Waterborne diseases, such as typhoid, dysentery and watery diarrhoea - all approaching epidemic levels - are creating concerns that conditions exist for a reprise of the 2008/09 cholera epidemic, which killed more than 4,000 people and infected nearly 100,000 others.
The Consolidated Appeal Process (CAP) for Zimbabwe, launched on 9 December, is asking for US$268 million for humanitarian assistance in 2012. The CAP highlights a decade of “neglect” of the country’s water sanitation and hygiene sector (WASH), which has left 8 million people, or about two-thirds of the population, “with limited access to WASH and health services”.
“A third of rural Zimbabweans still drink from unprotected water sources and are thus exposed to waterborne diseases. While cholera incidence is significantly decreased compared to past years, localized outbreaks continued in 2011 due to poor infrastructure for water, sanitation, hygiene and health,” the CAP pointed out.
Since the year-long cholera epidemic, which spilled across the border into neighbouring South Africa, donors have spent about $80 million on the sector, although the Country Status Overview (CSO2) Report for Zimbabwe, by the World Bank and the government, estimates that to salvage the sector and “bring basic services to reliable and sustainable levels both in rural and urban areas” will require an annual investment of $800 million.
The CAP has earmarked $23.6 million for WASH in 2012, the third-highest sector appeal. Food is allocated $127 million, and agriculture $32 million. It is projected that about one million people will require food assistance in the first quarter of 2012, as “Rates for chronic and acute child malnutrition still stand at 34 percent and 2.4 percent respectively.”
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In recent months hundreds of typhoid cases have been reported in the capital, Harare, mostly in the densely populated Dzivarasekwa township.
Intermittent water supplies in urban areas because of the dilapidated water and sanitation infrastructure, the start of the rainy season, and cut-offs of water to households unable to pay their bills, have forced the urban poor to sink shallow wells, which are easily contaminated. Media reports say shallow wells in Dzivarasekwa have tested positive for typhoid.
The latest Zimbabwe Weekly Epidemiological Bulletin, for weeks 46 and 47, published jointly by Zimbabwe’s health ministry and World Health Organization, say dysentery and diarrhoea are approaching epidemic levels, although there are no confirmed cases of cholera in the bulletin for these weeks.
A health sector official, who declined to be identified, told IRIN that cases of watery diarrhoea in Chipinge and other parts of the eastern province of Manicaland were being closely watched after reports of a suspected outbreak of cholera, but this has not been officially confirmed.
A senior official of a humanitarian NGO, who also did not wish to be named, told IRIN: “We are closely monitoring the situation and will only comment and activate our programmes if the presence of cholera is officially confirmed.”
Cephas Zinhumwe, head of the National Association of Non Governmental Organizations (NANGO), an umbrella group for NGOs, told IRIN that “The resurgence of waterborne diseases like typhoid and cholera [although unconfirmed], the risk of malaria in the presence of collapsing waste management services and excessive heat, are equally disturbing developments.”
Despite a bleak outlook for WASH, “Major potential disasters have been contained and many utilities, including in Harare, are now strengthened and able to provide more reliable services,” the CAP noted.
“In rural areas, although situations have improved and the incidence of cholera emergencies has reduced throughout the country, there are still highly vulnerable areas like Chipinge and Chiredzi in the eastern and southeastern parts of Zimbabwe,” the CAP said, “where situations contributing to cholera outbreaks have not yet been fully put under control, and unnecessary loss of life due to cholera and other WASH-related diseases still continues.”