Lucia Munenzwa was shell-shocked when she was presented with a list of items that the local clinic needed for her to give birth at the health center.
Top of the list were 10 pairs of latex gloves to be used by the midwives. There were also a surgical blade, clamp cord, cotton wool, linen saver, and rehydration fluid. To buy all the requirements, Ms. Munenzwa, a young widow who survives by selling items on the street, needed about $20 billion Zimbabwean dollars (nearly US $40) – a figure well beyond the reach of any ordinary Zimbabwean.
"The nurses have just told me that without the items, they can't allow me to give birth here," she said with tears in her eyes as she walked out of the clinic, heading home. Two days later, Munenzwa gave birth at home, with the assistance of an elderly neighbor. She named her baby boy Lucky.
The collapse of Zimbabwe's health sector, once the envy of many African countries, may seem to be an internal matter – yet another sign of the country's economic woes. But the flood of an estimated 3 million Zimbabwean refugees from their country – fleeing as much for food and medical care as for political freedom – has quickly spread Zimbabwe's internal crisis to other countries. The ongoing anti-immigrant violence in South Africa shows that Zimbabwe's problems have regional repercussions, putting pressure on African leaders to come up with solutions ... fast.
"What this shows is that effectively there is no government in Zimbabwe," says Chris Maroleng, a Zimbabwe expert at the Institute for Security Studies in Tshwane, as Pretoria is now called. "It says to us that in the end, we must have this issue of human security as an essential starting point for solving the crisis. But the question is how to get to the starting point. The international community that normally intervenes in situations like this is unwelcome now in Zimbabwe. So unless we resolve the underlying political problem, we're going nowhere."
Signs of the healthcare crisis have been obvious for some time to the few doctors still available in the country's largest hospitals, Parirenyatwa and Harare General Hospital.
At Parirenyatwa Hospital, only 1 out of 18 dialysis machines works. At Harare General, only 3 out of 50 incubators works, and the neonatal unit is seriously understaffed as nurses and doctors leave for more stable jobs abroad. There is only one radiologist who is servicing Harare and Parirenyatwa hospitals and the Zimbabwe National Army (ZNA). That radiologist is "borrowed" from the Army.
Refrigerators in the mortuary area at Harare General have stopped working.
Two weeks ago, surgeons and anesthesiologists at Parirenyatwa stopped doing any operations to protest the poor working conditions and inadequate supplies. The surgeons say they are afraid of ruining their reputations by continuing to lose patients by going into theater without adequate supplies.
Douglas Gwatidzo, chairman of the Zimbabwe Association of Doctors for Human Rights, describes the situation in Harare's health centers as "dire." "About one doctor is serving over 8,000 people in the country, [compared with] the world standard of 1 doctor to 500 patients," says Mr. Gwatidzo. "It's quite sad."
Many mothers walk into Harare Central Hospital's neonatal unit with little hope of taking their infant children home alive. "I tell you those who come out alive only do so by the grace of God," says Mary Moyo, a young mother who had her child hospitalized in the unit last week.
In Zimbabwe's second-largest city, Bulawayo, AIDS patients come to Thembelihle House for their last hope of a dignified end. Thembelihle is a hospice designed to provide terminally ill AIDS patients with enough food for them to regain their strength so their families can look after them.
But the shortage of drugs and medical supplies, the rising cost of food, and the growing poverty of Zimbabwean citizens are making it a lot harder for Thembelihle to do its job properly, says Gladys Dube, manager of the hospice.
She walks through the wards, where 62 of the 70 beds remain empty because of staff shortages. Women wash soiled sheets by hand. Used rubber gloves hang out on clothes lines to dry.
"We have nothing right now," says Ms. Dube. "We have a few candles in storage, for when the power goes out. Soap at the moment is difficult to find, so we are resorting to an entrepreneur who makes it himself, but the quality is not good."
She takes the hand of an emaciated young patient who has just checked in, and pats her forehead. "Some come to us in a very bad state. We can improve their nutrition so that they can go home to be looked after by their families." Aid agencies used to bring food, but there has been no food delivered here in the last month.
While doctors and even members of parliament blame the government for the crisis – Blessing Chebundo, chair of the parliamentary committee on health and child welfare, says the government lacks political commitment – the government itself says it is doing everything in its power to address the health care crisis.
"We are aware of the challenges in the health sector and we are doing everything within our means to tackle them," says David Parirenyatwa, the minister of health and child welfare. Parirenyatwa Hospital was named after his father, the country's first black doctor.
Minister Parirenyatwa blames the current crisis on economic sanctions against Zimbabwe, placed by Britain and the United States for Zimbabwe's alleged human rights violations. With little foreign currency, Zimbabwe cannot purchase drugs on the global market. "The shortage of foreign currency is a major impediment," he says.
• A journalist who could not be named for security reasons contributed from Harare.