In a recent letter to the New York Times, I suggested that donor governments maintain targeted sanctions against a small cohort of Zimbabwe’s power elite, but that they should also now provide targeted humanitarian support to the struggling country in transition. Newspaper editors value brevity, but here in the blogosphere, where the real estate is cheap, I’ll elaborate for some added clarity.
Terminological chaos abounds when describing amorphous concepts like humanitarian aid and developmental assistance. And this imprecision breeds poor policy, as in the case of the United States. Where’s the chaos, you ask? Take a look:
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So the good news is that the cholera epidemic in Zimbabwe is finally getting under control. Weekly case fatality rates have dropped from over 5% to now about 1%. The bad news is that tuberculosis may soon take its place as a leading cause of death in Zimbabwe. According to the WHO, Zimbabwe has the the fourth highest incidence of TB in the world.
When the government finally admitted four months following the cholera outbreak last year that it did indeed face a spiraling epidemic, the ZANU-PF regime funneled the meager resources it did have toward combating the disease. One of the problems with this vertical health approach, however, is that it redirected resources away from other pressing health issues.
Enter tuberculosis.
When PHR investigators spoke with physicians at Beatrice Infectious Diseases Hospital in Harare, they reported to us that they could no longer treat their TB patients because government authorities mandated they only treat people infected with cholera.
The current health crisis in Zimbabwe poses other major problems including a dysfunctional national laboratory, a lack of diagnostic capacity and a severe shortage of first-, second- or third-line drugs to treat TB. Do you hear the din of alarm bells? They’re sounding the spread of multiple-drug-resistant TB (MDR-TB) and the most severe form, extensively drug-resistant TB (XDR-TB). These highly lethal forms of TB develop and spread rapidly because treatment interruptions allow the bacillus to evolve and evade the antibiotics by various cellular mechanisms.
Drug-resistant variants of TB are arguably more of a threat to southern Africa than the spread of cholera, which is an acute illness that remains both treatable and curable with basic medical services. Drug-resistant TB will pervade in the regions for years and will greatly increase the cost and complexity of treatment and care.
Resources
A new documentary on Zimbabwe’s cholera epidemic quotes a former UN humanitarian official as saying:
The United Nations deliberately downplayed the crisis to avoid confrontation with President Mugabe and his ZANU-PF regime.
The Geneva-based International Council of Voluntary Agencies goes further and calls for the UN to sack the current UN humanitarian coordinator in Zimbabwe, Augostino Zacharias, because he’s too closely tied to Mugabe and won’t speak out against him. This blame-and-shame approach does make enticing news copy, but unfortunately does not address the real issue.
That the UN engages in quiet diplomacy with the host government should come as no surprise. It was this type of closed-door dialogue that ultimately persuaded Mugabe to allow humanitarian organizations to resume operations after a four-month mandatory hiatus in 2008.
So what are the real issues? Let’s start with Mugabe’s 2005 nationalization of municipal water services for political gain and profit. After the government took control, it abrogated its most fundamental responsibility toward its citizenry by
- dumping contaminated waste into the water reservoir
- failing to maintain the reticulated water system
- neglecting to procure enough aluminum sulfate for water treatment
- shutting off water to selected communities
- abandoning municipal waste collection
- ignoring sewerage repairs
It’s Mugabe’s malfeasance that directly caused the eight-month-old and ongoing cholera epidemic. So if there’s anyone to blame, it’s the octagenarian with all the power.
Resources
Australian Foreign Minister Stephen Smith just announced that his government will provide Zimbabwe with another $6.5 million in aid to help the so-called unity government restore urgent access to safe water, adequate sanitation and health services.
What’s so controversial? He’s betting that historically corrupt ZANU-PF government officials won’t again abscond with these aid dollars the way they have in the past. (Remember last November when reserve bank governor Gideon Gono stole $7.3 million from the Global Fund?)
At least Australia has done its homework. In May 2005, the Mugabe regime nationalized MDC-run municipal water services for political gain and profit. Within three years under ZANU-PF control, the national water authority had collapsed due to malfeasance, which directly led to the current cholera outbreak. 4,000 dead and 90,000 infected - and all from an entirely preventable and easily treatable disease. If there’s any good news with the new unity government, it’s that water services are now back under municipal control. And that’s why Australia is donating half of the new aid to municipal authorities for the provision of water treatment chemicals.
And what of Zimbabwe’s other major donors? Both the US government and UK government have placed their bets on ZANU-PF not changing its stripes any time soon. The United States and United Kingdom have both stated their respective intents to wait until the unity government has made tangible progress toward improving the human rights situation before they renew substantive development aid to Zimbabwe.
Unfortunately, this modest increase in humanitarian aid from the benevolent Aussies will not address the underlying causes of the current outbreaks in disease and collapse of the health system. For that Zimbabwe needs billions in development aid that will only pour in once the Americans and Brits are satisfied.
2008-09 humanitarian aid to Zimbabwe (USD):