#CholersOutbreak: Zimbabwe Under Siege, Again

Harare — Another bout of cholera outbreak has claimed 16 lives in a week, while 1 007 patients were treated at various institutions. 

The epidemic has now spread to other nearby towns and provinces — all of which have since been traced back to Harare. In 2008 — 98 596 cases were reported with 4 369 deaths declared. 
Cholera is a water-borne infection of the small intestines caused by drinking water infected with the bacterium Vibrio cholerae. The disease thrives under hot, humid and squalor conditions lacking proper sanitation services. And due to rapid unplanned residential expansion, more pressure is exerted on the old sewer system.

It is spread through water contaminated with solid human excreta from infected individuals, inducing vomiting, muscle cramps, seizures, dropped blood pressure and watery diarrhea known as ‘rice water’ with a distinct fish oudour, normally displaying two hours to five days after exposure. An untreated victim of cholera may produce 10 to 20 litres of diarrhea a day. 

The severity of the 2008 outbreak, last recorded a decade earlier, was attributed to poor access of health care, poor health infrastructure, high HIV prevalence, political instability, food shortages, high levels of displaced people and lack of access to safe water. 
Cholera Outbreak in Zimbabwe

High inflation triggered severe basic food shortages, collapse of service delivery and large volumes of refugees moving within the country and to neighbouring countries amplified the rapid spared of cholera. Raw sewage from burst and aging municipal pipes contaminated urban domestic water system, creating a national catastrophe.

The European Union, Britain and the Netherlands made a significant donation of €9 million, £3 million and £5 million separately. Other international agencies availed fresh water and essential drugs – though they were skeptical that the aid could be diverted to prop Mugabe’s prolonged stay in power.

Médecins Sans Frontières attributed the rapid spread of cholera from urban to rural areas due increased travel during Christmas holidays and unsafe burial of victims at rural homes. Zimbabwe’s neighbouring countries were not spared either, with Mozambique reporting 10 of its 11 provinces under siege, triggering 119 deaths by 1 March, 2009.

Zambia recorded the highest casualties by February 10, 2009 1 596 cases were identified, resulting in 55 deaths. The Democratic Republic of Congo, Ghana, Somalia and Tanzania also felt the ripple effects by February, 2009.

Due to high levels of dirt in the domestic water supply dams, water treatment was not enough to purify the dirt water. The tendering procurement system for water chemicals was sprinkled with serious corruption, rendering it a complete chaos. Old water supply pipes lost almost 60 percent of the treated precious liquid before it reached consumers.
Water Problems still Dog Zimbabwe Urban Areas  

Harare water taps ran dry on December 1, 2008 owing to a shortage of purification chemicals – effectively implying that Chitungwiza was affected as well. On 4 December, 2008 – as the cholera outbreak was gaining momentum, the then deputy minister of water announced that there were only chemical supplies for 12 weeks in stock.

Dormitory towns, including Chitungwiza purchase their domestic water from Harare at an extra cost. Nonpayment meant some suburbs could go for months without clean water supplies, after Harare disconnected regular supplies.

“I am happy to say our doctors have been assisted by others and WHO (the World Health Organisation). 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 anymore,” former President Robert Mugabe said, angering affected citizens.

Mugabe’s denial speech confirmed reports that the government did not acknowledge the existence of cholera, until it manifested and later declared a national emergency to receive international aid. In fact, cholera peaked in January 2009 – 8 500 cases were reported weekly – a month after Mugabe’s scandalous claims.

The ministry of health would only declare the end of the outbreak in July 2009, after several weeks without any fresh cases. This was their response to the breakout – a seemingly admittance to their failure to provide an essential service.
Raw Sewage Flow in Urban Areas Unattended 

Mugabe’s spokesperson, George Charamba tried vainly to dismiss his boss’s heartless statement, saying, “His argument was through sarcasm, noting that now efforts deployed so far towards containing the outbreak were beginning to yield positive results”.

Oxfam linked the high mortality to a population ‘seriously weakened by hunger, HIV and AIDS and collapse of public healthcare, confirmed by the closure of Zimbabwe’s four major hospitals at the end of November, 2008. 

In 2005, the through Zimbabwe National Water Authority (ZINWA) government had taken over water treatment facilities without proper funding to maintain purification processes. Hospitals that remained functional lacked medicines and skilled medical staff. With few options, some victims departed for Botswana and other neighbouring countries seeking medical attention.

Fatality rates were high for the outbreak was higher than expected in similar cases, with Chitungwiza recording the highest of 18 percent and Harare 2,5 percent. UNICEF and Oxfam estimated a 10 percent fatality rate with 60 000 cases recorded by January, 2009. 

WHO observed that the epidemic reached a fatality rate of 4,7 percent, unlike the 1 percent, were it can be controlled. Due to the high number of deaths, some places like Harare designated special burial places for cholera victims for free – as opposed to the usual burial fees charged. Al Jazeera and state-controlled media bolstered Mugabe’s earlier assertions of a ‘terrorist, biological’ attack on Harare.

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