Portal de Periódicos da CAPES

Zimbabwe's humanitarian crisis worsens

2009; Elsevier BV; Volume: 373; Issue: 9662 Linguagem: Inglês

10.1016/s0140-6736(09)60151-3

1474-547X

Clare Kapp,

Child Nutrition and Water Access

While political parties have been thrashing out a power-sharing deal, Zimbabwe's health crisis has deepened, with a staggering cholera outbreak claiming thousands of lives. Clare Kapp reports. Zimbabwe has reported more deaths from its cholera epidemic than were officially notified worldwide to WHO in 2005, the last year on record. The toll underlines the total collapse of the health and sanitation system which was once the pride of Africa. Education is in tatters, half the population is on food aid, and inflation is officially 231 million percent—but believed to run into the billions. “The cholera outbreak is just the tip of the iceberg”, commented UNICEF's Executive Director Ann M Veneman, who was the first UN agency chief to visit Zimbabwe in 3 years. After months of political deadlock which worsened the humanitarian crisis, there are tentative grounds for hope. The opposition Movement for Democratic Change signalled on Jan 30 that it was prepared to join a government of national unity with President Robert Mugabe, even though the 84-year-old autocrat has tried to grab all the key ministries for himself. It will be a rocky marriage, given the arrests and torture experienced by opposition supporters at the hands of Mugabe's forces. It is unclear whether the political thaw will convince sceptical donors to increase sorely needed international aid to tackle the cholera outbreak. Physicians for Human Rights recently called on the UN to take responsibility for the health system which proved unable to cope with the epidemic of an easily treatable disease. With 2 months left of the rainy season, the number of reported deaths has topped 3100 and there have been more than 60 000 cases—the worst case scenario predicted by WHO last year. Worldwide in 2005, 2272 cholera deaths were reported to WHO from 131 943 cases (the real toll was higher because of poor surveillance). Zimbabwe's epidemic has proved exceptional because of the excessively high case fatality rate of 5·7%—in some rural areas as high as 9%—against a target of less than 1%. A UN situation report said that many cholera treatment centres still lack food, medicines, equipment, and staff, and faced logistical difficulties such as a lack of reliable water supplies, electricity, and garbage collection. It said that staff shortages were so acute that it was difficult to maintain even a skeleton service in most clinics. After her visit on Jan 17, Veneman said UNICEF would immediately release US$5 million to pay salaries of health workers. But that is likely to be a drop in the ocean. Cholera is now spreading in neighbouring countries. Barbara Hogan, South Africa's health minister, said that from Nov 15, 2008, to Jan 24, 2009, 5696 patients were treated for cholera, nearly all of them in two provinces near Zimbabwe. She said that 36 people had died—a case fatality rate of 0·63%. Hogan told South Africans not to panic, but did not dispute the strain on local health facilities. The border town of Musina is swamped by hundreds of cross border traders, and hundreds more who sneak in illegally, wading through the Limpopo river and clambering under electric fences. UNICEF said increasing numbers of unaccompanied children were also crossing the border and trying to survive by begging and stealing and doing piecemeal jobs, and were at risk of being beaten, mugged, or abused by violent gangs. Save the Children estimated there were as many as 1000 unaccompanied children in Musina and more in the surrounding farming communities. Little remains for children who stay in Zimbabwe. Acute child malnutrition is on the increase, as is chronic long-term malnutrition. The education system has completely disintegrated. Parents are unable to afford uniforms or bus fares. As late as 2007, 85% of children were still going to school. By the end of 2008, attendance was already down to around 20%, and figures are likely to drop even further, according to Save the Children. The country's food crisis means many children spend their days scavenging for food. The schools that are open pose an additional health threat because they have little access to clean water or disinfectant. “Pupils and teachers who do make it back to the classroom could be faced with an increased threat of cholera”, said Save the Children's Zimbabwe country director Rachael Pounds. “Sanitation is now so bad in schools that they may become a breeding ground for infection.”