Why cholera is on the rise in Zimbabwe

The latest outbreak began in the town of Chegutu, about 60 miles south of the capital city, Harare, where the first patient with cholera was reported in February 2023. The number of cases increased throughout 2023, spreading to 10 provinces throughout the country. Cholera cases are still rising, with 35,000 recorded cases and 600 deaths in 2024 alone.

In addition to straining Zimbabwe’s health care systems, the outbreak has exposed vulnerabilities in water, sanitation, and hygiene infrastructure in both rural and urban areas. This has heightened the risk of transmission. The limited global supply of oral cholera vaccines has further complicated response efforts. Below, two experts with Doctors Without Borders/Médecins Sans Frontières (MSF) Southern Africa explain why a new approach is needed.

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

Cholera is a potentially deadly disease that is caused by bacteria that live in water. Access to clean water, proper sanitation infrastructure, and hygiene measures reduce the likelihood and severity of cholera outbreaks. Recurring outbreaks in Zimbabwe are a problem caused by old and degraded water and sewage systems in urban areas. Certain cities, such as Harare, have endured months without running water, with raw sewage becoming a common sight in the densely populated suburbs.

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 MSF teams supported the Ministry of Health and Child Care in the fight against cholera for three months, villagers have had to drink river water, which they shared with wild and domestic animals. Boreholes have broken down, leaving them with no other options. Unsurprisingly, cholera did not spare Buhera.  

MSF also intervened in Mbire District, about 120 miles north of Harare. In Mbire, our teams noticed there was 52 percent coverage for safe water sources, while 48 percent was from the river, and a paltry 37 percent latrine coverage. When people from Mbire work their gardens and fields along the river, they consume water from the river, which is unsafe. Without toilets in the fields, community members resorted to using bush toilets along the river. 

Mining communities are also recording a high number of cholera cases. Miners access water from contaminated sources like dumped mining pits and nearby rivers, creating a breeding ground for cholera. This is the case in Shamva district, where MSF teams recently provided support. 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 for bathing, which sometimes contaminates water sources. Many cases are 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 control the cholera outbreaks.  

In theory, cholera vaccines could also help to control the disease. Unfortunately, there’s a global shortage of oral cholera vaccines today and Zimbabwe doesn’t have enough doses to cover a wider breadth of the population. The situation is the same anywhere else—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 antiquated water and sewage systems, implementing a sustainable waste disposal system, and providing pipes for safe water. The provision of safe water, basic sanitation, and hygiene practices is critical to preventing and controlling the transmission of cholera and other waterborne diseases.  

Responding to cholera in Zimbabwe 

In response to the 2023 cholera outbreak in Zimbabwe, the government and non-governmental organizations 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 without meaningful action to ensure people’s access to safe drinking water, cholera is likely to resurface regularly in the country.