Polluted Water Spreads Cholera in Zimbabwe

Chamizo, a nurse with the Médecins Sans Frontières (Doctors Without Borders) project in Beitbridge, Zimbabwe, sees the absurdity of this statement. She is standing in the middle of dozens of cholera patients, on the dirt in the backyard of the main hospital. She says cholera has overwhelmed this border town of about 40,000 like wildfire.

On Friday, November 14, when the Zimbabwean health authorities in Beitbridge first reported cholera to MSF, there were five cases. Two days later, there were more than 500, and by week's end, over 1,500 people in the suburb were sick.

A widespread cholera outbreak, worsened by poor access to safe drinking water and hygiene, is threatening the well being of thousands of Zimbabweans. Contributing to the crisis is an under-resourced and under-staffed health system, the World Health Organization said today.

As of Tuesday, WHO says 775 people have died out of the 16,141 suspected cases of cholera that have been recorded since August in two-thirds of the country's 62 districts.

"This outbreak can be contained, but it will depend on many factors, in particular a coordinated approach between all health providers to make sure we are providing the right interventions where they are needed most," said Dr. Custodia Mandhlate, WHO Representative to Zimbabwe. "Such interventions include prevention, quick case detection and control, and improved treatment."

Cholera cases in Beitbridge, Zimbabwe lie on the dirt outside the hospital because there is no more room inside. (Photo courtesy Médecins Sans Frontières)

Cholera is an acute bacterial infection transmitted through contaminated water and food. WHO says it is closely linked to inadequate environmental management. The absence or shortage of safe water and sufficient sanitation combined with a generally poor environmental status are the main causes of spread of the disease.

WHO is establishing a cholera control and command center, in conjunction with the Zimbabwe Ministry of Health and Child Welfare and other health partners, to respond in a coordinated way to these health problems.

The world health body is seeking donor support for a US$6 million proposal for its cholera response plan.

About half of cholera cases have been recorded in Budiriro, a heavily populated suburb on the western outskirts of the capital, Harare.

Other major concentrations of cholera cases are in Beitbridge, on the South African border, and in Mudzi, on the border with Mozambique.

"The town of Beitbridge is a shifting tide of migrants, truckers, sex workers, unaccompanied children and desperate people trying to find a better life – mostly by attempting to cross the border into South Africa," says MSF. "With the current political and economic crisis in Zimbabwe, basic services are lacking, especially in a town with such uncontrolled growth. There is rubbish everywhere. Open sewage runs through most of Beitbridges' streets. Almost every day, there are cuts to water and electricity."

The outbreak could surpass 60,000 cases, according to an estimate by the Zimbabwe Health Cluster, a group coordinated by WHO that includes health providers, nongovernmental organizations and the Ministry of Health and Child Welfare.

The estimate is based on the fact that half of Zimbabwe's 12 million population are potentially being at risk of contracting cholera, with an estimated one percent of those at risk of actually suffering from the disease.

With the rainy season starting and more people traveling due to the Christmas season, there are risks for further spread of cholera if strong measures are not taken, WHO warns.

There are also serious regional dangers, with cholera cases crossing the borders into South Africa and Botswana.

On December 2, South African health authorities said the country had recorded 460 cholera cases and nine related deaths, mostly in border areas near Zimbabwe.

The major cause of the cholera outbreak is the inadequate supply of clean drinking water and poor levels of hygiene. Shortages of medicines, equipment and staff at health facilities throughout the country are compounding the health challenges.

WHO is advocating for improved access to oral rehydration salts for treating moderate dehydration, which is a symptom of cholera. Health officials say the rehydration salts could help quickly reduce sickness and deaths.

To help Zimbabwean authorities and partners respond to the health emergency, WHO has sent medical supplies to treat 50,000 people for common conditions for three months, as well as supplies to treat 3,200 moderate cases of cholera.

WHO has also sent epidemiologists, a water and sanitation expert and a logistician to Harare to strengthen response efforts on the ground.

MSF says the problems are long-term. In Beitbridge, "the water station does not have the parts to properly repair its pumps. Even if it did, it depends on electricity to pump water from the tower to the city. Electricity depends on a coal mine that has not been paid in over a year and can no longer supply coal. There is no fuel to run the garbage trucks; there is no money to pay salaries for people to collect the garbage. There is no equipment, or supplies, to fix the sewage system, nor money to pay personnel to do it. There are no quick solutions."

Copyright Environment News Service (ENS) 2008. All rights reserved.