2008 Zimbabwean cholera outbreak
Date | August 2008 – July 2009 |
---|---|
Location | Zimbabwe |
Cause | Vibrio cholerae |
Deaths | 4,369 |
Non-fatal injuries | 98,569 |
The 2008 Zimbabwean cholera outbreak was an epidemic of
Cause
The 2008 cholera outbreak was caused by widespread infection with the bacterium
One of the major contributing factors to the outbreak was the breakdown of the
The 2008 cholera epidemic in Zimbabwe had an unusually high fatality rate; Oxfam attributed the high mortality to a population "seriously weakened by hunger, HIV and AIDS".[20] A major contributing factor to the severity of the outbreak was the collapse of Zimbabwe's public health system, declared a national emergency on 4 December 2008.[22] By the end of November 2008, three of Zimbabwe's four major hospitals had shut down, along with the Zimbabwe Medical School, and the fourth major hospital had two wards and no operating theatres working.[23][24] Zimbabwean hospitals still open by December 2008 lacked medicines and staff. Due to hyperinflation, hospitals were not able to buy basic drugs and medicines, and the resources of even internationally funded emergency clinics were stretched.[14] The ongoing political and economic crisis contributed to the emigration of doctors and people with medical knowledge.[25] Some victims were travelling to Botswana and other neighbouring countries for treatment.[18]
Impact
The 2008 outbreak began in
The number of cases reported by the United Nations Office for the Coordination of Humanitarian Affairs escalated from 30 on 1 September 2008[33] to 15,572 by 10 December.[29] According to the Red Cross, around 46% of reported deaths occur en route to clinics and hospitals.[34] The head of the British Department for International Development in Harare said that "there are probably twice as many people with cholera as turn up for treatment".[35]
The case fatality rate for the outbreak was higher than expected for such outbreaks, although it began declining by January 2009.
Response
Assistance after the 2008 outbreak was made available by numerous international agencies,[14] and funding for water, sanitation and hygiene programmes, epidemic response and the provision of essential drugs came from several governments and trans-governmental organisations:
Government or Agency | Amount | Date |
---|---|---|
Government of Australia
|
A$8,000,000 for food and emergency aid | 2 December 2008[39] |
Government of Botswana | US$300,000 | 3 December 2008[40] |
Government of France
|
€200,000 for water purification tablets and distribution points Water treatment equipment |
4 December 2008[41] 11 December 2008[42] |
Government of Germany
|
€1,000,000 to the Red Cross | 8 December 2008[43] |
Government of Namibia
|
US$165,000 of medical supplies | 7 December 2008.[44] |
Government of the Netherlands | €5,000,000 for medication, drinking water and water purification tablets | December 2008.[45] |
Government of South Africa | Emergency food and medicine | 4 December 2008[46][47] |
Government of Switzerland
|
US$820,000 to an emergency aid programme and logistical support for UN agencies | 9 December 2008[48] |
Government of the United Kingdom | £3,000,000 | November 2008[49] |
USAID
|
US$6,200,000 for health, water and sanitation programmes | 11 December 2008[50] |
Government of Venezuela | Over 74 tons of medical supplies and drinking water | 3 January 2009[51] |
African Union | US$100,000 | 11 December 2008[52] |
European Commission | €9,000,000 | 3 December 2008[53] |
World Health Organization | US$340,000 of medication and supplies | 4 December 2008[54] |
World Vision
|
US$500,000 of medication | 2 December 2008[55] |
International Committee of the Red Cross | over 13 tons of medical supplies | 4 December 2008[54] |
World Vision and Health Partners International of Canada |
US$4,000,000 of medication | 13 January 2009[56] |
By 7 December 2008, UNICEF had secured international donor funding to provide sufficient water treatment chemicals for three weeks water supply for Harare and had arranged a shipment of chemical sufficient for four months supply.[20] UNICEF distributed 360,000 litres of water per day in Harare, as well as handing out soap and buckets.[35] Notwithstanding the contributions received, UNICEF indicated on 9 December 2008 that US$17,500,000 was needed to respond properly to the outbreak.[57] As of 15 December, following agreement with the Zimbabwe government, the World Health Organization was procuring medical supplies to roll out a response plan to run health centres.[58]
Spread
The 2008 cholera outbreak spread to districts in Botswana, Mozambique, South Africa and Zambia bordering Zimbabwe.[8]
South Africa
Cholera spread to the Zimbabwean migrant worker community in Limpopo and Mpumalanga provinces of South Africa[59] and cholera bacteria were detected in the Limpopo River on 3 December 2008.[57] By 12 December 2008, 11 deaths and 859 infections had been recorded in South Africa,[37] rising to 2,100 cases and 15 deaths by 14 January 2009,[60] and to 12,000 cases and 59 deaths by 10 March.[61]
The
Cholera is spreading... We are beginning to see a shift from Zimbabwe to South Africa. The situation is scary... I am concerned about the impact this is having on our provinces.[67]
Other countries
The spread of cholera to Zimbabwe's other neighbouring countries was initially slower than in South Africa, with one death recorded in Kafue District in Zambia and none in Botswana or Namibia by 9 December 2008.[31] In 2009, cases increased, with 4,354 cases and 55 deaths reported by 10 February 2009 in Zambia and 1,596 cases and 14 deaths in Katanga, the southernmost province of the DR Congo.[68] In Mozambique, cholera spread to 10 out of 11 provinces,[68] with a total of 9,533 cases by 1 Jan to 1 Mar 2009 and 119 deaths by 17 March.[69] Four health workers also died in a mob attack, blamed on "misinformation and misunderstanding in efforts to combat cholera",[70] and 12 of the prisoners from the incident died in jail.[69] In Malawi 104 deaths were recorded since January, making it the worst outbreak since 2001–02 where 960 people died.[71] Kenya, Somalia, Tanzania, DRC, and Ghana have had unrelated cholera outbreaks with between 10 and 100 deaths in 2009 as of February.[68]
Prevention
After the 2008 epidemic was declared a national emergency, the Ministry of Health and Child Welfare (MOHCW) collaborated with several other departments, governments, and non-governmental organizations to create a Cholera Command and Control Centre. This centre works to prevent cholera outbreaks in Zimbabwe by addressing broader societal factors that could contribute to cholera outbreaks, such as water sanitation and poor hygiene habits.[72]
Politicisation
Because of its well-organised health care system and effective water sanitation facilities,
A news commentator writing for The Lancet, Andrew Meldrum, said that President Mugabe's Youth Militia threatened health professionals that provided medical treatment to political opponents.[74] He said that, combined with decreasing education standards, low pay, and a shortage of medical supplies like latex gloves, this led doctors to leave Zimbabwe at an alarming rate.[74] According to Douglas Gwatidzo, the chairman of the Zimbabwe Doctors for Human Rights group, Zimbabwe had only one doctor assigned to a group of 12,000 citizens.[74] Doctors in Zimbabwe fill only 25% of the medical posts available, and even fewer specialist positions are taken.[74] According to Meldrum, this poses serious challenges to health care for diseases like HIV/AIDS and cholera. Similarly, the effects of cholera are exacerbated without proper nutrition, and Zimbabwe has faced food shortages for the last several years.[74]
Cholera and malnutrition keep children out of school – a serious social consequence of the outbreak. Rachel Pound, the director of Save the Children in Zimbabwe, said that attending school may be dangerous in Zimbabwe, instead of providing a ladder for self-improvement. She noted that "Sanitation is now so bad in schools that they may become a breeding ground for infection", rather than a place of valuable education.[75]
According to Meldrum, Zimbabwe's high inflation left the country with a lack of financial resources, resulting in a shortage of ambulances and pharmaceutical drugs.[74] According to Eric Pruyt of the Delft University of Technology in The Netherlands, this was exacerbated by a shortage of international aid, as Zimbabwe's government didn't acknowledge the epidemic and accept aid until the disease was widespread.[76] It was not contained or prevented from spreading. Until 2008, the government insisted that there was no cholera in Zimbabwe,[76] and Pruyt says the U.N. did not provide the country with safe drinking water until after the crisis started.[76] Meldrum says that, during Zimbabwe's continuing HIV/AIDS dilemma, some major international donors did not give much money because they believed it would help President Mugabe stay in power, which they did not want.[74]
As the outbreak and health crisis grew worse, American and British leaders cited the crisis as further proof that it was, in their view, "well past time for (President) Robert Mugabe to leave"[46] and that Zimbabwe had become a failed state.[50] Marian Tupy of the Cato Institute said that the crisis began in 2005 when the government took over water treatment facilities but without sufficient funding to maintain purification processes.[77] The transfer of water treatment from local government to the Zimbabwe National Water Authority was criticized by Innocent Nhapi of the National University of Rwanda on the basis of capacity and funding of the authority.[78] The lack of funding for water treatment chemicals, maintenance and staff salaries was cited by Colwell of the Baker Institute as a major cause of the epidemic.[73] According to Colwell, before funds were diverted from the plants to other uses, there were only sixty-five cases and four deaths from cholera in Zimbabwe.[73]
According to an editorial by Daniel J Ncayiyana in the South African Medical Journal, President Mugabe blamed the U.S. and the U.K. for the cholera outbreak, saying that they sent the disease so that they have a reason to credibly remove him from the presidency.[79] One Zimbabwean citizen was shown with a sign that blamed UK Prime Minister Gordan Brown for the disease; the sign expressed the horrors of "Brown's cholera".[79]
According to a news report in
Cholera is a calculated, racist, terrorist attack on Zimbabwe by the unrepentant former colonial power, which has enlisted support from its American and Western allies so that they can invade the country.[84][85]
In the meantime, a senior
I am happy to say our doctors have been assisted by others and WHO (the World Health Organization)... so now that there is no cholera... Because of cholera, Mr Brown wants a military intervention... Bush wants military intervention because of cholera... There is no cause for war any more. The cholera cause doesn't exist any more.[66][87]
Reports from the
I don't know what world he [Mugabe] is living in. There is a raging humanitarian crisis in Zimbabwe as well as an economic crisis and still there is no representative government able to lead the country out of this disaster.[89]
The
See also
- Health in Zimbabwe
- Water supply and sanitation in Zimbabwe
- Cholera outbreaks and pandemics
- 2018–2019 Zimbabwe cholera outbreak
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External links
- Cholera situation in Zimbabwe – UN OCHA
- UN Office for the Coordination of Humanitarian Affairs, Zimbabwe
- World Health Organization Alert: Cholera in Zimbabwe
- World Health Organization: Daily Cholera Updates
- US Centre for Disease Control and Prevention Notice: Cholera in Zimbabwe and Neighboring Countries Archived 6 May 2009 at the Wayback Machine
- Zimbabwe cholera crisis (Oxfam)
- Zimbabwe cholera crisis (Red Cross)