Problems with Postwar

Reconstruction: A History of
Nutrition Intervention from the Civil
War to Post-Civil War in Angola
Daniella Nicole Mak
Licenciada em História, em Estudos Africanos e Estudos do Médio Oriente pela Universidade de Pennsylvania; Mestranda em His-
tória Moderna e Contemporânea no ISCTE (2010/2011). Bolseira da Comissão Fulbright e da FLAD/Torre do Tombo. Investigadora
visitante do ICS-UL

Resumo Abstract
Problemas com a Reconstrução pós-Conflito: uma
História sobre a Intervenção Alimentar desde a This article examines the problems with nutrition in-
Guerra Civil ao pós-Guerra Civil em Angola tervention by NGOs in Angola from the civil war until
the current era of peace. The author argues that during
Este artigo procura analisar os problemas da inter‑ wartime nutrition intervention, aid agencies in Angola
venção alimentar por parte das ONG em Angola often contributed to the civil war, whether intended or
desde a guerra civil até à presente era de paz. A unintended. During the post-conflict stage, problems
autora argumenta que com a intervenção de apoio with aid have persisted. It is discussed how part of this
alimentar em tempo de guerra, as agências de burden stems from the lack of long-term planning spe-
ajuda humanitária contribuíram, intencional ou cially concerning the transition phase from war to peace
inadvertidamente, para a guerra civil, notando with a decisive impact on the populations.
que durante a fase pós-conflito, os problemas com
a ajuda externa continuaram a persistir. É ainda
discutido o impacto que a falta de planeamento a
longo prazo tem na transição da guerra para a paz
em termos de apoio alimentar às populações.

2012
N.º 131 – 5.ª Série 125 Nação e Defesa
pp. 125-135
Daniella Nicole Mak

Independence and the Civil War: an Emerging Food Crisis

Angola gained independence from Portugal in 1975. However, a 27-year civil

war emerged until 2002 between different three nationalist movements, the MPLA,
UNITA and FNLA. Before the civil war began in 1975, soil conditions were fertile,
and Angola was relatively self-sufficient. However, the civil war destroyed the agri‑
cultural sector. Violations of the laws of war were committed on all sides, with ‘land
mines placed in foot paths to fields and sources of water…and capturing or killing
civilians who tended their fields’ (Human Rights Watch, 1989: 84). Soldiers used food
strangulation of towns to ‘attain self-sufficiency for…troops and civilian supporters’
(Ibid: 84). The UN declared that Angola was the worst place to be a child. Reports by
Médecins Sans Frontières (2002) estimated that one in six children were malnourished,
with mortality rates for children under five exceeding the emergency threshold by
2.5. Peace agreements were signed in 2002, yet malnutrition persisted.

During Wartime: Taking Aid from the Devil?

Problems with Humanitarian Aid during the Civil War

“To win our independence we should take aid, as they say, from the devil himself.”
Agostinho Neto, MPLA Revolutionary, First President of Angola

In 1984, development assistance was estimated at USD 33 million, and Angola

appealed for USD 100 million in food aid in the mid-1980s (Angola Foreign As‑
sistance, 1989). Beyond aid from governments, aid agencies stepped in during the
1980s. Major food aid agencies included CARE, World Vision, Africare, WFP, MSF,
and Catholic Relief Services (Ostheimer, 2000: 115). WFP strategies involved emer‑
gency food distribution, social feeding programs, and were designed to combat
acute malnutrition (WFP Office of Evaluation, 2006).
However, emergency food aid often became politicized, prolonging the conflict.
Political parties tended to adhere to aid access agreements only when it fit well with
their agenda. Consequently, with aid access agreements ‘unilaterally suspended for
months, proportional divisions of relief aid [were] between the conflicting parties
(regardless of de facto existing needs)…aid became much more an integral part of
the conflict dynamics and the war economy than constructive support for the peace
process’ (Ostheimer, 2000: 128). Food aid “was used as a modus vivendi of negoti‑

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 Problems with Postwar Reconstruction: A History of Nutrition Intervention
from the Civil War to Post-Civil War in Angola

ated access….counteracting the original intention of advancing the peace process”

(Ibid: 129). Some have speculated that the WFP was less passive in its distribution
of politicized emergency food, and argue that food aid was given to rebel groups as
an indirect means to counter Soviet influence. While it is difficult to discern whether
there was indeed a gap between the WFP’s stated intentions and actual interests,
food aid did impose negative ramifications, intended or unintended.
In an ironic manner, NGOs began to take ‘the Hippocratic principle primum non-
nocere – first do no harm’ in a bid to appear impartial (Ibid: 117). Yet, as Ostheimer
has aptly argued, this led to an interpretation such that there was holding back of
aid, with fear of disagreement upon ‘the basis of humanitarian assistance [rather than
addressing] current problems (above all politicization of humanitarian assistance) or
establish[ing] space for humanitarian assistance during complex emergencies’ (Ibid).
Emergency aid during this period also affected farming patterns in Angola. David
Sogge (1994) details how poor farmers, displaced people, and peri-urban dwellers
were pushed out of business. In the middle of the civil war, in 1999, statistics from
the UN Food and Agricultural Organization and WFP indicated that Angola’s self-
sufficiency ratio was below 50% (Ostheimer, 2000: 128). Moreover, in some cases, the
WFP blatantly rallied against appeals for long-term agricultural policies. Food aid
was seen as a tool to rid agricultural surpluses on the part of donor nations. In one
case, an NGO suggested WFP ‘buy up the Manioc crop as an incentive to farmers who
were returning so that this could support local cultivation. It was a local crop and this
would increase the price by boosting local productivity. This suggestion was turned
down [as] manioc was not produced in the U.S. or the EU’ (Campbell, 1997: 32).

Transition to Peacetime: the Politics of Post-Conflict Development

Problems with Development Aid during Peacetime

In Angola, NGO fieldworkers have put into practice an innovative strategy that
leverages community volunteers, known as the WHO Community Based Manage‑
ment of Acute Malnutrition (CMAM) to target Severe Acute Malnutrition (SAM)1.
Community volunteers screen children for suspected cases by measuring arm cir‑
cumference (Myatt et al. 2006). At-risk children are sent to feeding centers, and
given the therapeutic food package, Plumpynut.

1 The WHO defines Severe Acute Malnutrition (SAM) as weight-for-height measurement of 70%
or less below the median or 3SD or more below the mean National Center for Health Statistics
reference values, the presence of bilateral pitting edema of nutritional origin, or a mid-upper
arm circumference (MUAC) of less than 110 mm in children age 1-5 years.

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Daniella Nicole Mak

Sadly, one of the primary issues with the transition to post-conflict develop‑
ment is donor fatigue. Aid work requires funds, and this necessitates publicity.
Thus it ‘is in the interest of every aid agency to have as high a profile as possible’
(Ostheimer, 2000: 115) in order to secure project funding. However, with the sign‑
ing of peace accords in 2002, funding has decreased. Yet as Francesco Checchi, an
epidemiologist who has done fieldwork in Angola, proclaimed, ‘once the conflict
is over and the cameras are switched off, the suffering continues’ (Brown, 2003).
Although aid agencies flowed in during the civil war, there was little long-term
planning as to how to phase out to the development stage. Consequently, the pro‑
longed crisis has meant that it becomes ‘easier for donors to threaten or carry out
a total or near-total cut-off of aid even to countries undergoing severe conflict’
(Keen, 2007: 138). Lack of transitional planning led to insufficient capability to deal
with this abrupt aid cutback.
Originally, WFP and the Angolan Ministry of Health opened a series of thera‑
peutic and supplementary feeding centers to address the high levels of malnutri‑
tion (ReliefWeb, 2004). There were formerly 26 operating therapeutic feeding centers
and 50 supplementary feeding centers supported by WFP. However, WFP has since
pulled out. There has been a severe cutback in the number of operational therapeutic
feeding centers and supplementary feeding centers. Due to the reduction of WFP
activities, malnourished children no longer benefit from food supplements and the
government supplementary programs are not able to cover the needs of malnour‑
ished children. Most of malnutrition cases are left untreated in the communities. The
mortality rate in the feeding centers can be as high as 10 to 25%. Many children with
moderate malnutrition run the risk of approaching a stage of severe malnutrition.
These issues can be linked to a lack of planning for transitioning, or scaling up
processes from the emergency to development phase. Yet sustainability is important
to assess when evaluating post-conflict development programs. Connectedness is
also a linked aspect that refers to the need ‘to ensure that activities of a short-term
emergency nature are carried out in a context which takes longer-term and intercon‑
nected problems into account’ (Minear, 1994). As CMAM programs take place in a
wide variety of contexts, it is useful to consider these two criteria together.
Beyond this, it is interesting to observe the problems that inertia of past nutri‑
tion intervention programs during the emergency context has created for CMAM.
CMAM relies on community volunteers. However, during the emergency period
from 1975-2002, volunteers were recruited for NGO or donor-supported top-down
programs. Former community volunteers have become habituated to receiving
better volunteer incentives, such as soap, food, bicycles, and money. Consequently,
in the transition to the development context in Angola, less people are willing to
be volunteers to screen for malnutrition in their communities with the wristbands.
Community volunteers who are conditioned to monetary or tangible incentives

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 Problems with Postwar Reconstruction: A History of Nutrition Intervention
from the Civil War to Post-Civil War in Angola

repeatedly talked about what they “used to receive.” As local expectations of vol‑
unteers have risen, it becomes difficult to structure incentives.
Angola is also experiencing problems with food dependency as a result of the
emergency phase. Agricultural production is still low as the country has transitioned
to the development phase. However, better planning from the beginning could have
improved transitional planning and timing of emergency aid. As Aidan Egan from
Creative Associates remarked, ‘In Angola the emergency phase has been drawn out
for too long; it has caused increased dependency…WFP continues to plan to expand
its free food distribution in Angola to incorporate more of the UNITA areas, though
its free food policy is criticized forgoing on too long’ (Hammock and Lautze, 1997).
Specifically, with the current CMAM program, the therapeutic food, Plumpynut,
comes from a French company called Nutriset. Whilst special therapeutic food may
be needed to address time-sensitive medical needs, in the long run, agricultural poli‑
cies should also be evaluated to foster Angola’s previous self-sufficiency.

Traditional Aid vs the Empowerment Model

William Easterly’s critique in The White Man’s Burden (2006) presented bottom-
up aid as the way forward, in comparison to the traditional top-down “planner”
approach. His argument stressed that planners believe in revolutionary social
change, based on an Enlightenment ideal where the “Rest,” or Africa, is tabula
rasa to be remade. Without a historical, legal, political, institutional and cultural
context, the “West” can inscribe its own superior ideals.
Jim Goodman (2008) from The Hunger Project has stressed the difference be‑
tween traditional top-down service-delivery aid and what he called the bottom-up
empowerment model. According to Jim, in the traditional top-down paradigm, the
target group is beneficiaries whose basic needs must be met, and services are pro‑
vided through governments and charities. Donors are in charge that provide the
money and hold implementers to account. The main constraints (as only a technical
analysis of CMAM would reflect) involve bureaucracy, and inefficiency of the deliv‑
ery system. The role of government is to operate these service-delivery programs,
and social and cultural issues are seen as conditions to be compensated for. Con‑
versely, with the empowerment model, the target groups are hardworking, creative
individuals who lack opportunities and are actors in development. Instead of simple
service delivery, mobilization and empowerment of self-reliant action in solidarity
is stressed. Rather than money an expertise, local vision and entrepreneurship is
emphasized. Local agents and the leaders who they hold accountable are in charge,
not donors. Rather than bureaucratic technicalities as the main constraints, institu‑
tional, historical, political, economic, and social factors are considered. The role of

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government in this model is to decentralize resources and decision-making to the

local level, build local capacity, set standards, and protect rights.
Nutrition interventions during both the emergency phase and the development
phase in Angola have presented their own particular set of problems. In short, the
challenge in transitioning stage from war to peacetime is that ‘emergency assist‑
ance is usually externally driven, with a risk of being inappropriate and even fuel‑
ling conflict. In addition, very few donors commit to longer term development,
once the most acute phase of a crisis passes, and so root causes of conflict and crises
remain untouched’ (Alinovi et al, 2007: vii).

Root Causes of Severe Acute Malnutrition in Angola

By approaching severe acute malnutrition as a humanitarian issue in the post-

conflict development phase, the assumption was that it could be treated through
technical solutions. It is important to note that severe acute malnutrition does de‑
mand immediate medical attention. However, a two-pronged approach is needed.
Little planning was done alongside CMAM to complement this program and ad‑
dress the long-term root causes of severe acute malnutrition. This is emblematic of
a particular discourse present in the ‘complex relation between the intentionality
of planning and the strategic intelligibility of outcomes’ (Ferguson, 1990: 20).
A framework of causes of SAM is shown below by the UNICEF Conceptual
Framework (UNICEF, 1990).

Chart 1 – UNICEF conceptual framework on severe acute malnutrition

Malnutrition / Death Manifestations

Immediate
Inadequate Dietary Intake Disease Causes

Insufficient Inadequate Insufficient Health

Housefold Food Maternal / Child Care Services / Unhealthy Underlying
Environment Causes

Resources and Control:

Human, Economic and Organizational
Basic
Causes
Political and Ideological Superstructure

Economic Structure

Potential Resources

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 Problems with Postwar Reconstruction: A History of Nutrition Intervention
from the Civil War to Post-Civil War in Angola

When assessing connectedness of a CMAM program, it is essential to appraise

the design in relation to how it addresses immediate and underlying causes of
Severe Acute Malnutrition. In evaluating the technical flaws with the efficacy of
CMAM (e.g. staff turnover, data collection problems, distribution problems of
therapeutic food), my initial report did not address the root causes of SAM in its
entirety. There are a range of causes of malnutrition which can be separated into
different time phases:
• Immediate causes (e.g. inadequate food intake, diseases, war);
• Underlying causes (e.g. food insecurity, caring capacity and essential servi‑
ces);
• Structural causes (e.g. economy, political ideology and government policies,
institutions and patterns of resource allocation, nutrition-related interven‑
tions).
Intervention designs that aim to tackle immediate causes of malnutrition are typ‑
ically more short-term in impact. Intervention against underlying causes are more
medium-term in impact and focus on capacity building. Interventions related to
structural causes are long-term in impact and focus on empowerment of the popu‑
lation. During the civil war, aid agencies stepped in to deal with immediate and
underlying causes of malnutrition. CMAM is perhaps more appropriate in tackling
immediate causes of SAM. It is also apt as an intervention that is rapid in response.
However as Angola has moved from war to peacetime, aid agencies did not
complement their food programs with a set of policies that addresses underlying
and structural causes. Aid agencies must realize that they are no longer operat‑
ing in the emergency phase, and the same rules of the game do not apply to the
post-conflict development phase. Policies should aim to target long-term hunger,
caused by availability and access as opposed to temporary emergencies. Yet the
literature published by operating aid agencies often displaces malnutrition from
its complex web of causes. Severe Acute Malnutrition arises from a complexity
of factors and mandates a joint clinical and public health response (Collins et al,
2006) that frames issues in a wider discourse. Root causes, not symptoms must
be brought to the foreground. The following discusses some of the possible root
causes, but is by no means exhaustive.

Underlying Causes of Malnutrition

According to informal discussions with community members and health co‑

ordinators, it seems that malnutrition in Angola arises in part from poor feeding
and caring practices for children. In the long run, sustainability will thus imply
promoting nutrition education and agricultural production. Distance is often an

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Daniella Nicole Mak

impediment for people trying to access health post services. Access is also imped‑
ed by remaining land mines, which take time to be eliminated. Poor infrastructure,
with roads slowly being rebuilt is another constraint.

Structural Causes of Malnutrition

Damage done to the supply-side during the war only explains part of low ca‑
pacity. Agricultural insufficiency is also historical, and tied to the colonial state.
During Portuguese rule, there was an ‘exploitative system, extracting surpluses
under the whip of taxation, and through a well-calibrated flow of incentive goods
(cheap Portuguese wine), wage goods (textiles), and producer goods (oxen, carts)’
(Sogge, 1994: 94). The impact of the colonial legacy on weak agriculture has per‑
sisted to today, with an influx of Portuguese goods in supermarkets that are too
high to afford. This is to the extent that the capital, Luanda, was rated as the most
expensive city in 2011.
Institutional factors also are key: in ‘the post-independence era the state bu‑
reaucracy has remained ineffective with the exception of the petroleum sec‑
tor’ (Ostheimer, 2000: 120). This has led to de-linkage on a socio-economic level,
whereby the MPLA government has formed strong partnerships with foreign oil
companies by means of the state-owned oil company, Sonangol. As such, it has
funded its ‘military and economic projects almost entirely with oil revenues [and]
the Angolan government no longer needed to diversify its economy and boost the
productive capacity of its population’ (Ibid: 121).

Working Towards an Empowerment Model

Complementary food programs that encourage better feeding-caring practices

as well as an agricultural self-sufficiency would promote sustainability. With the
transition from war to peacetime, aid agencies also need to start planning how
to integrate their nutrition intervention programs into Angola’s national health
system. Therefore, a strong partnership should be forged with the state with dis‑
cussion on decentralization of service delivery to the local level, and protection of
rights and standards.
As Jim Goodman (2008) emphasized, Angolans need to be respected as individ‑
ual actors in the development process. Local voices on authoring their own story
must be placed at the center. As cited by Elbadawi, World Bank Development Eco‑
nomic Research Group lead economist, ‘aid can work if good policies are already
in place, but can’t stimulate good governance on its own’ (Elbadawi, 1999: 580).

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 Problems with Postwar Reconstruction: A History of Nutrition Intervention
from the Civil War to Post-Civil War in Angola

Conclusions

As Angola has shifted from war to peacetime, malnutrition has persisted. Yet
aid agencies continue to pursue malnutrition as a ‘technical problem’ to be engi‑
neered with solutions that treat only its short-term causes. However, this type of
discourse is not framed in the history of Angola’s nutrition problems and interven‑
tion. Doing so weaves a narrative of institutional, historical, political, economic,
and social factors that work together to explain why malnutrition still remains a
major problem. With complex emergencies that have persisted to peacetime, in‑
terventions must also seek to look at long-term determinants of food insecurity to
complement immediate causes.
Since the formation of the colonial state, Angola witnessed a fallback in agricul‑
tural self-sufficiency. During wartime, as aid agencies and the WFP stepped in, this
often fuelled the conflict, increased dependency, and pushed farmers out of busi‑
ness. Whilst some have criticized these aid agencies on the basis of their ethics for
getting involved with humanitarian agency in the first place, this article’s criticism
of their practices stems from the results of actions taken. When the media spotlight
was on the civil war in Angola, aid agencies quickly flooded in, but failed to fa‑
cilitate discussion about the long-term consequences of their involvement. When
aid agencies decide to become embroiled in humanitarian intervention, they have
already justified to themselves why they entered in the first place. However, they
should also hold themselves accountable to evaluating their actions after deciding
to enter.
Evidently, the case of Angola was complex, and there was not a lot of discus‑
sion in the aid agency sphere about how to modify practices from emergency situ‑
ations to peacetime. Reports concur that for ‘many working in humanitarian and
development fields…an increasing number of crises do not fall neatly into either
of these broad categories. This is particularly true for protracted crisis situations
where what were originally considered emergency situations continued over years
and even decades. Indeed, it soon became clear that there was a huge policy gap
and a lack of suitable frameworks to guide response and longer-term program‑
ming in these complex and volatile situations’ (Alinovi et al, 2008: vii). However,
this does not evade us of our responsibility to start thinking more critically about
these issues. Analysis of any policy problem, not only malnutrition, needs to be
contextualized within an analytical framework that examines the root causes.
Some would criticize any intervention at all on the part of aid agencies on the
basis of aforementioned challenges, which have arisen from war to peacetime.
Others have even stressed that these aid agencies are a form of neo-colonial en‑
slavement. Yet there are solutions that need not be overly cynical or fatalistic. Not
all foreign aid is inherently flawed or imperial.

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Daniella Nicole Mak

As the history of nutrition intervention in Angola has demonstrated, perhaps

the answer is simply continuing to be engaged in these types of debates, and to ac‑
knowledge that ‘only by understanding the complex political nature of protracted
crises will we get away from the blueprints, stop treating them as short-term emer‑
gencies, and actually begin to deal with the root causes and hold the key to reso‑
lution’ (Alinovi et al, 2008: viii-ix). Any approach to such problems must involve
civil society. A discussion of civil society will acknowledge that it is the responsibil‑
ity of foreign aid agencies to complement services rather than replace them, and to
preserve local respect and dignity.

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