August 04, 2009

In July, Doctors Without Borders/Médecins Sans Frontières (MSF) began an intervention in Kwekwe prison in Zimbabwe’s central Midlands Province. The intervention at Kwekwe focuses on providing basic health care and therapeutic feeding to the inmates, many of whom are severely malnourished. Additionally, MSF aims to improve the poor water and sanitation conditions in the prison, including performing cholera prevention activities. The prison in Kwekwe is the first of seven institutions MSF will be working in over the next four months.

“We found prisoners wearing torn and ragged uniforms and lacking blankets during Zimbabwe’s coldest months . . .”

“In Kwekwe we have assessed 179 prisoners, of whom 17 percent were identified as being malnourished,” says Pip Millard, MSF project coordinator. “We found prisoners wearing torn and ragged uniforms and lacking blankets during Zimbabwe’s coldest months, with prison officers doing their best with limited resources.”

MSF first obtained access to two prisons during the cholera outbreak earlier this year, and discovered the needs were significant. “In late February, we were approached by prison authorities in two locations where we were active to assist in dealing with cholera inside their institutions,” says MSF Head of Mission Rian van de Braak. “The first prison we started working in was in Kadoma. This was the first time we were confronted with the severe situation of malnutrition inside the prisons. The conditions were highly concerning; the prisoners were nearly starving due to a lack of food supplies.”

Shortly afterward the cholera outbreak, MSF started an emergency intervention in the prison in Bindura, providing therapeutic food for the severely malnourished inmates and nutritional support for the rest of the prison population. Furthermore, basic water and sanitation activities were carried out to improve the sanitation situation and ensure the provision of clean drinking water.

“The condition of latrines was often dreadful due to a lack of water for flushing. Soap or other disinfectants were missing.”

Following good cooperation with the Ministry of Justice and the Ministry of Health, MSF expanded its involvement beyond the first interventions in Kadoma and Bindura. Two rapid surveillance teams conducted an assessment of the health, nutrition, and water and sanitation situations in 15 prisons. Rapid physical assessments were conducted together with prison health staff at each of the surveyed sites. Body mass index (BMI) and mid-upper arm circumference (MUAC) were calculated for almost 2,000 prisoners. MSF’s nutritional survey results revealed that four percent of the inmates were severely malnourished, five percent malnourished, and 14 percent at risk.

“Our water and sanitation survey showed that a basic and reliable water supply was often lacking, and water storage possibilities, apart from the occasional jerry can, were absent,” says Nick Rowe, an MSF water and sanitation expert. “The condition of latrines was often dreadful due to a lack of water for flushing. Soap or other disinfectants were missing.”

After Kwekwe, the team will continue with the prisons in Murewa, Motoko, Guruve, Chivu, Gokwe, and Marondera. Besides the actual intervention, MSF will lobby for more actors to step in so that long-term assistance can be ensured.

MSF has been working in Zimbabwe since 2000. Since the beginning of the cholera outbreak in August 2008, MSF has treated 45,000 patients. MSF also provides care for more than 40,000 people living with HIV/AIDS, including 26,000 who are receiving antiretroviral therapy (ART), and provides nutritional support to severely malnourished children.