hcghr

The Modern Plague

In Current Issue, Panorama on October 29, 2009 at 10:57 pm

The Cholera Epidemic in Zimbabwe

Lavinia Mitroi, Staff Writer

Courtesy Julien Harneis

Exceeding original worst-case scenario figures proposed by the World Health Organization (WHO), the ongoing cholera epidemic in Zimbabwe has infected over 93,000 individuals and taken the lives of over 4,000, according to a March 27 WHO update.

Since the outbreak began in August 2008, the Zimbabwean population’s needs have been difficult to meet with a heath care system that has been in decline since 2006, evidenced by the nation’s life expectancy at birth of 36 years, the lowest in the world.

Inadequate water treatment and sanitation systems have only provided an impetus for the spread of the infection, which has seen a cumulative death rate of over 5 percent, five times greater than the usual death rate from cholera, according to a report released in January by Physicians for Human Rights (PHR). The situation has only worsened with a spread of the epidemic to all ten of Zimbabwe’s provinces and exponential growth.

Cholera, an acute diarrheal infection caused by the bacterium Vibrio cholera, is contracted through the ingestion of contaminated food or water. Upon infection, even healthy adults can die in a matter of hours. Dr. Howard Zucker, former Assistant Director-General of the WHO and current Harvard Institute of Politics Fellow, characterized some factors that lead to an outbreak: “Stagnant water will serve as a source for this widespread infection. Primarily it begins when sanitary conditions are so poor. That is why the need for public health measures is so critical.”

Experts in this field, however, argue that health measures capable of dealing with such a crisis were never something with which the Zimbabwean administration was equipped. One action taken was the Mugabe regime’s nationalization of water sanitation and trash collection systems. In their report, “Health in Ruins: A Man-Made Disaster in Zimbabwe,” PHR experts assert that this intervention effectively set the stage for the perfect storm of cholera infection.

With raw sewage flowing through the streets and clean water unavailable, the cholera infection established its foothold in Zimbabwe. “I think the cholera epidemic is a terrible symptom of major underlying collapses of the social and economic infrastructure in Zimbabwe,” commented Dr. Jennifer Leaning, a PHR board member and reviewer of the report as well as Harvard School of Public Health professor.

Yet as the crisis has overtaken Zimbabwe and the ill look to hospitals for treatment, they find little comfort. Sky-high inflation rates, surpassing 11 million percent in 2008, have immobilized the population and barred health professionals from collecting their salaries, gradually causing hospitals to close their doors. PHR reports that by December 2008 not only was the patient-to-staff ratio too high, but there were no more critical care beds available for the public.

With Zimbabwe in a state of internal chaos, the global community has looked elsewhere for a solution. “The success of this is really the collaboration between multiple organizations such as the WHO, UNICEF, the World Food Program, and NGO’s. They play a very significant role; often countries look to these organizations for assistance because they have dealt with situations of such nature before,” explains Dr. Zucker.

Courtesy Pierre Holtz

As for the United States’ role in this situation, Zucker told the HCGHR, “The U.S. effort to help is critical. It is important to separate our political views from our public health assistance. I would hope our country would do all that they can to assist the people of Zimbabwe. My experience is that the U.S. will rise to the challenge.”

However, with the transition of the U.S. presidency and a failing economy taking center stage, health professionals in Zimbabwe and across the world are concerned that the cholera crisis has been put on the backburner. “Part of the issue is that much of this crisis unfolded under the Bush administration, and now we have a new administration that has not yet fully articulated its Africa policy. Under the Bush administration the U.S. position was to work with the national governments of Southern Africa to apply pressure on Zimbabwe, especially through urging the government of South Africa to exert more local and direct economic pressure on Zimbabwe,” describes Dr. Leaning.

U.S. humanitarian assistance for the cholera crisis in Zimbabwe through the Agency for International Development (USAID) was reported as a little over $7 million for the 2009 fiscal year. These funds support water, hygiene, and sanitation programs, as well as the WHO’s Cholera Command and Control Centre in the capital city of Harare.

Some experts, nevertheless, assert that U.S. intervention has been insufficient. In reference to the annual human rights report card released by the Department of State, focusing 26,000 words on the Mugabe regime’s mismanagement of the nation, Frank Donaghue, PHR CEO, commented, “It’s pretty surprising that the State Department can write thousands and thousands of words on Zimbabwe and fail to mention the right to health. They have not acknowledged that Zimbabwe is currently experiencing one of the most egregious assaults on health in the world.”

As the crisis continues, the cumulative death rate has been slowly decreasing since early January, yet this in no way implies that the epidemic is over. Dr. Leaning describes that attention should instead be focused on maintaining and continuing this downward trend: “The most important intervention is to provide clean water for drinking and household use to the population in the regions affected by the epidemic… In the long run, this approach would mean rebuilding at least some of the key water systems in the country. For these measures to occur, the government of Zimbabwe must permit more international aid to reach the population in need.”

References

“Daily Cholera Update and Alerts.” World Health Organization. 27 March 2009. Office of the WHO Representative in Zimbabwe. 28 March 2009. <http://www.who.int/hac/crises/zmb/sitreps/
zimbabwe_cholera_update_27march2009.pdf>.

Sollom, Richard et. al. “Health in Ruins: A Man-Made Disaster in Zimbabwe.” Jan. 2009. 29 March 2009. <http://physiciansforhumanrights.org/library/documents/reports/2009-health-in-ruins-zim-full.pdf&gt;.

“Cholera in Zimbabwe- update 2.” World Health Organization. 20 Feb. 2009. The World Health Organization. 29 March 2009. < http://www.who.int/csr/don/2009_02_20/en/index.html&gt;.

“Cholera Fact Sheet.” World Health Organization. Nov. 2008. The World Health Organization. 29 March 2009. <http://www.who.int/mediacentre/factsheets/fs107/en/index.html&gt;.

Sollom, Richard et. al. “Health in Ruins: A Man-Made Disaster in Zimbabwe.” Jan. 2009. 29 March 2009. <http://physiciansforhumanrights.org/library/documents/reports/2009-health-in-ruins-zim-full.pdf&gt;.

Sollom, Richard et. al. “Health in Ruins: A Man-Made Disaster in Zimbabwe.” Jan. 2009. 29 March 2009. <http://physiciansforhumanrights.org/library/documents/reports/2009-health-in-ruins-zim-full.pdf&gt;.

“Zimbabwe inflation hits 11,200,000 percent.” CNN.com International. Aug. 19, 2008. CNN. 29 March 2009. <http://edition.cnn.com/2008/BUSINESS/08/19/zimbabwe.inflation/index.html&gt;.

Sollom, Richard et. al. “Health in Ruins: A Man-Made Disaster in Zimbabwe.” Jan. 2009. 29 March 2009. <http://physiciansforhumanrights.org/library/documents/reports/2009-health-in-ruins-zim-full.pdf&gt;.

Sollom, Richard et. al. “Health in Ruins: A Man-Made Disaster in Zimbabwe.” Jan. 2009. 29 March 2009. <http://physiciansforhumanrights.org/library/documents/reports/2009-health-in-ruins-zim-full.pdf&gt;.

United States. USAID. Bureau for Democracy, Conflict, and Humanitarian Assistance and the Office of U.S. Foreign Disaster Assistance. Zimbabwe-Cholera Outbreak Fact Sheet #11, Fiscal Year (FY) 2009. Washington: March 6, 2009.

United States. USAID. Bureau for Democracy, Conflict, and Humanitarian Assistance and the Office of U.S. Foreign Disaster Assistance. Zimbabwe-Cholera Outbreak Fact Sheet #11, Fiscal Year (FY) 2009. Washington: March 6, 2009.

“Cholera in Zimbabwe- update 3.” World Health Organization. 23 March 2009. The World Health Organization. 29 March 2009. <http://www.who.int/csr/don/2009_03_23/en/index.html&gt;.


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