Norman Traub looks at the catastrophe facing Zimbabwe.

The cholera epidemic sweeping across Zimbabwe is yet another manifestation of a profound crisis which encompasses every aspect of life in the country. The bare statistics of nearly 600 deaths and 14,000 recorded cases since August can hardly capture the misery and suffering of the people exposed to the ravages of the epidemic raging in their midst. The severely malnourished population, thousands of whom are reduced to searching for berries and plant roots to try and sustain themselves, are much less able to resist the infection than the properly fed. The government has ignored the repeated warnings of doctors and other public health workers, that the severe shortage of running water in most areas of the country and the failure to treat and pump adequate supplies of water forcing the population to rely on unsafe supplies of water, is a health hazard. This coupled with the breakdown in the sanitation system with burst sewage pipes contaminating water supplies have created the conditions for the outbreak of the cholera epidemic. There have been previous outbreaks of cholera in Zimbabwe, as its water and sanitation systems have broken down, but this is the first epidemic of the infection. It started in Chitungwiza, a small town near the capital Harare and rapidly spread to the major urban areas and other parts of Zimbabwe.

The World Health Organisation estimates that the case fatality rate in Zimbabwe is 4.5%, whereas when the infection is properly managed with antibiotics and rehydration fluids, the normal fatality rate is below 1%. The lack of proper treatment for the infection in Zimbabwe is highlighted by the statement of the Zimbabwe Association of Doctors for Human Rights(ZADHR) last month. They say that the public health system is in a state of collapse, paralysed by drug shortages and insufficient medical supplies and that the main referral hospitals in Harare and Bulawayo have virtually closed down. Most district hospitals and municipal clinics are also closed. Sick people are turned away as are healthy women requiring caesarean sections, needlessly dying in childbirth. Resistance against the government’s health and other policies has been building up. Health workers in Harare last month protesting against the state of the public health system were assaulted and their demonstration broken up. Their protest a week ago, was again broken up by police using batons to disperse them. A number of trade unionists of the Zimbabwe Congress of Trade Unions throughout Zimbabwe, including its secretary Wellington Chilebe, demonstrating against the poor state of the health system and the worsening food crisis, have been arrested and many beaten up. Women belonging to the organisation ,Women of Zimbabwe Arise, protesting on urgent issues like food, water and electricity have also been arrested and beaten up. It is only in the last few days that the Zimbabwean government has been forced to declare the epidemic a national health emergency after repeatedly playing it down.

With thousands of refugees pouring over the borders of Zimbabwe to escape the epidemic, outbreaks of the infection with fatalities are occurring in South Africa and also in Mozambique and Botswana. The lack of access to clean water and sanitation for the refugees has contributed to the outbreaks of infection. In the South African border town of Musina refugees are living in the open under abysmal conditions. Between 200 and 400 refugees are arrested and deported back to Zimbabwe each day. The South African health authorities have set up five cholera treatment centres along the border to handle the influx but are set to be overwhelmed if the disease spreads. The South African government said it would hold an urgent meeting on the humanitarian crisis in Zimbabwe, “There are very clear signs…people are beginning to die of starvation. South Africa and SADC(the Southern African Development Community) can’t just fold our arms,” said a South African government spokesman, Themba Maseko.

The failure of the government to deal with the cholera epidemic has deprived it of any legitimacy it had among the population. Its failure has been comprehensive, “at the prevention stage, the intervention stage and the curative stage. It is also a manifestation of the absence of environmental health officers and of the absence of the effective governance at the local authority level. Interventions to manage cases and control the spread of the disease have mostly been undertaken by WHO, UN agencies and non-governmental organisations such as Medecins Sans Frontieres and Save the Children UK,” said ZADHR. The government has increasingly to rely on brute force to maintain its rule. In this regard, the riot by dozens of Zimbabwean soldiers in Harare a week ago, attacking banks after they were unable to withdraw their near worthless pay, must be deeply worrying to the government. The question that faces the Mugabe regime is how long it can survive, as the resistance in Zimbabwe to its rule builds up and the external pressures for change increase.