TIMELINE
12 February 2023: First cholera case reported in Chegutu town, Mashonaland-West.
15 February: Second case reported; government activates cholera response taskforces at all levels and a first cholera treatment centre (CTC) is set up in Chegutu.
18 April: Suspected cases increase to 579 with 9 suspected deaths reported.
6 June: IFRC DREF is allocated covering five districts in Manicaland province and Matebeleland-South.
October: Cholera continues spreading and is reported in 43 districts across the country, making international headlines.
16 November: IFRC issues Emergency Appeal for CHF 3 million, covering 550,455 people.
7 November: Suspected cases reach 6,685 according to the Zimbabwe Ministry of Health and Childcare Cholera Situation Report.
17 November: Harare City declares a state of emergency.
DESCRIPTION OF THE EVENT
The first cases of cholera in this outbreak were recorded on 12 February 2023 in Chegutu town, Mashonaland West province. By 10 November there were 6,114 suspected cases, 48 confirmed deaths, 134 suspected deaths and a case fatality rate of 2.7 per cent. To date suspected and confirmed cases have been reported in all 10 provinces of the country.
The outbreak has spread beyond the 17 previous hotspot districts due to (1) poor hygiene practices, (2) unsupervised gatherings and funerals, (3) high usage of unsafe/unprotected sources of water for drinking and domestic use, (4) low national sanitation coverage with 40 per cent open defecation, and (5) low safe-water coverage, which is just 35 per cent.
Severity of humanitarian conditions
1. Impact on accessibility, availability, quality, use and awareness of goods and services
Zimbabwe continues to face challenges in service provision, including in water and sanitation, and some communities are using unsafe water with attendant periodic diarrhoeal outbreaks, including cholera. The health system has now been overstretched due to the high number of admissions.
- There is a lack of local supplies for water treatment, lack of clinical supplies and lack of non-food items (NFIs). There is a lack of water supply and lack of access to sanitation. There are also shortages of cholera beds in cholera treatment centres as well, leading to poor infection control. There is also low safe-water supply particularly in schools and health centres.
- There are not enough cholera treatment units (CTUs), which necessitates converting some health facilities for the response.
- There has been a sharp increase in cholera morbidity in educational institutions with some colleges reportedly closing due to the caseload.
- Illness, death and burials may go unreported among groups whose religious doctrine discourages use of health facilities and medicines, which only worsens the spread.
- There is a significant burden on government health, education and social services.
- Risk of infection for women and children is greater because it is largely they who take on the household caregiver roles for ill family members. Most households also depend on informal work and when family members become ill they may not seek treatment for fear of losing income.
- There is a lack of human resources to manage the caseload and in some cases delays due to the bureaucracy in decision making for the response.
- The community health care system has been disrupted and active case finding and surveillance are a challenge, while there is little or no space for the treatment of cholera cases in the community.
- Measures aimed at containing the outbreak have also exacerbated hardship in communities already experiencing the impacts of global economic disruptions. These impacts in turn have resulted in limited government resources for scaling up preventive measures.
- The general population has become unsettled by the number of cases being reported across multiple districts, this compounded by the stress of commonly held myths, misconceptions and religious beliefs.
2. Impact on physical and mental well-being
- The crisis has significantly impacted family cohesion, as family members admitted to cholera treatment centres (CTCs) or CTUs have limited contact with their families.
- With over 7,000 cases and close to 140 deaths recorded there is increased need for mental health and psychosocial support (MHPSS) to lessen the emotional burden on people showing signs of stress.
- Many people are delaying health-seeking behaviours, and this only exacerbates the crisis.
3. Risks & vulnerabilities
- Delays in addressing the risk factors of the outbreak have contributed to increased cases and deaths. Risk factors include limited access to safe drinking water, sanitation and hygiene (WASH), and lack of a better understanding of barriers to health-seeking behaviours, especially in hotspots.
- The wide spread of the outbreak in such a short time this early in the rainy season threatens further worsening of the situation as the rainy season continues.
- The expected movement of people inside the country, and into Zimbabwe from neighbouring countries in both the run-up to the Christmas period and after the holiday, increases risk of cholera in areas where numbers may have been lower, and risk of transporting cholera to other countries as travellers cross borders.
- An imminent El Niño is forecast to bring dry spells and possibly hunger, which, when added to the cholera outbreak, water shortages and poor economic environment, will result in poorer health among people in affected areas.
- Zambia is also experiencing a cholera outbreak as well as an anthrax outbreak, which has spread to most provinces, including the capital, Lusaka. Zambia and Zimbabwe share a boarder and the risk of anthrax crossing over into Zimbabwe cannot be discounted.