WORLD HEALTH ORGANIZATION ORGANISATION MONDIALE DE LA SANTE AFRICA REGION REGION DE L'AFRIQUE WORLD HEALTH ORGANIZATION MISSION SUMMARY REPORT ANGOLA Theme: Moxico Inter UN Agency Mission. To evaluate the Submitted by: Dr.Arturo Silva-Emergency and Humanitarian Emergency Humanitarian situation Action – WHO -Angola Places visited: Cazombo, Lumbala Nguimbo and Luau From: 29/01/03 to: 31/01/03 Municipalities in Moxico Province. Participants: Lise Grande (OCHA), Victor Lara (UNICEF), Lucía Teoli (UNHCR), Alice Otiato (AHA), Fasil Tesera (MSF), Fernando del Castillo (CDC-Atlanta), Marques Dos Santos (UTCAH), Fernanda Guimaraes UN.HR and Arturo Silva (WHO) General Mission Objectives: Methodology: Personal interviews with the health authorities, - Assess the conditions of ex-combatants and their health workers, affected and vulnerable populations, Municipal family members living in abandoned buildings. Administrators and the Governor of Moxico. - Assess the conditions of IDPs families and returning refugees. - Confirm the status of the transit centers and new houses - Confirm the Government plans for resettlement and return. - Confirm the refugees’ areas of origin. - Assess condition in Calala gathering area Specific WHO objectives: - Assess the health conditions of the population in the three municipalities, mainly returning refugees, ex- combatants and their families and IDPs. - Evaluate the situation of the WHO programs and projects in the fields. - CDC-Atlanta and WHO-EHA Angola evaluate the health situation, infrastructures, security and the logistics needs to perform the study “Rapid assessment of HIV/AIDS Behavioral and HIV/AIDS and STI prevalence in the provinces of Moxico and Kuando Kubango Conclusions on HIV/AIDS/STIs (CDC-WHO): We found common problems in the three visited municipalities, they are: - No possibility of HIV Test - No condoms distribution - No information or education activities on STI or HIV/AIDS prevention. - There is certain preconception on the sero-status of the refugees coming from Zambia or Congo, between the authorities interviewed. - The medical services do not report cases of AIDS, not only because of the lack of test, nor based on clinical signs (this apply mainly to Luau, where the MSF doctor, with experience in other African countries where AIDS cases are common. The other health centers visited do not had medical doctors. In Cazombo the hospital was not yet finished and had not inpatients. ____________________________________________________________________________________ Rua Major Kanhangulo, 197 – 3° Andar, C.P. 3243 Luanda / E-mail <[email protected]> General Conclusions: Cazombo: is the main town of alto Zambeze, bordering with DRC and Zambia. A quite relevant number of refugees from both countries are expected to return to Cazombo in 2003. The deputy Administrator Mr. Francisco Chiwende is in charge of social affairs. Cazombo town is only accessible by plane. The road is considerable mined and its has many broken bridges. The main logistical constraint is considered the broken bridge at the river Zambeze. Cazombo has 6 communes and the all municipality has got one functional hospital in the process of reconstruction by the NGO AHA that is working in the area. The Medical Doctor from AHA is responsible for the Hospital services. The main problems in the hospital are: lack of essential drugs supplies, lack of laboratory for basis diagnosis, lack of maternity services, lack of trained health personnel, lack of development of HIV/AIDS, TB, Malaria, Lepra and Epidemiological Surveillance Programs. Lack of trained health personnel and lack of reintegration of ex- UNITA health personnel in the Hospital. Lack of Health post or centers in communes. Health NGOs present in the field: AHA and MSF-B is planning to work there. LWF working in the reconstruction and logistic. UNHCR is in the process of returning registration. In Calala gathering area remain to evacuate 2893 ex-combatants and their families, the evacuation process is stopped at the present and the health situation is very poor, the main diseases are: Malaria, Malnutrition (mainly under 5), intestinal parasitosis, scabies, ARI and ADD. There are 7 health untrained (basic technical) ex-UNITA in the area. 609 ex-combatants and their families are in the school at the present in very poor health conditions. In 1992 the population was estimated at 299.000 inhabitants, at the present is estimated in 36,000. Big problem is the refugee population returned with out identification papers because they are not included Lumbala Nguimbo: is one of the main expected areas of return Angolan refugees currently in Zambia. The Municipality is one the more destroyed and inaccessible of the Moxico Province. It is divided in 6 communes and more than 50 “barrios”. It is only accessible by air. Most of the population is returnees from Zambia or IDP who survived in the bush during the conflict. The estimated population was estimated at 89,000. At the end of 2002 the population was around 12,000; according to surveys conducted between the refugee populations the figures could return easily to the former figures. Approximately 150-200 families are arriving every week and currently up to 93 % of these are returning refugees. The administration was re-established in January 2002 and Mr.Fernando Kanyanga is the head of Administration. Most of the people depend on the river as their main source of water. Only an estimated 14 % of the population collect water from reliable water sources or protected springs. Only 16 % of families in Lumbala Nguimbo town have simple latrines with no covers, while in other rural barrios there are virtually no latrines. No hygiene education between the populations. There is only one functioning health center. People from rural barrios should walk for days to obtain health care. No medical equipment is available.. No diagnosis, not enough essential drugs, NO IMMUNIZATION available at the present, No Epidemiological surveillance as a consequence no data on morbidity and mortality are available but the most numerous cases of death are due to malaria, diarrhea, respiratory infections, malnutrition and STIs. MEDAIR NGO is involved in Health activities in the area. UNHCR is in the registration process of the returning populations. The estimated population in town is 5410 Refugees and 1787 IDPs. One of the main problems is the refugees returning population with out identification card/papers because they are not in the list of humanitarian food, seeds & tools and NFIs assistance and they are more than 60 % of that population. Luau: is located at the distance of 310 km from Luena and it is situated on the border with DRC. The population before the war was estimated at 90,000, most of them fled in DRC and a small part moved to Luena. Relevant movement of returning refugees and IDPs as well as of UNITA former combatants is still ongoing. Food and shelter remain the most urgent needs after seeds and access to health services mainly in the communes. The operational water supply in Luau was connected to the river Cachibango. Four public shallow wells. The population is using the functioning wells for washing and the drinking water is collected from the small rivers around. The main problem is the refugees that are returning before planed return from UNHCR, and more than 60 % are returning without any identification. In all the Municipal area is only one functioning hospital supervised by MSF-B, and 18- health post completely abandoned. In health this is the main problem because all the rural population have to walk long distances to obtain health services. There aren’t developments of HIV/AIDS, TB, Lepra, Malaria and epidemiological surveillance programs or projects in the area. Malnutrition is a big problem especially in 300 refugees returned from DCR in December 02 located in the Rail Station without any humanitarian support. We visited the resettlement area “Barrio Progreso” with 187 families of ex- combatants coming from Calala. They received not enough resettlement kits and they have not health post and school. LWF is UNHCR implementing partner for water and sanitation, registration of returnees, distribution of food and non-food items, seeds and tools, and rehabilitation of education structure. MSF-B is in charge of the hospital and they are planning to open 1 health post near of the border. ____________________________________________________________________________________ Rua Major Kanhangulo, 197 – 3° Andar, C.P. 3243 Luanda / E-mail <[email protected]> Suggestions: - Provide two NEHK-98 (WHO) for Cazombo (to AHA NGO) and Luau Hospital (to MSF-B). - Provide ten Health Center Kits (MoH-UNICEF) for Lumbala Nguimbo (to MEDAIR NGO). - Contact AHA, MSF-B and MEDAIR to implement prevention program activities on HIV/AIDS/STIs and condoms & peer education distribution in the three referred populations. - Start planning the implementation of the Behavioral Survey between WHO-CDC, mainly with the three NGOs involved in the areas. - Contact UNHCR to advice the serious problem of the returning from Zambia and DRC with any registration papers. - Contact PAV and POLIO Program responsible (MoH-WHO) to urgently reinforce the Routine Vaccination in the three areas. - Implement the Epidemiological Surveillance in the 3 municipalities. Mainly in Measles, Polio, Malaria, TB and HIV. - Achieve the mentioned areas through the implementation of activities from Emergency Malaria Program in prevention, diagnosis and treatment of Malaria. - Contact and advice the Human resources Program (MoH-WHO) to train health personnel in the three areas included the reintegration of the ex-UNITA health personnel. - Include the three areas in the planning implementation of the EU-WHO project through the provision of the MH&NCP activities. Contact MEDAIR, AHA and MSF-B to implement these activities. Specific suggestions on HIV/AIDS/STIs (CDC-WHO): - Establishing Voluntary Counseling Test (VCT) in each Municipality where the Refugees are going to be concentrated for the transit period. - In those Municipalities outreach work should be done with the returned refugees from Zambia and DRC, while in the transit centers.