Cholera is not going away anytime soon

“The epidemic has entrenched itself as Africa’s worst outbreak in more than 15 years,” killing more than 4,300 people and infecting 98,309 since August 2008, with an “unacceptably high” 4.4 percent death rate, the International Federation of Red Cross and Red Crescent Societies (IFRC), said in a report, The Spectre of Cholera Remains in Zimbabwe, released on 26 May.

In terms of international norms, a “controlled cholera outbreak” usually leads to a fatality rate of one percent or less. The waterborne disease, characterised by watery diarrheal stools, vomiting and rapid dehydration, can cause death within 24 hours if not treated.

The severity of Zimbabwe’s epidemic is attributed to the collapse of the water, sanitation and health infrastructure. The conditions that caused the outbreak – the worst on the continent since cholera rampaged through refugee camps in Goma, Democratic Republic of Congo, in 1994, killing up to 40,000 people in the aftermath of the Rwandan genocide – are still intact.

“The eradication of cholera in Zimbabwe, or the complete conclusion to this current epidemic, is unlikely unless the underlying causes of the health crises are addressed,” the IFRC noted in its report.

Worst-case scenario just got worse

In December 2008 the World Health Organisation (WHO) predicted a worst-case scenario of 60,000 cases – the number reached in February 2009 – and then revised its prediction to 115,000 cases. At the current fatality rate, should the revised WHO forecast be realised, the number of deaths from the outbreak would surpass 5,000 people.

The rate of cholera infections has been slowed by the end of the rainy season, and a humanitarian response in which thousands of community-based volunteers were mobilised in education drives, nationwide cholera treatment centres were establishment and millions of litres of clean water were distributed, but these are all temporary measures.

Emma Kundishora, secretary-general of the Zimbabwe Red Cross Society, told IRIN the NGO was building boreholes and digging latrines in rural areas, “as we don’t want this situation to be repeated,” but funding was becoming critical.

The IFRC expressed dismay at the “surprisingly slow donor response” to the cholera outbreak, and said that less than half its original budget of 10.17 million Swiss francs (US$9.35 million) to combat the disease had been covered, resulting in the “premature” scaling-down of cholera-related assistance.

“But while the international community continues to wrestle with the politics of Zimbabwe, Zimbabweans are still being infected,” it commented.

The endemic frustrations of operating in Zimbabwe – inadequate transport and communications – also played out more acutely. Aid organisations were often only made aware of community-level outbreaks when their treatment centres were inundated with cases.

Hollow victories

“The steady decline in the spread of the illness should not be seen as a complete victory,” the IFRC urged. “Unless significant efforts are made to rehabilitate at least some components of the country’s degraded infrastructure, communities remain vulnerable to further and severe outbreaks.”

Zimbabwe’s cholera outbreak sprang from a confluence of events: unchecked infrastructural degradation, extreme weather conditions, HIV/AIDS, economic decay and widespread hunger.

“The endemic frustrations of operating in Zimbabwe – inadequate transport and communications – also played out more acutely. Aid organisations were often only made aware of community-level outbreaks when their treatment centres were inundated with cases,” the IFRC said.

The effects of malnutrition – Zimbabwe is the world’s most food-dependent country – “with somewhere between 65 and 80 percent of the population reliant on food aid”, the IFRC said – enhanced the disease’s deadly efficiency.

The 2008 harvest was the worst in the country’s history and 2009 is not expected to be much better. “The food crisis is undermining stunted efforts to provide antiretroviral treatment, and is contributing to the high fatality rate of the cholera epidemic,” the ICRC pointed out.

IRIN