Luanda, 7 April 2009 -- In the past three years, Angola has witnessed a sharp decrease in rainfall as a result of climate change at the global level. During the rainy season last year, 16 of the 18 Provinces of Angola were affected by floods. Consequently, 23 407 families had no shelter and 11 401 houses and 23 facilities including health centres and hospitals were destroyed. 
The main victims of the disasters were the inhabitants of the poorest suburbs already characterized by high prevalence of diseases like malaria, cholera, diarrhea, acute respiratory diseases and food shortages.
Rainfall is obviously a risk factor for the health of these people whose access to health facilities has been further hampered by rain-induced floods with attendant worsening of their health status.

Comprehensive data on the cholera epidemic that has been rife in Angola since 2006 show that cholera cases have increased by 50%, peaking epidemiologically in the months of February and March 2007 and 2008 which are within the rainy season. Furthermore, under-five morbidity and mortality mainly from the burden of diarrhoeal diseases and acute respiratory diseases (70% of all causes), and malnutrition (29.2%), tend to worsen significantly during the rainy period.

In 2008, with 60% of its health facilities destroyed during the 1975-2002 war, a defective health information system and only 30%-40% of the population receiving health coverage, Angola had to mobilize human and material resources to rescue 50 346 displaced people and prevent the flooding from turning into a public health tragedy.

In Luanda, the country's capital, cholera cases increased from 79 in December 2007 to 370 by January-March 2008 due to torrential rains.

In the Northern Province of Uige, close to the DRC border, seven health posts and 22 schools were destroyed by torrential rains while 8410 people were displaced.

In the Cunene Province next to the Namibia border, the toll was higher: 26 915 people were displaced and 5383 houses were destroyed. In this Province, lack of health facilities and staff qualified to provide care for the populations in the border areas is such that the inhabitants usually leave for the neighbouring country in search of better health services. This situation is worsened by poor sanitation, shortage of drinking water and lack of insecticide-treated nets, resulting in an increase in the prevalence of cholera, acute respiratory and diarrhoeal diseases and malaria.

In the Kuando Kubango Province which has a lower population density and the greatest constraints in terms of accessibility, an assessment by WHO, UNICEF and IOM shows an overall toll of 29 162 people displaced and 16 facilities destroyed including a hospital in the Mavinga Municipality.

The records of the provincial directorate of health of Moxico in Eastern Angola show an increase in malaria cases by 10.7%, acute respiratory infections by 11.3% and acute diarrhoeal diseases by 26.1% during the floods in January 2009 compared to the month of December 2008.

Leonor Jose, social mobilization officer in Luena, Capital of Moxico, says: "bednets are being distributed to the population and door-to-door interpersonal communication campaigns for treatment of drinking water are being conducted in order to prevent diarrhoeal diseases". Mrs Arminda Kassueka, also from Luena, and an inhabitant of the Mandembue suburb, is one of the 15 965 people displaced. The 30-year old mother of six had to seek refuge in the house of neighbours, searching for help as a result of the flooding.

Multisectoral coordination and response to these challenges including the fielding of mobile teams and the conduct of community information and mobilization campaigns have helped to reduce drastically the prevalence of diseases among the disaster victims. In the Benguela Province, churches helped to sensitize the disaster victims to the increase in cases of malaria and diarrhoeal diseases during the floods which affected 3000 people while the civil defence agency organized groups to improve basic sanitation in partnership with community services.

Arcanjo Junior, an Angolan civil defence service officer says "the painful experience of the past has helped to strengthen national capacity in needs assessment and emergency and disaster management and control".

The civil defence budget estimates for the 2008-2009 rainy season indicate that, by the end of April, the Government of Angola would need over US$ 12 million (equivalent to 814.5 million Kwanzas) worth of medical equipment and supplies including saline solution, overcoats, stretchers, biosafety coats, hospital tents and medicines for flood victims.

According to data from the Angola national civil defence service, in January and February 2009, a total of 22 545 people had no shelter as a consequence of torrential rains in only 8 provinces. Should trends in previous years continue, more than 70 000 people nationwide will be without shelter, and will be thus exposed to malaria, malnutrition, diarrhoeal diseases, respiratory diseases, cholera and HIV/AIDS.

The Government has drawn up a people re-housing plan under which 1 million safer houses will be built countrywide at a pace of 70 000 houses per annum in addition to refurbishing peripheral health units. Free distribution of tents, bednets and drinking water in delivery tankers, with the involvement of municipal authorities and community groups are some of the activities already undertaken to address the impact of this year's floods.

In order to support this effort, the United Nations Central Emergency Fund (CERF) has provided US$ 1.4 million to Angola through WHO, UNICEF and IOM. With this donation distributed among the three agencies, WHO supported capacity building for 112 health professionals in timely case detection, notification and management during emergencies; needs assessment in risk areas; strengthening of epidemiological surveillance teams; strengthening of national capacity in drinking water supply and sanitation; and strengthening of health promotion campaigns including the production of a musical CD containing six songs on prevention of cholera, HIV/AIDS and malaria.

In this regard, the WHO Representative in Angola, Dr Nsue Milang has said "the country is taking effective action to improve the quality of support and rehabilitate health infrastructure as part of the strategy to revitalize district health services based on Primary Health Care. The objective is to protect the vulnerable populations, implement policies and strategies for improving health services and use environmentally-sound technologies". To that end, he added, "WHO interventions will focus on strengthening the national epidemiological surveillance system; strengthening diagnostic and treatment capacity; establishing integrated and multidisciplinary emergency teams in each province; providing an accessible minimum package of services in health units; and strengthening monitoring and evaluation".