2008–2009 Zimbabwean cholera outbreak
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The 2008 Zimbabwean cholera outbreak was an epidemic of
cholera Cholera is an infection of the small intestine by some strains of the bacterium ''Vibrio cholerae''. Symptoms may range from none, to mild, to severe. The classic symptom is large amounts of watery diarrhea that lasts a few days. Vomiting and ...
affecting much of Zimbabwe from August 2008 until June 2009. The outbreak began in
Chitungwiza Chitungwiza is an urban centre and town of Harare Province in Zimbabwe. History As of the 2022 census, Chitungwiza had a population of 371,244. There are two main highways which connect the city to Harare namely Seke road and Chitungwiza r ...
in Mashonaland East Province in August 2008, then spread throughout the country so that by December 2008, cases were being reported in all 10 provinces. In December 2008, The
Zimbabwean government The politics of Zimbabwe takes place in a framework of a full presidential republic, whereby the President is the head of state and government as organized by the 2013 Constitution. Executive power is exercised by the government. Legislati ...
declared the outbreak a
national emergency A state of emergency is a situation in which a government is empowered to be able to put through policies that it would normally not be permitted to do, for the safety and protection of its citizens. A government can declare such a state du ...
and requested international aid. The outbreak peaked in January 2009 with 8,500 cases reported per week. Cholera cases from this outbreak were also reported in neighboring countries South Africa, Malawi, Botswana, Mozambique, and Zambia. With the help of international agencies, the outbreak was controlled, and by July 2009, after no cases had been reported for several weeks, the Zimbabwe Ministry of Health and Child Welfare declared the outbreak over. In total, 98,596 cases of cholera and 4,369 deaths were reported, making this the largest outbreak of cholera ever recorded in Zimbabwe. The large scale and severity of the outbreak has been attributed to poor sanitation, limited access to
healthcare Health care or healthcare is the improvement of health via the prevention, diagnosis, treatment, amelioration or cure of disease, illness, injury, and other physical and mental impairments in people. Health care is delivered by health profe ...
, and insufficient healthcare infrastructure throughout Zimbabwe.


Cause

The 2008 cholera outbreak was caused by widespread infection with the bacterium '' Vibrio cholerae'' which is spread through water contaminated with the feces of infected individuals. Cholera had been seen in Zimbabwe in the decade leading up to the 2008 outbreak. However, the severity of the 2008 has been attributed to a combination of societal factors including poor access to
health care Health care or healthcare is the improvement of health via the prevention, diagnosis, treatment, amelioration or cure of disease, illness, injury, and other physical and mental impairments in people. Health care is delivered by health profe ...
and poor health care infrastructure, high HIV prevalence, political instability, food shortages, high levels of displaced people, and lack of access to safe water. In 2008, Zimbabwe was suffering from an economic crisis and hyperinflation which led to shortages of food and other basic goods, disruption of public services, and a large number of refugees moving within the country and to neighboring countries. One of the major contributing factors to the outbreak was the breakdown of the municipal water supply, sanitation, and waste collection programs throughout the country, but especially in urban areas. With this, the onset of the rainy season led to cholera-contaminated faeces being washed into water sources, in particular public drains, as well as providing readily available but contaminated water. Due to a shortage of purification chemicals, such as chlorine, the capital city of Harare stopped receiving piped water on 1 December 2008. By that date, many suburbs had not had any water supply for much longer. On 4 December 2008, the Zimbabwe deputy minister for water and infrastructural development stated that there were only sufficient treatment chemicals in stock nationally for 12 weeks supply. The collapse of these systems was blamed on the then-current economic crisis; many households cannot afford fuel to boil water. According to Médecins Sans Frontières, the spread of cholera from urban to rural areas from December 2008 onwards was due to infected city-dwellers visiting their families' rural homes for Christmas and the burial of infected city-dwellers in rural areas. The 2008 cholera epidemic in Zimbabwe had an unusually high
fatality rate In epidemiology, case fatality rate (CFR) – or sometimes more accurately case-fatality risk – is the proportion of people diagnosed with a certain disease, who end up dying of it. Unlike a disease's mortality rate, the CFR does not take int ...
; Oxfam attributed the high mortality to a population "seriously weakened by hunger,
HIV and AIDS Human immunodeficiency virus infection and acquired immunodeficiency syndrome (HIV/AIDS) is a spectrum of conditions caused by infection with the human immunodeficiency virus (HIV), a retrovirus. Following initial infection an individual m ...
". 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. 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. 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. The ongoing political and economic crisis contributed to the emigration of doctors and people with medical knowledge. Some victims were travelling to Botswana and other neighbouring countries for treatment.


Impact

The 2008 outbreak began in
Chitungwiza Chitungwiza is an urban centre and town of Harare Province in Zimbabwe. History As of the 2022 census, Chitungwiza had a population of 371,244. There are two main highways which connect the city to Harare namely Seke road and Chitungwiza r ...
on 20 August 2008. In September, cases spread to the urban areas of Makonde and Chinhoyi. By the end of October, cases had spread to 3 provinces:
Mashonaland West Mashonaland West is a province of Zimbabwe. It has an area of 57,441 km² and a population of approximately 1.5 million (2012). Chinhoyi is the capital of the province. Districts Mashonaland West is divided into 7 districts: * Chegutu * ...
,
Mashonaland East Mashonaland East, informally Mash East, is a province of Zimbabwe. It has an area of 32,230 km2 and a population of approximately 1.35 million (2012). Marondera is the capital of the province. Geography Districts Mashonaland East i ...
, and
Harare city Harare (; formerly Salisbury ) is the capital and most populous city of Zimbabwe. The city proper has an area of 940 km2 (371 mi2) and a population of 2.12 million in the 2012 census and an estimated 3.12 million in its metropolitan ...
. In the first two weeks of November, the epidemic rapidly spread across Zimbabwe, appearing in a total of 9 provinces and 54 districts. The disease spread to reach all of Zimbabwe's ten provinces. The attack rate was highest in Beitbridge, Chegutu, Mudzi and Zvimba Districts (above 1,000 cases per 100,000 people or 1.0%). The number of cases reported by the United Nations Office for the Coordination of Humanitarian Affairs escalated from 30 on 1 September 2008 to 15,572 by 10 December. According to the Red Cross, around 46% of reported deaths occur en route to clinics and hospitals. The head of the British
Department for International Development , type = Department , logo = DfID.svg , logo_width = 180px , logo_caption = , picture = File:Admiralty Screen (411824276).jpg , picture_width = 180px , picture_caption = Department for International Development (London office) (far right ...
in Harare said that "there are probably twice as many people with cholera as turn up for treatment". The case fatality rate for the outbreak was higher than expected for such outbreaks, although it began declining by January 2009. Official estimates of fatalities have run from 484 to 800, since the outbreak in August 2008, with an upper estimate of 3,000 from an anonymous senior official in the Ministry of Health and Child Welfare. Fatality rates varied from 2.5% in Harare to 18% in Chitungwiza. In Harare, the crisis reached the extent that the city council offered free graves to cholera victims. By 7 December,
Oxfam Oxfam is a British-founded confederation of 21 independent charitable organizations focusing on the alleviation of global poverty, founded in 1942 and led by Oxfam International. History Founded at 17 Broad Street, Oxford, as the Oxford Co ...
estimated 60,000 cases by the end of January 2009 and a 10% fatality rate, with UNICEF giving a similar estimate. On 4 December 2008, the Zimbabwe government declared the outbreak to be a national emergency.


Response

Assistance after the 2008 outbreak was made available by numerous international agencies, and funding for water, sanitation and hygiene programmes, epidemic response and the provision of essential drugs came from several governments and trans-governmental organisations: 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. UNICEF distributed 360,000 litres of water per day in Harare, as well as handing out soap and buckets. Notwithstanding the contributions received, UNICEF indicated on 9 December 2008 that US$17,500,000 was needed to respond properly to the outbreak. 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.


Spread

The 2008 cholera outbreak spread to districts in Botswana, Mozambique, South Africa and Zambia bordering Zimbabwe.


South Africa

Cholera spread to the Zimbabwean migrant worker community in Limpopo and
Mpumalanga Mpumalanga () is a province of South Africa. The name means "East", or literally "The Place Where the Sun Rises" in the Swazi, Xhosa, Ndebele and Zulu languages. Mpumalanga lies in eastern South Africa, bordering Eswatini and Mozambique. It ...
provinces of South Africa and cholera bacteria were detected in the Limpopo River on 3 December 2008. By 12 December 2008, 11 deaths and 859 infections had been recorded in South Africa, rising to 2,100 cases and 15 deaths by 14 January 2009, and to 12,000 cases and 59 deaths by 10 March. The South African government set up medical facilities and drinking water supplies at the
Beitbridge Beitbridge is a border town in the province of Matabeleland South, Zimbabwe. The name also refers to the border post and bridge spanning the Limpopo River, which forms the political border between South Africa and Zimbabwe. The border on the S ...
border post and deployed the National Outbreak Response Team and additional medical personnel to Musina. Anthony Turton, a political scientist and Unit Fellow with the
Council for Scientific and Industrial Research The Council for Scientific and Industrial Research (CSIR) is South Africa's central and premier scientific research and development organisation. It was established by an act of parliament in 1945 and is situated on its own campus in the cit ...
(CSIR) in South Africa, who had earlier warned of the risk of cholera in South Africa and wrote a report that recommended that the South African government increase its spending on water treatments lest a cholera outbreak occur in the country, was suspended for having made "inappropriate statements to the media". On 10 December 2008, the Limpopo Provincial Government declared
Vhembe District Municipality Vhembe is one of the 5 districts of Limpopo province of South Africa. It is the northernmost district of the country and shares its northern border with Beitbridge district in Zimbabwe and on the east with Gaza Province in Mozambique. Vhembe co ...
, which borders Zimbabwe at Beitbridge, Matabeleland South province, a disaster area. On a 28 January 2009 visit to Musina with high-ranking government and ruling party officials, Health Minister
Barbara Hogan Barbara Hogan (born 28 February 1952) is a former Minister of Health and of Public Enterprises in the Cabinet of South Africa. Early life Hogan attended St Dominic's Catholic School for Girls, Boksburg, and gained a degree at the University o ...
said


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 Kafue District is a district of Zambia, located in Lusaka Province. The capital lies at Kafue. As of the 2000 Zambian Census, the district had a population of 150,217 people. Kafue has many business areas to invest in. There are more services one c ...
in Zambia and none in Botswana or Namibia by 9 December 2008. 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 The Democratic Republic of the Congo (french: République démocratique du Congo (RDC), colloquially "La RDC" ), informally Congo-Kinshasa, DR Congo, the DRC, the DROC, or the Congo, and formerly and also colloquially Zaire, is a country in ...
. In Mozambique, cholera spread to 10 out of 11 provinces, with a total of 9,533 cases by 1 Jan to 1 Mar 2009 and 119 deaths by 17 March.AFP:12 Mozambican prisoners die after cholera riot
/ref> Four health workers also died in a mob attack, blamed on "misinformation and misunderstanding in efforts to combat cholera", and 12 of the prisoners from the incident died in jail. In Malawi 104 deaths were recorded since January, making it the worst outbreak since 2001–02 where 960 people died. Kenya, Somalia, Tanzania,
DRC The Democratic Republic of the Congo (french: République démocratique du Congo (RDC), colloquially "La RDC" ), informally Congo-Kinshasa, DR Congo, the DRC, the DROC, or the Congo, and formerly and also colloquially Zaire, is a country in ...
, and Ghana have had unrelated cholera outbreaks with between 10 and 100 deaths in 2009 as of February.


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.


Politicisation

Because of its well-organised health care system and effective water sanitation facilities,
Rita R. Colwell Rita Rossi Colwell (born November 23, 1934) is an American environmental microbiologist and scientific administrator. Colwell holds degrees in bacteriology, genetics, and oceanography and studies infectious diseases. Colwell is the founder and ...
of the
James Baker Institute Rice University's Baker Institute for Public Policy, also known as the Baker Institute, is an American think tank on the campus of Rice University in Houston, Texas. Founded in 1993, it functions as a center for public policy research. It is named ...
says Zimbabwe was historically one of the African countries least affected by cholera. A news commentary in '' The Lancet'' said that, under President Robert Mugabe, the country's health programs were negatively impacted, resulting in diminished health care for those infected with cholera. According to a draft paper from the WHO's World Conference on Social Determinants in Health, there were fewer health workers in the villages than in urban areas, which hindered early detection and isolation of cholera cases. 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. 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. 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. Doctors in Zimbabwe fill only 25% of the medical posts available, and even fewer specialist positions are taken. 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. 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. 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. 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. It was not contained or prevented from spreading. Until 2008, the government insisted that there was no cholera in Zimbabwe, and Pruyt says the U.N. did not provide the country with safe drinking water until after the crisis started. 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. 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" and that Zimbabwe had become a failed state. 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. The transfer of water treatment from local government to the
Zimbabwe National Water Authority Zimbabwe (), officially the Republic of Zimbabwe, is a landlocked country located in Southeast Africa, between the Zambezi and Limpopo Rivers, bordered by South Africa to the south, Botswana to the south-west, Zambia to the north, and Mozam ...
was criticized by Innocent Nhapi of the National University of Rwanda on the basis of capacity and funding of the authority. 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. 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. 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. 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". According to a news report in ''
Al Jazeera Al Jazeera ( ar, الجزيرة, translit-std=DIN, translit=al-jazīrah, , "The Island") is a state-owned Arabic-language international radio and TV broadcaster of Qatar. It is based in Doha and operated by the media conglomerate Al Jazeera ...
'', the Zimbabwe government and state media blamed the outbreak on European and American sanctions and a Reuters report said it accused Britain of plotting an invasion under the cover of the outbreak. Information minister
Sikhanyiso Ndlovu Sikhanyiso Ndlovu was a Zimbabwean politician who was Minister of Information and Publicity from 2007 to 2008. He was also a member of the ZANU-PF Politburo. Political career After serving as Deputy Minister of Education, Ndlovu was appointed as ...
blamed the cholera deaths on Western sanctions, saying "the cholera issue has been used to drive a wedge among us". On 12 December, Ndlovu repeated his accusation, and claimed that the cholera outbreak was actually a "serious biological-chemical weapon" attack by the United Kingdom, which Ndlovu asserted was trying to commit genocide. Said Ndlovu: In the meantime, a senior ZANU-PF official argued that the government and party leadership was more focussed on the forthcoming ZANU-PF conference than on the current crisis. On 11 December 2008, President Robert Mugabe made a speech screened on national television in which he said: Reports from the WHO contradicted Mugabe's view and indicated a growing death toll. According to the WHO, as of 8 December nearly 800 people had died of cholera and more than 16,000 cases were being treated. Later that same day, Zimbabwean visas were denied to six French aid workers, including three crisis management specialists, two epidemiologists and a water treatment expert. Britain's Africa minister,
Mark Malloch-Brown George Mark Malloch Brown, Baron Malloch-Brown (born 16 September 1953) is a British diplomat, communications consultant, journalist and former politician serving as president of Open Society Foundations since 2021, having previously served as ...
, dismissed Mugabe's claim that the Zimbabwe cholera crisis is over, commenting as follows: The
French French (french: français(e), link=no) may refer to: * Something of, from, or related to France ** French language, which originated in France, and its various dialects and accents ** French people, a nation and ethnic group identified with Franc ...
foreign ministry and USAID also contradicted Mugabe's statements and called on him to allow aid to reach the people in need.


See also

*
Health in Zimbabwe Zimbabwe was once a model functional healthcare system in post colonial Africa, boasting a strong primary healthcare system and skilled healthcare workers under the Mugabe administration. In 2008, Zimbabwe had a 76.9 billion percent inflation rate a ...
* Water supply and sanitation in Zimbabwe *
Cholera outbreaks and pandemics Seven cholera pandemics have occurred in the past 200 years, with the first pandemic originating in India in 1817. The seventh cholera pandemic is officially a current pandemic and has been ongoing since 1961, according to a World Health Organizat ...
*
2018–2019 Zimbabwe cholera outbreak The 2018–2019 Zimbabwe cholera outbreak began on 1 September 2018, and the last reported case occurred on 12 March 2019.ReliefWeb (2019). Zimbabwe: Cholera Outbreak - Sep 2018. nlineAvailable at: https://reliefweb.int/disaster/ep-2018-000150-zwe ...


References


External links


Cholera situation in Zimbabwe – UN OCHA

UN Office for the Coordination of Humanitarian Affairs, Zimbabwe





US Centre for Disease Control and Prevention Notice: Cholera in Zimbabwe and Neighboring Countries



Zimbabwe cholera crisis (Red Cross)
{{DEFAULTSORT:Zimbabwean Cholera Outbreak 2008 disease outbreaks 2009 disease outbreaks 2008 in Zimbabwe 2009 in Zimbabwe
2008 File:2008 Events Collage.png, From left, clockwise: Lehman Brothers went bankrupt following the Subprime mortgage crisis; Cyclone Nargis killed more than 138,000 in Myanmar; A scene from the opening ceremony of the 2008 Summer Olympics in Beijing; ...
Disease outbreaks in Zimbabwe