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Too much cholera, too little food - UN mission

Catherine Bragg, United Nations Assistant Secretary-General for Humanitarian Affairs and Deputy Emergency Relief Coordinator Tomas de Mul/IRIN
Zimbabwe will gladly receive any and all humanitarian assistance, but with a cholera epidemic expanding rapidly into rural areas and millions still food insecure, much more will be needed for months to come, a United Nations inter-agency mission to the country concluded.

"From what we have heard from members of the international community, and seen from our visits to several areas in the field, it is obvious that humanitarian needs in the country remain grave," Catherine Bragg, UN Assistant Secretary-General for Humanitarian Affairs and Deputy Emergency Relief Coordinator, who led the mission's five-day visit to Zimbabwe, told reporters in Johannesburg, South Africa, on 26 February.

The mission met with President Robert Mugabe, Prime Minister Morgan Tsvangirai, and a number of cabinet ministers. "We were given assurances of full cooperation. We spoke of having further engagements as we widened the scope of our cooperation," Bragg said.

Acknowledging the problem

"We must stress that the welfare of the people is the responsibility of the government – we trust that the all-inclusive government will take the necessary steps to address the fundamentals of governance that would allow stability and economic recovery," she commented.

She said President Mugabe acknowledged the severity of the crisis. "He has recognized that there is one ... [and] in our discussions with the rest of the cabinet ministers they quite freely used the terms, 'humanitarian situation', and 'humanitarian crisis'. Both the president and the prime minister expressed appreciation for the support Zimbabwe has been receiving from the humanitarian community," Bragg noted.

''They quite freely used the terms 'humanitarian situation' and 'humanitarian crisis'''

Too much cholera

According to Daniel Lopez Acuna, Director of Recovery and Transition Programmes at the World Health Organization (WHO), the cumulative number of cholera cases as at 25 February was 83,265, with 3,877 deaths.

While weekly observed cases showed a decline, Acuna said the case fatality rate remained stubbornly high at 4.7 percent. The WHO has noted that the acceptable level should be below 1 percent.

"One of the things that the mission had been discussing with the different stakeholders ... has been that the actions ... to curb the cholera epidemic need to go beyond just immediate measures, and need to address the more structural problems of water and sanitation and the sewage system, and of the health system.

"The critical action now is to go closer to where the problem is, and that is in the communities that don't have access to adequate water, where sewage is a problem, and that have no access to cholera treatment centres (CTC). Most of the deaths that happen do not even reach the CTCs, and that's where we need to make sure that the humanitarian action is intensified."

Robin Nandy, Senior Health Advisor to the United Nations Children's Fund (UNICEF), said the challenge now was dealing with the outbreak in rural areas. The collapse of infrastructure meant that peripheral health services were interrupted.

"When the cholera outbreak started it was mainly in the urban areas, which ... has been addressed. Now the disease has spread to more remote areas with access to very few services ... [where there is a need] to interrupt transmission, to prevent people from getting the disease and, if they do get sick, to try to ensure that treatment services are provided. This shift is now currently taking place," Nandy said.

Too little food

"Food security is another mayor issue," Bragg said. "A growing number of households are reducing the number of meals they have per day. The people of Zimbabwe have shown considerable resilience in the face of hardship, but everyone has his or her limit. We expect there will be continued need for food assistance through 2009."

According to Timo Pakkala, the World Food Programme's (WFP) Deputy Regional Representative, "On the food aid side, obviously requirements have been very high. During the peak lean season, where we are now, in Zimbabwe some seven million people are receiving [food] assistance until the next harvest, expected in April."

Zimbabwe's population is officially estimated at around 12 million, but several million are believed to have left the country in recent years in search of work.

"The cost of such a large-scale operation has been very high. We have been providing assistance worth US$240 million in 2008/09," Pakkala said. New assessments after the April harvest would give a better indication of needs.

"The indications are that the harvest prospects are not very good, so it is likely that food aid will continue this year," Pakkala warned. With the WFP's programme projected to continue into 2010 – subject to the post-harvest assessment results - "The budget that we are still resourcing is about US$315 million - that is the current shortfall," he said.

Moving forward takes money

"This is therefore the time to step up our action," Bragg said. "If we do not ensure farmers have the necessary inputs for the next agricultural season, which begins in September and October [2009] we could end up next year with situations similar to what we have today. Seven million in need of food aid should not become the new norm in 2010."

The humanitarian community "will continue to provide food aid where needed; to continue to establish and operate cholera treatment centres, especially further in the periphery, and we will continue to intensify community public health outreach," she told reporters.

"It is going to be very important to continue getting support from the international community to carry out these actions," Bragg said, noting that "with adequate resources" the humanitarian community would be able to quickly mobilize the required material and personnel to strengthen the response to the humanitarian needs in Zimbabwe.

The international community has been very generous to the people of Zimbabwe, Bragg said, adding: "We will be approaching them again with requests for additional resources, based on new assessments of the evolving situation. We are counting on their continued generosity."

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