VZCZCXRO3312
OO RUEHBZ RUEHDU RUEHJO RUEHMR RUEHRN
DE RUEHSB #0050/01 0230830
ZNR UUUUU ZZH
O 230830Z JAN 09
FM AMEMBASSY HARARE
TO RUEHC/SECSTATE WASHDC IMMEDIATE 3954
RUEHSA/AMEMBASSY PRETORIA IMMEDIATE 5628
INFO RUCNSAD/SOUTHERN AF DEVELOPMENT COMMUNITY COLLECTIVE
RUEHGV/USMISSION GENEVA 1858
RUCNDT/USMISSION USUN NEW YORK 1979
RUEHRN/USMISSION UN ROME
RUEHBS/USEU BRUSSELS
RHEHAAA/NSC WASHINGTON DC
RUEKJCS/SECDEF WASHINGTON DC
RHMFISS/JOINT STAFF WASHINGTON DC

UNCLAS SECTION 01 OF 03 HARARE 000050 
 
SIPDIS 
AIDAC 
 
AFR/SA FOR ELOKEN, LDOBBINS, BHIRSCH, JHARMON 
OFDA/W FOR PMORRIS, 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 TBIO EAGR PREL PHUM ZI
SUBJECT:  ZIMBABWE CHOLERA - USAID/DART SITUATION REPORT #4 
 
HARARE 00000050  001.2 OF 003 
 
 
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SUMMARY 
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¶1. As of January 22, the UN World Health Organization (WHO) reported 
a total of over 48,600 cholera cases in Zimbabwe since the outbreak 
began in August, with 2,755 deaths and a case fatality rate (CFR) of 
5.7 percent.  According to the WHO epidemiological report covering 
the week of January 11 to 17, nearly 70 percent of the deaths 
occurred in communities rather than in health facilities, far above 
the approximately 58 percent of deaths recorded outside of health 
facilities for the outbreak overall.  The increasing number of 
community deaths is likely due to the expanding number of cholera 
cases in rural, hard-to-reach areas without nearby cholera treatment 
centers (CTCs) and adequate or affordable transportation.  WHO noted 
large increases in new cases reported between January 11 and 17 in 
Masvingo, Matabeleland North, Midlands, and Mashonaland Central 
provinces, while noting declines in the Harare area, as well as 
Mashonaland East Province. 
 
¶2. To date, USAID's Office of U.S. Foreign Disaster Assistance 
(USAID/OFDA) has committed nearly USD 4.9 million for grants and 
relief commodities to five implementing partners to conduct water, 
sanitation, and hygiene (WASH) interventions.  USAID/OFDA-procured 
soap has begun to arrive at the UN Children's Fund (UNICEF) 
warehouse in Harare, where it will be provided to humanitarian 
organizations conducting hygiene materials distributions to at-risk 
populations.  The USAID Disaster Assistance Response Team 
(USAID/DART) continues to finalize grants with 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 as well as additional WASH-focused 
programming.  END SUMMARY. 
 
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HUMANITARIAN SITUATION 
----------------------- 
 
¶3. As of January 22, the WHO reported a total of over 48,600 cholera 
cases in Zimbabwe since the outbreak began in August, with 2,755 
deaths and a case fatality rate (CFR) of 5.7 percent.  Since the 
outbreak began in August 2008, cholera has spread to all of 
Zimbabwe's provinces and 55 of Zimbabwe's 62 districts.  WHO noted 
that there are currently 235 CTCs in Zimbabwe, with 49 percent 
receiving assistance from humanitarian organizations. 
 
¶4. In the most recent WHO weekly epidemiological update, the most 
detailed to date, WHO reported 6,466 new cases, 420 deaths, and a 
CFR of 6.5 percent, covering the week running from January 11 to 17. 
 The WHO epidemiologist noted that the number of cases and deaths 
reported were the highest weekly totals to date for new cases and 
deaths, with approximately 500 more cases reported than the previous 
peak in the week ending on December 27. 
 
¶5. Reported cases and deaths had fallen significantly during the 
week running from December 28 to January 3 and began to rise again 
during the week of January 4 to 10, likely due in part to reporting 
delays during the holiday period.  The CFR for the week ending on 
January 17 also returned to approximately the same level as the CFR 
recorded during the week ending on December 27, though still below 
the nearly 9 percent weekly CFR recorded in early December.  The 
increase in cases and deaths is due to continued outbreaks in rural 
areas of the country, likely resulting from people traveling from 
cholera-affected areas to home villages during the holiday season. 
 
¶6. For the week of January 11 to 17, nearly 70 percent of the deaths 
occurred outside of health facilities, far above the approximately 
58 percent of deaths recorded outside of health facilities for the 
outbreak overall.  The increasing number of community deaths is 
likely due to the expanding number of cholera cases in rural, 
hard-to-reach areas without nearby CTCs and adequate or affordable 
transportation. 
 
 
HARARE 00000050  002.2 OF 003 
 
 
¶7. WHO noted that more than 1,850 new cases, or nearly 30 percent of 
the total cases for the week, were reported in Masvingo Province, a 
large increase over previous weeks.  Sharp increases in new cases 
reported were also noted in Midlands and Mashonaland Central 
provinces.  Harare and Mashonaland West provinces continue to 
account for more than half of the total cumulative cases.  The 
current caseload in Harare has declined over the past two weeks, and 
is far below the caseload from late November.  A declining caseload 
was also noted in Mashonaland East Province. 
 
¶8. WHO also reported 385 new cases in Binga District of Matabeleland 
North Province during the week of January 11 to 17.  The province 
had previously only reported two cholera cases during the entire 
outbreak. 
 
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USG RESPONSE 
------------- 
 
¶9. USAID/DART staff are conducting field visits, participating in 
humanitarian coordination meetings, and meeting with implementing 
partners.  To date, USAID/OFDA has committed more than USD 4.9 
million for grants and relief commodities to five implementing 
partners to conduct WASH interventions.  USAID/OFDA-procured soap 
has begun to arrive at the UNICEF warehouse in Harare, where it will 
be provided to humanitarian organizations conducting hygiene 
materials distributions to at-risk populations. 
 
¶10. The USAID/DART continues to finalize grants with 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, as well as additional WASH programming. 
The USAID/OFDA strategy in response to the cholera crisis focuses on 
meeting the most critical outstanding needs through WASH promotion 
and hygiene commodity distributions in at-risk rural and urban areas 
to reduce the CFR. 
 
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HUMANITARIAN COORDINATION 
------------------------- 
 
¶11. Reporting has improved considerably though the establishment of 
the WHO-managed cholera command-and-control center, making it 
possible that weekly outbreak totals in earlier stages of the 
outbreak were underreported.  The center is currently receiving 
reports daily from nearly half of the districts, while continuing to 
follow up with any district that has not reported in three days. 
 
¶12. On January 21, the health cluster lead noted that staff from WHO 
and the International Center for Diarrheal Disease Research - 
Bangladesh (ICDDRB) had deployed to Mashonaland West, Matabeleland 
North, Matabeleland South, and Masvingo provinces to provide 
additional case management support. 
 
¶13. On January 22, humanitarian organizations met to discuss the 
role of district-level focal points for the cholera response, which 
have been identified for most districts.  Staff from humanitarian 
organizations will act as focal points for the health and WASH 
sectors, working with district authorities, such as district medical 
officers, to coordinate cholera response activities, identify needs 
and gaps in programming, promote the application of agreed health 
and hygiene standards, and provide weekly reporting on planned and 
implemented activities to the cholera command-and-control center. 
UNICEF agreed to provide financial support for up to four months for 
any humanitarian organization that needs to hire additional national 
staff to serve as a district-level focal point. 
 
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HEALTH 
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¶14. UNICEF has pledged USD 5 million towards the national health 
staff retention scheme.  With funding from the UK Department for 
 
HARARE 00000050  003.2 OF 003 
 
 
International Development (DFID), health workers in Harare received 
retention incentives beginning in mid-January. The retention scheme 
will be rolled out to additional areas in the coming weeks. 
 
¶15. From January 16 to 19, the ICDDRB team conducted a case 
management assessment in Makonde District of Mashonaland West 
Province, visiting three CTCs, two of which were located in remote 
areas.  The team found that the CTC staff correctly classified 
dehydration levels, but tended to provide more treatment than 
necessary, overusing antibiotics and intravenous fluids (IVF) and 
underutilizing oral rehydration solution.  The CTCs had adequate 
WASH infrastructure and infection control measures, but staff lacked 
adequate food, fuel, and any financial incentives, with some staff 
on strike as a result. 
 
¶16. UNICEF conducted a health facilities baseline survey in Harare 
and nearby high-density suburbs between December 17 and 20.  The 
survey found that most health facilities lacked regular electricity, 
water, and waste pickup.  In addition, only one of the 29 health 
facilities surveyed had a full supply of essential medicines.  Less 
than half of the health staff were on duty during the survey. 
 
¶17. On January 21, humanitarian organizations cited reports of 
health workers in cholera treatment centers charging informal fees 
to patients for services.  One organization offered a specific 
example of nurses in one district CTC charging patients USD 20, 200 
South African Rand, or a goat for treatment with IVF.  The Ministry 
of Health and Child Welfare (MOHCW) representative promised to 
follow up on the report, noting that the ministry had previously 
investigated a similar report during the outbreak in Chegutu 
District. 
 
¶18. The nutrition cluster is finalizing educational materials on 
infant feeding during cholera outbreaks.  The cluster is also 
preparing guidance on the rehydration of severely malnourished 
children. 
 
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WASH 
----- 
 
¶19. UNICEF has deployed an international WASH information management 
specialist to work with the cholera command-and-control center for 
three months to improve coordination and reporting.  The specialist 
presented a standardized weekly reporting form, which will be 
finalized with cluster input by January 23.  The cholera 
command-and-control center will use the data to develop a "who is 
doing what were and when" map, and analyze the data in conjunction 
with epidemiological reporting to determine remaining gaps in the 
response. 
 
¶20. Humanitarian organizations remain concerned about the potential 
spread of cholera in schools, which are currently scheduled to 
reopen on January 27 after a two week delay.  The joint health and 
WASH cluster social mobilization task force has identified four 
non-governmental organizations as responsible for distributing 
educational materials on cholera prevention to schools, while four 
other humanitarian organizations will work with the MOHCW and the 
Ministry of Education, Sports, and Culture to conduct a training for 
hygiene promoters at the provincial level before schools reopen. 
 
¶21. From December 17 to 20, a UNICEF team conducted a cholera 
knowledge, attitudes, and practices baseline survey, interviewing 
more than 1,400 people in community gathering places in Harare and 
Harare-area suburbs.  The survey found nearly universal awareness of 
cholera and noted the majority of respondents clearly perceived that 
a lack of clean water and functioning sanitation facilities was the 
main barrier to cholera prevention. 
 
MCGEE