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

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):

• United States                $220 million

• United Kingdom          $65 million

• European Union          $45 million

• Australia                        $24 million

The US Department of State released this week its human rights report card for 194 countries and territories, which it has submitted annually to the US Congress in compliance with the federal Foreign Assistance Act (PDF) since 1977. It took a whopping 26,000 words to describe the Mugabe regime’s “pervasive and systematic abuse of human rights” during 2008.

You’d think the State Department’s Bureau of Democracy, Human Rights, and Labor, who wrote the tome, would address most if not all of the rights enshrined in the United Nations Universal Declaration of Human Rights. But that’s not the case.

As part of the Physicians for Human Rights delegation who traveled to Zimbabwe to investigate Mugabe’s immiseration of the health sector in December 2008, I was eager to read the State Department’s report and compare findings. What? Not one paragraph devoted to violations of the right to health in Zimbabwe? The 2008 collapse of the health sector in Zimbabwe was unprecedented in scale and scope, and the State Department didn’t address it?!

This dearth of information should in no way imply the counter-factual position that Mugabe’s ZANU-PF regime respects and protects the right to health. In fact, the PHR delegation found that the health crisis in Zimbabwe is a direct outcome of the malfeasance of the ZANU-PF government and the systematic violation of a wide range of human rights—not just civil and political rights, which the US State Department details.

PHR documented violations of

• the right to life due to:
  • uncontrolled cholera epidemic
  • cessation and obstruction of humanitarian aid
  • lack of access to emergency obstetric care
  • changes in ARV regimens
• the prohibition against torture:
  • widespread ZANU-PF policy of torture, intimidation, kidnappings and other inhuman and degrading treatment
• core obligations of the rights to health, water, and food such as:
  • denial of equal access to health services on a non-discriminatory basis directly following from the dollarization of the health sector
  • denial of access to medicines
  • denial of access to safe water and adequate sanitation
  • denial of minimum essential food that is nutritionally adequate

Perhaps Secretary of State Clinton will conduct a more thorough assessment of human rights violations when reporting to Congress next year.

Just take a look at Zimbabwe, which until recently was one of Africa’s leading agricultural producers.  In fact agriculture contributed to 45% of Zimbabwe’s export earnings and provided livelihood to more than 70% of the population.  Tragically, more than seven million Zimbabweans today rely on food assistance, according to the UN World Food Program.

How did this phenomenal collapse happen so quickly, rendering Zimbabwe the ignominious distinction of becoming the first failed state without a war to blame? Land reform.

In April 2000, the ZANU-PF-controlled parliament approved amending the Zimbabwe Constitution to establish a legal framework for land acquisition.  Mugabe quickly mobilized some 35,000 war veterans and unemployed youth militia and ordered them to begin expropriating white-owned farms while brutally assaulting and sometimes murdering the commercial farmers and farm workers.

The Government claims “that restoring land to the landless majority was right and necessary”.  But under the guise of land redistribution to benefit landless black Zimbabweans, Mugabe instead awarded many of these once productive farms to government ministers and other ZANU-PF supporters for their patronage.  Many of these farmlands now remain fallow and serve as nothing more than second homes to these non-farming cronies, including Zimbabwe’s First Shopper, Grace Mugabe.

The land seizure led to a 70% fall in agricultural production, and precipitated the collapse of the economy.  In fact Zimbabwe’s economy is so bad, one needs to employ scientific notation (remember general chemistry?) to comprehend the rate of inflation – estimated to be 89.7 x 10²¹% – otherwise known as 89.7 sextillion percent!

Zimbabwe’s new Prime Minister Morgan Tsvangirai sure has his work cut out for him, especially by promising that “every health worker, teacher, soldier and policeman will receive their pay in foreign currency until we are able to stabilize the economy.”

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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The BBC News website today reported on PHR’s emergency report on the health crisis in Zimbabwe, Health in Ruins: A Man-Made Disaster in Zimbabwe.

The BBC News states:

Physicians for Human Rights says the “shocking” findings in its report - Health in Ruins, a man-made disaster in Zimbabwe - should compel the international community to act.

“These findings add to the growing evidence that Robert Mugabe and his regime may well be guilty of crimes against humanity,” it says in the report’s preface, which is signed by South African Archbishop Desmond Tutu, former UN High Commissioner for Human Rights Mary Robinson and Richard Goldstone, a former chief prosecutor at the International Criminal Tribunal for Rwanda.

The BBC goes on to say

President Mugabe has been facing intensified criticism over the dire economic and humanitarian situation in Zimbabwe. He signed a power-sharing deal with his rival, Morgan Tsvangirai, in September, intended to rescue the collapsing economy, but progress has since stalled over who should control key ministries.

Among its recommendations, the report says the UN Security Council and Southern African Development Community (SADC) should call on Mr Mugabe to accept the first round of last year’s presidential election, which was won by Mr Tsvangirai.

Read more about this humanitarian disaster in PHR’s new report.

Other news coverage:

The Zimbabwean: Call for world to assist with Zim healthcare system

The Times (South Africa): Deadly cholera across Southern Africa

Le Temps.ch (Switzerland): «Crimes contre l’humanité» au Zimbabwe

The Earth Times (Britain): Zimbabwe’s health system in crisis; cholera claims 1,937