VZCZCXRO3086
OO RUEHBZ RUEHDU RUEHJO RUEHMR RUEHRN
DE RUEHSB #0028/01 0091042
ZNR UUUUU ZZH
O 091042Z JAN 09
FM AMEMBASSY HARARE
TO RUEHC/SECSTATE WASHDC IMMEDIATE 3904
RUEHSA/AMEMBASSY PRETORIA IMMEDIATE 5619
INFO RUCNSAD/SOUTHERN AF DEVELOPMENT COMMUNITY COLLECTIVE
RUEHGV/USMISSION GENEVA 1816
RUCNDT/USMISSION USUN NEW YORK 1971
RUEHRN/USMISSION UN ROME
RUEHBS/USEU BRUSSELS
RHEHAAA/NSC WASHDC
RUEKJCS/SECDEF WASHDC
RHMFISS/JOINT STAFF WASHDC

UNCLAS SECTION 01 OF 04 HARARE 000028 
 
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 
 
E.O.  12958: N/A 
TAGS: EAID EAGR PREL PHUM TBIO ZI
SUBJECT:  ZIMBABWE CHOLERA USAID DART SITUATION REPORT #3 
 
HARARE 00000028  001.2 OF 004 
 
 
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SUMMARY 
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¶1. As of January 8, the U.N. World Health Organization (WHO) 
reported a total of more than 36,000 cholera cases in Zimbabwe since 
the outbreak began in August, with 1,822 deaths and a case fatality 
rate (CFR) of 5.0 percent.  On January 6, the health cluster 
coordinator noted that a number of the new cases reported in recent 
days were actually from previous days due to reporting delays, 
particularly over the holiday season.  WHO reported that the 
countrywide CFR has decreased in recent weeks, most likely 
reflecting an improvement in case management.  However, the 
currently reported national rate of 5.0 percent is still well above 
the emergency threshold of 1 percent.  WHO reported that CFRs are 
above 10 percent in Midlands and Matabeleland South provinces, and 
also are increasing in Mashonaland Central and Mashonaland West 
provinces. 
 
¶2. To date, USAID's Office of U.S. Foreign Disaster Assistance 
(USAID/OFDA) has committed more than USD 3.4 million for grants and 
relief commodities to four implementing partners to conduct water, 
sanitation, and hygiene (WASH) interventions, and the USAID Disaster 
Assistance Response Team (USAID/DART) continues to review proposals 
to program the remaining funds from the USD 6.8 million pledged for 
the cholera response, including a request from WHO to provide 
funding for the cholera command-and-control center.  USAID/DART 
staff noted that the cholera command-and-control center still lacks 
overall leadership, but reported that WHO epidemiologists have 
provided technical support that has significantly improved the 
center's epidemiologic analysis, including an alert system.  At the 
January 7 joint health and WASH cluster meeting, currently held 
biweekly, USAID/DART staff noted some continued miscommunication and 
lack of coordination between the two clusters.  The health and WASH 
clusters are working together to identify organizations to act as 
focal points for each province, or ideally, each district.  END 
SUMMARY. 
 
----------------------- 
HUMANITARIAN SITUATION 
----------------------- 
 
¶3. As of January 8, WHO reported a total of 36,671 cholera cases in 
Zimbabwe since the outbreak began in August, with 1,822 deaths and a 
CFR of 5.0 percent.  Since the outbreak began in August 2008, 
cholera has spread to all of Zimbabwe's 10 provinces and 55 of 
Zimbabwe's 62 districts.  Currently, the health cluster continues to 
plan based on a worst-case scenario of 60,000 cases nationwide, but 
may revise the estimate based on the continuing analysis of 
epidemiological data from the holiday period. 
 
¶4. According to the most recent WHO epidemiological bulletin, 
covering the week ending on January 3, cholera cases and deaths 
reported during the week have decreased from previous weeks, but 
cholera transmission is continuing in most areas of the country. 
WHO noted that reporting during the holiday period was variable, and 
the data should be interpreted with caution due to likely reporting 
delays. On January 6, the health cluster coordinator noted that the 
higher number of new cases reported on January 5 and 6 were due in 
part to reporting delays over the holiday season. 
 
¶5. WHO reported that the countrywide CFR has decreased in recent 
weeks, most likely reflecting an improvement in case management. 
However, the currently reported national rate of 5.0 percent is 
still well above the emergency threshold of 1 percent.  WHO reported 
that the CFR is above 10 percent in Midlands and Matabeleland South 
provinces, and also increasing in Mashonaland Central and 
Mashonaland West provinces.  WHO noted that the CFR can be 
influenced by access to care and inadequate case management, as well 
as the level of underlying malnutrition and the HIV/AIDS status of 
cholera patients.  Additionally, a lack of awareness at the 
community level could be contributing to the high proportion of 
deaths outside of health centers. 
 
HARARE 00000028  002.2 OF 004 
 
 
 
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USG RESPONSE 
------------- 
 
¶6. The USAID/DART continues to conduct field visits, participate in 
U.N. health, logistics, and WASH cluster meetings, and meet with 
humanitarian partners.  To date, USAID/OFDA has committed more than 
USD 3.4 million for grants and relief commodities to four 
implementing partners to conduct WASH interventions, and the 
USAID/DART continues to review proposals to program the remaining 
funds from the USD 6.8 million pledged for the cholera response, 
including a request from WHO to provide funding for the cholera 
command-and-control center. 
 
¶7. On January 5, the USAID/DART health advisor returned to Zimbabwe 
to conduct additional monitoring of health activities and to 
evaluate the progress made to date in health coordination and the 
establishment of the cholera command-and-control center.  A health 
specialist from USAID's Africa Bureau is currently in Harare as 
well, examining complimentary USAID/Zimbabwe responses to health and 
nutrition issues. 
 
------------------------- 
HUMANITARIAN COORDINATION 
------------------------- 
 
¶8. At the January 7 joint health and WASH cluster meeting, currently 
held biweekly, USAID/DART staff noted some continued 
miscommunication and lack of coordination between the two clusters. 
A number of meeting participants advocated for a weekly joint health 
and WASH cluster cholera response meeting, which the health and WASH 
cluster coordinators will discuss with participating organizations. 
The health and WASH clusters are working together to identify 
organizations to act as focal points for each province, or ideally, 
each district. 
 
¶9. The WHO epidemiologist is finalizing the joint WASH and health 
assessment form that can also be used for monitoring progress of 
cholera response interventions.  The form is scheduled to be 
finalized by the close of business on January 8.  Despite efforts to 
encourage health and WASH clusters coordination, each cluster 
initially produced separate assessment forms.  As the technical lead 
on data collection, the cholera command-and-control center has 
provided the necessary input to ensure future collaboration between 
clusters on data collection. 
 
¶10. Participants at the January 7 meeting agreed that concerns 
regarding water, sanitation, and food safety should be presented to 
the Ministry of Education, Sports, and Culture (MOESC) and the 
Ministry of Health and Child Welfare (MOHCW) as soon as possible, 
before schools reopen.  The MOESC recently delayed the school term 
by two weeks, to January 27.  Humanitarian concerns include 
non-functional WASH infrastructure that could promote cholera 
transmission, as well as how to manage ill children in the school 
setting.  The health and WASH cluster coordinators will attend the 
next education cluster meeting to ensure standards are available for 
school safety. 
 
-------- 
HEALTH 
-------- 
 
¶11. USAID/DART staff noted that the cholera command-and-control 
center still lacks overall leadership, but reported that WHO 
epidemiologists have provided technical support that has 
significantly improved the center's epidemiologic analysis, 
including an alert system.  On January 8, the center moved from the 
WHO offices on the outskirts of Harare to the Parirenyatwa hospital, 
near to a number of humanitarian and government offices. 
 
¶12. WHO staff from the cholera command-and-control center note 
districts requiring immediate follow up in each daily cholera update 
 
HARARE 00000028  003.2 OF 004 
 
 
based on four criteria.  The four criteria are districts reporting 
more than 30 cholera cases in the previous day, districts reporting 
more than three deaths outside of health centers, districts with a 
CFR of more than 5.0 percent, or districts that have not reported 
for the past three days. 
 
¶13. The response to the alerts remains slow, with greater emphasis 
now being placed on provincial level coordination and rapid response 
teams.  The response of health partners to cholera outbreak alerts 
is expected to improve with the deployment of personal for 
provincial-level coordination and rapid response teams.  The 
provincial-level staff would work closely with the cholera 
command-and-control center and share a similar organizational 
structure. 
 
¶14. On January 7, the USAID/DART health specialist was informed that 
the Ministry of Health and Child Welfare (MOHCW) approved the 
deployment of a team from the International Center for Diarrheal 
Disease Research - Bangladesh (ICDDRB) after a delay of 
approximately two weeks.  The ICDDRB staff should significantly 
improve case management at the provincial and district levels, 
decreasing case fatality rates, though the MOHCW has claimed that 
expertise exists nationally and has called for broader support of 
staff retention bonuses. 
 
------------------------------- 
WATER, SANITATION, AND HYGIENE 
------------------------------- 
 
¶15. UNICEF has initiated the hiring process for a WASH 
representative to provide full-time technical support to the cholera 
command-and-control center.  WHO has suggested that two WASH 
representatives participate in the center to ensure rapid response 
from the WASH cluster partners to alerts. 
 
¶16. On January 6, the USAID/DART information officer accompanied the 
USAID/Zimbabwe acting Mission Director and health specialists from 
USAID's Africa Bureau and USAID/Zimbabwe on a monitoring visit of 
USAID Office of Foreign Disaster Assistance-funded WASH activities 
conducted by an implementing partner.  The USAID staff viewed 
examples of the organization's integrated WASH response to the 
cholera outbreak in several high-density suburbs of Harare, visiting 
two community water tanks served by the organization, a cholera 
treatment center that the organization provided with cholera 
prevention educational materials, and a distribution of soap and 
aquatabs for household water treatment to 1,000 beneficiaries.  The 
group observed a well-managed distribution, but was informed that 
both water tanks managed by the organization were currently empty as 
water tankers were still waiting for power to be restored at the 
water source. 
 
-------------------- 
SOCIAL MOBILIZATION 
-------------------- 
 
¶17. On January 2, WHO was asked to help prepare for the January 5 
launch of a "Media and Stakeholder Blitz" for cholera awareness led 
by the Reserve Bank of Zimbabwe and Ministry of Health and Child 
Welfare.  The event was attended by national and regional government 
officials, state media, and the U.N. Resident Coordinator, but had 
only a very small diplomatic presence.  The Minister of Health and 
Child Welfare praised the efforts of the various government 
agencies, while only emphasizing the contributions of non-Western 
donors and including illegal sanctions and war as some of the 
"predisposing factors" for cholera.  WHO's technical input was 
largely ignored during the meeting, in favor of self-congratulation 
from government representatives. 
 
¶18. The health and WASH cluster have formed a joint social 
mobilization working group, which will be led by Oxfam/Great 
Britain.  Technical input is being provided by the cholera 
command-and-control center social mobilization focal point.  The 
working group will require robust participation from humanitarian 
 
HARARE 00000028  004.2 OF 004 
 
 
organizations working with community-level volunteers, particularly 
from the International Federation of Red Cross and Red Crescent 
Societies.  The working group will be providing guidance on a 
variety of cholera education and awareness materials, including 
guidance for large gatherings such as funerals. 
 
MCGEE