The 2008 Zimbabwean cholera outbreak was an epidemic of cholera affecting much of Zimbabwe from August 2008 until June 2009. The outbreak began in Chitungwiza in Harare Metropolitan Province in August 2008, then spread throughout the country so that by December 2008, cases were being reported in all 10 provinces. In December 2008, The Zimbabwean government declared the outbreak a national emergency and requested international aid. The outbreak peaked in January 2009 with 8,500 cases reported per week. Cholera cases from this outbreak were also reported in neighboring countries South Africa, Malawi, Botswana, Mozambique, and Zambia. With the help of international agencies, the outbreak was controlled, and by July 2009, after no cases had been reported for several weeks, the Zimbabwe Ministry of Health and Child Welfare declared the outbreak over. In total, 98,596 cases of cholera and 4,369 deaths were reported, making this the largest outbreak of cholera ever recorded in Zimbabwe. The large scale and severity of the outbreak has been attributed to poor sanitation, limited access to healthcare, and insufficient healthcare infrastructure throughout Zimbabwe.
Cause
The 2008 cholera outbreak was caused by widespread infection with the bacterium Vibrio cholerae which is spread through water contaminated with the feces of infected individuals. Cholera had been seen in Zimbabwe in the decade leading up to the 2008 outbreak. However, the severity of the 2008 has been attributed to a combination of societal factors including poor access to health care and poor health care infrastructure, high HIV prevalence, political instability, food shortages, high levels of displaced people, and lack of access to safe water. In 2008, Zimbabwe was suffering from an economic crisis and hyperinflation which led to shortages of food and other basic goods, disruption of public services, and a large number of refugees moving within the country and to neighboring countries.
One of the major contributing factors to the outbreak was the breakdown of the municipal water supply, sanitation, and waste collection programs throughout the country, but especially in urban areas. With this, the onset of the rainy season led to cholera-contaminated faeces being washed into water sources, in particular public drains, as well as providing readily available but contaminated water. Due to a shortage of purification chemicals, such as chlorine, the capital city of Harare stopped receiving piped water on 1 December 2008. By that date, many suburbs had not had any water supply for much longer. On 4 December 2008, the Zimbabwe deputy minister for water and infrastructural development stated that there were only sufficient treatment chemicals in stock nationally for 12 weeks supply. The collapse of these systems was blamed on the then-current economic crisis; many households cannot afford fuel to boil water. According to Médecins Sans Frontières, the spread of cholera from urban to rural areas from December 2008 onwards was due to infected city-dwellers visiting their families' rural homes for Christmas and the burial of infected city-dwellers in rural areas.
The 2008 cholera epidemic in Zimbabwe had an unusually high fatality rate; Oxfam attributed the high mortality to a population "seriously weakened by hunger, HIV and AIDS". A major contributing factor to the severity of the outbreak was the collapse of Zimbabwe's public health system, declared a national emergency on 4 December 2008. By the end of November 2008, three of Zimbabwe's four major hospitals had shut down, along with the Zimbabwe Medical School, and the fourth major hospital had two wards and no operating theatres working. Zimbabwean hospitals still open by December 2008 lacked medicines and staff. Due to hyperinflation, hospitals were not able to buy basic drugs and medicines, and the resources of even internationally funded emergency clinics were stretched. The ongoing political and economic crisis contributed to the emigration of doctors and people with medical knowledge. Some victims were travelling to Botswana and other neighbouring countries for treatment.
Impact
The 2008 outbreak began in Chitungwiza on 20 August 2008. In September, cases spread to the urban areas of Makonde and Chinhoyi. By the end of October, cases had spread to 3 provinces: Mashonaland West, Mashonaland East, and Harare city. In the first two weeks of November, the epidemic rapidly spread across Zimbabwe, appearing in a total of 9 provinces and 54 districts. The disease spread to reach all of Zimbabwe's ten provinces. The attack rate was highest in Beitbridge, Chegutu, Mudzi and Zvimba Districts (above 1,000 cases per 100,000 people or 1.0%).