As Zimbabwe celebrates the end of the cholera outbreak that has claimed more than 700 lives since February 2023, Gerald Tozivaripi, 50, vividly remembers the day he was diagnosed with the disease, exactly one year ago, and how his friends cried at his hospital bedside as if he were already dead.
He came very close, he says: the cholera symptoms were as sudden as they were intense. “I was getting off a bus from Harare when I felt an urgent need to go to the toilet,” says the survivor from Beitbridge, a town about 360 kilometres south of the capital. “It was like a pipe burst. I also started vomiting profusely, then I lost consciousness and collapsed,” Tozivaripi says by telephone.
By then, nearly 79 people had died in Zimbabwe from cholera and more than 3,500 cases had been recorded. The diarrheal disease can be fatal within hours if left untreated, so when he regained consciousness in a hospital bed surrounded by a team of nurses wearing face masks, and his friends informed him of his condition, he feared for his life.
Tozivaripi’s is one of the 34,550 cases registered in the country until August 9, when the World Health Organization (WHO) declared Zimbabwe cholera-free with no new infections reported since June 30. The African country has achieved this, According to the WHOwith improved surveillance, prevention and water, sanitation and hygiene services. The plan to combat the disease has included the establishment of treatment centres in outbreak hotspots and public awareness campaigns on the risks of cholera. Elisha Sithole, coordinator of Médecins Sans Frontières (MSF) response to the outbreak in Zimbabwe, explains that it was an example of “very good collaboration and coordination between all those involved” [Gobierno y organizaciones como MSF]”For example, he notes, MSF focused on managing cholera cases, while other organizations specialized in water and sanitation.
Another element of success was the availability of vaccines: Zimbabwe launched door-to-door vaccination in densely populated neighbourhoods on the outskirts at the beginning of the year, with the help of WHO, to reinforce the fixed vaccination points in health facilities.
Stay on alert
Another 25 countries, mostly African, are still battling outbreaks. from this deadly bacterial infection. And in the case of Zimbabwe, experts say more must be done to keep it cholera-free, with efforts focused on sanitation, clean water and hygiene. After all, previous victories over the disease have been overshadowed by its resurgence, albeit with fewer deaths. In 2008, a year-long outbreak in Zimbabwe claimed more than 4,200 lives.
Many relatives did not come to mourn my uncle [cuando murió de cólera] because they feared for their lives
Precious Machado, niece of two people who died from the infection
Not everyone was as lucky as Tozivaripi. In May, Precious Machado lost her uncle and his wife to cholera, five days apart. They died shortly after returning home to Mrewa, 88 kilometres from Harare, after attending a funeral in Mbare, one of the city’s oldest and most populated suburbs. “Shortly after returning, my aunt complained of stomach pain and died before we could even take her to the clinic; the autopsy confirmed that she had contracted cholera,” Machado, 28, said in an interview with EL PAÍS. “Three days after she was buried, my uncle followed her, succumbing to the same disease,” she said sadly. “This time, many relatives did not come to mourn her because they feared for her life.”
Concern about water
To prevent the disease from re-emerging and protect the population, experts call for addressing the current limited access to drinking water and adequate sanitation, which is necessary to improve hygiene. Cholera is generally transmitted by the ingestion of contaminated food or water with fecal matter.
A 2023 report by the Zimbabwe Vulnerability Assessment Committee (ZimVAC) showed that 35% of rural households had inadequate access to water services, 45% of rural families had to travel more than half a kilometre to fetch water, and a similar percentage of households did not use basic sanitation systems.
These statistics are expected to worsen, According to Unicef, due to prolonged periods of drought caused by The Child, a recurring climatic phenomenon in Zimbabwe associated with reduced rainfall and rising temperatures. ZimVAC predicts that drought will continue to exacerbate water insecurity.
Lawmaker Josiah Makombe, head of the parliamentary committee on health, says that improving water, sanitation and hygiene (WASH) services is essential to prevent future outbreaks. The defeat of cholera “is a milestone, but more needs to be done, especially on water, sanitation and hygiene, and the multi-sectoral response needs to be intensified,” Makombe told this newspaper in a telephone interview.
“Local authorities must do more to ensure water availability, and presidential well-drilling projects must be intensified,” he added, referring to the plan the government launched in March 2022 — before the outbreak — with the aim of drilling 10,000 wells by November this year. By June only 2,000 had been completed..
But even these newly drilled wells are not safe. According to numerous local reports, up to half of those dug in Harare are contaminated, exposing the populations that rely on them for water to multiple diseases, including cholera.
Simbarashe James Tafirenyika, president of ZIMNAWU, an independent union of nurses and other municipal employees, said by phone: “We appreciate the government for drilling boreholes across the country to help prevent cholera, but if proven, some of the boreholes were closed because they were contaminated.”
Preventable deaths
According to Itai Rusike, executive director of the Community Working Group on Health (CWGH) — a local non-governmental organization focused on promoting community participation in health issues — cholera was “preventable.”
“We are very concerned about the disease and the unnecessary loss of life due to avoidable and preventable causes,” he said by phone. Stressing the need to continue oral vaccination against cholera, he added that this should be “a complementary measure and not a substitute for interventions to improve water, sanitation and hygiene, which should be carried out even while the population is receiving vaccination.”
Particularly in rural areas, many Zimbabweans are at high risk of contracting cholera as a result of poor daily hygiene practices and a lack of clean water. Piles of rubbish infested with insects and rodents, as well as pools of dirty and sewage water, are common in many of these areas. Tafirenyika also points to the unresolved problem of broken sewers. “There is a great need for proper water treatment, and chemicals are supposed to be readily available in the country,” she says.
Norman Matara, secretary general of the Zimbabwe Physicians for Human Rights Association, stresses the need to invest in infrastructure to provide running water across the country. “The absence of cases alone is not enough,” he says in a telephone interview. “We need to comprehensively address the underlying water, sanitation and hygiene problems that keep us perpetually on the cholera map.”
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