When does denial of health care amount to a human rights violation? When the health crisis is man-made, the government restricts health care access to none but the wealthy, and the epidemic is no longer contained so it now spills over the borders into neighboring countries. Such is the case of the 2008 cholera epidemic in Zimbabwe which continues today.
Cholera, as defined by the Center for Disease Control, is an acute diarrheal illness caused by an infection of the intestines. In persons with severe symptoms, rapid loss of body fluids leads to dehydration and shock. If detected early, cholera is easily treated with oral rehydration or, in severe cases, with intravenous rehydration. Without treatment, death from cholera can occur within hours. A person may contract cholera by eating food or drinking water contaminated with feces of an infected person. The disease can spread quickly in areas with inadequate treatment of sewage and drinking water.
Although the public health sector in Zimbabwe has been on a downward spiral for the past several years, the current cholera epidemic seems to have started in August 2008. And just how did the epidemic start? It all began when the Mugabe regime failed to maintain water purification measures and manage sewer systems, among other things. There were reports that Zimbabwe's Water Authority failed to procure one of the four chemicals used to treat water, aluminum sulphate, so it shut down a plant just outside Harare.
According to a recent report released by Physicians for Human Rights, "more than 1,700 Zimbabweans have died from the disease and another 35,000 people have been infected. The U.N. reports that cholera has spread to all of Zimbabwe's ten provinces, and to 55 of the 62 districts ... the cumulative fatality rate is five times greater than what is typical in cholera outbreaks. Control has not been reached."
In fact, the cholera epidemic has now spilled over into neighboring South Africa as Zimbabwean natives cross the border seeking refuge and access to health care there. Last week, I attended a panel discussion hosted by the Open Society Institute, spotlighting the crisis in Zimbabwe. One of the panelists was Rebecca Shaeffer, of Human Rights Watch. Ms. Shaeffer highlighted the fact that many Zimbabwean nationals risk life and limb, paying smugglers to spirit them across the border, only to discover a new set of challenges await them. In 2007, the majority of Zimbabwean nationals in South Africa were undocumented. In 2008, the number of Zimbabwean nationals in South Africa who applied for asylum was twice the number of applicants from 2005-2007. And the historical asylum grant rate stands at less than one percent.
The South African government provides asylum seekers and refugees access to primary and emergency health care on an equal footing with its citizens. However, there exist barriers to realizing these health rights, including the fear of arrest, discrimination by health care staff, fees, linguistic differences, and lack of knowledge and services. Consequently, there has been a spike in the number of cholera cases in South Africa, particularly in border towns. The fact sheet provided by Ms. Shaeffer indicates that, in Limpopo, there were 2,550 confirmed cases and 10 deaths -- all Zimbabwean nationals. On December 11, 2008, the Vhembe Disrict was declared a disaster area.
There is, without a doubt, a correlation between President Mugabe's economic policies and the prevailing outbreak of infectious disease. The situation has been compounded by the ongoing "brain drain". There's a large scale mass migration, not only out of public health and into the private sector, but to other countries.
Just what can be done about the cholera epidemic in Zimbabwe? Whose responsibility is it anyway? Should the response be unilateral? Multilateral? International? And what is the role of the African Union in solving this dilemma? One of the recommendations put forth by the Physicians for Human Rights is to place Zimbabwe's health system in a receivership of sorts. Under the proposal, the government of Zimbabwe would yield control, not only of its health services but also its disease surveillance, water supply, sanitation, Ministry of Health operations, and other public health functions, to an agency or consortium designated by the United Nations.
Zimbabwe is facing a humanitarian crisis. The cause of the crisis is a political one. It will take the collective effort of nongovernmental organizations and the political will of international leaders to change the tide.