2008 zimbabwean cholera outbreak 2008 zimbabwean cholera outbreak 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 mashonaland east 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. 2008 zimbabwean cholera outbreakthe spread of cholera in zimbabwe as of 5 february 2009, using data from several sources.dateaugust 2008 – july 2009locationzimbabwecausevibrio choleraedeaths4,369non-fatal injuries98,569 cause an open drain in kuwadzana township, harare in 2004. by 2008 drains such as this were carrying sewage from burst sewage pipes and feces washed out of the neighbouring areas as the urban sanitation system collapsed. this contributed to the rapid spread of the cholera outbreak. 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 spread of cholera in zimbabwe: (top) the number of cases recorded in the most infected centres and districts, and in the remainder of each province of zimbabwe as of 4 march 2009. (bottom) total number of reported cases. since totals for many districts are not updated daily, the first occurrence of a case may represent the date of the reporting of that case, not the date of infection. data sources: united nations office for the coordination of humanitarian affairs, the world health organization, the international federation of red cross and red crescent societies. and news media, 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%). the number of cases reported by the united nations office for the coordination of humanitarian affairs escalated from 30 on 1 september 2008 to 15,572 by 10 december. according to the red cross, around 46% of reported deaths occur en route to clinics and hospitals. the head of the british department for international development in harare said that "there are probably twice as many people with cholera as turn up for treatment". the case fatality rate for the outbreak was higher than expected for such outbreaks, although it began declining by january 2009. official estimates of fatalities have run from 484 to 800, since the outbreak in august 2008, with an upper estimate of 3,000 from an anonymous senior official in the ministry of health and child welfare. fatality rates varied from 2.5% in harare to 18% in chitungwiza. in harare, the crisis reached the extent that the city council offered free graves to cholera victims. by 7 december, oxfam estimated 60,000 cases by the end of january 2009 and a 10% fatality rate, with unicef giving a similar estimate. on 4 december 2008, the zimbabwe government declared the outbreak to be a national emergency. response assistance after the 2008 outbreak was made available by numerous international agencies, and funding for water, sanitation and hygiene programmes, epidemic response and the provision of essential drugs came from several governments and trans-governmental organisations: government or agency amount date government of australia a$8,000,000 for food and emergency aid 2 december 2008 government of botswana us$300,000 3 december 2008 government of france €200,000 for water purification tablets and distribution pointswater treatment equipment 4 december 200811 december 2008 government of germany €1,000,000 to the red cross 8 december 2008 government of namibia us$165,000 of medical supplies 7 december 2008. government of the netherlands €5,000,000 for medication, drinking water and water purification tablets december 2008. government of south africa emergency food and medicine 4 december 2008 government of switzerland us$820,000 to an emergency aid programme and logistical support for un agencies 9 december 2008 government of the united kingdom £3,000,000 november 2008 usaid us$6,200,000 for health, water and sanitation programmes 11 december 2008 government of venezuela over 74 tons of medical supplies and drinking water 3 january 2009 african union us$100,000 11 december 2008 european commission €9,000,000 3 december 2008 world health organization us$340,000 of medication and supplies 4 december 2008 giving children hope and world vision us$500,000 of medication 2 december 2008 international committee of the red cross over 13 tons of medical supplies 4 december 2008 world vision and health partners international of canada us$4,000,000 of medication 13 january 2009 by 7 december 2008, unicef had secured international donor funding to provide sufficient water treatment chemicals for three weeks water supply for harare and had arranged a shipment of chemical sufficient for four months supply. unicef distributed 360,000 litres of water per day in harare, as well as handing out soap and buckets. notwithstanding the contributions received, unicef indicated on 9 december 2008 that us$17,500,000 was needed to respond properly to the outbreak. as of 15 december, following agreement with the zimbabwe government, the world health organization was procuring medical supplies to roll out a response plan to run health centres. spread spread of cholera within southern africa, as of 10 february 2009. not all cases are part of the 2008–2009 zimbabwean cholera outbreak. key:█ deaths recorded █ infections recorded the 2008 cholera outbreak spread to districts in botswana, mozambique, south africa and zambia bordering zimbabwe. south africa cholera spread to the zimbabwean migrant worker community in limpopo and mpumalanga provinces of south africa and cholera bacteria were detected in the limpopo river on 3 december 2008. by 12 december 2008, 11 deaths and 859 infections had been recorded in south africa, rising to 2,100 cases and 15 deaths by 14 january 2009, and to 12,000 cases and 59 deaths by 10 march. the south african government set up medical facilities and drinking water supplies at the beitbridge border post and deployed the national outbreak response team and additional medical personnel to musina. anthony turton, a political scientist and unit fellow with the council for scientific and industrial research (csir) in south africa, who had earlier warned of the risk of cholera in south africa and wrote a report that recommended that the south african government increase its spending on water treatments lest a cholera outbreak occur in the country, was suspended for having made "inappropriate statements to the media". on 10 december 2008, the limpopo provincial government declared vhembe district municipality, which borders zimbabwe at beitbridge, matabeleland south province, a disaster area. on a 28 january 2009 visit to musina with high-ranking government and ruling party officials, health minister barbara hogan said cholera is spreading... we are beginning to see a shift from zimbabwe to south africa. the situation is scary... i am concerned about the impact this is having on our provinces. other countries the spread of cholera to zimbabwe's other neighbouring countries was initially slower than in south africa, with one death recorded in kafue district in zambia and none in botswana or namibia by 9 december 2008. in 2009, cases increased, with 4,354 cases and 55 deaths reported by 10 february 2009 in zambia and 1,596 cases and 14 deaths in katanga, the southernmost province of the dr congo. in mozambique, cholera spread to 10 out of 11 provinces, with a total of 9,533 cases by 1 jan to 1 mar 2009 and 119 deaths by 17 march. four health workers also died in a mob attack, blamed on "misinformation and misunderstanding in efforts to combat cholera", and 12 of the prisoners from the incident died in jail. in malawi 104 deaths were recorded since january, making it the worst outbreak since 2001–02 where 960 people died. kenya, somalia, tanzania, drc, and ghana have had unrelated cholera outbreaks with between 10 and 100 deaths in 2009 as of february. prevention after the 2008 epidemic was declared a national emergency, the ministry of health and child welfare (mohcw) collaborated with several other departments, governments, and non-governmental organizations to create a cholera command and control centre. this centre works to prevent cholera outbreaks in zimbabwe by addressing broader societal factors that could contribute to cholera outbreaks, such as water sanitation and poor hygiene habits. politicisation because of its well-organised health care system and effective water sanitation facilities, rita r. colwell of the james baker institute says zimbabwe was historically one of the african countries least affected by cholera. a news commentary in the lancet said that, under president robert mugabe, the country's health programs were negatively impacted, resulting in diminished health care for those infected with cholera. according to a draft paper from the who's world conference on social determinants in health, there were fewer health workers in the villages than in