Thousands of Zimbabweans are dying, uncounted and out of sight in a silent emergency as hospitals shut, clinics run out of drugs and most cannot afford private medical care, health groups say.
Even as deaths from a cholera epidemic climbed into the hundreds, international and local organisations say many more are dying needlessly in a disaster critics blame on President Robert Mugabe's government.
The toll will never be known, according to Itai Rusike, executive director of the Community Working Group on Health - a civil society network grouping 35 national organisations.
"Zimbabwe used to have one of the best surveillance systems in the region," Rusike said in a telephone interview. "But phones are not working, nurses are not there, so their information system has collapsed. ... It is very difficult to tell how many people have died."
"These are symptoms of a failed state," he said in a telephone interview. "Nothing is working."
Thousands of deaths unreported
The British charity Oxfam agreed with estimates of thousands of unreported deaths due to the collapse of the health system and says the situation will get worse with the onset of the rainy season, which lasts until February.
"When you look at people who are already weakened by hunger, many already weakened by HIV and Aids, and with rainy season comes malaria, and we know anthrax is spreading, it's really just a recipe for disaster," spokeswoman Caroline Hooper-Box said in neighbouring South Africa.
She said many people Oxfam interviewed in Zimbabwe say they have cut back to one meal in three days. Some are trying to survive on insects and berries.
Once a major food exporter, Zimbabwe has been crippled by shortages of necessities including food and medicine as Mugabe, the leader since independence in 1980, clings to power.
As businesses collapse, unemployment has risen to 80% with the majority of the population depending on handouts from a growing diasporas; more than a third of a population has fled, many to South Africa and former coloniser Britain, but some as far as New Zealand.
In a new health report published last week, the civic group Women of
Zimbabwe Arise recounted the case of an 8-year-old boy who fell in a
school yard and twisted his knee.
Boy dies from 'swollen knee'
"A week later, he was dead," the report said. "The death certificate cited cause of death as 'swollen knee' ... But the real cause of death is clear criminal negligence of the worst kind on the part of the ZANU-PF government."
The report was dedicated to two of the group's own leaders who it said died needlessly. One was Thembelani Lunga, a 32-year-old in Zimbabwe's second city of Bulawayo who was HIV-positive and had problems accessing life-preserving antiretroviral medication. Lunga died after being jailed for four days in Bulawayo Central Police Station, where she was denied access to Aids medication, the organisation said.
Deaths from treatable conditions
To the cholera deaths, the report said, it was necessary to add people with diabetes who run out of insulin, appendicitis cases, asthma attacks, bleeding ulcers and septicaemia - "all treatable conditions from which thousands of deaths are now occurring."
Save the Children, a British charity, said hundreds, if not thousands of pregnant women and their children "stand a very high risk of death."
Zimbabwe director Rachel Pounds said the United Nations reported that 700 women were recently turned away from hospitals in Harare that are no longer able to provide maternity services.
Last week, Health Minister David Parirenyatwa appealed for help from international organisations.
"Our central hospitals are literally not functioning. Our staff is demotivated and we need your support to ensure that they start coming to work and our health system is revived," he was quoted as saying in The Herald.
Both Rusike, of the community health group, and Women of Zimbabwe Arise said the cholera epidemic could be linked directly to the government's failures. The disease is caused by contaminated water and food, in Zimbabwe's case the collapse of water and sewage services.
US calls on Zim's neighbours
In Washington, State Department spokesman Sean McCormack said the US would continue to press the international community to take action on Zimbabwe, but also stressed the importance of pressure from the country's African neighbours.
"We made extensive efforts in the (UN) Security Council to get the international system to act. And we're going to continue those efforts," McCormack told a press briefing on Monday.
"But, quite frankly, some of the states of the region need to step up. They need to use their leverage."
Rusike warned in June 2007 that Zimbabwe was in danger of suffering epidemics of cholera and malaria when he called for Parirenyatwa to intervene as water supplies became more erratic.
Mugabe's government took control of water supplies from city and town councils when the councils were taken over by opposition politicians in elections three years ago. Rusike said the government officials fired water engineers and other staff and replaced them with "friends and relatives with no qualifications in water management."
Last week, water authorities cut all supplies in Harare, the sprawling capital of about 2 million people and the epicentre of the cholera epidemic, saying they had no purifying chemicals and feared piping contaminated water would help spread the disease. – (Michelle Faul/Sapa)
National health emergency in Zim