The cholera epidemic, which started in August 2008 has been unprecedented in scale for Zimbabwe and still continues today. MSF has treated more than 45,000 cholera patients during this time – which represents approximately 75% of all cholera cases since the outbreak began. The level of MSF’s response has been necessitated by the scale of the epidemic and the inability of local health structures to cope.

The continuing Cholera emergency 

Cases have been found in all provinces. More than 500 MSF staff members are presently working to identify new cases and to treat patients in need of care. As of early February 2009, the focus of the outbreak had shifted from the cities to rural areas, where access to health care is particularly limited, but the number of cases in some urban areas are still significant. The epidemic is far from under control. In the first week of February 2009, 4,000 new cases were treated in MSF supported structures alone.

The reasons for the outbreak are clear: lack of access to clean water, burst and blocked sewage systems, and uncollected refuse overflowing in the streets, all clear symptoms of the breakdown in infrastructure resulting from Zimbabwe's political and economic meltdown.

Although MSF has been able to respond to the outbreak on a massive scale – delays and restrictions have been encountered. In December, when the number of cholera patients in Harare had reached a peak with close to 2,000 admissions a week, it took weeks to get permission to open a second empty ward in Harare’s Infectious Disease Hospital to increase the capacity for cholera treatment.

The political crisis and resultant economic collapse is manifesting in cholera, population movement, hyperinflation, food insecurity, violence and a lack of access to HIV/AIDS treatment and health care more generally.

Despite the glaring humanitarian needs, the government of Zimbabwe continues to exert rigid control over aid organisations. MSF faces restrictions in implementing medical assessments and interventions. Especially in cases of emergencies where quick action often determines life or death, allowances for a rapid humanitarian response is crucial.

To address the humanitarian issues facing Zimbabwe requires a shift of approach or strategy from a range of political and aid actors – including the UN and donors. There is not only a need for an increased humanitarian response, but also for a move to a more proactive emergency approach based on a recognition of the severity of the crisis in all its manifestations – not just Cholera. Urgent steps must be taken today to ensure that Zimbabweans have unimpeded access to the humanitarian assistance they desperately need.

Now more than ever, an adequate humanitarian response in Zimbabwe will require an increase in "humanitarian space” for independent aid organisations to carry out our work. The Zimbabwean government must facilitate independent assessments of need, guarantee that aid agencies can work wherever needs are identified and ease bureaucratic restrictions so that programmes can be staffed properly and drugs procured quickly.

Donor governments and United Nations agencies must ensure that the provision of humanitarian aid remains distinct from political processes. Their policies towards Zimbabwe must not come at the expense of the humanitarian imperative to ensure that malnourished children, victims of violence, and people with HIV/AIDS and other illnesses have unhindered access to the assistance they need to survive.