The non-profit organization, Physicians for Human Rights (PHR), published a report in January of 2009 on the cholera outbreak and related health crises in Zimbabwe. Outlining the outbreak in painful detail, the report suggests that the scope of the disaster, largely due to government mismanagement and neglect on a national scale, constitutes crimes against humanity. PHR thoroughly examined the wide-spread public health crisis in the context of the 28 year rule of Robert Mugabe and urges further investigation and involvement from the international community and possibly the International Criminal Court.
Article 7 (1) (k) of the Rome Statute of the International Criminal Court describes crimes against humanity to include “other inhumane acts of a similar character intentionally causing great suffering, or serious injury to body or to mental or physical health.” Zimbabwe is not a signatory of the Rome Treaty. However PHR asserts that crimes against humanity, as defined by the Rome Treaty, are within the bounds of customary international law. Because Zimbabwe has disregarded the epidemic and openly blocked international aid resulting in the deaths of thousands, PHR believes this constitutes a crime against humanity.
The situation in Zimbabwe dire. During August of 2008, the country saw the beginning of a cholera outbreak that the World Health Organization has categorized as “explosive.” Cholera is easily treated with fluids administered orally or intravenously while the infection runs its course. Without this simple intervention, cholera leaves its victims with severe dehydration that can lead to death. An update published by the World Health Organization on February 20, 2009 listed nearly 80,000 cases and almost 4,000 as recorded by Zimbabwe’s Ministry of Health and Child Welfare (MoHCW). The WHO did provide some encouraging data as it estimated the epidemic peaked in November of 2008.
As PHR detailed, the epidemic spread with unusual vigor because of inadequate or non-functioning sewer and sanitation systems. In December of 2008, the New York Times described a scene of children playing in “streets that flow[ed] with raw sewage.” Further exacerbating the epidemic has been the near complete collapse of the public health system, caused in part by the rapidly declining economic situation. The Zimbabwe dollar is now worthless due to hyperinflation. In January of 2009, the country released a 100 trillion Zimbabwe dollar note that at the time was worth a mere 37 US dollars. Health care workers stopped showing up for work in the fall of 2008 as the monthly salary ceased to cover the cost of transportation to work for a single day. Hospitals lacking essential staff shut their doors. Patients that need treatment either cannot get treatment or must pay hundreds of US dollars in fees for private healthcare.
Despite the recent decline in deaths, there remain significant challenges in protecting the right to health of all citizens of Zimbabwe. There are significant barriers to access to health care including the high cost of private health services and a public health system that has completely collapsed. The nation will continue to be in danger of a resurgence of an outbreak as long as the sanitation and sewer systems remain in ill repair. The high prevalence of HIV and widespread malnutrition makes the population particularly susceptible to infections such as cholera.
Finally, this epidemic has the potential to lead to serious problems, not only for the people of Zimbabwe, but for the entire region. Already neighboring countries have reported an increase in the number of reported cases of cholera as people flee from Zimbabwe to escape political turmoil and seek medical care. Clearly, a drastic intervention is needed to protect the right to health of so many.
Additional Resources:
NYTimes Video: Confronting Rape on Zimbabwe’s Border
NYTimes Op-Ed: Zimbabwe is Dying
UNICEF: Widespread Collapse of Social Services Creates “Twin Disaster” in Zimbabwe
UNICEF: The Tragedy of Zimbabwe’s Cholera Outbreak
The Zimbabwean: Who Controls the Water Determines the Severity of the Cholera