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Cablegate: Disaster Declaration in Zimbabwe for Cholera

VZCZCXRO6377
OO RUEHBZ RUEHDU RUEHJO RUEHMR RUEHRN
DE RUEHSB #1119/01 3501250
ZNR UUUUU ZZH
O 151250Z DEC 08
FM AMEMBASSY HARARE
TO RUEHC/SECSTATE WASHDC IMMEDIATE 3818
RUEHSA/AMEMBASSY PRETORIA IMMEDIATE 5593
INFO RUCNSAD/SOUTHERN AF DEVELOPMENT COMMUNITY COLLECTIVE
RUEHGV/USMISSION GENEVA 1759
RUCNDT/USMISSION USUN NEW YORK 1956
RUEHRN/USMISSION UN ROME
RUEHBS/USEU BRUSSELS
RHEHAAA/NSC WASHDC
RUEKJCS/SECDEF WASHINGTON DC
RHMFISS/JOINT STAFF WASHINGTON DC
RUEHPH/CDC ATLANTA GA

UNCLAS SECTION 01 OF 03 HARARE 001119

SIPDIS
AIDAC

AFR/SA FOR ELOKEN, LDOBBINS, HIRSCH, HARMON
OFDA/W FOR KLUU, ACONVERY, LPOWERS, TDENYSENKO
FFP/W FOR JBORNS, ASINK, LPETERSEN
PRETORIA FOR HHALE, PDISKIN, SMCNIVEN
GENEVA FOR NKYLOH
ROME FOR USUN FODAG FOR RNEWBERG
BRUSSELS FOR USAID PBROWN
NEW YORK FOR DMERCADO
NSC FOR CPRATT
ATLANTA FOR THANDZEL

E.O. 12958: N/A
TAGS: EAID EAGR PREL PHUM PGOV ZI
SUBJECT: DISASTER DECLARATION IN ZIMBABWE FOR CHOLERA

REF: HARARE 0904

HARARE 00001119 001.2 OF 003


1. This is an action cable (see paragraph 15).

-------
SUMMARY
-------

2. Beginning in August 2008, cholera outbreaks have spread to affect
9 of the 10 provinces in Zimbabwe. A breakdown in water and
sanitation infrastructure has exacerbated Zimbabwe's cholera
outbreak, and the nation's collapsed health system is unable to
respond adequately. On December 3, the Government of Zimbabwe (GOZ)
Minister of Health and Child Welfare declared an emergency and
requested international assistance to respond to the cholera
outbreak.

3. In FY 2008, USAID's Office of U.S. Foreign Disaster Assistance
(USAID/OFDA) provided more than USD 4 million to implement water,
sanitation, and hygiene (WASH) programs as well as distribute
emergency hygiene supplies in anticipation of a cholera outbreak
(REFTEL). In early December, USAID/OFDA provided an additional USD
600,000 to Population Services International (PSI) for water
treatment supplies and community hygiene education. On December 5,
health advisor from USAID/OFDA and a WASH advisor from the U.S.
Centers for Disease Control and Prevention (CDC) arrived in Harare
to assess the situation. On December 10, to augment ongoing
response efforts, USAID/OFDA activated a Disaster Assistance
Response Team (USAID/DART). In response to the ongoing cholera
outbreaks, the Charge d'Affaires, a.i. declares that a disaster
exists, it is beyond the capacity of the GOZ to respond, and that it
is in the interest of the U.S. Government (USG) to provide
assistance to cholera-affected populations. END SUMMARY.

-----------
BACKGROUND
-----------

4. Beginning in August 2008, cholera outbreaks have spread to
affect 9 of the 10 provinces in Zimbabwe. According to relief
agencies, the breakdown of Zimbabwe's water, sewage, and sanitation
systems due to aging and poorly maintained infrastructure has
exacerbated the spread of cholera. USAID/DART staff report that
many high-density urban areas lack clean water for months at a time
and that residents obtain drinking water from contaminated shallow
wells.

5. Zimbabwe's health care system remains unable to cope adequately
with the outbreak due to collapsing infrastructure, lack of salaries
for medical staff, and inadequate soap for medical staff and
patients. On December 3, the GOZ Minister of Health and Child
Welfare declared an emergency and requested international assistance
to respond to the cholera outbreak, including medicine, equipment,
and food for patients.

------------------
CURRENT SITUATION
------------------

6. As of December 11, the U.N. World Health Organization (WHO)
reported 792 deaths due to cholera, with 16,700 total cases. WHO
noted that 60 percent of the cholera cases were reported in Harare
and 23 percent in Beitbridge, the southern town which serves as the
main entry point to South Africa. WHO reported a case fatality rate
(CFR) of approximately 4.7 percent, considerably higher that the 1
percent emergency threshold used by humanitarian organizations. The
U.N. Office for the Coordination of Humanitarian Affairs (OCHA)
noted that the U.N. health cluster is planning based on a worst case
scenario of up to 60,000 cholera cases.

7. The USAID/DART public health advisor reported that cholera rates

HARARE 00001119 002.2 OF 003


are declining in current hot spots but are increasing in new
locations. OCHA noted that the cholera outbreak caseload in
Beitbridge has declined substantially from 300 cases per day to 20
cass per day as of December 10. However, local healt authorities
reported nearly 600 cases and 45 chlera deaths in a new outbreak in
Chegutu town, suthwest of Harare.

8. High-density, peri-urban reas with limited access to clean water
remain particularly vulnerable to increased cholera rates. Limited
information flow from rural clinics impedes the GOZ Ministry of
Health and Child Welfare (MOHCW) and humanitarian organizations from
gauging trends in rural areas. In addition, people who do not seek
care outside the home may not be included in official statistics.
Hyperinflation and a shortage of basic goods have resulted in a lack
of access to sugar and salt, both of which could be used to assist
with community-based oral rehydration to treat and mitigate the
effects of cholera.

9. USAID/DART staff report that Harare's hospitals have closed and
that additional urban hospitals lack sufficient resources, resulting
in residents traveling to rural health facilities and potentially
transmitting cholera to new areas. The onset of the November to
April rainy season will lead to conditions favorable for increased
cholera transmission, while the annual Christmas season migration
will likely lead to the spread of cholera to previously unaffected
areas of the country.

10. In response to the cholera outbreaks, WHO recently deployed a
high-level, seven-person team to Zimbabwe to improve coordination of
the cholera response. The team includes a logistician,
communications officer, social mobilization expert, and a
USAID/OFDA-funded epidemiologist. WHO is receiving updated
information from the GOZ MOHCW on reported cholera cases and deaths,
which is passed to OCHA for inclusion in daily and weekly cholera
situation reports.

----------------
REGIONAL IMPACT
----------------

11. According to WHO, the cholera outbreak has affected border areas
of neighboring countries, with confirmed cases reported in Botswana,
Mozambique, and South Africa, primarily among populations of
Zimbabwe nationals. On December 12, the U.S. Embassy in Gaborone
reported five confirmed cholera deaths, all among Zimbabwe
nationals. As of December 7, the Government of South Africa reported
11 cholera deaths and 751 cases, with a CFR of 1.46 percent. The
majority of the cases were reported in Vhembe District of Limpopo
Province.

12. On December 9, OCHA reported 708 cases and eight deaths in South
Africa's Limpopo Province. On December 11, the government of
Limpopo Province declared a disaster due to a cholera outbreak in
Vhembe District. Within the district, the border town of Musina
serves as a primary destination for Zimbabweans seeking medical
treatment in South Africa. On December 11, USAID/OFDA's principal
regional advisor based in Pretoria, South Africa, traveled to Musina
to assess the situation.

--------------------------------------
USG CHOLERA ASSISTANCE REPONSE TO DATE
--------------------------------------

13. In FY 2008, USAID/OFDA provided the non-governmental
organizations Oxfam/UK and World Vision with over USD 4 million to
implement water, sanitation, and hygiene (WASH) programs as well as
distribute emergency hygiene supplies, including soap, in Bulawayo,
Harare, and Masvingo Provinces in anticipation of a cholera
outbreak. In early December, USAID/OFDA provided an additional USD
600,000 to PSI for water treatment supplies and community hygiene
education.

HARARE 00001119 003.2 OF 003

14. On December 5, health advisor from USAID/OFDA and a WASH advisor
from CDC arrived in Harare to assess the situation. On December 10,
to augment ongoing response efforts, USAID/OFDA activated a Disaster
Assistance Response Team (USAID/DART) to monitor and assess
humanitarian conditions, identify priority programming needs, and
facilitate humanitarian coordination and information sharing.

---------------------
DISASTER DECLARATION
---------------------

15. ACTION REQUEST: The Charge d'Affaires, a.i. declares that a
disaster exists, it is beyond the capacity of the GOZ to respond,
and that it is in the interest of the USG to provide assistance to
cholera-affected populations. Post requests the release of USD
50,000 under the Ambassador's Authority to purchase relief supplies
to meet immediate health and sanitation needs. The funding will be
part of the overall USD 6.2 million pledged by USAID to respond to
cholera in Zimbabwe. The USAID/DART, in coordination with
USAID/Zimbabwe, the U.S. Embassy in Harare, humanitarian partners,
and other donors, will continue to closely monitor the situation and
conduct assessments to determine any additional humanitarian needs.


DHANANI

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