Who controls the water determines the severity of cholera

A protracted tussle over Bulawayo's water and sanitation services between local councillors and the ZANU-PF controlled water parastatal allowed Zimbabwe's second city to escape the nationwide cholera epidemic relatively unscathed.

More than 4,000 people have died and nearly 90,000 have been infected by the waterborne disease since the outbreak began in August 2008; total infections could reach 120,000 cases before it abates.

Bulawayo's director of health, Dr Zanele Hwalima, said the city had recorded 440 cases and 18 deaths since the outbreak began, compared with 2,606 cases and 167 fatalities in Chitungwiza, a dormitory town near the capital, Harare, which has a population of similar size.

"We are fortunate that the drawn-out wrangle between us and the government, through the Zimbabwe National Water [ZINWA], apparently saved the city residents from an outbreak at a scale similar to Harare," said Bulawayo's mayor, Patrick Thabamoyo. "We resisted the takeover and we have somehow been vindicated."

The provision of services in urban areas became the source of an acute power struggle between President Robert Mugabe's ZANU-PF and the opposition Movement for Democratic Change (MDC), led by the recently installed Prime Minister, Morgan Tsvangirai.

Zimbabwe's urban populations were the first to turn against Mugabe - the country's only leader since independence from Britain in 1980 - and increasingly voted in MDC-dominated city councils.

ZANU-PF attempted to dilute the power of MDC municipalities by transferring the provision of services, and their budgets, to parastatals under the control of central government.

In May 2005, ZINWA, previously the bulk water supplier, took over water delivery and sewerage management. This was widely seen as the genesis of Zimbabwe's cholera epidemic, as the parastatal soon proved hopelessly inadequate in its new task and the services under its control collapsed.

By March 2006 Harare's civic organisations were warning of a "cholera time-bomb" after the disease killed 27 people that month. However, unlike Harare - the epicentre of the current outbreak - Bulawayo's councillors managed to stave off the imposition of ZINWA on their water affairs.

Since the formation of the unity government ZINWA has reverted to its role as a bulk water supplier.

Drought a friend in times of cholera

Water scarcity in Bulawayo, in the country's drought-prone region, has always demanded careful planning to keep the taps of its 1.5 million residents running. The city's main supply dams - Upper Ncema, Lower Ncema, Inyankuni, Insiza and Umzingwane - are located about 30km from the city in the Mzingwane area.

The rural setting of the dams makes them less susceptible to industrial pollution than is the case with Harare's water sources, and relatively free from the risk of burst sewage pipes contaminating streams and rivers.

Three months after the August 2008 cholera outbreak began, ZINWA admitted to pumping raw sewage into Lake Chivero, Harare's main water source.

''While it takes more than a dozen chemicals to purify water for Harare residents, our water requires at most three different chemicals because it is less polluted''

"While it takes more than a dozen chemicals to purify water for Harare residents, our water requires at most three different chemicals because it is less polluted," Bulawayo councillor Emmanuel Munjoma told IRIN.

Zimbabwe's economic malaise, which has seen unemployment reach 94 percent and hyperinflation all but killing off the local currency, has resulted in the collapse of health services, made hard currency scarce, and the purchase of water purification chemicals extremely difficult.

In Harare, the response was an almost total shut-down of the public water supply, forcing residents to dig shallow wells or to source water from contaminated rivers and streams.

In Bulawayo, water scarcity had instilled a different discipline and the council made use of "208 boreholes drilled with financial assistance from aid agencies at the peak of water shortages, because of the drought in the past two seasons," Thabamoyo said.

"We deploy water bowsers to deliver water to affected suburbs whenever we run short of purification chemicals," he said. "These have been augmented by boreholes on the Nyamandhlovu aquifer outside of the city."

Cholera stabilizing

The World Health Organization (WHO) said in its regional cholera update on 6 March, "In Zimbabwe, the epidemic appears to be stabilizing in urban areas, while outbreaks in rural areas remain high or are on the increase."

Gregory Härtl, spokesman for the World Food Programme's Epidemic and Pandemic Alert and Response (EPR) in Geneva, told IRIN: "It is difficult to pinpoint one reason for the decline [of cholera cases in Zimbabwe].

"Health providers have been undertaking intensive infection control measures within hospitals, particularly training of health staff in appropriate control procedures, and social mobilization efforts have been continuing to raise awareness about the threats posed by the disease," Härtl noted.

"But the measures that have been promoted by WHO, the MoH [Ministry of Health] and other health providers are likely to have contributed to the declining rates of new cases."