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Statement on health and human rights in Zimbabwe
International Federation of Health and Human Rights Organisations (IFHHRO)
November 20, 2007

Introduction

The International Federation of Health and Human Rights Organisations (IFHHRO), a federation of organisations around the globe engaging doctors, nurses and other professionals in promoting human rights, held its annual meeting in Harare, Zimbabwe, from 24 to 26 October on the theme "Equitable health care systems and the right to health". Representatives from 24 countries considered strategies to advance the human right to the highest attainable standard of health in Zimbabwe and throughout the world. IFHHRO thanks its Zimbabwe member, Zimbabwe Association of Doctors for Human Rights, for hosting the meeting, and appreciates the participation of the Zimbabwe Medical Association (ZiMA) and the Ministry of Health and Child Welfare in the conference program.

The meeting took place against the background of an economic, public health and human rights crisis in Zimbabwe, which together are having devastating consequences on the lives, health and human rights of the people of Zimbabwe. Allied to its conference activities, IFHHRO representatives had an opportunity to hear presentations and/or meet with community members, health providers in the public and private sectors, non-governmental organizations including faith-based organizations, and the Ministry of Health and Child Welfare, and prepared this statement on health and human rights in Zimbabwe.

The health and human rights situation in Zimbabwe

Like many nations in southern Africa, people in Zimbabwe suffer from high rates of malaria, tuberculosis, HIV/Aids, and other infectious diseases, from a very high maternal mortality ratio, and the effects of widespread poverty and deprivation. Zimbabwe's economic crisis, characterized by hyperinflation of 8000%, 80% unemployment, minimal agricultural production and a dire shortage of foreign currency, has multiple and reinforcing effects on these endemic public health concerns and on the right to health itself. Food, including staples such as mealie-meal, flour, bread, and milk, let alone cooking oil and meat, are largely unavailable in the markets and stores, and the poor often lack resources and transport to purchase the few supplies remaining on the parallel market. Salaries of civil servants, including teachers, nurses, and doctors in the public sector have plummeted to less than US$20 a month, and sometimes much less, accelerating an already acute exodus of doctors and nurses, leaving huge vacancy rates in the public sector, where the vast majority of people receive services. The compensation for doctors and nurses is untenable: we even learned of nurses sleeping in parks because they could not afford transport to work. Medical education, once a source of great pride, has deteriorated as university staff leave, resulting in staff/student ratios on clinical rounds at an unacceptable 1:25. Zimbabwe used to have several thousands of doctors. Now only several hundreds remain.

The economic crisis has also led to rapid deterioration of key infrastructure for economic activity and public health, notably power and water. The water crisis is most acute in Bulawayo, where certain areas have recently gone without water for weeks and months at a time, requiring the digging of wells and hurried construction of latrines in a large urban area. Even in Harare, water is often available only intermittently in some areas. Although no data is currently available, the risk of increase of diarrheal diseases and even cholera is evident as individuals dig shallow wells and are also forced to defecate outside when there is no water. There are confirmed cases of dysentery in all suburbs of Harare. Electricity is only occasionally available now in most urban areas.

The combined effects of the economic crisis and compromised infrastructure express themselves throughout the health system, which was once a model for all of southern Africa. IFHHRO learned, for example that the blood bank in Harare had to destroy its entire supply of blood when power outages prevented refrigeration of blood. Essential medical supplies, such as rudimentary requirements for testing blood and urine to make sound diagnoses, re-hydration supplies, and other essential consumables have become only intermittently available; the shortage also creates pressure to charge patients for these items, which are not only unaffordable and come at a time when the poor are becoming much poorer, but violates the right to health as enshrined in article 12 of the International Covenant on Economic, Social, and Cultural Rights. Manufacture of generic drugs is declining because of lack of supplies, and pharmacies in many areas run out of essential medications that need to be purchased with foreign exchange. While the HIV prevalence rate is dropping, waiting lists for anti-retroviral (ARV) treatment remain long. We met people whose very lives hang in the balance as they desperately seek to move up the list. Many patients die or deteriorate irreversibly before their turn to receive ARVs comes.

A single recent incident captures the many dimensions of the tragedy of violations of the right to health the people of Zimbabwe: a woman in an obstetric emergency was brought to Harare Hospital, but when she arrived the hospital had no power, no water, and no doctor - and she was chastised for failing to bring a candle. She died soon thereafter, as do many other women in Zimbabwe; The Lancet recently estimated Zimbabwe's maternal mortality ratio as far higher than official figures.

It is not the economic crisis alone that has brought about this catastrophe and led to deep and wide violations in the availability, accessibility, acceptability and quality of health services that are at the heart of the right to health (see General Comment 14, para.12, UN Committee on Economic, Social, and Cultural Rights). The legacy of Operation Murambatsvina ("Clean Up The Filth") campaign is still fresh, and the more than 700,000 people who were directly (and 2.4 million indirectly) violently displaced by the campaign still have received no form of justice or compensation, and large numbers of victims remain insecure and vulnerable. In fact, the operation is still ongoing, as IFHHRO was informed of 27 families rendered homeless just three weeks ago. They sleep in the open now, with the rainy season just beginning. The impact of this Operation on health treatment has been tremendous; for example, many victims with HIV/AIDS have had their treatment disrupted. The total estimated cost of the WHO-driven 3x5 Initiative for Zimbabwe is less than the amount budgeted to rebuild the destroyed homes.

Due to lack of adequate perinatal care, maternal mortality is rising to a level which meets that of the world poorest countries. These and other factors have led to an average life expectancy that, according to the WHO, declined from 60 years to 37 years for men and 34 for women during the past decade. It is estimated that 40% of the Zimbabwean people suffer from serious depression. At the same time, the government is escalating state-sponsored violence on political opponents, using tactics including torture, assaults, and threats. The wanton, brutal beatings of members of the Save Zimbabwe Campaign engaged in a prayer meeting on 11 March are but the most notorious incident in a year marked by increasing violence inflicted by the state. Credible sources report that between January and August, 2007, there were more than 1200 cases of unlawful arrests and detentions by police, military and security forces, more than 750 assaults, and more than 500 instances of torture inflicted by the government.

These assaults have been mainly targeted at the political opposition but have also included other reformers, community and student leaders, members of women's organizations and others. In one instance, lawyers protesting the arrest of lawyers performing their duties to clients in a court of law were themselves beaten. Major forms of torture reported by victims and substantiated by medical examination include beatings and kicking, stress positions for lengthy periods of time, suspending victims in painful positions, electric shock, and psychological torture including forced nakedness.

State-sponsored violence and intimidation has spread to the health sector. When medical students, along with other students at the University of Zimbabwe, protested increased fees for accommodations, the president of the medical students association, among others, was summarily expelled. A nurse reported that in 2006 she was denied medical care after a traffic accident because she was a well-known member of the opposition party. She had to be transported 150 km to find medical care. In 2005, a physician in the network of rehabilitation of torture victims, attending a patient at night in a hospital, had a bone in her hand broken from protecting her abdomen of the rocks which were being thrown. She was about 7 months pregnant. These severe violations of human rights and many others have brought about a climate of fear and intimidation and undermined the right to health.

IFHHRO salutes the thousands of health professionals and health workers in Zimbabwe who, despite personal economic hardship and conditions of life and practice that severely compromise their ability to provide the quality of care to which they are committed, persevere in serving their patients and communities as best they can. Their dedication and courage are unsurpassed. But that dedication and courage is no substitute for action by the Government of Zimbabwe to comply with its obligations under human rights principles and law.

Calling the government of Zimbabwe to account

In October, 2007, the World Medical Association passed a resolution that recognized the "collapsing health system and public health crisis in Zimbabwe," and noted the existence of systematic and repeated violations of human rights related to free expression and personal integrity. It also took note of escalating state torture, threats to health care workers, denial of access to persons associated with the opposition political party, and threats to the clinical independence of physicians. It called upon all member national medical associations, and the Zimbabwe Medical Association in particular, to "create an environment where all Zimbabweans have equal access to quality health care and medical treatment, irrespective of political affiliation," to end the use of torture and other forms of cruel, inhuman, degrading treatment or punishment, to affirm clinical independence, and to take other steps including an international fact-finding mission to address the health needs of the citizens of Zimbabwe.

The International Federation of Health and Human Rights Organisations supports the resolution of the World Medical Association demanding action by its member national medical associations. Adherence to the universal principles of human rights, however, requires immediate steps by the Government of Zimbabwe, to end the human rights violations that are causing intense and unwarranted suffering by the people of Zimbabwe and severe impairment of their health. These rights include the right to the highest attainable standard of health, the right to free expression, the right to protection against torture, the right to due process of law, and more. The Government of Zimbabwe must:

• Cease the use of violence, intimidation, torture and violations of due process of law;
• Respect freedom of expression including rights of students to improve the conditions of their education;
• Take all steps within its power to protect, respect and fulfil the right to health for all members of the community, even within the economic constraints it faces;
• Create conditions under which good training quality for health professionals is guaranteed;
• Provide adequate infrastructure needed for effective and efficient healthcare, such as: running water, electricity, transport, drugs and medical equipment;
• Establish safe and transparent conditions for young Zimbabweans during their mandatory stay within the National Youth Services.
• Ensure sustainable agricultural production that is the mainstay of the Zimbabwean economy so as to guarantee food security.

IFHHRO also calls upon regional and world leaders and their governments to condemn the actions of the Government of Zimbabwe that violate the human rights of their citizens, and ensure that claims of sovereignty are not used as an excuse for escaping accountability for imposing suffering on the people of Zimbabwe.

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