VZCZCXRO6377
OO RUEHBZ RUEHDU RUEHJO RUEHMR RUEHRN
DE RUEHSB #1119/01 3501250
ZNR UUUUU ZZH
O 151250Z DEC 08
FM AMEMBASSY HARARE
TO RUEHC/SECSTATE WASHDC IMMEDIATE 3818
RUEHSA/AMEMBASSY PRETORIA IMMEDIATE 5593
INFO RUCNSAD/SOUTHERN AF DEVELOPMENT COMMUNITY COLLECTIVE
RUEHGV/USMISSION GENEVA 1759
RUCNDT/USMISSION USUN NEW YORK 1956
RUEHRN/USMISSION UN ROME
RUEHBS/USEU BRUSSELS
RHEHAAA/NSC WASHDC
RUEKJCS/SECDEF WASHINGTON DC
RHMFISS/JOINT STAFF WASHINGTON DC
RUEHPH/CDC ATLANTA GA

UNCLAS SECTION 01 OF 03 HARARE 001119 
 
SIPDIS 
AIDAC 
 
AFR/SA FOR ELOKEN, LDOBBINS, HIRSCH, HARMON 
OFDA/W FOR KLUU, ACONVERY, LPOWERS, TDENYSENKO 
FFP/W FOR JBORNS, ASINK, LPETERSEN 
PRETORIA FOR HHALE, PDISKIN, SMCNIVEN 
GENEVA FOR NKYLOH 
ROME FOR USUN FODAG FOR RNEWBERG 
BRUSSELS FOR USAID PBROWN 
NEW YORK FOR DMERCADO 
NSC FOR CPRATT 
ATLANTA FOR THANDZEL 
 
E.O. 12958: N/A 
TAGS: EAID EAGR PREL PHUM PGOV ZI
SUBJECT:  DISASTER DECLARATION IN ZIMBABWE FOR CHOLERA 
 
REF:  HARARE 0904 
 
HARARE 00001119  001.2 OF 003 
 
 
¶1. This is an action cable (see paragraph 15). 
 
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SUMMARY 
------- 
 
¶2. Beginning in August 2008, cholera outbreaks have spread to affect 
9 of the 10 provinces in Zimbabwe.  A breakdown in water and 
sanitation infrastructure has exacerbated Zimbabwe's cholera 
outbreak, and the nation's collapsed health system is unable to 
respond adequately.  On December 3, the Government of Zimbabwe (GOZ) 
Minister of Health and Child Welfare declared an emergency and 
requested international assistance to respond to the cholera 
outbreak. 
 
¶3. In FY 2008, USAID's Office of U.S. Foreign Disaster Assistance 
(USAID/OFDA) provided more than USD 4 million to implement water, 
sanitation, and hygiene (WASH) programs as well as distribute 
emergency hygiene supplies in anticipation of a cholera outbreak 
(REFTEL).  In early December, USAID/OFDA provided an additional USD 
600,000 to Population Services International (PSI) for water 
treatment supplies and community hygiene education.  On December 5, 
health advisor from USAID/OFDA and a WASH advisor from the U.S. 
Centers for Disease Control and Prevention (CDC) arrived in Harare 
to assess the situation.  On December 10, to augment ongoing 
response efforts, USAID/OFDA activated a Disaster Assistance 
Response Team (USAID/DART).  In response to the ongoing cholera 
outbreaks, the Charge d'Affaires, a.i. declares that a disaster 
exists, it is beyond the capacity of the GOZ to respond, and that it 
is in the interest of the U.S. Government (USG) to provide 
assistance to cholera-affected populations.  END SUMMARY. 
 
----------- 
BACKGROUND 
----------- 
 
¶4.  Beginning in August 2008, cholera outbreaks have spread to 
affect 9 of the 10 provinces in Zimbabwe.  According to relief 
agencies, the breakdown of Zimbabwe's water, sewage, and sanitation 
systems due to aging and poorly maintained infrastructure has 
exacerbated the spread of cholera.  USAID/DART staff report that 
many high-density urban areas lack clean water for months at a time 
and that residents obtain drinking water from contaminated shallow 
wells. 
 
¶5. Zimbabwe's health care system remains unable to cope adequately 
with the outbreak due to collapsing infrastructure, lack of salaries 
for medical staff, and inadequate soap for medical staff and 
patients.  On December 3, the GOZ Minister of Health and Child 
Welfare declared an emergency and requested international assistance 
to respond to the cholera outbreak, including medicine, equipment, 
and food for patients. 
 
------------------ 
CURRENT SITUATION 
------------------ 
 
¶6.  As of December 11, the U.N. World Health Organization (WHO) 
reported 792 deaths due to cholera, with 16,700 total cases.  WHO 
noted that 60 percent of the cholera cases were reported in Harare 
and 23 percent in Beitbridge, the southern town which serves as the 
main entry point to South Africa.  WHO reported a case fatality rate 
(CFR) of approximately 4.7 percent, considerably higher that the 1 
percent emergency threshold used by humanitarian organizations. The 
U.N. Office for the Coordination of Humanitarian Affairs (OCHA) 
noted that the U.N. health cluster is planning based on a worst case 
scenario of up to 60,000 cholera cases. 
 
¶7. The USAID/DART public health advisor reported that cholera rates 
 
HARARE 00001119  002.2 OF 003 
 
 
are declining in current hot spots but are increasing in new 
locations.  OCHA noted that the cholera outbreak caseload in 
Beitbridge has declined substantially from 300 cases per day to 20 
cass per day as of December 10.  However, local healt authorities 
reported nearly 600 cases and 45 chlera deaths in a new outbreak in 
Chegutu town, suthwest of Harare. 
 
¶8. High-density, peri-urban reas with limited access to clean water 
remain particularly vulnerable to increased cholera rates.  Limited 
information flow from rural clinics impedes the GOZ Ministry of 
Health and Child Welfare (MOHCW) and humanitarian organizations from 
gauging trends in rural areas.  In addition, people who do not seek 
care outside the home may not be included in official statistics. 
Hyperinflation and a shortage of basic goods have resulted in a lack 
of access to sugar and salt, both of which could be used to assist 
with community-based oral rehydration to treat and mitigate the 
effects of cholera. 
 
¶9. USAID/DART staff report that Harare's hospitals have closed and 
that additional urban hospitals lack sufficient resources, resulting 
in residents traveling to rural health facilities and potentially 
transmitting cholera to new areas.  The onset of the November to 
April rainy season will lead to conditions favorable for increased 
cholera transmission, while the annual Christmas season migration 
will likely lead to the spread of cholera to previously unaffected 
areas of the country. 
 
¶10. In response to the cholera outbreaks, WHO recently deployed a 
high-level, seven-person team to Zimbabwe to improve coordination of 
the cholera response.  The team includes a logistician, 
communications officer, social mobilization expert, and a 
USAID/OFDA-funded epidemiologist.  WHO is receiving updated 
information from the GOZ MOHCW on reported cholera cases and deaths, 
which is passed to OCHA for inclusion in daily and weekly cholera 
situation reports. 
 
---------------- 
REGIONAL IMPACT 
---------------- 
 
¶11. According to WHO, the cholera outbreak has affected border areas 
of neighboring countries, with confirmed cases reported in Botswana, 
Mozambique, and South Africa, primarily among populations of 
Zimbabwe nationals.  On December 12, the U.S. Embassy in Gaborone 
reported five confirmed cholera deaths, all among Zimbabwe 
nationals. As of December 7, the Government of South Africa reported 
11 cholera deaths and 751 cases, with a CFR of 1.46 percent.  The 
majority of the cases were reported in Vhembe District of Limpopo 
Province. 
 
¶12. On December 9, OCHA reported 708 cases and eight deaths in South 
Africa's Limpopo Province.  On December 11, the government of 
Limpopo Province declared a disaster due to a cholera outbreak in 
Vhembe District.  Within the district, the border town of Musina 
serves as a primary destination for Zimbabweans seeking medical 
treatment in South Africa.  On December 11, USAID/OFDA's principal 
regional advisor based in Pretoria, South Africa, traveled to Musina 
to assess the situation. 
 
-------------------------------------- 
USG CHOLERA ASSISTANCE REPONSE TO DATE 
-------------------------------------- 
 
¶13.  In FY 2008, USAID/OFDA provided the non-governmental 
organizations Oxfam/UK and World Vision with over USD 4 million to 
implement water, sanitation, and hygiene (WASH) programs as well as 
distribute emergency hygiene supplies, including soap, in Bulawayo, 
Harare, and Masvingo Provinces in anticipation of a cholera 
outbreak.  In early December, USAID/OFDA provided an additional USD 
600,000 to PSI for water treatment supplies and community hygiene 
education. 
 
HARARE 00001119  003.2 OF 003 
 
 
 
¶14. On December 5, health advisor from USAID/OFDA and a WASH advisor 
from CDC arrived in Harare to assess the situation.  On December 10, 
to augment ongoing response efforts, USAID/OFDA activated a Disaster 
Assistance Response Team (USAID/DART) to monitor and assess 
humanitarian conditions, identify priority programming needs, and 
facilitate humanitarian coordination and information sharing. 
 
--------------------- 
DISASTER DECLARATION 
--------------------- 
 
¶15. ACTION REQUEST:  The Charge d'Affaires, a.i. declares that a 
disaster exists, it is beyond the capacity of the GOZ to respond, 
and that it is in the interest of the USG to provide assistance to 
cholera-affected populations.  Post requests the release of USD 
50,000 under the Ambassador's Authority to purchase relief supplies 
to meet immediate health and sanitation needs.  The funding will be 
part of the overall USD 6.2 million pledged by USAID to respond to 
cholera in Zimbabwe.  The USAID/DART, in coordination with 
USAID/Zimbabwe, the U.S. Embassy in Harare, humanitarian partners, 
and other donors, will continue to closely monitor the situation and 
conduct assessments to determine any additional humanitarian needs. 
 
 
DHANANI