Mortality surveys in conflict and post conflict Angola Sibylle Gerstl, Harold Noël, Vincent Brown Epicentre, Paris, France

History end of colonialism civil war April 6: cease-fire agreement signed great potential for development (oil, diamonds)

Consequences of the war civil war  people killed  Thousands of people internally displaced  Resettlement areas  Landmines  Ranked 161/177 on the Human Development Index cease-fire agreement

MSF in Angola MSF in Angola 1982

MSF in Angola surveys Epicentre/MSF

surveys Epicentre/MSF Surveys Epicentre / MSF in Angola during civil war in resettlement areas just after the war 1 in rural area post - war

Democratic Republic of the Congo Zambia Namibia ANGOLA Geographical distribution of surveys Malanje (2000) During civil war Kuito (2000) Cubal (1999) After the war Camacupa (2002) Bailundo (2002) Bunjei (2002) Bie (2002) Mavinga (2002) Xa-Muteba (2006) Post - war

Survey methodology  Two-stage cluster sampling  30 clusters x 30 households  Standardized questionnaire  Recall period 2 – 14 months  CMR (crude mortality rate)  U5MR (under five mortality rate)  Reported causes of death

Deaths / / day CMR U5MR during civil war just after war post - war

just after war Main causes of death ViolenceMalnutritionInfectious diseases during civil war [%]

A closer look at the post-war survey Xa-Muteba, 2006  85.4% (41/48) died at home  10 deaths were ≤ 1 month (10/48)  Fever / Malaria leading cause of death  Total: 37.5% (18/48)  < 5 years: 51.6% (16/31)  MSF will close Xa-Muteba, July 2007

Discussion The health emergency continues even after war and displacement subside  CMR and U5MR remain unacceptably high  Typical pattern of infectious diseases Did these surveys have an impact for the health of these populations? How do we use mortality surveys to focus attention on post-war health crises? Do we really even understand post-war health crises? WHAT NOW?