JOHANNESBURG , 5 December 2008 (IRIN) - The UN is calling it an "unprecedented cholera outbreak", with more than 500 lives claimed in Zimbabwe since August 2008. This is a timeline of cholera in the country in recent years and how it reached epidemic proportions.
1993 - The World Health Organisation (WHO) reports 5,385 cases and 332 deaths from the waterborne disease.[click below for full timeline]
1998 - For nearly five years there are no reports of cholera, but 335 cases and 12 fatalities are recorded in 1998.
1999 - 700 cases and 88 deaths, attributed to unsafe water, poor sanitation facilities and the lack of information on how the disease spreads.
2002 - 3,125 cases and 192 deaths recorded.
2004 - Interruptions in reticulated water supplies, burst sewage pipes and contaminated reservoirs are blamed for an outbreak that kills 40 people and infects 900 others.
2005 - About 14 recorded deaths and a further 203 infected during the low-risk months from May to June. Shortages of medicines hamper treatment.
2006 - Civic organisations in the capital, Harare, warn of a "cholera time-bomb" after an outbreak in March kills 27 people; refuse collection is poor and burst sewage pipes remain unrepaired. Government dismisses the concerns of civil society.
2007 - February - Erratic reticulated water supplies are blamed for an outbreak in Harare that kills three people and infects another 19.
2007 - August - Reports that the Zimbabwe National Water Authority (ZINWA) has dumped raw sewage into Lake Chivero, Harare's main water supply source. Public clinics report they are treating about 900 cases of diarrhoea daily. Burst sewage pipes remain unrepaired.
2007 - September - Severe water shortages in Zimbabwe's second city, Bulawayo, with about 400 people treated for cholera and dysentery. About 40 cases reported in Harare. Residents dig shallow wells as erratic water supplies continue. Hygiene and sanitation become increasingly compromised.
2007 - November - Severe water shortages lead to over 3,000 cases of diarrhoea in Bulawayo. WHO and UNICEF, the UN children's agency, and other humanitarian agencies assist the health ministry in containing the outbreak.
2008 - January - Hundreds of cases of stomach ailments reported and at least 10 people die from dysentery and diarrhoea; sporadic reports of cholera in Harare's working-class suburbs. Health services become increasingly stretched as doctors and nurses embark on strike action for higher wages because of the country's hyperinflation.
2008 - February - Bulawayo municipality says it is bankrupt and cannot deliver services or purify water. Water rationing imposed. Cholera outbreak in the rural areas of Mashonaland East and Central provinces claims at least 11 lives. Hundreds of cases of diarrhoea reported in Harare's poor suburbs of Mabvuku, Tafara, Hatcliffe and Chitungwiza.
2008 - March - Service delivery collapsing. Refuse uncollected, and more than 500 reported unrepaired burst sewage pipes in Harare. At least 14 cases of cholera reported and four fatalities.
2008 - August - Rising discontent over ZINWA's failure to provide uninterrupted water supplies and government's inability to collect refuse after another diarrhoea outbreak in Harare; 19 cases of cholera reported in the townships of Mbare, Kuwadzana, Highfields, Chikurubi and Mbvuku.
2008 - September - Sewage flowing in the streets and interrupted water supplies result in at least 11 fatalities from cholera. A political power-sharing deal is signed between the parties, but fails to break Zimbabwe's post-election logjam.
2008 - October - About 120 cholera deaths reported since February, and the recognition that cholera is becoming more difficult to contain as it spreads from urban to rural areas.
The UN says it is battling the disease in three areas: Chitungwiza, a dormitory town on the outskirts of Harare, where 144 cases and 15 deaths are reported as of 13 October; Mola, in Mashonaland West Province, where 22 cases are reported and one fatality recorded as of 7 October; and Chinhoyi, also in Mashonaland West, where 15 cases and six deaths are reported by 13 October. The political deadlock is said to be hampering the fight against cholera.
2008 - November - The Civil Protection Unit (CPU), which is usually deployed in times of disaster, assists in water provision, establishes cholera clinics and conducts educational programmes. The government says the CPU's deployment was not in response to a disaster. UNICEF assists in water provision and ZINWA acknowledges that they have been pumping raw sewage into Lake Chivero, Harare's main water source.
Cholera crosses international borders and 14 cases and two fatalities in four days are reported in the South African border town of Musina. In Beitbridge, a Zimbabwean town on the border with South Africa, 445 cholera cases are reported and South Africa's Red Cross Society evacuates hundreds of patients from Zimbabwe for treatment in South Africa, where medical resources are more readily available.
In Zimbabwe, humanitarian organisations report 2,893 cases and at least 115 deaths from cholera since August. Health organisations warn that the onset of the rainy season will exacerbate an already precarious situation. Médecins Sans Frontières warns that 1.4 million people are at risk from cholera in Harare alone.
Reliefweb, the website of the UN Organisation for the Coordination of Humanitarian Affairs, reports 9,463 cases and 389 dead as of 27 November. WHO procures supplies to establish 30 treatment centres.
2008 - December - The Limpopo River, which delineates the border between South Africa and Zimbabwe before flowing through Mozambique to the Indian Ocean, tests positive for cholera. The UN says there have been 12,546 cases and 565 deaths since August, although civil society says cholera deaths could be in excess of 1,000. UNICEF provides Harare's water authority with a month's supply of water treatment chemicals.
On 4 December the Zimbabwean government declares the cholera outbreak a national emergency and calls for international assistance. Britain, the country's former colonial power, pledges about US$11 million. The government says it required US$4 for water treatment and delivery alone.
Hundreds of asylum seekers from Zimbabwe have been streaming into South Africa daily; the number of illegal immigrants is unknown. Authorities fear the migration could result in cholera establishing a foothold in South Africa.
WHO says the death rate among infected Zimbabweans is 4.5 percent, and as much as 20 percent to 30 percent in remote areas. The normal fatality rate, where clean water and medication are available, is below one percent.
ks/go/he
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