VZCZCXRO8374
OO RUEHBZ RUEHDU RUEHJO RUEHMR RUEHRN
DE RUEHSB #1129/01 3521203
ZNR UUUUU ZZH
O 171203Z DEC 08
FM AMEMBASSY HARARE
TO RUEHC/SECSTATE WASHDC IMMEDIATE 3834
RUEHSA/AMEMBASSY PRETORIA IMMEDIATE 5597
INFO RUEHGV/USMISSION GENEVA 1770
RUCNDT/USMISSION USUN NEW YORK 1959
RUEHRN/USMISSION UN ROME
RUEHBS/USEU BRUSSELS
RHEHAAA/NSC WASHDC
RUEKJCS/SECDEF WASHINGTON DC
RHMFISS/JOINT STAFF WASHINGTON DC
RUCNSAD/SOUTHERN AF DEVELOPMENT COMMUNITY COLLECTIVE
RUEHPH/CDC ATLANTA GA

UNCLAS SECTION 01 OF 03 HARARE 001129 
 
SIPDIS 
AIDAC 
 
AFR/SA FOR ELOKEN, LDOBBINS, BHIRSCH, JHARMON 
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 ZI
SUBJECT:  ZIMBABWE CHOLERA USAID DART SITUATION REPORT #1 
 
REF:  A) HARARE 1119 
 
HARARE 00001129  001.2 OF 003 
 
 
------- 
SUMMARY 
------- 
 
¶1. As of December 15, the U.N. Office for the Coordination of 
Humanitarian Affairs (OCHA) reported a total of 18,413 cholera cases 
in Zimbabwe since the outbreak began in August, with 978 deaths and 
a case fatality rate (CFR) of 5.3 percent.  Humanitarian 
organizations consider a CFR over 1 percent as the emergency 
threshold for cholera.  As of December 15, the highest cholera 
caseloads by district were in Harare, Beitbridge, and Mudzi 
districts.  In response to the ongoing cholera outbreak, USAID 
activated a Disaster Assistance Response Team (USAID/DART) on 
December 10.  On December 11, the USAID Administrator pledged USD 
6.2 million for cholera mitigation and response activities. 
 
¶2. On December 15, the USAID/DART health advisor met with the U.N. 
World Health Organization (WHO) senior epidemiologist from Geneva, 
the U.N. health and water, sanitation, and hygiene (WASH) cluster 
leads, and the U.N. Children's Fund (UNICEF) emergency health 
coordinator from New York regarding the status of the cholera 
command and control center, as well as strengthening coordination 
between the health and WASH clusters.  On December 13, the 
USAID/DART health advisor and U.S. Centers for Disease Control and 
Prevention (CDC) WASH advisor conducted an assessment of a recent 
cholera outbreak in Chegutu town with the International Organization 
for Migration (IOM).  The health and WASH advisors met with local 
health officials, community members, and attended the initial 
coordination meeting of responding humanitarian organizations.  End 
Summary. 
 
----------------------- 
HUMANITARIAN SITUATION 
----------------------- 
 
¶3. As of December 15, OCHA reported a total of 18,413 cholera cases 
in nine of the 10 provinces in Zimbabwe since the outbreak began in 
August, with 978 deaths and a CFR of 5.3 percent.  Humanitarian 
organizations consider a CFR over 1 percent as the emergency 
threshold for cholera.  As of December 15, the highest cholera 
caseloads by district were in Harare, Beitbridge, and Mudzi 
districts. The most recent large outbreak was reported in Chegutu 
District, southwest of Harare. 
 
¶4. The Government of Zimbabwe (GOZ) Ministry of Health and Child 
Welfare (MOHCW) and WHO reported on a December 10 to 12 assessment 
in Mudzi District in northeast Zimbabwe, where the second cholera 
outbreak of the year began on October 6.  As of December 12, the 
MOHCW had recorded 1,526 cholera cases, with 39 deaths in health 
centers, 49 deaths in the community, and a CFR of 2.56 percent.  As 
of December 15, Mudzi had the third highest total number of cholera 
cases reported at the district level.  On December 9, the USAID 
Office of U.S. Foreign Disaster Assistance (USAID/OFDA) Zimbabwe 
humanitarian coordinator and the CDC WASH advisor conducted an 
assessment in Mudzi District. 
 
¶5. The cholera outbreak in Zimbabwe has spread to border areas of 
neighboring countries, particularly affecting South Africa as 
Zimbabweans cross the border to seek medical treatment.  As of 
December 12, South Africa had registered 859 cholera cases, 
including 731 in Limpopo Province, with 11 fatalities, according to 
the U.N. health cluster.  The CFR was reported at 1.2 percent. 
 
¶6. On December 11, USAID/OFDA's principal regional advisor based in 
Pretoria, South Africa, traveled to Musina to assess the situation. 
The principal regional advisor reported that outbreak was currently 
under control but the caseload could spike with seasonal migration, 
and indicated that additional hygiene promotion and distribution of 
hygiene supplies may be needed.  Save the Children and IOM are 
 
HARARE 00001129  002.2 OF 003 
 
 
currently assisting local South African health authorities to 
respond to the outbreak. 
 
------------------------------------------ 
USG RESPONSE AND DEPLOYMENT OF USAID/DART 
------------------------------------------ 
 
¶7. On December 5, a health advisor from USAID/OFDA and a WASH 
advisor from CDC arrived in Harare to assess the cholera outbreak. 
On December 10, to augment ongoing response efforts, USAID activated 
a USAID/DART. 
 
¶8. On December 11, the USAID Administrator pledged USD 6.2 million 
for the cholera response.  The funding was in addition to the USD 
4.6 million provided by USAID/OFDA in FY 2008 and to date in FY 2009 
for WASH interventions.  On December 15, the Charge d'Affaires a.i. 
declared a disaster due to the continuing cholera outbreak (REFTEL). 
 In FY 2008 and to date in FY 2009, USAID has provided more than USD 
220 million in emergency assistance to Zimbabwe, including nearly 
180,000 metric tons of P.L. 480 Title II emergency food assistance. 
 
 
------------------------- 
HUMANITARIAN COORDINATION 
------------------------- 
 
¶9. On December 15, the USAID/DART health advisor met with the WHO 
senior epidemiologist from Geneva, the U.N. health and WASH cluster 
leads, and the UNICEF emergency health coordinator from New York 
regarding the status of the cholera command and control center, as 
well as strengthening coordination between the health and WASH 
clusters.  The meeting helped to define the roles of the clusters in 
the context of the control center. WHO updated the U.N. health 
cluster on the control center status on December 16. 
 
¶10. The control center is a technical coordination unit to monitor, 
guide, and evaluate interventions related to cholera outbreak 
response for disease surveillance, case management, WASH, social 
mobilization, and logistics.  The center will provide guidance and 
strategies for the implementation of control measures and provide 
recommendations to the clusters, including the logistics cluster, as 
well as monitoring implementation of the measures.  The WHO senior 
epidemiologist indicated that if successful, the center could be 
used as a model for future outbreaks globally. 
 
¶11. WHO is in the process of mobilizing staff for the center and 
selecting a trained health cluster coordinator from the global 
health cluster roster.  Donors are advocating for an experienced 
coordinator with strong leadership skills to ensure that there is 
good guidance and response.  The staff for the center will come from 
a Global Outbreak Alert and Response Network alert and will include 
staff from the International Centre for Diarrhoeal Disease Research, 
Bangladesh for case management. 
-------- 
HEALTH 
-------- 
 
¶12. On December 8, local authorities set up a treatment center in 
Epworth, an informal settlement approximately 12 km southeast of 
Harare, with a large population and little public infrastructure. 
The treatment center lacks water, electricity, and the fuel needed 
for transportation to conduct disease surveillance and community 
mobilization.  To date, the number of cholera cases remains low, but 
WHO highlighted Epworth as an area where prevention and social 
mobilization activities are needed to prevent a large outbreak. 
 
¶13. On December 15, the non-governmental organization World Vision 
reported delivering essential drugs valued at USD 7 million.  The 
supplies include both drugs for cholera treatment and for general 
health care. 
 
 
HARARE 00001129  003.2 OF 003 
 
 
------------------------------- 
ASSESSMENT IN CHEGUTU DISTRICT 
------------------------------- 
 
¶14. On December 9, local health officials in Chegutu observed a 
large increase in cholera cases and deaths in the town.  The alert 
did not go out to authorities in Harare until December 10, and was 
not received by WHO and other humanitarian organizations until 
December 12.  The lack of information led to a delayed response and 
resulted in a high CFR at the peak of the outbreak as the number of 
patients overwhelmed the local health system.  On December 12, the 
local organization Celebration Health responded with medical 
supplies and a team of doctors and nurses.  As of December 15, OCHA 
reported 378 cholera cases and 121 deaths, with a CFR of 32 percent 
in Chegutu town.  In the remainder of Chegutu District, a much lower 
CFR of 3.3 percent was recorded, with 368 cases resulting in 12 
deaths. 
 
¶15. On December 13, the USAID/DART health advisor and CDC WASH 
advisor conducted an assessment of the situation in Chegutu town 
with IOM.  During the USAID/DART visit on December 13, other 
agencies, including Medecins Sans Frontieres (MSF), UNICEF, WHO, 
Concern and IOM were present. 
 
¶16. The USAID/DART health and WASH advisors noted that the outbreak 
was likely due to a combination of unprotected shallow wells and 
cross-contamination of the town sewage and water lines.  The town 
public health engineer said that sewage contamination of the wells 
may also be the cause or contributing factor to the outbreak.  There 
are no boreholes or other sources of safe water in the two most 
affected wards of Chegutu town. 
 
¶17. Discussions with the community revealed a good understanding 
that the contaminated water supply has made the community sick and 
participants were very interested in methods of improving the water 
system.  The community members also had a good understanding of how 
to use sugar and salt for oral rehydration.  Some of the people 
interviewed were not going to the treatment center because the 
facilities were too crowded and the individuals thought they would 
not receive care. 
 
¶18. During the USAID/DART assessment, an initial coordination 
meeting was held on the grounds of the treatment center, with all 
responding agencies and local health officials present.  Two teams 
were created, one to focus on the treatment center and the other to 
work with communities.  Concern, IOM, and UNICEF agreed to take the 
lead on community mobilization, distribution of soap, aquatabs, and 
water containers, and provision of safe water.  UNICEF will provide 
four to five 10,000 liter water bladders and arrange for water 
tankering from a nearby borehole, beginning December 14.  The town 
engineer shut off water to the two most affected wards of Chegutu 
city.  Concern will organize distribution of water containers, soap, 
and water treatment tablets.  Agencies with local counterparts will 
mobilize community workers and chuch leaders to deliver hygiene 
promotion and cholra awareness messages. 
 
¶19. The district health officials, MSF, WHO, and Celebration Health 
will coordinate the treatment center and case management. 
Celebration Health has provided doctors and nurses, while UNICEF, 
MSF, IOM and WHO have been supplying medical commodities.  WHO will 
continue to monitor the situation in coordination with local health 
authorities. 
 
DHANANI