Issue 19 - Article 9

Beyond the classic humanitarian response: MSF's advocacy in Angola

June 3, 2003
Marc Dubois
9 min read

As the humanitarian community becomes more sophisticated in its approaches to delivering aid in protracted crises, it simultaneously grows more aware of the pitfalls of operating in such a context. One way to help offset these negative consequences is to bear witness to people’s suffering, and use our presence in the field to advocate for change.

The war in Angola pits the MPLA government, once the ally of the Soviet Union and Cuba and now the oil-rich friend of the West, against the increasingly marginalised UNITA under Jonas Savimbi, the one-time ally of the US and apartheid South Africa, now an international pariah and the object of far-ranging UN sanctions. After a few years of relative calm, the war restarted with a vengeance in late 1998. Since then, the government has reduced UNITA to a guerrilla force capable of doing much harm, but no longer of seizing power. With its new-found military advantage, the government is talking of normalisation, presenting a façade of control to the international community and focusing on prosperous business links.

Behind this ‘normalisation’, both government and (especially) UNITA forces have been responsible for an increasingly bloody disregard for inter-national humanitarian and human-rights law. The distinction between combatants and non-combatants has been obliterated, with civilians punished for perceived support to the other side. Whole populations are manipulated by violence, or abandoned without assistance or protection. Out of a total population of 12 million, a million have died and 3.8m been displaced, 2.8m of them since the most recent fighting began in 1998. A million Angolans depend on food assistance, yet peasant farmers are forced into crowded urban centres while fields lie fallow. According to UNICEF, Angola is the second worst place on Earth (after Sierra Leone) in which to be a child, with an under-five mortality rate of 295 per 1,000.

A rich country poor people

A frustrating presence

MSF has worked in Angola since 1983, with all five operational sections (Belgium, France, Holland, Spain and Switzerland) present since 1993. We have roughly 80 expatriates on the ground, and are working in nine different provinces. Like the rest of the humanitarian community, our operations represent an enormous investment in Angola. But in broader terms, despite the huge effort, conditions over the past two and a half years have been worse than at any time in the past.

In such a context, hard questions arise: what are we doing in Angola? Will we continue to provide assistance, no matter how long the war marches on? These concerns return us to the difficulties faced by humanitarian organisations operating in a protracted crisis, as discussed in Humanitarian Exchange 18. How does aid contribute to the conflict? What role does it play in an entrenched war economy, where violence is accepted as fated or normal, and apathy, both domestic and foreign, greets the piles of dead? In such situations, there is a greater need for humanitarian agencies to deliver assistance and take measures to address this entrenched cycle of disregard for international humanitarian law. Humanitarian Exchange also asked whether relief agencies need to break free of the classic humanitarian response mould in order to address needs in the grey zone, between emer-gency and development. For MSF, bearing witness has long been one possible solution, and should be considered a complementary and under-explored addition to the classic model of aid delivery.

MSF’s Angola analysis

MSF advocacy efforts emanate from our presence in the field, and are hence inextricably linked to our medical programmes. In Angola, it would be more accurate to say that our message was forced upon us by the situation; it grew out of our diverse efforts to bear witness to the terrible suffering, and articulate an analysis of it. What did MSF want to say? What could MSF show? After studying the situation as witnessed by our project teams and talking individually to hundreds of IDPs, certain core issues emerged.

16 year old

  • For most Angolans, healthcare is unavailable. The government has neglected the people’s right to adequate health services, and has failed to use the resources at its disposal to better the health of Angolans; UNITA no longer provides healthcare of any kind to civilians in areas under its control.
  • Forced displacement is used as a strategy of war. Whole populations are abducted, as people are important commodities in the creation and maintenance of a military force; others flee violence and abuse in the mata (the bush).
  • The humanitarian community lacks access to populations in danger. Insecurity, landmines and the threat of attack by armed parties or groups, along with a lack of infrastructure (airstrips, fuel and roads), impede or prohibit humanitarian operations. Assistance is restricted to provincial capitals, a few large towns and the narrow security perimeters surrounding them. In Malange, for instance, our project team has access to only about four per cent of the province.
  • • Lack of respect for international humanitarian law is extensive. The government and UNITA have engaged in systematic and widespread violations of humanitarian and human-rights law. Millions of Angolans have been stripped of their human dignity, and many are victims of murder, torture, abduction, rape, pillage and other abuse.

MSF’s strategy

The basic advocacy strategy that evolved was to bear witness on these four points (rather than spreading the message too thinly by addressing other issues) – to show the real Angola, as confronted by our teams in the field. On 9 November 2000, in a series of press conferences, MSF issued a press release and published its report, Angola: Behind the Façade of ‘Normalization’ – Manipulation, Violence, and Abandoned Populations. This report tracks the aforementioned issues and delivers, to the best of our ability, the view from the ground, using medical data, such as war-related surgical rates and nutritional statistics, and direct testimonies from IDPs. Our network of partner sections was critical in getting the word out as widely as possible.

The link between the report’s message and field operations cannot be overstated. It would have been much easier to produce a typical report: research from afar, coupled with facts culled during a three-week field visit. In this report, the various projects in-country spent months trying to collate and analyse data from 2000 and before, so that MSF could show the specific effects of this war. For instance, it was clear that access was restricted, but what did that mean? To help quantify this, we used medical data: MSF supported 14 health structures in five districts of Malange province, which in 1997 represented 152,408 consultations for a population estimated at 200,000 people. Since the resumption of the war, total consultations in these districts equal zero.

A successful debut

In Luanda, nobody knew what to expect from the government. A public document of this nature – neutral in its approach but nonetheless very critical of the government and UNITA – could have provoked a negative reaction against MSF, impaired our operations or possibly led to expulsion. The only official reaction from the government was a letter from a minister cautioning that MSF should be more careful when characterising the actions of the government. In the international community, many colleagues praised MSF’s action, not necessarily for the message delivered, but for the act of speaking out itself. There seems to be a general feeling that something had to be said.

It is rarely possible to measure the impact of advocacy. The report certainly stirred debate, and helped bring certain issues to the fore, such as the imperative need for greater access and for the UN to take concrete steps towards establishing IDP protection mechanisms at the provincial level. The UN in particular realised that there was a collective vacuum when it came to the obvious task of talking with people, and is now integrating systematic inter-viewing into its programmes. There also appears to be more pressure on the Angolan government to improve its healthcare performance, and there has been some movement in this direction.

Within MSF itself, the process strengthened the teams’ sense of purpose and awareness of the underlying causes of the situation. Finally, while many did not agree with MSF’s analysis (i.e., the politics of normalisation), all seemed moved by our depiction of reality. In particular, the many IDP testimonies included in the report possessed an undeniable power.

Conclusion and lessons learnt

The first lesson of the MSF experience is that project-up, rather than headquarters-down, advocacy carries risks. There is a delicate balance to be struck between using data/information from the field and safeguarding the security of beneficiaries and staff, and the continued presence of the project itself. Organisations should not engage in advocacy unless they understand how to do so without jeopardising the safety of beneficiaries or staff. However, project-up advocacy carries the authority of the organisation speaking to its accepted core area of work, as opposed to tangential analyses or research. Moreover, denouncing a situation itself is often not as much the problem as the tone in which it is done.

Second, to minimise any potential backlash and to generate momentum behind the message, MSF’s country managers in Luanda met beforehand with key members of the diplomatic community, the UN and the government (partner ministries and provincial governors) in order to present the report. They also held a joint meeting with all national staff, and fully briefed all the teams in the field. This transparency was seen as vital to preventing a hostile reaction, and ensured that the report was supported and understood by the entire organisation in Angola.

The publication of the report had unforeseen benefits. First, our public advocacy contributed to the opening up of space more generally for critical public opinion. Second, Angolans were able to use our report to push for better healthcare themselves – it is much less dangerous for them to reiterate the opinion of others (for example, that MSF states that the government has neglected healthcare) than to advance such an opinion as their own.

Marc DuBois is a Humanitarian Affairs Advisor at MSF-Holland. He has recently returned from an 11-month mission in Angola.


Angola: Behind the Façade of ‘Normalization’ – Manipulation, Violence, and Abandoned Populations is available on the MSF website www.msf.orgunder the Angola country section

Angola Unravels: The Rise and Fall of the Lusaka Peace Process, Human Rights Watch. Available on the HRW website at

Tony Hodges, Angola: From Afro-Stalism to Petro-diamond Capitalism (London: James Currey, 2001)

A Crude Awakening: The Role of the Oil and Banking Industries and the Plunder of State Assets, Global Witness, 1999. Available on the Global Witness website at


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