Are we beyond cholera and the crisis in Zimbabwe?

In February, Médecins Sans Frontières (MSF) released the report "Beyond Cholera: Zimbabwe's Worsening Crisis" to alert to the humanitarian crisis ravaging Zimbabwe, most visibly expressed by the unprecedented cholera outbreak, which claimed thousands of lives.

Now, six months later, the cholera outbreak has died down and the new unity government has passed its first half year. How is the medical situation today? What has changed and what are the challenges Zimbabwe still has to battle?

In this interview, MSF Head of Mission Rian van de Braak talks about the current situation in the country.

In MSF’s February report, we read that Zimbabwe’s Health System is in a total state of collapse. Health facilities had to close down for a lack of drugs, supplies, and staff. What is the situation today?

Things have been improving bit by bit over the last couple of months. The multi-donor retention scheme, which includes small salaries for health staff, has helped to bring some health workers back to hospitals and clinics – especially in rural settings. The lack of drugs and supplies is still a problem; despite the fact that stocks have increased on a central level in Harare, transporting them to the clinics is a huge logistic constraint. Also, many of the health facilities have now started to ask fees from the patients, which make access to health care for many people unaffordable. In Epworth, one of our project areas, for instance, women now have to pay $50US for antenatal care services – an amount impossible to pay for most residents.

The historic cholera outbreak, infecting nearly 100,000 people up to date, has been a major concern over the last year. In fact, it started exactly a year ago, in August. Since May, the numbers have been going down, does that mean the threat is over?

No the threat is definitely not over; everyone expects cholera to be back – latest with the next rainy season – because the root cause for the outbreak has not been addressed adequately yet. The dilapidated water and sewage systems are still a major problem. Several aid agencies are drilling new boreholes in cholera hotspots, which is an important contribution to safe drinking water. But for the big cities like Harare, the problem is of an enormous scope. Dealing with those causes before the next rainy season will be a race against the clock.

Nobody knows how big the next outbreak will be, but we are ready to respond immediately. We have the necessary stocks in the country and a contact list of all the extra 250 Zimbabwean staff who we recruited for the last outbreak. They are well-trained and experienced by now and many of them would be ready on short notice. Additionally, we have been distributing cholera kits to 50 of the most remote clinics we have been working with, and trained the health staff on how to intervene when the first cases arrive. We also distributed 11.000 hygiene kits and reached more than 40.000 households with our hygiene promotion.

The socio-economic crisis prevented a lot of people living with HIV/AIDS from access to medical care, and many who were on treatment to continue it properly. With a prevalence rate of an estimated 15.3 percent this is a major concern in Zimbabwe. How is the situation now

In this area the problems are still huge. There are more than 400 people dying in Zimbabwe everyday of AIDS-related causes. To put things in perspective: there were around 4.000 cholera-related deaths in total during the nine-months outbreak. With AIDS we have that number of casualties within ten days, every ten days, again and again.

MSF projects are implemented in cooperation with the Zimbabwean Ministry of Health and set-up within the national health structures. Currently, they are ensuring medical care to more than 42,000 HIV positive patients, out of whom around 27,000 are receiving anti-retroviral (ARV) therapy. But again, only about 20 percent of the people in need of ARV treatment are currently obtaining the medication in Zimbabwe.

The main source of financial support for the Zimbabwean health sector in relation to HIV/AIDS is the Global Fund to Fight AIDS, Tuberculosis and Malaria. Due to political and administrative challenges however, this funding has come to a temporary standstill and with it the dearly needed scaling up of the national ARV program. As long as this problem is not solved, thousands of HIV positive patients are deprived of the treatment they urgently need.

What about the food situation? In February, the peak of the hunger season was reached with over five million Zimbabweans facing severe food shortages, depending on international aid. What do you see in your project areas today?

In general the peak of the hunger season is over again. While we had around 150 children in our Therapeutic Feeding Centre in Epworth every day during the peak season in December/January, numbers now went down to 10 to 15 children a day.

Another concern with regards to malnutrition, however, is the situation in Zimbabwean prisons. During the cholera intervention we were granted access to two prisons to assist in dealing with cholera inside these institutions. There, we were confronted with a severe situation of malnutrition.

We started an emergency intervention with therapeutic feeding for the most seriously malnourished inmates, supplementary feeding for the other prisoners, and basic water and sanitation activities to ensure the provision of clean drinking water. The intervention has been expanded recently to six of the most affected prisons we found after a rapid assessment of 15 institutions in the Midlands and Mashonaland provinces.

Would you say that your ability to work has improved under the new government?

In a number of respects, our ability to work has improved substantially. Our counterparts in the government are seeking cooperation with international NGOs on the ground, especially in the area of health, water and sanitation, and nutrition. The fact that the Ministry of Justice openly admitted their problems and lack of supplies within the prison system and were appreciative of our support to the prisoners can be seen in this light.

So we definitely see positive signals but it remains to be seen if the remaining barriers for NGOs, such as the lengthy process to receive temporary employment permissions for international staff, the necessity for foreign doctors to undergo a three months rotation in a Zimbabwean clinic before being granted hands-on work, or the possibility to receive registration as an NGO in Zimbabwe, will be lifted accordingly. This is important to effectively carry out our work and to motivate other NGOs to come to the country and assist the Zimbabwean people in coping with the enormous needs.

In your opinion, what is to be done to improve the situation in Zimbabwe and which are the challenges ahead?

Zimbabwe is in dire need of substantial humanitarian aid to get itself back on its feet. Although the rock-bottom situation of December/January has been overcome in large parts, the population still does not have adequate access to health care, people continue to die of AIDS in outrageously high numbers and the next cholera outbreak is at the doorsteps. The donor community should review the conditionality of releasing humanitarian funds and target them as much as possible to the areas most in need and with direct impact for the population itself.

In addition, the government needs to further reduce bureaucratic obstacles for international NGOs and increase the humanitarian space for aid organizations to assist the struggling Zimbabwean population. At this point in time, Zimbabwe urgently needs all the help it can get to make sure the population no longer suffers needlessly.