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Prior to 1975, there had been a constant abuse of power within the countries of Angola and Mozambique by an Imperial power forcing its will on indigenous peoples living within the territory. Portugal was the colonial power ruling over these two countries since the early 16th century; along with their asserted power they chose to neglect the health and well-being of their colonized peoples. The Portuguese chose to neglect their colonized people for a number of underlying factors. The main factor for Portugal withholding healthcare assistance to these colonies was money; the point of imperializing a country was to improve the economy back home while profiting off free labor and new resources. The other factor was racism and a belief of superiority; Portuguese colonial powers deemed their colonial subjects to be less than them and figured their health was not as important as turning a pure profit. Once the wars for liberation began to take place, nationalist parties within Angola and Mozambique ensued a time of infrastructure buildup and saw about the creation of medical centers and health wards for colonized people. Yet, these medical centers were in distant locations which brought about an obstacle for people in need. The healthcare in Luso-Africa, specifically in Angola and Mozambique, has been a troubling matter dating back to its colonial roots tied to the Portuguese Empire. Portuguese rule in these countries greatly repressed the growth of healthcare for its colonized peoples through systematic racism and a misappropriation of colonial funds. Despite nationalists struggles during the war for liberation to create healthcare programs within Angola and Mozambique that were far more inclusive than programs offered by the Portuguese government; the programs have been severely affected by the turbulent era of state-building following the process of decolonization in Luso-Africa.
To understand post-colonial public health services, one must first analyze the healthcare infrastructure, or lack thereof, left behind by the Portuguese after liberation was achieved. A principal reason for the Portuguese empire to limit, in both quality and quantity, healthcare programs within their colonies deals with the ideology of racial hierarchy. The notion that the color of one’s skin, or proximity to western lifestyle, is relative to the civility of said person instigated a shared mindset amongst many European colonizers that led to innumerable acts of epistemic violence. Leading up to 1890 the Portuguese colonies were primarily controlled by indigenous leaders; it was not until the conference of Berlin that Portugal was pressured into an intensified occupation of their African colonies.[footnoteRef:1] …. Prior to the fundamental establishment of schools and hospitals dedicated to ‘tropical medicine’, ill colonial subjects were often overlooked and were left to use traditional remedies such as the use of medicinal plants to quell the symptoms of diseases like malaria.[footnoteRef:2] Within the early years of Portugal’s intense colonization of Angola and Mozambique, the focus of medical treatment, and their facilities, was centered [image: https://iiif.wellcomecollection.org/image/V0015560.jpg/full/800%2C/0/default.jpg]upon the European colonizers. An accurate portrayal of colonial focus on the health of colonizers is depicted by F.C. Dickenson and E. Watts; in their collaborative painting Dickenson and Watts depict four scenes revolving around the first European hospital in Beira, Mozambique, created for the English during the Boer War in 1899.[footnoteRef:3] This painting, although representative of an English hospital, gives a subtle first-hand look at the underlying systematic racism within Mozambique as one can note the African characters laboriously working while the European characters are enjoying themselves within this euro-centric society. This method of focusing healthcare resources on the European population would aptly continue well into the 1920s. [1: The emergence of tropical medicine in Portugal: The School of Tropical Medicine and the Colonial Hospital of Lisbon (1902-1935). 303-304] [2: A review of antimalarial plants used in traditional medicine in communities in Portuguese-Speaking countries: Brazil, Mozambique, Cape Verde, Guinea-Bissau, São Tomé and Príncipe and Angola. 144 & 153] [3: F.C. Dickinson and E. Watts, Boer War: four scenes from the first English hospital in Beira, Mozambique, (1899).]
Within Angola, healthcare initiatives would not be shifted to acknowledge colonial subjects until the late 1920s when a dramatic population decline was observed. Officials within the colony began to note a steep decline in the native (labor) population between 1920 and 1927 and accredited the roughly estimated 2 million deaths to endemic diseases of the times such as sleeping sickness and smallpox.[footnoteRef:4] In reaction to the health-related population crises during this time, in Angola , the Portuguese colonial government opted to raise “poll” and “hut” taxes in order to fund a mediocre infrastructure project narrowly focused on bettering healthcare provision for indigenous people.[footnoteRef:5] Other than the establishment of the African Health Care Program (AMI) created mainly to curtail endemic diseases amongst the indigenous population[footnoteRef:6]; Portuguese colonial rule did relatively little in curbing inequalities of healthcare for their colonial subjects because they focused efforts on building tertiary hospitals in urban centers that tended to the ruling class.[footnoteRef:7] Despite the diminishing effects that a lack of concentrated public health services had on the colonial subjugated population, the Portuguese Empire promoted the colonies of Angola and Mozambique as exemplary states with prospect for African hope. As described in a guide to Mozambique published by the Portuguese Empire in the years just prior to the liberation wars, “Certainly medical and hospital care in both Angola and Mozambique bears favorable comparison with neighboring African territories…these services are the finest in tropical Africa.”[footnoteRef:8] Although the Portuguese did in fact provide a relatively decent healthcare system in comparison to surrounding colonies owned by competing colonial powers, the longevity of the healthcare infrastructure did not hold up against the needs for the liberation . [4: Tensions of Colonial Demography. Depopulation Anxieties and Population Statistics in Interwar Angola. 475] [5: Havik. Policies & Revenue in Portuguese Africa, 1900-1960. 193] [6: Tensions of Colonial Demography. Depopulation Anxieties and Population Statistics in Interwar Angola .476] [7: Enrico Pavigani and Alessandro Colombo, “Providing health services in countries disrupted by civil wars: a comparative analysis of Mozambique and Angola 1975–2000”. World 11. Health Organization, Department of Emergency and Humanitarian Action, (2001). 47] [8: Mozambique guide ]
Throughout the duration of the liberation wars – starting respectively for Angola in 1961 and for Mozambique in 1964 – the nationalist parties leading the fight for liberation sought to create a medical infrastructure of their own to provide for both war and civilian efforts. Yet, the mass emigration of Portuguese medical professionals, cadres, and settlers left both Angola and Mozambique to practically start the process of state-building from the ground up.[footnoteRef:9] Leaders within the MPLA (People’s Movement for the Liberation of Angola) and FRELIMO (Mozambique Liberation Front) alike sought to create relations with outside nations in order to build up humanitarian aid, military, and infrastructure. [9: Enrico Pavigani and Alessandro Colombo, “Providing health services in countries disrupted by civil wars: a comparative analysis of Mozambique and Angola 1975–2000”. World 11. Health Organization, Department of Emergency and Humanitarian Action, (2001). 47]
Angola received an immense amount of medical and military support from communist Cuba, led at the time by Fidel Castro. Such support aided to Angola by Cuba entailed: civilian medical teams, state of the art Cuban hospitals in over ninety percent of Angolan provinces, and mass medical training systems.[footnoteRef:10] In his book, Southern Africa Stands Up, Wilfred Burchett claims, “By the end of 1976, Cuba was training some 6,500 Angolans – 500 of them in Cuba, the rest in Angola — to become doctors, engineers…”[footnoteRef:11] Such healthcare advancements brought the indigenous population of Angola out of the social inequalities surrounding them, for the moment being. Concurrently, FRELIMO merely depended on communist nations such as China, the USSR, and Cuba for militaristic struggles against the Portuguese.[footnoteRef:12] Albeit the war for liberation was necessary in the hearts and minds of most Angolans and Mozambicans, the absence of the colonial powerhouse created a near void in the power and control of both countries by a sovereign polity. This brought about rival anti-colonial insurgent groups such as UNITA in Angola and RENAMO in Mozambique; ensuing an all-out civil war in both countries torn apart by the political climate of the Cold War. America and its communist enemies swooped down on both of the weak nationalist party rivalries in Angola and Mozambique following the ousting of the Portuguese in 1975.[footnoteRef:13]The civil wars fought within these countries would oversee the shifting of healthcare systems to their worst state since colonial times. [10: Wilfred G. Burchett, Southern Africa Stands Up: The Revolutions in Angola, Mozambique,Zimbabwe, Namibia, and South Africa. (New York: Urizon Books, 1978), 93 – 94. ] [11: Ibid. ] [12: Wilford, Southern Africa Stands Up. 53] [13: Wilford, Southern Africa Stands Up]
Although much was attained during the fight for liberation, the ensuing civil war created by the power vacuum left behind by the Portuguese Empire and heavily instigated by the Cold War actively destroyed accomplishments and set a substantial number of obstacles for future health care systems. Both the war for liberation and the civil wars fought between the MPLA and UNITO in Angola and between FRELIMO and RENAMO in Mozambique relied heavily upon on the use of landmines for the dual purpose of greater number of casualties and cost-effectiveness.[footnoteRef:14] In his essay on the geography of landmines within the African continent, Joseph Oppong states, “Angola and Mozambique are excellent examples of how landmines were deployed to degrade the environment, making them an environmental and health problem.”[footnoteRef:15] Despite physically destroying cites of civilian medical centers, RENAMO and UNITO systematically mined paths leading to medical centers, schools, markets, and fields.[footnoteRef:16] The stipulations caused by heavily mining any given area go beyond war time efforts and civilian casualties; landmines reconstruct the geography and limit the extent of medical progress reachable to outer-lying communities.[footnoteRef:17] [14: Oppong and Kalipeni, ‘The Geography of Landmines and Implications for Health and Disease in Africa,” 8. ] [15: Oppong and Kalipeni, ‘The Geography of Landmines and Implications for Health and Disease in Africa,” 11. ] [16: Ibid 11. ] [17: ?]
As soon as landmines are planted into the ground whole regions become untouchable and impediments are put on the expansion of public health initiatives and infrastructure; mines cannot be easily rounded up and disposed of because of they are hidden and extremely sensitive. The trickling effects caused by accidental discharge of mines set off by civilians during and after the civil war are seemingly endless. As the civil war in Angola came to an end, eighty thousand people were reported as amputees with a sizeable amount of that demographic under the age of fifteen.[footnoteRef:18] Increasing the chances of succumbing to mine-related injuries, a report published a few years before the end of the Angolan Civil War showed that there was an estimated 20 million landmines within Angola alone.[footnoteRef:19] Medical work pertaining to landmine victims is strenuous on the amount of humanitarian resources, medical professionals, and society. The average victim of a landmine explosion requires a multitude of surgical procedures and blood transfusions to sustain life; the number of blood transfusions facilitates the possible spread of deadly diseases such as malaria, syphilis, and HIV.[footnoteRef:20] [18: oppong 12] [19: ibid 11. ] [20: ibid. 5]
The scattered placement of landmines throughout Angola and Mozambique also had the abysmal consequence of creating a famine brought about by a forced agricultural decline. Within areas containing ideal farming situations e.g., fertile soil and good rains, civilians avoided farming in the likelihood of possibly stepping on a landmine.[footnoteRef:21] Oppong goes on to state, “landmines have a more insidious effect than drought and environmental disasters-and able-bodied people starve, despite an abundance of fertile soil.”[footnoteRef:22] This quote echoes an accurate representation of the ramifications landmines have on a region and its people. [21: ibid 17. ] [22: Oppong and Kalipeni, ‘The Geography of Landmines and Implications for Health and Disease in Africa,” 4. ]
Another complication brought about by the civil wars in Angola and Mozambique was the systematic destruction of public health systems during the years of liberation. Within Mozambique, RENAMO sought to kill and kidnap healthcare professionals in order to weaken the healthcare systems established by FRELIMO, to a point of incapacitation.[footnoteRef:23] This faction of the civil wars – coupled with famine and the rise of deadly illnesses brought on by a growing number of landmine victims– allowed for diseases and death to run rampant within both of the countries, and transformed the hopeful health and political situation into bludgeoned mess. Within Angola specifically, the second wave of war from 1992 till 1994 severely diminished the capacities of the healthcare systems provided by the supporting communist countries.[footnoteRef:24] The intense destruction of both Angolan and Mozambican nationalist healthcare progresses brought about a societal inequality produced in terms of subtle racial hierarchy. This accounts for a cause in the harboring mindset amongst people in ‘first-world’ countries with regards to the state of health for Africans. The harboring mindset within most ‘first-world’ people is one of pity as it is often portrayed within media that all people of Africa are in despair and reliant upon ‘our’ help. Although there are regions within Angola and Mozambique that are still reliant upon foreign aid, there is a vast number of thriving countries within Africa that do not mirror the pitiful images permeating the mind of ‘first-world’ people. Recent efforts made by Mozambique and Angola have aimed to reconfigure the common notions preemptive on the idea of health within said countries. [23: Pavgini and Colombo, “Providing health services in countries disrupted by civil Wars”, 10. ] [24: Ibid. ]
Within nearly three decades, Mozambique has turned itself from an impoverished, aid-dependent entity into a country that has endlessly worked to witness substantial growth in healthcare goals and initiatives.[footnoteRef:25] Despite being heavily reliant on international aid for the first twenty years following the end of civil war, health initiatives in Mozambique saw about decreasing the infant mortality rate and the number of deaths in women occurring at childbirth.[footnoteRef:26] A case study done by the Developmental Progress Organization on the number of deaths between child-bearing women and infants observed over a 14 year period resulted in a notable, fifty percent decline for deaths amongst infants and a forty-six percent decline in maternal mortality.[footnoteRef:27] The relatively high numbers in the decline of death amongst two different demographics is representative of a successful healthcare program fixed on fully recovering years lost in the wars fought for independence and political autonomy. [25: Romina Rodriguez Pose., J. Engel, et al,. ‘Against the odds: Mozambique’s gains in primary health care.’ London: Overseas Development Institute (2014).] [26: Ibid. 9. ] [27: Ibid. 9 & 11. ]
Unfortunately in the case of Angola, a prolonged civil war and an exceedingly high volume of landmines have caused progressions within public health initiatives to be prolonged. The number of landmine related injuries appear at the forefront in recent post-war attempts to revert the healthcare system in Angola into a healthy one. During the first two years following the end of the Angolan Civil War, NGOs reported the clearance of nearly three million square meters of land, and destruction of more than eighteen thousand unexploded weapons left behind from the war. Coupling these effective efforts with preliminary healthcare measures will produce a much-warranted advancement in the progression of healthcare initiatives.
Before the 1960’s, the Portuguese Colonial rule had imposed such a major hindrance on the expansion of healthcare for African people living in the colonies through systematic racism and a purposeful misrepresentation of the colony abroad. While the war for liberation warranted a new means for the healthcare systems within the countries of Angola and Mozambique, the limitations imposed by a subsequent Civil War quelled any progression from that point forward. Yet, the progress that was created through the war for liberation could not be ill-regarded either; for it was the fight for freedom that pushed for and built a more modern understanding in the necessary healthcare focused on the lives of indigenous people. Although medical systems within Angola and Mozambique are not the most advanced in the world, or Africa for that matter, they are steadily recovering from a major debilitating era of repression by political rivals brought about by the long-lasting effects of Portuguese Colonialism.
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