All but one of Zimbabwe's ten provinces have reported fatalities as a result of a cholera epidemic sweeping the country, according to the UN.
The rapid spread of the waterborne disease is attributed to a confluence of events that have created the perfect storm, in which a disease described by the World Health Organisation (WHO) as "easily treatable", is thriving.
The collapse of municipal services, such as potable water, refuse collection and sanitation in the past few years, a health service hamstrung by an annual inflation rate that the government has estimated at 231 million percent, and the onset of the rainy season, have all conspired to officially kill about 300 people and infect thousands more.
The eastern province of Manicaland is so far the only place not to have recorded any official cholera deaths. "The cholera outbreak has taken a national dimension. Newer outbreaks are reported from all the provinces," said a situational report by the UN Office for the Coordination of Humanitarian Affairs (OCHA).
"The spatial distribution of outbreaks will most likely continue to expand, as well as the number of people infected as the water and sanitation [services] worsen, with severe water shortages, sewage and waste disposal problems reported in most densely populated areas. The starting of the rains further raises alarm levels," the report said.
Warnings by the UN and other relief agencies that Zimbabwe was facing a humanitarian crisis, on top of acute food shortages - expected to peak in the first quarter of 2009, when nearly half the country's 12 million population will require emergency food aid - were dismissed by President Robert Mugabe's ZANU-PF government.
"The situation is under control," Deputy Health Minister Edwin Muguti told an international news agency on 27 November, although the government was reportedly appealing to regional governments for body bags.
Efforts to contain the spread of the disease across international borders have failed, with victims seeking assistance from neighbouring countries, particularly the continent's economic powerhouse, South Africa.
Neighbouring countries feel the effects
About 1,000 victims have received rehydration treatment at the South African border post of Beitbridge in recent weeks, according to local reports.
Barbara Hogan, South Africa's health minister, told local media on 26 November that an emergency medical response team, including nurses, epidemiologists and medical supplies, had been sent to the Zimbabwe border.
|Given the scale of the outbreak, the weakened health system in Zimbabwe and the extent of cross-border movement of people ... all aspects of our interventions need to be scaled up, and a renewed sense of urgency [is required] to deal with this outbreak|
"Given the scale of the outbreak, the weakened health system in Zimbabwe and the extent of the cross-border movement of people ... all aspects or our interventions need to be scaled up, and a renewed sense of urgency [is required] to deal with this outbreak," Hogan told a press briefing in Pretoria.
She dismissed claims by Zimbabwean authorities that the cholera situation was under control, as there was "no recognised government".
Zambian authorities have put medical services in Southern Province, which borders Zimbabwe, on high alert, health ministry spokesman Canicius Banda told IRIN, although there have been no recorded incidents of cholera in the province.
"We are not leaving anything to chance. We are screening all Zimbabwean nationals crossing into Zambia and, should anyone be found with cholera, our health workers will treat them," Banda said.
"We have health workers at all the three border posts [with Zimbabwe] ... our health workers are very much alert in case of any possible [cholera] outbreak," he said. "All the  districts in the province have epidemic preparedness committees which run all year round; these have also been put on alert."
Zambia shares three border posts with its southern neighbour at Chirundu, Kariba and Kazungula, in the country's tourism capital, Livingstone.
"We are also carrying out random inspections of all foodstuffs, such as meat at the market places, to ensure that the products sold are of high standards," Banda said.
Since the onset of the rainy season, Zambia has recorded about 1,000 cholera cases in its northern regions and the capital, Lusaka; there have been nine confirmed fatalities.
The Zimbabwe Association of Doctors for Human Rights (ZADHR), which advocates the right to care and protection from abuse, told media organisations on 26 November that the country's cholera death toll was probably much greater as a consequence of the collapse of health services, because many hundreds of deaths were not recorded when people died in their homes.
One in ten fatality rate
ZADHR Chairman Dr Douglas Gwadziro said figures "are pointing towards a 10 percent death rate of those that have been affected by cholera", although the waterborne intestinal infection causing acute diarrhoea and vomiting, which can cause death from dehydration within 24 hours, could be easily treated with dehydration salts.
|Figures are pointing towards a 10 percent death rate of those that have been affected by cholera|
According to the state-controlled daily newspaper, The Herald, China had pledged to supply US$500,000 worth of cholera vaccines "as soon as consultations with the Ministry of Foreign Affairs were complete."
However, when the vaccines arrive, distribution and administration may be complicated by industrial action in the health services. Health workers have defied a government order to return to work, and said they would only comply with government demands in 2009 if concerns about their remuneration were addressed.
Nurses are demanding better salaries to cope with hyperinflation estimated by independent economists to be billions of percent annually, and exemption from the Z$500,000 (US$0.25) daily maximum cash withdrawal from banks because they are "essential" personnel.
The average one-way commuter fare in the capital, Harare, is about Z$1 million (US$0.50), if there is cash available.
Doctors working in the public health services are also refusing to return to work unless the government pegs their salary to a monthly equivalent of US$2,500.
Lovemore Matombo, president of the Zimbabwe Congress of Trade Unions (ZCTU), the country's largest union federation, said the growing trend of government to sanction the use of foreign currency by retail outlets prejudiced both government employees and other workers, although less than 20 percent of people were employed in the formal economy.
"It does not make sense for the government to say traders can sell commodities in foreign currency, while it pays its workers in local currency which they cannot get from the bank," Matombo told IRIN.
"Calls by workers that they should be paid in foreign currency are legitimate because almost all outlets are providing services using the US dollar denomination," he said.
"If the government acknowledges that its currency is useless by allowing traders to sell in US dollars, why does it want the workers to receive the useless and worthless local currency?"
This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions
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