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Zimbabwe Health System Crisis
Zimbabwe is at the center of an international public health crisis as the country struggles with a devastating cholera outbreak that has, as of March 6, 2009, claimed the lives of over 4,000 Zimbabweans (over 124,000 cases have been reported). The cholera outbreak, however, is merely a symptom of a collapsing health system paralyzed by a government in turmoil.

A power-sharing deal signed on September 15 aimed to bring together the current president Robert Mugabe and opposition leader Morgan Tsvangirai, signaled a moment of hope for the future of Zimbabwe. Instead, it marked the start of the country's most recent descent into chaos: water and sanitation services shut down; inflation skyrocketed; food shortages spread across the country; hospitals and clinics closed their doors; outbreaks of cholera, anthrax, and possibly malaria threaten lives; and in a country where where AIDS kills over 400 Zimbabweans a day, care for HIV/AIDS and opportunistic infections have lost priority.  While innocent civilians fight for their lives the governing parties clash over the rule of Zimbabwe.

In Zimbabwe, The Cancer Called Mugabe - Read the Washington Post editorial by Dr. Chris Beyrer and Frank Donaghue (8 January 2009)

Health in Ruins: A Man-Made Disaster in Zimbabwe The Physicians for Human Rights (PHR) and Dr. Beyrer released their emergency assessment report, Health in Ruins: A Man-Made Disaster in Zimbabwe, on January 13, 2009 in South Africa and at the UN in New York. The PHR report, which includes a preface by Justice Richard Goldstone, Mary Robinson and Archbishop Desmond Tutu, accuses the Mugabe ZANU-PF regime of the systematic violation of a wide range of human rights, including the rights to life, health, food, water and work.  On February 2, 2009, while highlighting the extreme death toll attributed to the cholera outbreak and the concerns for HIV infected individuals, PHR called for the Obama administration and global leaders to take action in addressing the situation in Zimbabwe.  Read the press release.

Media reports covering the release of the PHR Report: Voice of America (listen); BBC ; Associated Press; ZimOnline; JHSPH

The Council on Foreign Relations interviews Dr. Beyrer and reports the PHR trip and findings and describes the current situation and events leading up to the crisis in Zibabwe. CFR Global Health Report (Mugabe's Cholera, page 2)

Cholera Patient in Wheelbarrow (AP)

Available reports:
OCHA Cholera Update- reports total cases in Southern Africa was 167,604 cases and 4,932 deaths due to cholera (1 June 09)
OCHA Cholera Map- illustrates cholera cases in Southern Africa (1 June 09)
USAID Humanitarian Assistance Report- reports $257,091,279 in assistance in 2008 and $6,800,000 thus far in 2009 (23 January 2009)

USAID Humanitarian Assistance Map- (23 January 2009)
FAO Food Insecurity Map- (June 2008)
PEPFAR Country Profile The HIV prevalence rate 15.3%; PEPFAR contributed $26.4mil

Timeline of the Collapse
29 March - The Movement for Democratic Change (MDC) won a majority of parliamentary seats in the general election on 2008, but failed to garner the 50% plus one vote required to take the presidency.

15 September - Robert Mugabe, leader of the ZANU-PF party, and the two MDC formations, led by Morgan Tsvangirai and Arthur Mutambara, sign a power-sharing agreement witnessed by heads of state and government of the SADC and others; Tsvangirai (as prime minister) to share executive powers with Mugabe (as president with reduced authority).

Tsvangirai calls on the international community to assist with aid as inflation shoots over 11 million percent, unemployment above 80%, and shortages of fuel, electricity, food and foreign currency. Oxfam echoes his call. The EU, US, and Australia maintain targeted sanctions against Mugabe and members of ZANU-PF. ZANU-PF and MDC supporters clash outside the venue.

16 September - Aid workers estimate up to 6,000 Zimbabweans are crossing the border into South Africa daily.

17 September - Rebellion within ZANU-PF over appointment of cabinet ministers under the power-sharing deal.

18 September -?UNICEF, to continue providing humanitarian assistance. The African Development Bank and World Bank indicate they will provide help. Coalition talks hit deadlock over allocation of ministries. Water shortages in Harare, with a lack of water treatment chemicals because of fuel shortages.

22 September - Drought exacerbates acute food shortages. Aid agencies step in to assist - Mugabe imposed a ban on NGO operations ahead of the presidential run-off in June until 28 August. UN estimate: 5 million will require food aid in beginning of 2009. ZANU-PF youth militia continue violence against MDC supporters.

25 September - Children discouraged from going to school because of teacher shortage. National Constitutional Assembly (NCA), Zimbabwe's leading civil society group of trade unions, human rights organisations and churches, rejects deal amid continued violence. ZANU-PF torture bases not being dismantled. EU boosts aid to Zimbabwe by 10 million euros.

26 September - Save the Children, an international NGO, warns that many children are being forced to eat poisonous roots and rats to stave off hunger. Mugabe lashes out at the West at the UN General Assembly. Power-sharing deal appears to be disintegrating. Cholera claims 20 lives.

27 September - Zimbabweans start using foreign currency as legal tender, an acknowledgement of the collapse of its own currency (Z$).

29 September - Zimbabwe's central bank issues large denomination bank notes Z$10,000 and Z$20,000 - a further sign of hyperinflation worsening.

7 October - Renewed power-sharing talks again fail to end the deadlock.

8 October - Urgent call from the UN for aid to avert an impending humanitarian disaster as a result of the ailing agricultural industry and conditions in the country. Power-sharing deal on the brink of collapse.

9 October - UN World Food Programme (WFP) says emergency food aid could run out at the peak of the crisis if US$140 million is not provided, and that 83 percent of Zimbabweans live on less than US$2 a day, with 45% malnutrition plaguing the population. Reports confirm that annual inflation has soared to 231 million percent.

10 October - Political rivals agree to fresh mediation by Thabo Mbeki to break the 4-week deadlock.

12 October - Mugabe unilaterally allocates key ministries to himself, including defence, home affairs, foreign affairs, local government, justice and legal affairs, prompting Tsvangirai to threaten pulling out of the power-sharing deal.

13 October - Mugabe swears in two vice-presidents. EU threatens more sanctions, which already target about 160 of the ruling elite, including a travel ban and freezing of assets.

16 October - MDC is given finance ministry. Police beat up more protestors.

19 October - Government makes it impossible for aid agencies to provide humanitarian assistance as their Zimbabwean bank accounts have been frozen.

20 October - Tsvangirai not able to attend regional crisis summit to save power-sharing deal because he does not have the necessary travel documents to go through South Africa to Swaziland. ZANU-PF is blamed, sparking a boycott of the summit by the MDC. SADC postpones the summit until 27 October. UN reports 120 deaths from cholera. State-owned Zimbabwe National Water Authority (ZINWA) pumping untreated sewage into Lake Chivero, the main water source of Harare, the capital. 10 cases of anthrax reported north of Harare.

21 October - Teaching and schooling has virtually ground to a halt, school graduation pass rate of 3 percent expected; 45,000 teachers estimated to have left the system since 2004. Catastrophic breakdown in water supply and sanitation services set to cause thousands of cholera infections.

23 October - Government centralises distribution of agricultural inputs, giving a military official the responsibility of determining the beneficiaries of agricultural inputs. Parliament announces food shortages as a national disaster.

28 October - Regional summit fails to break political deadlock; SADC calls for full-scale summit. Many Zimbabweans surviving on wild fruits and roots.

29 October - UN Secretary-General Ban Ki-moon calls for rivals to resolve the political impasse.

30 October - Cholera hits Harare.

31 October - Amnesty International, an NGO working to protect human rights, reports that rights abuses are worsening and going unpunished, and the food crisis is worsening.

3 November - Zimbabwe will soon introduce bank notes of up to Z$1 million to ease cash shortages.

4 November - Zimbabwe AIDS organisations condemn the government for holding back US$7 million provided by the GFATM. Gold mining industry on the brink of collapse as the central bank owes private mining companies US$30-million.

5 November - The Civil Protection Unit, Zimbabwe's national disaster response agency, deployed to contain the cholera outbreak.

8 November - Regional leaders gather to try to resolve the political impasse but fail, while Human Rights Watch, reports that 163 people have been killed in political violence.

11 November - Mugabe announces he will form a new government. The WFP announces it will have to cut rations to Zimbabwe due to lack of funding.

12 November - MDC refuses to join the new government with Mugabe.

13 November - A new wave of attacks is launched on the MDC as ZANU-PF torture camps are set up around the country.

14 November -MDC officially withdraws from the power-sharing deal. Warning of cholera catastrophe.

19 November - The rival parties draft a constitutional amendment creating the post of prime minister, but they differ. Cholera sufferers forced across the border into South Africa because medical facilities in Zimbabwe are struggling to cope.

20 November - Zimbabwe announces a new round of power-sharing talks.?South Africa withholds aid until a representative government is set up.

21 November - Zimbabwe's only medical school closes following the closure of the country's main referal hospitals in Harare and Bulawayo. Protests led by Zimbabwe Association of Doctors for Human Rights (ZADHR), were brutally ended by armed police.

22 November - The Elders - former UN Secretary-General Kofi Annan, former US President Jimmy Carter, advocate of women's and children's rights Graca Machel - part of a group?working for peace and human rights, are banned from entering Zimbabwe on a humanitarian mission.

24 November - Anthrax claims the lives of villagers and about 200 livestock north of Bulawayo.

28 November - MDC officially withdraws from talks with ZANU-PF until Mbeki returns as mediator. UN Office for the Coordination of Humanitarian Affairs (OCHA) warns of an alarming spread of cholera throughout the region; over 9,000 infected in Zimbabwe and numbers rising in neighbouring countries South Africa and Botswana. Disgruntled uniformed Zimbabwean soldiers raid some informal foreign currency traders in Harare after being unable to withdraw money at a bank.

29 November - Political parties agree on a draft constitutional amendment that will lead to the formation of a power-sharing government. Warnings that the rainy season, which has begun, will worsen the cholera epidemic.

1 December - water supplies to Harare cut off due to ZINWA's lack of chemicals to treat the water supply. Police and soldiers from Mugabe's presidential guard battle in Harare as soldiers resort to robbery out of desperation.

3 December - Limpopo River, on border between South Africa and Zimbabwe, tests positive for cholera. UN reports 565 cholera deaths and over 12,000 infected in Zimbabwe.

4 December - Zimbabwean government announces cholera a national emergency and appeals for international aid to tackle the epidemic. Human rights activist and journalist Jestina Mukoko abducted from her house at gunpoint.

5 December - Botswana says it will close its embassy in Harare. EU plans more sanctions unless progress is made on the political impasse.

9 December - EU extends travel ban to 11 more officials and puts pressure on Mugabe to step down. UNICEF announces it needs US$17.5 million to tackle the cholera epidemic.

10 December - Gandhi Mudzingwa, former personal assistant to Tsvangirai, is abducted, bringing to 19 the number of missing abducted MDC supporters and civil society activists in recent weeks. Reports indicate 746 cholera deaths in Zimbabwe, with 15,572 infected.

11 December - South Africa declares a cholera disaster area on its border with Zimbabwe. As International organizations warn of worsening cholera epidemic, Mugabe insists the outbreak has been contained, "I am happy to say our doctors are being assisted by others and the WHO have now arrested cholera."

15 December - Zimbabwe's justice minister told state media they have "compelling evidence" Botswana was hosting military training camps for opposition rebels; a claim which Botswana rejects.

18 December - the Zimbabwe Health Cluster released a US$19 million Cholera Outbreaks Co-ordinated Preparedness and Operation Plan to help it respond to the crisis. The Cluster released a US$19 million Cholera Outbreaks Co-ordinated Preparedness and Operation Plan to help it respond to the crisis. The plan includes giving medical personnel incentives to resume work, such as "topping-up" their salaries; a functional early-warning system, and helping to capacitate district and provincial laboratories.  SADC launched the international campaign called the Zimbabwe Hunitarian and Development Assistance Framework (ZHDAF) to mobilize financial and material resources.

28 December - The International Federation of the Red Cross (IFRC) and Red Crescent Societies report a country total of 29,131 suspected cholera cases and 1,564 deaths with a case-fatality rate of 5.4%.

29 December - Save the Children reports that malnutrition in children aged six months to five yrs. has doubled since 2007 in one of the two districts in which it has been working.? International aid organizations warn of possible malaria outbreak in the environemnt of the rainy season and among a population with weakened immune systems.

1 January 2009 - Political talks between Mugabe and Tsvangirai are moribund; declare the talks will be terminated if 42 abducted MDC members are not released or charged by 1 January 2009.

3 January - Mugabe fires 12 ministers and deputy ministers, including those in the food and agricultural sectors, and reports that he will begin preparing for a unity governement.

14 January - African government officials and diplomats voice concern that the R300 million (US$32 million) South African aid package to Zimbabwe, to reach the 5.5mil people in need of food aid, appears to have been distributed without an agreed monitoring mechanism in place to ensure transparence. Distribution was to have been overseen by the Zimbabwe Humanitarian and Development Assistance Framework (ZHDAF), a concept launched in Harare on 21 December 2008 by the SADC, but officials state that South Africa appears to have sidestepped the ZHDAF and released the aid directly to the government.  There were also rumours that part of the fuel component of the package, meant to support distribution, had not been used for its intended purpose. 
16 January - Hyperinflation increases: Zimbabwe introduces a Z$100 trillion note, currently worth about US$30

16 January - Zimbabwe Pres. Mugabe met UNICEF's executive director Ann Veneman. Discussions centered on children's issues; UNICEF has been providing assistance to 250,000 orphans/vulnerable children in Zimbabwe; following an appeal by the Zimbabwean government for assistance to combat cholera and to resuscitate the health sector, UNICEF has since appealed for 17.5 million U.S. dollars to boost its 120-day emergency plan

17 January - UNICEF establishes a $5 million fund to provide salaries for health workers; payments will be made to workers through the trust, not the government.

19 January - Resumed power-sharing talks in Zimbabwe between the opposition and President Robert Mugabe, "a last ditch attempt to form a unity government", ended without a deal.  Morgan Tsvangirai, leader of the opposition Movement for Democratic Change, or MDC, called it the "darkest day of our lives".  

19 January - Resumed power-sharing talks in Zimbabwe between the opposition and President Robert Mugabe, "a last ditch attempt to form a unity government", ended without a deal.  Morgan Tsvangirai, leader of the opposition Movement for Democratic Change, or MDC, called it the "darkest day of our lives".  

20 January - Human Rights Watch reports an exodus of over 38,000 from Zimbabwe into South Africa, "seeking asylum, health care, and better job opportunities... the numbers being registered are far in excess there of what we saw in the last year, and people are in bad shape."

28 January - Susan Rice, US Ambassador to the UN, urges the UN to take stong action to push Mugabe towards reaching a power sharing agreement. 

30 January - Tsvangirai agrees to concession made by Mugabe and Zanu-PF and signes a power sharing amidst international skepticism

11 February- Tsvangirai is sworn into the office of prime minister, the agreement includes the creation of a joint committee charged with monitoring the pact.

5 May - 18 Zimbabwe activists, including Justina Mukoko, jailed two months after release from previous detention; released on bail May 6.

22 May - World Bank issues statement that they are not resuming lending to Zimbabwe stating that the "right conditions have not yet been created for the World Bank to re-engage on a full-fledged economic development program with Zimbabwe."  The bank currently supports humanitarian assistance by channeling fund through NGOs and aid agencies.

29 May - Dr. Douglas Gwatidzo of the Zimbabwe Association of Doctors for Human Rights (ZADHR) is the recipient of the 2009 Jonathan Mann Award for Global Health and Human Rights.

29 May - UN OCHA releases the revised 2009 Consolidated Appeal for Zimbabwe and call for increased activities including water, sanitation, health, and, now, "humanitarian plus" activities.  The report also indicate international caution despite initiatives by the new Inclusive Government.  The Inclusive Government releases statement of their reservations, stating that several assertions were inaccurate or unsubstantiated; calls for urgent meeting.

Source: adapted from the timeline provided by IRIN, Relief Web, BBC and contributed by other news sources.

In the News...

Just Released: Safeguarding Health in Conflict Coalition’s 3rd annual report: No Protection, No Respect. The report details attacks on health care facilities, infrastructure, workers, and patients during 2015 and the first quarter of 2016.
Congratulations! Director Chris Beyrer to be installed as first Desmond M Tutu Professor of Public Health and  Human Rights.
News: African academinc challenge homophibic laws. Read here.
Listen! CPHHR Director Chris Beyrer discusses the AIDS Pandemic on Minnesota Public Radio.
New Publication: Sexual violence against female sex workers in the Gambia
Just Released! New JAIDS Special Issue: HIV Risks and Vulnerabilities Among Key Populations in West and Central Africa - Evidence to Inform HIV Prevention, Treatment, and Care
Join Us: March 31 4-5:30pm in Sheldon Hall for 'Health Transitions in Myanmar: 2015'
New Report: Syrian Medical Voices from the Ground: The Ordeal of Syria’s Healthcare Professionals.
Free: Editors of The Lancet have identified important articles from their respective journals to highlight World AIDS Day. They're freely available Dec. 1-31, including the Series on HIV and Sex Work.
Hot News! CPHHR Director Chris Beyrer has been appointed to the UNAIDS Scientific Experts Panel and is a newly elected member of the Institute of Medicine.
Just Released! The Lancet Series on HIV and Sex Work was recently released at AIDS 2014 in Melbourne. Congratulations to the team on an incredible Series!
New publication: MSM in Malawi: a qualitative assessment of health seeking and provision practices
New Publication: GBV in Conflict: Displaced Women in Colombia
Article: Sex Work Criminilization and HIV - Facing Reality
AIDS 2014: The 20th International AIDS Conference is fast approaching! The newly released destination guide is a great resource for LGBT attendees.
Just released! On the frontline of eastern Burma’s chronic conflict - Listening to the voices of local health workers in Social Science and Medicine. Full article.
New Report: The full report from the conference on the protection of health workers, patients and facilities in times of violence is now available.
Post-Doc Position: The CPHHR is looking for a post-doctoral research fellow to conduct analysis of quantitative data from studies with MSM in several settings. Details and application instructions.
Call to Action: Len Rubenstein recently convened a group of experts to address the issue of protection of health workers, patients and facilities in times of conflict. The Call to Action is available here.
Tribute: Please visit the IAS website for a tribute to Nelson Mandela, as well as links to his AIDS conference speeches.
New Reports: OSF profiles 11 access to justice projects in their new report Bringing Justice to Health. Read.
Just out: The Task Force on Preserving Medical Professionalism has found that since 9/11/2001, the DoD and CIA have involved U.S. military and intelligence agency health staff in activities that inflicted severe harm on detainees in U.S. custody. Read.
New Reports! Meeting the HIV-related needs of gay men, other MSM and Transgendered persons worldwide. Read.
Just Released: 'A Human Rights Approach to Heath and Conflict' by Center faculty Katherine Footer and Len Rubenstein. Read.
New Report: Center faculty have just published a new report 'Social and Structural Risks for HIV among migrant and immigrant MSM in Moscow." Read.
Just Released: Turning surveillance into support for MSM in Africa. Read.
HOT NEWS! The US Supreme Court ruled that Groups receiving federal money to combat AIDS abroad may not be required to adopt policies opposing prostitution. Read the full article here.
New Report: A new project lead by Dr. Stef Baral highlights HIV risk among MSM in Malawi and the discusses the need for data. Read.

New! Center faculty have published a new article"Modified social ecological model: a tool to guide the assessment of the risks and risk contexts of HIV epidemics" available here.

Read! Center faculty have published a new article 'Modeling the impact of HIV prevention and treatment for MSM on HIV trajectories in LMICs. Read.
Exclusive: The AMA has written to Secretary of Defense Hagel concerning allegations that detainees on hunger strike are being force-fed with assistance from physicians. Click here to view the letter.
Just out! Center faculty member Len Rubenstein published an article in Foreign Affairs describing issues of compromised medical care in conflict zones.
Hot News! The Huffington Post released an article on a recently published study on HIV among transgendered women, led by Center Faculty member Stefan Baral. Read.
New! The NYTimes published a letter comcerning a recent piece on attacks on Syrian doctors, written by Center faculty member Len Rubenstein. Read.
Update: HIV among MSM examined at CROI 2013. Read.
New! Click here for video of the CROI 2013 Plenary 'The Global HIV MSM Epidemic: Time to Act', by Center Director Chris Beyrer.
Hot Topic: The Center recently hosted the film "Beneath the Blindfold", which reveals the reality of life after torture. This informative documentary follows the lives of four torture survivors as they build new lives, careers and relationships. Please visit the website for more information.
Just Released! The eBriefing for the NYAS/CPHHR event 'New Paradigms of Risk and Protection: Understanding the HIV Epidemics among Gay and Bisexual Men' is now available on the NYAS website. Congratulations to everyone who worked together and made this event a tremendous success!
Congratulations! Gift Trapence attended the LGBT Human Rights Defenders event at the UN in NYC with Secretary General Ban Kyi-Moon, Yvonne Chaka Chaka and Ricky Martin as a leader in the fight against homophobia. Congratulations on this incredible honor!
Just Released: 'Free and Equal', a booklet published by the UN human rights office describes sexual orientation and gender identity in international human rights law. Read.
New Report: 'Impact of Maternal Depressive Symptoms on Growth of Preschool- and School-Aged Children', just published in Pediatrics, found that Maternal depressive symptoms during infancy may affect physical growth in early childhood. Congratulations to the Center's Pam Surkan and team on this interesting article. Read. Article.
Hot News! Burma's Daw Aung San Suu Kyi spoke via video to the International HIV/AIDS Conference in Washington D.C. on Thursday about ending the stigma experienced by many HIV/AIDS patients. Read. 
New Video! Burma's Aung San Suu Kyi accepts Nobel Peace Prize in Oslo, Norway. Watch Video.

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