Health Crisis Threatens Zimbabwe's Neighbours

The collapse of health care services in Zimbabwe poses a serious threat to its neighbours and may worsen the HIV/AIDS crisis in the region, according to a new report by a southern African anti-malaria organisation.

The Johannesburg-based group Africa Fighting Malaria says the country’s serious health problems are spilling across its borders as Zimbabweans flee political violence, economic turmoil and poverty. More than three million Zimbabwean refugees are in neighbouring countries. More than two million of them are in South Africa and another 400,000 have reached Botswana.

With HIV/AIDS, malaria and tuberculosis now out of control in Zimbabwe, refugees bring with them these rampant diseases from their home country, said the report, entitled “Despotism and Disease: A report into the health situation of Zimbabwe and its probable impact on the region’s health”.

The report, published last week, says that at independence in 1980, Zimbabwe had an admirable healthcare system. One of the first acts of the new government, of which Robert Mugabe was then prime minister, was to increase spending on health by 80 per cent, spending almost three times as much per capita than other sub-Saharan countries. Zimbabwe had one of the highest rates of immunisation in Africa, and life expectancy rose from 55 years at independence to 65 by 1987.

But as a result of the subsequent collapse in healthcare and good governance, since 1987, life expectancy has fallen by 50 per cent to barely 33 now, said the report’s main author, Richard Tren, the director of Africa Fighting Malaria. “Lives that ordinary Zimbabweans now lead are not only shorter, but more brutish and nasty,” said Tren. “Their lives are also in peril because of inadequate nutrition. For the first time in decades, children with kwashiorkor [protein malnutrition] are streaming into clinics and hospitals.”

Malaria, which had been a minor health problem for decades, has exploded in recent years because of the collapse of health services. The once highly efficient malaria control teams “not only lack insecticides, but also cannot obtain the fuel they require to drive into the malarial areas”, said the report. “The result of this lack of control has been a sharp rise in malaria cases, possibly in excess of two million cases [in a population of 11.5 million] in 2004, five times higher than the low of 400,000 cases in 1992.”

HIV/AIDS infection levels have reached catastrophic levels and because of the collapse of health services, effective treatment – which can prolong the lives of people living with AIDS – is virtually unavailable. The United Nations estimated that by 2003 every fourth adult was HIV-positive, but this is likely to be an underestimate. Some 3,300 people die from AIDS-related diseases every week, and the population of AIDS orphans has probably topped one million.

Anecdotal evidence suggests that the scale of the disease is substantially worse than is reported in the country’s increasingly unreliable statistical analyses. Dr Mark Dixon of Mpilo Hospital in Bulawayo, Zimbabwe’s second city, estimates that seven out of every ten patients he sees are HIV-positive.

Incredibly, the International Monetary Fund believes that on current trends, 83 per cent of all teachers alive in 2003 will have died from AIDS-related infections by 2010. Despite the scale of this disaster, the Global Fund for AIDS, TB and Malaria last year rejected the Zimbabwean government’s application for funding because it could not be trusted to use the money effectively.

Poor funding and administration is exacerbated by the flight abroad of doctors and nurses. Some 2000 nurses are estimated to leave Zimbabwe each month. Bulawayo surgeon Mike Cotton says he can no longer carry out some of the most basic procedures because of the flight of skilled assistants and the deterioration of equipment. He says that a mere three general surgeons and just one gynaecologist now serve Bulawayo’s one million people. A decade ago there were seven general surgeons, four orthopaedic surgeons, one neurosurgeon and four gynaecologists.

The report says Zimbabwe’s health-care disaster has ceased to be purely a domestic issue.

“The exodus of Zimbabweans means that their poor health status threatens the country’s neighbouring states,” it said, asserting that refugees are transporting HIV at an alarming rate.

The report concludes, “The failure of Zimbabwe’s neighbours to respond adequately to the political crisis and deal with the refugee problem has probably worsened the health status of their own countries.

“It is therefore incumbent on the SADC [Southern African Development Community] states, but particularly South Africa, given its political and economic power, to recognise the crisis in Zimbabwe and exert pressure on the Mugabe regime to reform, restore democracy and reduce political violence. Anything less will destabilise the region and imperil the health status of ordinary citizens in all neighbouring states.”

Fred Bridgland is IWPR’s Zimbabwe project editor based in Johannesburg.