VZCZCXRO0656
OO RUEHBZ RUEHDU RUEHJO RUEHMR RUEHRN
DE RUEHSB #1134/01 3541009
ZNR UUUUU ZZH
O 191009Z DEC 08 ZDK
FM AMEMBASSY HARARE
TO RUEHC/SECSTATE WASHDC IMMEDIATE 3844
RUEHSA/AMEMBASSY PRETORIA IMMEDIATE 5600
INFO RUCNSAD/SOUTHERN AF DEVELOPMENT COMMUNITY COLLECTIVE
RUEHGV/USMISSION GENEVA 1778
RUCNDT/USMISSION USUN NEW YORK 1962
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 001134 
 
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 #2 
 
HARARE 00001134  001.2 OF 003 
 
 
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SUMMARY 
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¶1. As of December 18, the U.N. Office for the Coordination of 
Humanitarian Affairs (OCHA) reported a total of 20,896 cholera cases 
in Zimbabwe since the outbreak began in August, with 1,123 deaths 
and a case fatality rate (CFR) of 5.4 percent.  According to the 
U.N. World Health Organization (WHO) the major causes for the 
current outbreak continue to be a lack of clean drinking water and 
sanitation facilities, weak health services, and an ongoing strike 
by health staff, particularly nurses.  WHO indicated that the 
current outbreak began on August 20 in the suburb of Chitungwiza, 
south of Harare.  Following a late October outbreak in the Harare 
suburb of Budiriro, cholera quickly expanded to an additional 46 
districts from November 1 to 15. 
 
¶2. The USAID Disaster Assistance Response Team (USAID/DART) 
continues to conduct field visits, participate in U.N. health, 
logistics, and water, sanitation, and hygiene (WASH) cluster 
meetings, and review proposals from humanitarian partners to program 
the USD 6.2 million pledged by the USAID Administrator in response 
to the cholera outbreak.  WHO reported that 22 metric tons (MT) of 
medical supplies arrived in Harare during the first week of 
December.  The U.N. logistics cluster is currently planning to use 
the U.N. World Food Program (WFP) logistics systems to move items to 
the provincial level, and is still determining how to deliver 
supplies to the sub-provincial level.  Humanitarian organizations 
are focusing on addressing prevention needs within the response, and 
will develop a checklist to provide guidance on how to mainstream 
protection within the ongoing cholera response.  END SUMMARY. 
 
----------------------- 
HUMANITARIAN SITUATION 
----------------------- 
 
¶3. As of December 18, OCHA reported a total of 20,896 cholera cases 
in Zimbabwe since the outbreak began in August, with 1,123 deaths 
and a CFR of 5.4 percent.  Humanitarian organizations consider a CFR 
over 1 percent as the emergency threshold for cholera.  The figures 
represent an increase of more than 2,000 cases and 100 deaths since 
the OCHA update issued on December 15, with virtually all of the new 
cases reported in Harare, Masvingo, and the Mashonaland provinces, 
and some new cases reported in Midlands Province. 
 
¶4. According to WHO the major causes for the current outbreak 
continue to be a lack of clean drinking water and sanitation 
facilities, weak health services, and an ongoing strike by health 
staff, particularly nurses.  WHO noted that health staff are unable 
to obtain salaries due to a shortage of banknotes and GOZ cash 
withdrawal limits, and cannot afford to travel to work. 
 
¶5. On December 16, WHO published the first epidemiologic report of 
the cholera situation in Zimbabwe, analyzing trends since the 
beginning of the outbreak in August 2008.  WHO indicated that the 
current outbreak began on August 20 in the Harare suburb of 
Chitungwiza, though the organization did not rule out the 
possibility of undetected low-level transmission from the earlier 
January to April 2008 outbreak.  Following a late October outbreak 
in the suburb of Budiriro, cholera quickly expanded to an additional 
46 districts from November 1 to 15. 
 
¶6. As of December 17, local media sources in Malawi reported that 
Lukini hospital in Lilongwe, designated by the Government of Malawi 
Ministry of Health as the quarantine center for cholera cases, has 
recorded 88 cases with five deaths.  Local media sources cited a 
strike by city water treatment workers as a contributing factor in 
the outbreak. 
 
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USG RESPONSE 
 
HARARE 00001134  002.2 OF 003 
 
 
------------ 
 
¶7. The USAID/DART continues to conduct field visits, participate in 
U.N. health, logistics, and WASH cluster meetings, and review 
proposals from humanitarian partners to program the USD 6.2 million 
pledged by the USAID Administrator in response to the cholera 
outbreak. 
 
¶8. Beginning December 5, the USAID/DART health advisor and U.S. 
Centers for Disease Control and Prevention (CDC) WASH advisor have 
conducted meetings with Government of Zimbabwe (GOZ) Ministry of 
Health and Child Welfare (MOHCW) officials, USAID/Zimbabwe and CDC 
staff, U.N. agencies, and non-governmental organizations.  The 
health and WASH advisors have participated in field assessments in 
the Harare suburbs of Budiriro and Chitungwiza, as well as Chegutu 
and Mudzi districts. 
 
¶9. The USAID/DART advisors examined the effectiveness of the 
response to date in reducing spread of the outbreak, including 
disease surveillance and early warning, social mobilization for 
hygiene promotion, and limiting mortality through early detection, 
treatment, and referral.  The advisors also examined overall 
coordination efforts to date.  The advisors encouraged approaches 
including the prioritization of an early warning system to alert 
humanitarian organizations to new outbreaks, increased hygiene 
promotion in areas with increasing cholera caseloads, and increased 
monitoring in areas at potential risk for outbreaks, including 
high-density urban areas lacking WASH infrastructure. 
 
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HUMANITARIAN COORDINATION 
------------------------- 
 
¶10. At the December 16 U.N. health cluster meeting, the GOZ MOHCW 
representative promised to assist in expediting the importation of 
urgent medical supplies and the issuing of temporary work permits 
for humanitarian staff.  The GOZ office that issues the work permits 
is scheduled to meet next on February 19, making it difficult for 
humanitarian organizations to continue work as staff temporary 
permits expire or remain pending. 
 
¶11. On December 17, USAID/Zimbabwe Mission Director, the USAID/DART 
team leader, and other major donors attended a meeting with WHO 
Regional and Zimbabwe representatives.  The WHO regional 
representative stated that the purpose of his visit was to help 
WHO/Zimbabwe strengthen the health cluster to ensure better 
coordination of cholera response efforts.  WHO's contribution would 
entail setting up provincial offices and warehouses, and most 
importantly getting GOZ MOHCW staff back to work to staff the 
offices.  The GOZ Minister of Health and Child Welfare told the WHO 
Regional Representative that the MOHCW needed USD 1.5 million a 
month for health workers' salaries.  The WHO Regional Representative 
added that the issue of the sustainability of paying MOHCW salaries 
could be dealt with later.  Donors explained that strong 
coordination was urgently needed and asked about the status of the 
proposed cholera command and control center.  The WHO Regional 
Representative will review the proposed control center. 
 
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HEALTH 
-------- 
 
¶12. WHO reported that 22 MT of medical supplies arrived in Harare 
during the first week of December.  The organization noted that an 
additional 7 MT of supplies, including five interagency health kits 
and five trauma kits, are in the logistics pipeline. 
 
¶13. At the December 16 U.N. health cluster meeting, participants 
noted that the GOZ MOHCW had approved the use of oral rehydration 
salts (ORS) at the community level after an appeal from WHO. 
 
 
HARARE 00001134  003.2 OF 003 
 
 
------------------------------- 
WATER, SANITATION, AND HYGIENE 
------------------------------- 
 
¶14. The International Federation of Red Cross and Red Crescent 
Societies will mobilize Zimbabwe Red Cross volunteers with hygiene 
and health education messages as well as relief supplies, including 
ORS, water purification tablets, water containers, and soap for 
community-level interventions.  USAID's Office of U.S. Foreign 
Disaster Assistance is supporting Oxfam to co-coordinate the WASH 
cluster's social mobilization efforts, in conjunction with the U.N. 
Children's Fund. 
 
¶15. The U.N. logistics cluster is currently planning to use the WFP 
logistics systems to move items to the provincial level, and is 
still determining how to deliver supplies to the sub-provincial 
level.  The cluster has submitted a U.N. Emergency Response Fund 
proposal for human resources, fuel, storage, and transport.  The 
cluster is not differentiating between WASH and health supplies, but 
coordinating based on a general cholera response.  The cluster lead 
indicated that there is a sufficient supply of lactated ringer's 
solution and ORS at the provincial level for January, but supplies 
are needed for February. 
 
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PROTECTION 
---------- 
 
¶16. Humanitarian organizations noted the specific protection risks 
related to cholera outbreak, particularly for at-risk groups such as 
children, women, mobile and vulnerable populations in high-density 
urban areas, and individuals in orphanages and prisons. 
Humanitarian staff noted the need for age and sex disaggregated data 
to inform the response. 
 
¶17. Humanitarian organizations are focusing on addressing prevention 
needs within the response, and will develop a checklist to provide 
guidance on how to mainstream protection within the ongoing cholera 
response.  Humanitarian staff plans to disseminate the list in 
coordination with the health and WASH clusters. 
 
DHANANI