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The Zimbabwean cholera epidemic, which has now claimed 3 400 lives, was only part of the country's public health crisis, Médecins Sans Frontières said on Tuesday.
"It is only the most visible manifestation of a much broader problem in the whole country," MSF International president Dr Christophe Fournier told reporters in Johannesburg.
"The public health system has collapsed."
MSF head of mission to Zimbabwe Manuel Lopez said that in Zimbabwe's "once lauded health system" there was a lack of supplies, staff and clinics.
People who were ill were unable to travel to the clinics that were still open.
Doctors can't get to work
Many health professionals were also no longer able to travel to work because their salaries were sometimes less than travel costs.
"Only in (Zimbabwe) have I seen this kind of collapse in the public health system in the absence of conflict," said Fournier.
This collapse had affected the treatment of HIV and other diseases. It had particularly affected rural areas, and this was worsening the cholera epidemic there.
Cholera moves to rural areas
"Cholera has moved to the rural areas, where there is a lack of awareness about cholera and no access to public health facilities," said Lopez.
The cholera outbreak, which began in November, had started in urban areas. It had since moved to rural areas where many public health facilities had closed.
Those that had remained open were either poorly supplied, staffed, or were charging fees for their services which were outside the means of most rural Zimbabweans.
"People die because they do not have the money for treatment," said Lopez.
He said this shift of the epidemic from urban to rural was the reason the past two weeks had been the most severe.
"We are at a very high peak and we don't know what's going to happen in the future," he said.
Patients not easily reached
International aid groups were having difficulty in dealing with cholera in the countryside. When the outbreak was in the cities, aid workers and supplies could easily reach afflicted people.
Getting help to rural areas had been impeded by poor roads as well as government bureaucracy.
Lopez said Zimbabwean regulations made it difficult for MSF doctors to work in areas without local supervision.
The cost of work permits and visas was also very high. Importing medicine was also time-consuming and expensive. "The cost of the importation of the drug is more expensive than the drug itself," said Lopez.
This had severe implications for those who are HIV positive and were being treated with antiretrovirals.
MSF said the international community should treat Zimbabwe as an emergency and provide aid regardless of political conditions. "Nutrition and food has become a political issue," said Lopez.
"The health of the people is not political. You can't play games with these things." –(Sapa)
Read more:
Cholera: nearly 70 000 infected
Worst case scenario: WHO on Zim
February 2009
