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Africa's
Pol Pot
Roger Bate
March 30, 2005
http://www.aei.org/publications/filter.all,pubID.22215/pub_detail.asp
As Zimbabweans prepare
to go to the polls on Thursday and Zimbabwe receives global attention,
if only for a few hours, it is important that the desperate HIV situation
there is acknowledged--if for no other reason than it is beginning to
harm regional AIDS control programs funded by the US Government and the
private sector.
"If I had enough to
eat I could take the adult dose," claims Lucy who is one of the "lucky"
Zimbabweans receiving treatment for HIV. Fragile, just able to lift her
arm, I was apparently seeing her at her best in her small shabby house
she shares with too many others in the unbearably poor outskirts of Zimbabwe's
second city, Bulawayo.
Everything is falling to pieces in Bulawayo and especially the health
care system. But while the regional African Presidents see refugees pushing
up their burden of malaria and HIV, they shy from breaking ranks with
a fellow African leader and refuse to condemn Zimbabwe's patent contempt
for democracy. It's time to ask whether aid to the region should be stopped
until these spineless leaders decide to act on the only leader Zimbabwe
has ever known--his excellency, comrade President Robert Mugabe.
Zimbabwe's rapidly escalating and politically-induced humanitarian disaster,
which has manifested itself in chronic shortages of food, medicine, fuel,
electricity and hard cash, has driven over three million Zimbabweans into
South Africa, Botswana and other neighboring states. In a chilling echo
of what the Khmer Rouge did in Cambodia in the 1970s, Didymus Mutasa,
Secretary of President Mugabe's Zanu-PF government, said: "We would be
better off with only six million people". Prior to the crisis, Zimbabwe's
population estimate was 12 million; today 60 to 70 percent of the country's
productive population is now living elsewhere. Since the World Food Programme
(WFP) was thrown out of the country in December, what food remains is
allocated along political lines, leaving over 5 million malnourished:
Secretary Mutasa may get his wish.
Zimbabwean Health Collapse--Probably the Worst in the World
According to Amnesty International many refugees are assaulted or raped
on arrival and destitute young women frequently end up as prostitutes.
The refugees know it's going to be very hard, but leaving is still preferable
to staying.
Twenty years ago, life expectancy in Zimbabwe was 58; in 2002 it was 33
and dropping. The official HIV/AIDS rate in 2002 was about 25 percent
(the highest in the world for any sizeable country), but the real rate
is probably much higher. With no hope for treatment, and little for long
term survival, behavior rapidly worsens. According to one survey, over
a third of Zimbabwean men who are aware they are HIV positive do not tell
their partners they have the disease. And astonishingly 79% of women surveyed
said they would not tell their partner if they had HIV. As one put it
to me--"life is too short here to worry about HIV."
Dr. Mark Dixon from Mpilo Hospital in Bulawayo says that 70 percent of
the patients he treats for any reason carry the HIV virus. A possible
explanation for this extraordinary number is the high incidence of unprotected
sex (usually rape) in Mugabe's youth camps, where sexual power is used
to suppress dissent against the ruling party.
Over 250,000 Zimbabweans now die from AIDS annually. Many sufferers have
no drugs and no future, as they are too sick to travel and seek treatment
abroad. The only good thing about this is that they won't carry the virus
elsewhere. Younger Zimbabweans, who are generally healthy though malnourished,
leave if they possibly can. This is exactly the age group that carries
the highest HIV burden--estimated by local doctors to be over 40 percent--and
they take the virus with them wherever they go.
To make matters worse, some of the Zimbabwean strains of HIV are probably
resistant to drugs that were used in frequently interrupted trials in
Zimbabwe. In Bulawayo, Lucy's drug regimen has been changed twice in the
past six months, once due to drug shortages, the second due to lack of
food, without which she was unable to take the correct dosage of drugs.
South Africa Takes the Strain, Can Others?
South Africa, with its 42 million people, is perhaps big enough and rich
enough to accommodate the Zimbabwean influx. Other countries are not so
well placed. According to figures from nongovernmental organizations working
in the region, Botswana, with just over a million people, now probably
hosts more than 200,000 illegal Zimbabwean immigrants. And that allows
for the thousands who are unofficially deported from Botswana back to
Zimbabwe every week (official figures talk of only 2,500 per month, but
NGOs say it's far higher).The permanent and temporary influx has caused
terrible strains, leading to conflict, rape, and the possibility of increasing
the HIV rate from an already staggering 38 percent.
The HIV infection rate in Zambia and Mozambique is worsening. Official
figures say it's 16.5% and 12.2% respectively, but neither country has
the level of border control enjoyed by Botswana and hundreds of thousands
of HIV-positive Zimbabweans may well be entering both countries.
According to Michael Biemba, the Livingstone council AIDS coordinator,
HIV rates are 55% in Livingstone (the closest Zambian town to Zimbabwe)
and this is partly due to the influx of prostitutes from Zimbabwe. There
are fights breaking out between local sex workers and the influx of desperate
Zimbabweans who are undercutting their prices. AIDS rates in close by
Katima Mulilo in Namibia and Kasane in Botswana are also high and rising,
and Zimbabwean sex workers are largely to blame there, too. One Zambian
doctor monitoring AIDS in this border region said that rates of over 60%
were not unusual. Given the lag for HIV to take its fatal toll, the Zimbabwean
influx into the entirety of its neighboring states will take time to really
show its worst effects, but the worst is what we should expect.
An Old Foe Returns--Malaria Again
Although HIV is the main concern, malaria rates in the region are set
to rise as well. In 2004 Zimbabwe's underfunded health department managed
to cover just 3.4% of buildings designated to be sprayed with insecticides.
Exact malaria rates are unknown but likely to be soaring; the child death
rate is extremely high, due to the shortages of drugs. Meanwhile at a
malaria rally my colleague Richard Tren attended in November, the health
minister was more interested in attacking the opposition MDC party than
in combating malaria. His chant "Down with the MDC; Down with Mosquitoes"
was half-heartedly taken up by a shocked audience expecting a health speech.
The Limpopo Province in South Africa forms the Southern border of Zimbabwe.
Its health department has excellent data, and Dr. Philip Kruger says that
January's malaria rate in the Province was five times higher than last
year, and "Zimbabweans are a likely cause."
Despite the impact on the region, few non-Zimbabweans, especially political
leaders, will openly criticize Mugabe. This leaves a vacuum the international
community is loathe to fill. Tom Woods of the State Department told me
that the "US would not hold the region hostage over Zimbabwe." But he
agrees that an African solution is required, such as occurred recently
in Togo, and only South African president Thabo Mbeki has the clout to
provide it.
While Mbeki continues with his strategy of "quiet diplomacy", the corpses
of those who die of AIDS related diseases and kwashiorkor--caused by acute
malnutrition--continue to pile up in Zimbabwe's mortuaries. Also piling
up are the bodies of murder victims since there are no longer any qualified
personnel left in the country to conduct forensic post mortem examinations.
Until the pathology tests are done, relatives of the victims cannot bury
their dead.
With Western help, an exit strategy for Mugabe could be devised and the
rule of law returned to Zimbabwe. But to achieve this aim the international
community must speak with one voice.
Carole Bellamy, head of UNICEF, last week asked for more aid for Zimbabwe.
This is the wrong signal to be sending regional leaders who will use any
sign of Northern weakness to vacillate over Mugabe. Bellamy must know
that the aid will not be used to save lives of the poor but will be used
politically. Mugabe only knows about power and protecting it, aid and
soft words have not worked, tough talk from the Sate Department, backed
up by action from the region, is what is required. Lucy's life and that
of millions of fellow Africans hinges on political will to push change
in this outpost of tyranny.
*Roger Bate is a resident fellow at AEI and a director of Africa Fighting
Malaria.
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