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January 13, 2009  

Completely Predictable: Cholera in Zimbabwe

Zimbabwe’s cholera crisis, which has caused more than 1,900 deaths, is a “manmade disaster” caused by President Robert Mugabe’s government, according to a January 13 report by Physicians for Human Rights (PHR), co-authored by Johns Hopkins Bloomberg School of Public Health researcher Chris Beyrer, MD, MPH ’90.

The report, which presents qualitative data derived from interviews with health care workers, engineers, school teachers, NGO and UN representatives, and other officials in the country, attributes the epidemic to Mugabe’s intentional neglect of water treatment and sanitation services, which have fallen into severe disrepair since he was accused of electoral fraud and political violence during run-off elections this summer.

Beyrer, director of the Johns Hopkins Center for Public Health and Human Rights, gathered data in Zimbabwe with three other PHR physicians during a covert five-day visit to the country in mid-December. Escorted by a group of Zimbabwean doctors, Beyrer and colleagues, in-country on tourist visas, toured four provinces, in both rural and urban locations. The general hospitals were “bolted closed,” said Beyrer, the cholera hospitals were under tight surveillance, and the mission hospitals were stretched beyond the point of being able to deliver medical supplies or even running water.

“Zimbabwe offers a classic lesson in public health,” said Beyrer. “When government neglects its basic functions, citizens die. The cholera epidemic in Zimbabwe is completely predictable and preventable. It’s the outcome of the collapse of the most basic water and sanitation measures.”

The health care infrastructure in Zimbabwe has been deteriorating since 2000, when Mugabe began a “land reform” program that undermined the nation’s agriculture industry and crippled the economy. After the disputed polls this summer and a UN order to share power with his political rival in September, Mugabe became proactive in his punishment of Zimbabweans. According to Beyrer, professor of Epidemiology, Mugabe created an extreme breakdown of the health care system.

“You can’t mistake the stench of the sewage,” said Beyrer. In all provinces visited, he and his colleagues observed ruptured sewage pipes and garbage that lines the dirt roads alongside ditches. “There’s open sewage,” said Beyrer. “In some towns, citizens have built walls of garbage—the garbage hasn’t been collected in months.”

The outlook for cholera in the country is grim. The monsoon rains are just beginning in Zimbabwe now, after five months of a cholera crisis, and Beyrer expects the epidemic to worsen.

As a stopgap measure, said Beyrer, aid groups can provide medicine and food. But the crisis may intensify to a degree that the international community would intervene in Zimbabwe against Mugabe’s wishes, acting on a controversial concept known as Responsibility to Protect (a UN-endorsed concept that obligates the international community to respect, protect and fulfill nations’ rights to sovereignty).

A telling footnote to the cholera story, said Beyrer, is the prevalence they observed, among Zimbabweans, of pellagra, a vitamin deficiency disease precipitated by a carbohydrates-only diet. Health officials in Zimbabwe are not allowed to report malnutrition, because no one is supposed to be starving in Zimbabwe, the nation formerly known as “the breadbasket of the world.”

“All of this is evidence of why good government is so central to public health,” said Beyrer. “The basic functions of public health really are state functions. When a state ceases in that, public health fails.”             — Christine Grillo

Read In Zimbabwe, a Cancer Called Mugabe, by Chris Beyrer and Frank Donaghue, in the Washington Post.