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Zimbabwe's Ruined Healthcare System A 'Man-Made Disaster:' Report

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What happens when a government presides over the dramatic reversal of its population's access to food, clean water, basic sanitation, and healthcare? When government policies lead directly to the shuttering of hospitals and clinics, the closing of its medical school, and the beatings of health workers, are we to consider the attendant deaths and injuries as any different from those resulting from a massacre of similar proportions?

These are the questions prefaced in a new report released today by Physicians for Human Rights (PHR) which finds that a causal chain runs from Mugabe's economic policies to Zimbabwe's economic collapse, food insecurity and malnutrition and the current outbreaks of infectious disease. The report is based on a health assessment by public health and human rights experts who traveled to Zimbabwe four weeks ago. In addition to the widely reported cholera epidemic, the report highlights increases in maternal mortality, growing malnutrition, disruptions in HIV/AIDS treatment, unchecked tuberculosis, and outbreaks of anthrax.

As of December 2008, there were no functioning critical care beds in the public sector in Zimbabwe.

"We see women with eclampsia who have been seizing for 12 hours. There is no intensive care unit here, and now there is no intensive care in Harare. If we had intensive care, we know it would be immediately full of critically ill patients. As it is, they just die," said one director of a mission hospital.

Access to essential medications was raised by nearly all providers interviewed. In addition to drug shortages, medical supplies (including cleaning agents, soap, surgical gloves, and bandages) were also in critically short supply--or absent altogether.

The Mugabe regime intentionally suppressed initial reports of the cholera epidemic and has since denied or underplayed its gravity. The Minister of Information and Publicity, Sikhanyiso Ndlovu, reportedly ordered government-controlled media to downplay the cholera epidemic, which he said had given the country's enemies a chance to exert more pressure on President Robert Mugabe to leave office. The Minister instructed the media to turn a blind eye to the number of people who have died or [have become] infected with cholera, and instead focus on what the Government and NGOs are doing to contain the epidemic.

Furthermore, the government has exacerbated food insecurity for Zimbabweans in 2008 by blocking international humanitarian organizations from delivering food aid and humanitarian aid to populations in the worst-affected rural areas, an act itself a crime against humanity. Patients with HIV/AIDS and TB are especially vulnerable to food insecurity.

UNAIDS figures show that an estimated 1.3 million adults and children in Zimbabwe are living with HIV infection in 2008. Of these, some 680,000 were women of childbearing age. In 2007, some 140,000 Zimbabweans died of AIDS, and the current toll is estimated at 400 AIDS deaths per day. Access to HIV/ AIDS care and treatment is threatened by the current collapse and HIV programs are currently capped: some 205,000 people are thought to be on treatment (Anti-Retroviral), but no major program is currently able to enroll new patients.

For HIV/AIDS the most severe threat has been the interruption of regular supplies of antiretroviral drugs. According to the report, multiple key informants, patients, and providers reported that ARV supplies had become irregular due to breakdowns in drug delivery, distribution, provision, and theft of ARV drugs by government operatives. Most troubling were reports that some physicians were switching patients on established ARV regimens to other regimens based not on clinical need, but on drug availability. This can lead to drug resistant HIV strains. These dangerous practices constitute a significant threat to public health since the development and transmission of multi-drug resistant variants of HIV in Zimbabwe could undermine not only Zimbabwe's HIV/ AIDS program, but regional programs as well.

The health and healthcare crisis in Zimbabwe is a direct outcome of the malfeasance of the Mugabe regime and the systematic violation of a wide range of human rights, including the right to participate in government and in free elections and egregious failure to respect, protect and fulfill the right to health. "When examined in the context of 28 years of massive and egregious human rights violations against the people of Zimbabwe under the rule of Robert Mugabe, they constitute added proof of the commission by the Mugabe regime of crimes against humanity," states the report.

The report calls for the urgent resolution of the political impasse in Zimbabwe, an emergency international health intervention equivalent to putting the health system into receivership, a UN Security Council referral to the International Criminal Court to investigate crimes against humanity, and a summit to address disruptions in HIV-AIDS and tuberculosis prevention and treatment.