Fetching water in the river in Mbire, Zimbabwe. Contaminated water can cause cholera.

To win the fight against cholera, the approach must be changed

By Phillip Aruna, Regional Operations Team Leader and Dr Mounia Amrani, Regional Medical Team Leader for Doctors Without Borders (MSF) Southern Africa

The cholera outbreak in Zimbabwe

Zimbabwe is grappling with the second-biggest outbreak of cholera in its history, with cases rapidly spreading across the country. It started on 12 February 2023, and to date, more than 600 people have died from cholera, and over 35,000 have been infected. To prevent people from continuously falling sick and to save lives, Zimbabwe has to invest in its water sanitation and hygiene (WASH) infrastructure.

Bacteria living in water causes cholera, a potentially deadly disease. Access to clean water, proper sanitation infrastructure, and hygiene measures reduce the likelihood and severity of cholera outbreaks. The problem of recurring outbreaks in Zimbabwe is old and degraded water and sewage systems in the urban areas. Certain cities, such as Harare, have endured months without running water. Raw sewage has become a common sight in the densely populated suburbs.

MSF, Doctors Without Borders, Cholera response in Zimbabwe

Cholera response in Zimbabwe | Mini documentary

In Zimbabwe, 501 people have died from cholera since February 2023. 2,223 people have been infected with cholera in the Buhera district.

Unsafe drinking water in rural communities

Rural communities are affected because they are resorting to drinking unsafe water from the surrounding rivers. The lack of substantial, adequate rain has compounded the situation both in urban and rural areas with the water table depleting.

In Zimbabwe's Buhera District, where Doctors Without Borders (MSF) teams supported the Ministry of Health and Child Care in the fight against cholera for three months, villagers had to drink river water, which they shared wild and domestic animals. Boreholes have broken down, leaving villagers with no other options. Unsurprisingly, cholera did not spare Buhera.

MSF also intervened in Mbire District, 200km north of Harare. In Mbire, our teams noticed there was 52% coverage for safe water sources, while 48% was from the river, and just a paltry 37% latrine coverage. When people from Mbire work their gardens and fields along the river, they consume water from the river. This water is unsafe. As there were no toilets in the field, community members resorted to using bush toilets along the river.

Villagers fetching water for drinking in the river in Mbire, Zimbabwe. Contaminated water can cause cholera.
Villagers fetching water for drinking in the river in Mbire, Zimbabwe.
MSF/Grace Mavhezha

Contaminated water sources

Mining communities are also recording a high number of cases. They attract a transient population of artisanal miners and the surrounding communities. Miners access water from contaminated sources like dumped mining pits and nearby rivers, creating a breeding ground for cholera. This is a case of the Shamva district, where MSF teams recently supported it. Open defecation and limited sanitation facilities further exacerbate the situation.

Another population recording a high number of cases is a conservative religious community that objects to contemporary medication. They believe in using water as a way of cleansing. This sometimes contaminates water sources, with many cases believed to have emanated from their gatherings.

The common element between all these communities, is the lack of access to clean water and adequate sewage facilities. This problem urgently needs to be addressed to get control over the cholera outbreaks.

MSF staff treating a cholera patient in a scotch cart on the road side in Zimbabwe

Francesco Di Donna, MSF Emergency Coordinator, talks about cholera outbreaks in Zimbabwe.

Francesco Di Donna, an MSF Emergency Coordinator, has worked in Zimbabwe responding to the cholera outbreaks. He describes the role MSF plays in capacitating the Zimbabwean health system. The system is prepared to respond to cholera outbreaks endemic to the country but often has human resource challenges due to staff moving around frequently. 

Utilising cholera vaccines to control cholera

In theory, cholera vaccines could also help to control cholera. Unfortunately, there’s a global shortage of those vaccines today. Zimbabwe doesn’t have enough doses to cover a wider breadth of the population. (The situation is the same in any other place: no country has enough cholera vaccines today.) This shortage is not going to be solved soon so countries shouldn’t count on vaccination to prevent or curb cholera outbreaks. This stresses the urgency of strengthening water and sanitation systems.

The longer-term solutions include replacing the antiquated water and sewage systems, a sustainable waste disposal system and the provision of piped safe water. The provision of safe water, basic sanitation and hygiene practices is critical to prevent and control the transmission of cholera - and other waterborne diseases too.

MSF staff treating a cholera patient in a scotch cart on the road side in Zimbabwe
MSF staff treating a cholera patient in a scotch cart on the road side in Zimbabwe

In response to the 2023 cholera outbreak in Zimbabwe, the government and non-governmental organisations launched extensive efforts to combat the disease. These combined efforts appear to be working, but more effort will be needed to get to zero cases. MSF continues to support cholera response around the country.

Caring for patients and enhancing cholera prevention measures are both critical elements to bringing the outbreaks under control. But MSF warns that, without meaningful action to ensure people’s access to safe drinking water, cholera is likely to resurface regularly in the country.