1. Mortality surveys in conflict and post conflict Angola 1990 - 2006 1990 - 2006 Sibylle Gerstl, Harold Noël, Vincent Brown Epicentre, Paris, France

2. History 1974 20022006 1975 end of colonialism civil war April 6: cease-fire agreement signed great potential for development (oil, diamonds)

3. Consequences of the war 20022006 1975 civil war  500 000 people killed  Thousands of people internally displaced  Resettlement areas  Landmines  Ranked 161/177 on the Human Development Index cease-fire agreement

4. MSF in Angola 200220061975 MSF in Angola 1982

5. 20021975 1982 MSF in Angola 20061990 9 surveys Epicentre/MSF

6. 20061990 9 surveys Epicentre/MSF Surveys Epicentre / MSF in Angola 2000 3 during civil war 2002 5 in resettlement areas just after the war 1 in rural area post - war

7. 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

8. 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

9. Deaths / 10 000 / day 1 2 3 4 7 8 9 10 CMR U5MR during civil war just after war post - war

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

11. 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

12. 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?