The deadly diarrhoea epidemic in Zimbabwe could have been foreseen and avoided. Health Committees were a verhicle both for emergency relief and social protest.
The singularity of aid lies in its dual nature. Helping people in need is a humanitarian imperative which their very survival may depend on. However, aid is all too often a substitution for political action, legitimising the status quo. In order to describe this dilemma within its own work, Medico has coined the phrase “critical emergency relief”, expressing the following: whenever people need aid, we need to critically examine our own role, the root cause of their plight and how the need for aid can be overcome.
Critical emergency relief can be illustrated by the work of Medico’s partner, the Community Working Group on Health (CWGH), in Zimbabwe. In summer 2008 a cholera epidemic broke out, infecting almost 100,000 people so the CWGH started to provide emergency relief straightaway. Their 300 health-workers were active in ten districts and attended around 40,000 individuals. The moment the epidemic began in 2008 they distributed several thousand hygiene kits containing water disinfection tablets, carbolic soap, detergent, rubber gloves and rehydration salts to counter the dangerous dehydration.
Local health committees
Colleagues worked closely with those affected and encouraged the creation of local health committees including elected councillors or traditional community representatives in addition to experts. CWGH began its awareness campaigns with the committees, explaining how to deal with cholera, how to avoid infection and how to administer first aid to the sick. Talks were given in village squares, but the information was also timeconsumingly delivered house to house, door to door. Zimbabwe‘s infrastructure has collapsed providing ideal circumstances for an epidemic. Symptomatic of this massive deterioration is a lack of access to clean drinking water even though Zimbabwe had once a good water supply system. However, the government put the water supply under central government control in 2006 in order to increase water revenue. At the same time, they left the water pipes to rot. Soon virtually no-one had access to clean water, not even in the capital, Ha-rare. Cholera spread easily through the dirty water and 3,500 people have now died from the disease. Normally, fewer than one percent of those who fall ill actually die during a cholera outbreak. In Zimbabwe that figure was five per cent. Not only malnutrition contributed to this deadly statistic,but also the high rate of HIV Infections, that weakens many people and makes them susceptible to infections . Due to HIV/AIDS, the average life expectancy of a young adult in Zimbabwe has already halved over the last 20 years; at 45 years for men and 44 for women it is among the lowest in the world.
Reformed to destruction
While providing emergency relief, our CWGH colleagues were already courageously denouncing the government which had done literally nothing other than announce a big information campaign. In a letter to the World Health Organisation (WHO), they did not just accuse the government of inaction, but stated „the crisis in the health sector has its roots in the country’s economic collapse and the fact that fewer and fewer people have access to basic public services like education, transport, water and electricity. Education is an important part of health but most schools are now closed”. Zimbabwe actually used to have a relatively good public health system, with a much-admired participatory primary health care strategy. The government invested a considerable part of its budget in ensuring that more people had access to healthy living conditions and appropriate medical care if they became ill. As a result of the debt crisis, in the 90ths the IMF and the World Bank imposed heavy cuts on the country’s social infrastructure, including its health sector. Costs rose and qualified health workers emigrated. The brain-drain flowed, in particular, towards former colonial power Great Britain whose national health system had gone through a neoliberal reform process and now depended on ever cheaper workers. The loss of specialist medical staff led to worsening health care until the whole public health system collapsed. In 2008 nearly all public hospitals were closed and there were only about 300 trained doctors left in the country. When cholera broke out, emergency relief was the only thing left.
Much more than emergency relief
The health committees started by CWGH also became a basis for broad-based protest against hospital closures or medicine and healthcare shortages. Despite a violent government response towards the protesters, they managed to join forces not only with trade unions and women’s groups, but also with traders in the informal sector and human rights groups. “There is more to us Zimbabweans”, says CWGH leader, Itai Rusike, “than the figures for cholera cases or deaths”. Our colleagues’ report shows that they did at least manage to stem the epidemic’s spread.
Medico’s total funding in 2008 was € 25,500 for emergency relief and the Community Working Group’s courageous political mission.
