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Cablegate: Zimbabwe Cholera Usaid Dart Situation Report #2

VZCZCXRO0656
OO RUEHBZ RUEHDU RUEHJO RUEHMR RUEHRN
DE RUEHSB #1134/01 3541009
ZNR UUUUU ZZH
O 191009Z DEC 08 ZDK
FM AMEMBASSY HARARE
TO RUEHC/SECSTATE WASHDC IMMEDIATE 3844
RUEHSA/AMEMBASSY PRETORIA IMMEDIATE 5600
INFO RUCNSAD/SOUTHERN AF DEVELOPMENT COMMUNITY COLLECTIVE
RUEHGV/USMISSION GENEVA 1778
RUCNDT/USMISSION USUN NEW YORK 1962
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 001134

SIPDIS
AIDAC

AFR/SA FOR ELOKEN, LDOBBINS, BHIRSCH, JHARMON
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 ZI
SUBJECT: ZIMBABWE CHOLERA USAID DART SITUATION REPORT #2

HARARE 00001134 001.2 OF 003


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

1. As of December 18, the U.N. Office for the Coordination of
Humanitarian Affairs (OCHA) reported a total of 20,896 cholera cases
in Zimbabwe since the outbreak began in August, with 1,123 deaths
and a case fatality rate (CFR) of 5.4 percent. According to the
U.N. World Health Organization (WHO) the major causes for the
current outbreak continue to be a lack of clean drinking water and
sanitation facilities, weak health services, and an ongoing strike
by health staff, particularly nurses. WHO indicated that the
current outbreak began on August 20 in the suburb of Chitungwiza,
south of Harare. Following a late October outbreak in the Harare
suburb of Budiriro, cholera quickly expanded to an additional 46
districts from November 1 to 15.

2. The USAID Disaster Assistance Response Team (USAID/DART)
continues to conduct field visits, participate in U.N. health,
logistics, and water, sanitation, and hygiene (WASH) cluster
meetings, and review proposals from humanitarian partners to program
the USD 6.2 million pledged by the USAID Administrator in response
to the cholera outbreak. WHO reported that 22 metric tons (MT) of
medical supplies arrived in Harare during the first week of
December. The U.N. logistics cluster is currently planning to use
the U.N. World Food Program (WFP) logistics systems to move items to
the provincial level, and is still determining how to deliver
supplies to the sub-provincial level. Humanitarian organizations
are focusing on addressing prevention needs within the response, and
will develop a checklist to provide guidance on how to mainstream
protection within the ongoing cholera response. END SUMMARY.

-----------------------
HUMANITARIAN SITUATION
-----------------------

3. As of December 18, OCHA reported a total of 20,896 cholera cases
in Zimbabwe since the outbreak began in August, with 1,123 deaths
and a CFR of 5.4 percent. Humanitarian organizations consider a CFR
over 1 percent as the emergency threshold for cholera. The figures
represent an increase of more than 2,000 cases and 100 deaths since
the OCHA update issued on December 15, with virtually all of the new
cases reported in Harare, Masvingo, and the Mashonaland provinces,
and some new cases reported in Midlands Province.

4. According to WHO the major causes for the current outbreak
continue to be a lack of clean drinking water and sanitation
facilities, weak health services, and an ongoing strike by health
staff, particularly nurses. WHO noted that health staff are unable
to obtain salaries due to a shortage of banknotes and GOZ cash
withdrawal limits, and cannot afford to travel to work.

5. On December 16, WHO published the first epidemiologic report of
the cholera situation in Zimbabwe, analyzing trends since the
beginning of the outbreak in August 2008. WHO indicated that the
current outbreak began on August 20 in the Harare suburb of
Chitungwiza, though the organization did not rule out the
possibility of undetected low-level transmission from the earlier
January to April 2008 outbreak. Following a late October outbreak
in the suburb of Budiriro, cholera quickly expanded to an additional
46 districts from November 1 to 15.

6. As of December 17, local media sources in Malawi reported that
Lukini hospital in Lilongwe, designated by the Government of Malawi
Ministry of Health as the quarantine center for cholera cases, has
recorded 88 cases with five deaths. Local media sources cited a
strike by city water treatment workers as a contributing factor in
the outbreak.

------------
USG RESPONSE

HARARE 00001134 002.2 OF 003


------------

7. The USAID/DART continues to conduct field visits, participate in
U.N. health, logistics, and WASH cluster meetings, and review
proposals from humanitarian partners to program the USD 6.2 million
pledged by the USAID Administrator in response to the cholera
outbreak.

8. Beginning December 5, the USAID/DART health advisor and U.S.
Centers for Disease Control and Prevention (CDC) WASH advisor have
conducted meetings with Government of Zimbabwe (GOZ) Ministry of
Health and Child Welfare (MOHCW) officials, USAID/Zimbabwe and CDC
staff, U.N. agencies, and non-governmental organizations. The
health and WASH advisors have participated in field assessments in
the Harare suburbs of Budiriro and Chitungwiza, as well as Chegutu
and Mudzi districts.

9. The USAID/DART advisors examined the effectiveness of the
response to date in reducing spread of the outbreak, including
disease surveillance and early warning, social mobilization for
hygiene promotion, and limiting mortality through early detection,
treatment, and referral. The advisors also examined overall
coordination efforts to date. The advisors encouraged approaches
including the prioritization of an early warning system to alert
humanitarian organizations to new outbreaks, increased hygiene
promotion in areas with increasing cholera caseloads, and increased
monitoring in areas at potential risk for outbreaks, including
high-density urban areas lacking WASH infrastructure.

-------------------------
HUMANITARIAN COORDINATION
-------------------------

10. At the December 16 U.N. health cluster meeting, the GOZ MOHCW
representative promised to assist in expediting the importation of
urgent medical supplies and the issuing of temporary work permits
for humanitarian staff. The GOZ office that issues the work permits
is scheduled to meet next on February 19, making it difficult for
humanitarian organizations to continue work as staff temporary
permits expire or remain pending.

11. On December 17, USAID/Zimbabwe Mission Director, the USAID/DART
team leader, and other major donors attended a meeting with WHO
Regional and Zimbabwe representatives. The WHO regional
representative stated that the purpose of his visit was to help
WHO/Zimbabwe strengthen the health cluster to ensure better
coordination of cholera response efforts. WHO's contribution would
entail setting up provincial offices and warehouses, and most
importantly getting GOZ MOHCW staff back to work to staff the
offices. The GOZ Minister of Health and Child Welfare told the WHO
Regional Representative that the MOHCW needed USD 1.5 million a
month for health workers' salaries. The WHO Regional Representative
added that the issue of the sustainability of paying MOHCW salaries
could be dealt with later. Donors explained that strong
coordination was urgently needed and asked about the status of the
proposed cholera command and control center. The WHO Regional
Representative will review the proposed control center.

--------
HEALTH
--------

12. WHO reported that 22 MT of medical supplies arrived in Harare
during the first week of December. The organization noted that an
additional 7 MT of supplies, including five interagency health kits
and five trauma kits, are in the logistics pipeline.

13. At the December 16 U.N. health cluster meeting, participants
noted that the GOZ MOHCW had approved the use of oral rehydration
salts (ORS) at the community level after an appeal from WHO.


HARARE 00001134 003.2 OF 003


-------------------------------
WATER, SANITATION, AND HYGIENE
-------------------------------

14. The International Federation of Red Cross and Red Crescent
Societies will mobilize Zimbabwe Red Cross volunteers with hygiene
and health education messages as well as relief supplies, including
ORS, water purification tablets, water containers, and soap for
community-level interventions. USAID's Office of U.S. Foreign
Disaster Assistance is supporting Oxfam to co-coordinate the WASH
cluster's social mobilization efforts, in conjunction with the U.N.
Children's Fund.

15. The U.N. logistics cluster is currently planning to use the WFP
logistics systems to move items to the provincial level, and is
still determining how to deliver supplies to the sub-provincial
level. The cluster has submitted a U.N. Emergency Response Fund
proposal for human resources, fuel, storage, and transport. The
cluster is not differentiating between WASH and health supplies, but
coordinating based on a general cholera response. The cluster lead
indicated that there is a sufficient supply of lactated ringer's
solution and ORS at the provincial level for January, but supplies
are needed for February.

----------
PROTECTION
----------

16. Humanitarian organizations noted the specific protection risks
related to cholera outbreak, particularly for at-risk groups such as
children, women, mobile and vulnerable populations in high-density
urban areas, and individuals in orphanages and prisons.
Humanitarian staff noted the need for age and sex disaggregated data
to inform the response.

17. Humanitarian organizations are focusing on addressing prevention
needs within the response, and will develop a checklist to provide
guidance on how to mainstream protection within the ongoing cholera
response. Humanitarian staff plans to disseminate the list in
coordination with the health and WASH clusters.

DHANANI

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