UNITED NATIONS NATIONS UNIES Office for the Coordination of Bureau de Coordination des Humanitarian Affairs des Affaires Humanitaires OCHA Zimbabwe

Situation Report on Cholera in Zimbabwe Issue Number 03 20 November; 2008

Summary

The cholera outbreak has taken a national dimension. Newer outbreaks are reported from all provinces. The total number of suspected cholera cases in the country stands at 6072 cases and 294 deaths as at 18 November, 2008. The latest outbreaks were reported from , with 700 cases and 20 deaths, with health facilities in the area reporting an admission rate of 200 patients/per day. The outbreak has now been reported from all provinces as shown by the table below.

Provinces/ Mash Mash Mash Matabele Manicaland Midlands Total Cases West East Central South Urban Suspected 3535 176 959 13 1302 9 5 34 39 6072 cases Deaths 152 14 62 4 50 3 0 6 3 294

I. Situation analysis

The spatial distribution of outbreaks will most likely continue to expand as well as the number of people infected, as the water and sanitation situation worsening, with severe water shortages, sewage and waste disposal problems reported in most densely populated areas. The starting of the rains further raises alarms levels. Already anticipated spread of the outbreak has been observed in Bulawayo urban and parts of Midland provinces. Areas in Midlands affected by the new wave of outbreaks are , Gokwe, city, and Mberengwa of and Makoni of Manicaland.

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So far, there were five serious confirmed outbreaks since August 2008: Chitungwiza, (Nyaminyami), Makonde (Chinoyi), Mudzi and Harare (centred in Budiriro but also in other areas). In Chitungwiza, the outbreak was considered controlled with sporadic cases continuing to appear at the Cholera treatment unit at Seke North clinic, but could resurface again as it did before, while in Budiriro it is not under control and patients are currently coming from an ever widening circle of high density areas around. Many patients with diarrhoea continue to come to Budiriro clinic, with other clinics in the area referring to Budiriro CTC. Elsewhere, the Mudzi outbreak, which has now developed into a full scale outbreak, is presumed to be linked with the one in Guro (Manica Province in Mozambique.

Areas where cases were reported previously include Chitungwiza and Budiriro in Harare, Makonde, Kariba and Mola in Mash west, Mudzi, Murewa, , Goromonzi, , Chikomba, Hwedza, UMP and Seke in Mash East, Shamva and Mazowe in Mash Central, in Manicaland, and Mushandike in Masvingo.

Not all districts are affected, and impact of the outbreak varies across affected districts. The following table shows the spread of the cholera by localities and districts. The overall trend shows an increase of cases in most of the affected districts and localities. The table below shows the distribution of the outbreak across districts and localities with number of cases, deaths and case fatality rate.

Outbreak/area affected Suspected Deaths Case fatality Remark on the trend cases rate (%) Chitungwiza 203 32 16 Stable Budiriro (Harare) 3332 120 4 Increasing Makonde () 103 11 11 Stable Kariba 34 0 0 Stable Mola 36 3 8 Stable Kadoma city 3 0 0 Stable Mudzi 810 42 5 Increasing Murehwa 52 4 8 Increasing Mutoko 59 3 5 Increasing Goromonzi 23 4 17 Increasing Marondera 4 3 75 Increasing Chikomba 1 0 0 Stable Hwedza 1 0 0 Stable UMP 4 2 0 Increasing Seke 5 4 20 Increasing Shamva 12 4 33 Stable Mazowe 1 0 0 Stable Beitbridge** 1302 50 1 New outbreak** Bulawayo urban 9 3 0 New outbreak Makoni 2 0 0 New outbreak Chipinge 3 0 0 Stable Zvishavane 9 2 22 New outbreak Gweru city (Mkoba) 1 0 0 New outbreak Mberengwa 23 4 17 New outbreak Gokwe 1 0 0 New outbreak Masvingo (Mushandike) 39 3 8 Increasing Total 6072 294 ** Figures for BeitBridge are updated based on information received on November 20, from WASH cluster.

For more information contact: Steven Maphosa at [email protected]

II. Response

Health response The health cluster is responding through provision of drugs and supplies, camping equipment, IEC materials, disinfectants and water treatment tablets. WHO had provided strategic stocks of emergency supplies to each province previously, and had sent additional supplies to the current outbreak. Presently a team comprising officials from the ministry of health is carrying out an assessment.

The cholera outbreak in Beitbridge has particularly caught the attention of the Government as well as the Humanitarian Community. Verbal reports from the field indicate that response teams from the Zimbabwe Army have been mobilized; more than 10 vehicles have been made available by the Reserve Bank of Zimbabwe. The health cluster, led by IOM, MSF and WHO 2 Disclaimer: - The content of this document is for information purposes only and not an official record of the United Nations’ views.

has also mobilized medical supplies, staff and expertise – and presently are supporting the response and monitoring the situation on the ground.

The main gaps and challenges in the health response are identified as inadequate level of preparedness for investigation and confirmation of outbreaks vis‐à‐vis expected number of alerts; lack of comprehensive, multi‐sector cholera response plan, and reporting on the cases and response to the outbreak being not timely, and lacking quality and consistency. Furthermore, case management in health facilities is not up to the required minimum standards, and community involvement is minimal in surveillance and prevention activities.

WASH response

ACF is coordinating response with support from Oxfam GB and other organizations working in the district. Water storage and tap stands being established at the Cholera Treatment centre at the hospital as well as public areas and most affected communities. Water treatment tablets, soap and other hygiene materials are being distributed along with public health and hygiene education. MSF‐E on the ground, together with IOM is assisting MoHCW with establishing and running the CTC. Joint UNICEF, WHO and MoHCW team on site at this time. UNICEF, WHO, IOM provided one seven ton truck load of materials and supplies for establishing the CTC and general WASH response. This outbreak is now spreading to many other districts in Zimbabwe and as of today in Musina South Africa as people fan out from Beit Bridge

In Masvingo, MSF‐L is setting up a CTC there and intends to establish a CTU in . Additional supplies are being organized to support this by UNICEF and WHO. Awaiting more information on the need in Gutu

In Chitungwiza, trucking of 30,000 litres of water by UNICEF continues to the clinic and five other sites in the community. GAA are currently fitting two boreholes with motorised pumps and tanks, the third borehole is already providing water with a hand pump. Likewise, PSI, Oxfam GB and City Health continue with public health/hygiene campaign.

In Budiriro, water trucking to the clinic and 10 other community sites where tanks/bladders have been located is carried out by ACF, GAA, ICRC, ZINWA, ICRC and UNICEF, with a target of 360,000 litres daily. Demand has been calculated at 405,000 litres daily ‐ based on population. More static tanks and tankers are being organised. WASH cluster members are providing water storage and tap stands for clinics and community, hygiene kits, and water treatment tablets distributed in epicentre communities. Hygiene promotion, public awareness activities are undertaken by WASH cluster members. City health officials are decontaminating homes and carrying out “super chlorination” of wells, but the main challenge is accessing water sources, with much of the city currently without water.

In Makone, the MoHCW are managing the CTC, with GAA and Oxfam GB taking the lead in response supported by UNICEF with supplies; while In Kariba, SC‐UK are on the ground. Oxfam FB and MSF‐H are assisting in the establishment of the CTC in Mudzi and with provision of water and sanitation supplies. Major challenges in Mudzi, as identified by MoHCW are, food for patients and staff, Vehicles and fuel, Staffing levels, staff allowances and morale, communication, water availability, cross border human traffic .

For more information contact: Steven Maphosa at [email protected] (for health) and Ben Henson at [email protected] for WASH.

III. Gaps and needs It is very likely with the current water and sanitation problems in the country, low capacity of the government to deal with the outbreak, glaring gaps in response, coupled with the rainy season that has started, cholera outbreaks could get catastrophic and claim many more lives. Therefore, it is imperative that the humanitarian community, including donor agencies, consider mobilizing unconditional financial, material and human resources support for emergency response operations.

As a matter of urgency, although it is a nationwide problem, efforts to carry out blanket super‐chlorination of all shallow wells and decontamination of toilets must be scaled up and wider coverage of hygiene education activities and, monitoring of food hygiene in commercial food outlets must be undertaken. In addition, the issue of incentives, food, and protection equipment should be addressed immediately; WHO and the Health Cluster should ensure providing on‐site training of at least 90% of all staff involved in various activities at the cholera treatment centers; and strategies to mobilize personnel from the private sector should be sought.

IV. Coordination

The following arrangements have been put in place by the IASC to facilitate effective humanitarian coordination:

1. WASH and Health clusters mobilised and coordinating the response.

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2. Possible gap areas in coordination support are being monitored by the country IASC, as well as needs for surge capacity from HQ and the regional level. Agencies requested to look into the possibility of gearing up to emergency mode and divert available funds from development towards humanitarian aid.

3. WFP to coordinate local logistical support to the cholera response

4. Daily Cholera Situation Reports to be issued by OCHA on figures (not including gaps/response)

5. Weekly Cholera Situation Report to be issued by OCHA on gaps analysis, response and figures.

6. Weekly IASC CT Cholera meetings every Wednesday at 11:00am

7. Bi‐weekly Donor/IASC CT Cholera meetings on Fridays at 10:30 (First meeting, 21 November at 10:30 – Takura House)

8. Cholera Inter‐Cluster meeting led by OCHA on Monday and Thursday mornings

9. Contingency planning of worst‐case scenario on cholera to take place at the next Cholera Inter‐Cluster Meeting

10. Agencies requested to look into the possibility of gearing up to emergency mode and divert available funds from development towards humanitarian aid.

CONTACT DETAILS Georges Tadonki Head of Office (Harare), +263 4 792681

Rania Dagash Desk Officer (New York), +1 917 367 3668

Elizabeth Byrs, Press contact (Geneva), +41 22 917 2653

Stephanie Bunker, Press contact (New York), +917 367 5126

4 Disclaimer: - The content of this document is for information purposes only and not an official record of the United Nations’ views.