Cablegate: Zimbabwe Cholera Usaid Dart Situation Report #1

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

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SUMMARY
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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.

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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.

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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.

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HUMANITARIAN COORDINATION
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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.
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HEALTH
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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.

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ASSESSMENT IN CHEGUTU DISTRICT
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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

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