February 18, 2009

As Zimbabwe’s cholera continues to spread, the disease has expanded from urban centers into rural areas, aid agency World Vision reported recently. The epidemic is expected to worsen as the rainy season continues for the next several months. So far, more than 3,000 people have died from the disease, with more than 58,000 reported cases.

An estimated three million Zimbabwean refugees are spilling in South Africa and other neighboring countries, taking the disease with them.

Cholera, an easily treatable waterborne disease, thrives in poor sanitary conditions and has been accelerated by systematic under-funding in water and sanitation infrastructure and health delivery service.

Despite relief efforts, the outbreak has yet to be contained.

Relief organization World Vision has sent additional staff and nurses to the affected areas, including Shamva, Bindura, Bikita, Chivi and Mudzi in Zimbabwe. World Vision has already sent assessments teams to these areas to identify needs and is supplying cholera kits in many of the affected areas. Teams from Medecins San Frontieres (MSF), a medial relief organization, have now treated almost 45,000 people, but group believes that other outbreaks are possible.

“There has been a devastating implosion of Zimbabwe’s once-lauded health system, which doesn’t just affect cholera patients.” said Manuel Lopez, MSF Head of Mission in Zimbabwe in a statement on Feb. 17.

“We know that public hospitals are turning people away; health centers are running out of supplies and equipment; there is an acute lack of medical staff; patients can’t afford to travel to pick up their HIV medication or to receive treatment; and many of our own clinics are overflowing. From what we see each day it couldn’t be clearer – this is a massive medical emergency, spiraling out of control.”

The Politics That Kill

The cholera outbreak has been exacerbated by Zimbabwe’s economic collapse and the rough start of the power-sharing deal between President Robert Mugabe and Prime Minister Morgan Tsvangirai.

Zimbabwe’s currency has the world’s worst inflation rate, leaving its economy in tatters. The unemployment rate is estimated at 90 percent or higher, and the local currency is practically worthless. Health concerns, including the cholera outbreak, are also emerging as a result of the overall humanitarian crisis.

The power-sharing deal, which comes after a year of political standstill, aims to have the rival political leaders working together to resolve the countries on-going, critical economic situation. The deal retains Mugabe, who has held power for three decades, and who many blame for the country’s economic collapse. Tsvangirai has long criticized Mugabe for his bad policies and refusal to accept outside aid for his country. The new cabinet faces monumental tasks ahead, with a hunger crisis forcing about seven million people to depend upon foreign aid, as well as, anticipated extreme food and gasoline shortages.

“Zimbabwe currently has an inflation rate that is currently at 231,000,000 percent. What is happening right now with the cholera outbreak is basically making a situation that was already desperate, worse,” said Rose Craigue, Humanitarian and Emergency Affairs Specialist with World Vision, based in Washington, D.C.

Health Crisis Compounded by Sanitation and Nutrition Problems

“Cholera is a very treatable disease,” Craigue said. “It is not untreatable. Why it is spreading so rapidly in Zimbabwe is because there is a breakdown of the health system and the sanitation system, and of course the economic challenges that the country is facing are not helping.”

Zimbabwe’s sanitation system is poor at best, and broken down in some areas. Also, water is not treated for potability, and many people are not able to receive water in their homes. As a result, people may obtain water from a ditch, or a well, or other untreated sources.

“What needs to be done is to make sure that they are receiving water that is treated,” Craigue said. “So, there are things that can be done to make sure that the cholera outbreak is contained, and so that it doesn’t happen again in the future.”

World Vision immediately began responding to the epidemic when the cholera outbreak first started last year. The current six-month cholera response budget, November through April, is budgeted at $1,105,000 for this particular response.

Craique said several efforts are in place to address this concerns at the household level, including usage of water purification tablets, education and teaching people things like how to wash their hands after they go to the toilet, or how to wash their food, especially food that is consumed raw, that it has to be washed with clean water.

Still, some of the challenges in the country can’t be resolved at the household level. Some issues, such as sewage blockage, need to be addressed at a community or broader level.

World Vision officials said one of its greatest concerns is the children. “Some of the 3,000 who have died are children,” Craigue said. “So having the cholera outbreak, on top of HIV Aids pandemic, and on top of the economic situation is horrible.”

Zimbabwe’s children already face rampant malnutrition due to the country’s economic collapse. Many who used to be fed through feeding programs at schools have also been denied that access, because the teachers are striking. When the children don’t go to school, the feeding programs can’t continue.