Six months after an unprecedented cholera outbreak killed more than 4,000 in Zimbabwe and across its borders, a top medical aid organization warns that the water-borne disease is almost certain to return.
The root causes of the initial outbreak – including dilapidated drinking water systems and leaky sewage systems – have not been addressed adequately, said Rian van de Braak, head of mission in Zimbabwe for Medecins Sans Frontieres (Doctors Without Borders), on a visit to South Africa this week.
With the rainy season fast approaching, "everyone expects cholera to be back," says Ms. van de Braak, adding that major cities like Harare, Bulawayo, Gweru, Mutare, and Masvingo are the most prone areas, owing to their large populations.
"Dealing with the causes [of the initial outbreak] before the next rainy season will be a race against the clock," says van de Braak. "Nobody knows how big the next outbreak will be, but we are ready to respond immediately. We have the necessary stocks [of medical supplies] in the country and a contact list of all the extra 250 Zimbabwean staff who we recruited for the last outbreak."
Just as the supply of clean drinking water is one of the most basic functions of a government, cholera is a sign that a country's government simply isn't functioning very well. Fixing a water-sanitation system is not difficult, but it also isn't cheap, and given Zimbabwe's swift decline from an agricultural powerhouse to an food-aid recipient, it isn't surprising that Zimbabwe's seven-month-old coalition government has been unable to fix its water systems ahead of the coming rainy season, due in October.
Until the government gets around to fixing the causes of the outbreak, aid agencies as diverse as UNICEF and Doctors Without Borders are preparing short-term solutions, drilling new wells in cholera hotspots, and contacting nurses and doctors who had been on the front-lines during the previous outbreak, van de Braak says.
Doctors Without Borders is also distributing 11,000 cholera kits – complete with water purification tablets, rehydration salts, soap, and other basic sanitation items – in 50 of the most remote clinics in the countryside and has trained local health staff on how to intervene when the first cases appear.
Despite such concerns, some aspects of Zimbabwe's humanitarian situation have shown gradual signs of improvement, van de Braak says. A multi-donor funded retention program, aimed at keeping trained health professionals from fleeing the country for better employment, has managed to provide small but livable salaries for hospital and clinic staff, bringing back health workers even to rural areas.
But in an economy where wages earned in the local Zimbabwe currency have been rendered worthless, and where stores sell their goods in dollars or other foreign currency, healthcare remains unaffordable for many Zimbabweans.