The first months of 2008 marked a period of further economic meltdown and political violence throughout Zimbabwe. While the country has been in crisis for years, the situation deteriorated to ever more alarming levels, with inflation of 231 million percent, shortages of essential goods, repression of opposition supporters, and additional restrictions on humanitarian organizations in the lead up to contested elections in June.
The crisis was especially troubling for the country’s estimated two million people living with HIV/AIDS. According to the United Nations, life expectancy in Zimbabwe has plummeted to just 34 years of age because of the HIV/AIDS pandemic. As a result of the crisis, many people undergoing treatment were forced to skip meals, unable to afford bus fares to clinics, or were simply too afraid to leave their homes. MSF has 40,000 people with HIV/AIDS under its care in Zimbabwe, half of them on antiretroviral therapy. As patients missed appointments, some were feared to have fled the country. Unplanned treatment interruptions can have severe health consequences, including treatment failure due to the development of drug resistance.
Throughout the year, Zimbabweans continued to flee the country in alarming numbers. The flight of much needed medical staff placed an even greater strain on the country’s deteriorating health-care system. About 3 million Zimbabweans have fled to neighboring South Africa; an unprecedented figure for a country not at war. Every day, thousands of people crossed the Limpopo River to reach the South African border town of Musina, risking beatings, rape, or robbery by bandits. MSF launched a project in the border town of Beitbridge to assist migrants on their way to South Africa and ran mobile clinics for new arrivals at sites along the Limpopo River and in Musina itself. Many who reached South Africa were forced to live underground to avoid arrest and deportation and in May, Zimbabweans, along with other foreign nationals, were targeted with violent xenophobic attacks, which displaced more than 100,000 people throughout South Africa. MSF provided emergency assistance to victims of the xenophobic violence.
The worst outbreak of cholera in years began in August and quickly spread as a result of the country’s collapsed infrastructure. The outbreak, which has been centered in Harare, was declared a national emergency in early December, by which time MSF had treated more than 11,000 patients. MSF’s medical teams set up more than a dozen cholera treatment centers and units, helped chlorinate water sources, disinfected homes, and sent teams throughout the countryside to treat outbreaks in rural areas. Significant new outbreaks were found in mid-December, particularly worrying as the rainy season had not yet started in many areas. Cholera spreads more easily in the rainy season, November to March, when contaminated sewage is more likely to be flushed into unprotected wells. MSF expects to be caring for cholera patients in Zimbabwe into 2009.
“Imagine a cholera ward with dozens of people under the most basic conditions. For instance, there is only a little electricity so there is hardly any light. It is difficult for the doctors and nurses to even see the patients they are treating. The nurses have to monitor multitudes of IV bags to make sure they don't run dry which is also difficult to do in the dark and when there are so many patients.”
MSF Emergency Coordinator