

MSF teams also work in Kuito Hospital and are about to launch a health and sanitation assistance programme in the sites for the displaced. In Luena in Moxico province, the nutritional situation is similar but not quite as serious. Here MSF runs therapeutic and supplementary feeding centres for about a thousand patients at a time.

An MSF team supports the hospital and three health posts. In Caala, Huambo province, there are currently 4,000 patients in MSF's supplementary feeding centre and 350 in the therapeutic feeding centre. MSF teams also support the hospital and health centres.

In Huambo town, MSF runs another feeding programme. There are currently 500 patients in the supplementary feeding centre and 200 in the therapeutic feeding centre. Both displaced populations and residents receive food rations.

However, in Caala, the displaced are receiving food rations but distributions have not begun for residents. The ICRC will carry out a census with a view to rectifying this. MSF works in the displaced camps in Matala, Huila province.

There are 10,000 newly displaced people according to a December 1999 mapping exercise. MSF teams provide health care, a referral service and some water and sanitation assistance.

This is foreseen six for months. MSF also intends to launch a programme in the paediatric hospital in the near future. A team will arrive this month to carry out the second diagnosis. In Quilengues, there is now a full-time MSF presence in the municipal health centre.

MSF is beginning an emergency nutritional programme in Uige city as well as assistance to existing nutritional activities in the city of Negage, also in Uige province. MSF is also planning to provide assistance to the displaced in Negage as some 6,000 are known to be camping out in a warehouses.

In Malange, MSF runs eight therapeutic feeding centres. The organisation Concern is taking care of supplementary feeding. Adult malnutrition is also prevalent here. There are a great deal of newly displaced people and MSF is not sure why they have been displaced and how many more can be expected. The programme in M'Banza Congo Hospital continues to run thanks to MSF's local staff.

MSF is exploring the possibility of working in other parts of the province. MSF continues to run the trypanosomiasis (sleeping sickness) project in N'Dalatando, Kwanza Norte province, which started up in 1994. There are two treatment centres for inpatients and outpatients. Screening is a very important part of the programme.

However, access to medicine is problematic. MSF treats 50 patients at a time over a period of several weeks. MSF believes that the 5% mortality rate is a consequence of the arsenic in the current medication and is pushing for more research into new treatments.

MSF is currently running an international drug campaign to draw attention to the need for more access to life-saving medicine. MSF is also calling for research to be carried out into finding new medicines for tropical diseases such as trypanosomiasis. Teams also run a primary health care programme in Bibala and Camacuio in Namibe province.

Although, the Bibala programme will come to an end this year, teams are planning to reinforce their presence in Camacuio where assistance will be provided to 6,000 displaced.

Plans are also afoot to work in the paediatric clinic in Namibe province. A new programme to assist the urban displaced will also be launched in Menongué in the province of Cuando Cubango.