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

• PHR’s Zimbabwe report, videos and advocacy opportunities

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

• PHR’s Zimbabwe report, videos and advocacy opportunities

It hurts that as we celebrate here today there are some who are in prison. I can assure you that they are not going to remain in those dungeons any day or any week longer.

Morgan Tsvangirai, Zimbabwe’s new Prime Minister, made this pledge to thousands of Movement for Democratic Change (MDC) supporters following his swearing-in ceremony on 11 February 2009 at Glamis Stadium in Harare. One week later, human rights advocate Justina Mukoko and MDC activists Ghandi Mudzingwa and Fidelis Chiramba remain in Chikurubi Maximum Prison where Zimbabwean security forces have tortured and starved these three civic leaders as well as some 30 other individuals.

Zimbabwean police, military, and CIO officers are skilled sadists who employ an array of techniques in their arsenal of torture: electrocution, falanga (beating the soles of the feet), genital mutilation, water boarding, bludgeoning, and burning to name a few. Government authorities are violating the most basic rights and freedoms of these detainees - some of whom have been imprisoned and held incommunicado in inhumane conditions for several months. Their health has severely deteriorated, and they have not received adequate medical attention.

That ZANU-PF has successfully retained control over the military, police, and security forces bodes poorly for an amelioration of the human rights situation. But Tsvangirai opted to join the unity government with his nemesis Mugabe as president. If he cannot wield enough power as prime minister to keep his pledge and have these men and women be released immediately, there is little hope Tsvangirai will be able to succeed in tackling even bigger challenges such as establishing rule of law, feeding seven million Zimbabweans who face starvation, or addressing the underlying causes of the current outbreaks in disease and collapse of the health system.

The New York Times Feb. 13 editorial on Zimbabwe’s new unity government got it partly right. That the country’s illegitimate president, Robert Mugabe, will not allow the new prime minister, Morgan Tsvangirai, to establish rule of law and bring much-needed relief to the seven million starving people is an accurate presupposition based on Mugabe’s past three decades of autocratic misrule.

Mr. Mugabe stole last year’s election after Mr. Tsvangirai won the first-round vote. The best solution would have been an end to Mr. Mugabe’s rule. But with Mr. Mugabe refusing to resign and key African leaders refusing to push him out, Mr. Tsvangirai apparently decided that the power-sharing deal was his best chance to rescue his foundering country.

If there is any real hope, African leaders — especially South Africa’s — must pressure Mr. Mugabe to stop tormenting the opposition and let Mr. Tsvangirai do his job. And they must make clear that if Mr. Mugabe does not, they will finally stop protecting him.

It is perhaps misguided to think that African leaders alone will now begin pressuring Mugabe to share power and stop tormenting the opposition. Just last week at the African Union Summit in Addis, I witnessed the majority of African heads of state kowtow to Mugabe as he deftly side-stepped public censure for crimes against humanity and the collapse of the country’s public health system.

Instead, the UN Security Council should compel the government of Zimbabwe to relinquish control of its health services, water supply, sanitation, and disease surveillance to the United Nations. Only when the international community gets serious about its commitment to the global responsibility to protect civilians will Zimbabweans begin to enjoy their universal human rights.

Newsweek’s 31 January interview with Zimbabwe’s central banker, Gideon Gono, is lamentable not only for its factual inaccuracies, but also for giving voice to a Mugabe henchman whose monetary policies have led to the collapse of the economy, shuttering of hospitals, and closing of schools.

As part of PHR’s emergency assessment delegation, I traveled throughout Zimbabwe in December 2008 and found that a causal chain runs from Mugabe’s economic policies, to Zimbabwe’s economic collapse, food insecurity and malnutrition, and the current outbreaks of cholera, anthrax, and multidrug-resistant tuberculosis.

Reading the Newsweek interview, one incorrectly infers that international sanctions have caused Zimbabwe’s ruin.

NEWSWEEK: A lot of people have blamed you for Zimbabwe’s economic collapse.
GONO: The West wants you to think it’s because of mismanagement. But sanctions have had a devastating effect on the country. I cannot think of any genocide that is worse than that. By their very nature, sanctions are supposed to induce fear. It’s like terrorism. It’s callous.

These sanctions, employed by only a handful of countries, restrict access to assets squirreled away in foreign bank accounts of some 160 of Mugabe’s cronies who have looted humanitarian aid over the years to the detriment of starving civilians. I saw cases of pellagra, rare gastrointestinal anthrax (caused by eating infected carrion), and marasmic Kwashiorkor – all resulting from extreme food insecurity, not from Gono’s inability to access his private American bank account.

Interestingly, the Newsweek interviewer queried the central banker on the current cholera epidemic that rages in his country.

NEWSWEEK:Many people have called the government’s handling of the cholera epidemic a crime.
GONO: Cholera is under control. Every year there is a cholera outbreak in southern Africa; the epicenter of the disease just happened to be in Zimbabwe this year.

I assure you, vibrio cholerae is not “under control” in Zimbabwe. In fact, the case fatality rate for this easily treatable and entirely preventable disease is more than 20 times the international norm in some areas. Cholera continues to spread in Zimbabwe and across its borders because the Mugabe regime has failed to address the underlying causes of the disease: broken water and sewerage pipes, poor sanitation, and untreated water.

State funds from Gono’s central bank could be used to fix such essential public health services; instead, the Reserve Bank of Zimbabwe serves more as a personal checking account for Gono and Mugabe than as a means for providing succor to the seven million Zimbabweans who are currently dependent on international food aid.

The new PHR report on the collapse of health systems in Zimbabwe has brought media attention to the crisis there.

The Washington Post today reports:

The cholera outbreak gripping the country is just one sign of the disintegration of a once-admired health-care structure that essentially ceased to function in late 2008, denying Zimbabweans their human right to health, according to U.S.-based Physicians for Human Rights.

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