Violet Gonda: International medical rights organisation, Physicians for Human Rights recently released a report on how the collapse of Zimbabwe’s public health system has caused the devastating cholera epidemic. The organisation also labelled Zimbabwe’s health crisis a crime that should be the subject of an investigation by the International Criminal Court. The group CEO, Frank Donaghue is my guest on the programme Hot Seat. Welcome on the programme Frank.
Frank Donaghue: Thanks a lot, it’s great to be here Violet.
VG: You were part of the emergency delegation that went to investigate the collapse of health care in Zimbabwe in December and you said, this week, that this is the first Human Rights evaluation on Zimbabwe by international health professions, can you start by telling us your findings?
FD: Sure. This is my third or fourth trip to Zimbabwe in the last year and on November 18 when hospitals were basically shut down and after Mr Mugabe attacked health care workers that were protesting in order to get medicine and water for their patients; I spoke to one of the medical students. I told him that I was so sorry and I wished we could do more and he said “Frank you are doing all you can by being our voice and telling our story.” And I said “How are you doing?” and he said “We have no water. We are just waiting to die.”
And I think this is was what prompted us within two months to be in Zimbabwe and do this research and to have this report issued, both in Johannesburg and in the United Nations. What we found was absolutely startling. You know people talk about the cholera epidemic and I think the statistics of cholera speak for themselves, in most countries in war-torn countries, about 1% of people who contract cholera die. In Zimbabwe it is over 5% and in some regions in Zimbabwe it has been as high as 34, 35%.
So 35% of the people that are getting cholera in some places in Zimbabwe are dying. Coincidentally they are of course in regions where the MDC is more popular than Mr Mugabe’s regime.
So that was the first thing and then we visited regions in rural areas. There is no public health system. We all know that, it is gone. Mr Mugabe has completely destroyed that basically because of his incredibly poor bad economic policies and the collapse of the economy. There is no water and sanitation. I mean we saw kids drinking out of the sewer. Turn on someone’s spigot for those people who do have water and see what comes out – and so you have the water collapse which is obviously part of the cholera epidemic.
But even more enlightening to me, I spent half a day meeting with some women who had the HIV disease. They basically have no food, they are getting any retro viral drugs sporadically and they’re changing their drugs on a regular basis. So they might get for about one month, they might only get a two weeks supply. So we’re creating drug resistant HIV disease. There is no TB monitoring so we’re creating drug resistant TB. We know that there’s no obstetric care. If a woman wants or needs a C section in Zimbabwe, and obviously there are private hospitals, a C section in the Avenues Hospital costs $3000. Who can afford that? And so the solution, I asked a doctor what happens if you don’t have the $3000 and she said “You die”.
VG: And this $3000, this is $3000 US dollars?
FD: US dollars in a private hospital. And so we went out to some of the mission hospitals, and thank God there are mission hospitals, but as you know they are primarily out in rural regions. And now people that have some money can afford to get to a rural hospital like Howard and get treatment. A C-section there costs US $15 but there are very few people that have the US$15 or the money to transport themselves out to the hospital to get there. And yet the hospital is overflowing with people.
And so the poorest of the poor of the poor have no healthcare in Zimbabwe. Mr Mugabe and his regime have signed onto a number of international covenants and commitments with the United Nations and other civil societies to protect the life of his citizens. He is in gross violation of those covenants and therefore we’re saying the United Nations has the responsibility to step in and we’re suggesting the United Nations through its power, and they have that power, to take over the health system, the sanitation system and anything that relates to the health of the people – put together a consortium of non-profit organisations and non-government organisations to take care of those until the rightful government is put in place in Zimbabwe. And we know the rightful government was elected in March.
VG: We’ll talk a bit more about that, but I just wanted to go back to the statistics that were in your report and you say that at least 400 people are dying daily from HIV Aids, now are these people who have been diagnosed HIV positive or is this just based on clinical assessments because as you said earlier on, there are no facilities to test people because of the breakdown of the health system?
FD: There are about 200 000 people on anti-retrovirals in Zimbabwe – primarily thanks to governments like Britain and the United States by the way, who Mr Mugabe calls the enemies. And those people are getting treatment. However we know of about 800 000 people who should be on anti-retrovirals in Zimbabwe but there’s no way, the health system has totally collapsed so there’s no way to put new people on these rolls. So increasingly people are dying because they’re not getting treatment.
So these are people we know who have HIV, but as the women told me that afternoon, they know other women – obviously sex workers have increased because people are just hoping to survive, feed their families – who think they might have HIV and need to get tested and they can’t get tested because there’s no hospital to test them. So HIV will continue to spread as will the other diseases because there’s no way for prevention even.
VG: So how many people would you say from your investigations are dying daily because you said 400 are dying daily from Aids, now have you factored in all those people who are dying from cholera and of course those people who are not accessing health services and who are dying in their homes and remote areas?
FD: Well what is also so sad is the collapse of any surveillance or data collection so you really don’t know how many are dying. Let’s take cholera itself – they say that there are 2000 people who have died of cholera. Now you know in five days that many people die of Aids – but there are 2000 people who have died of cholera, presumably. But since there’s no health system how many people are dying at home because there’s nowhere to go to die of cholera? Noone knows. Everyone believes that the 2000 is far under-estimate of what is really happening. That there’s no data collection. There’s one person now working in TB surveillance in all of Zimbabwe. You can imagine. So no one knows how many people are dying or even contracting TB and there are no places for them to go for treatment.
One of the most startling things we saw was utter starvation. In some of the regions we visited, we actually went down roads and stopped at peoples’ homes and asked if we could see the food supply which they had. And people would readily open their food storage areas of which they might have had a week or two of grain left to eat for weeks. You know it is the rainy season so the chances of getting more, people are dying. Now more than half the population in Zimbabwe need food subsistence in order to sustain their life. This is a country that was once one of the world’s bread baskets and now half the people don’t have enough food to eat. That’s sort of telling. So to answer your question directly there really aren’t adequate statistics…
VG: So you wouldn’t have independent estimates?
FD: Well we don’t. Let’s take childbirth, the maternal mortality. Ten years ago, twelve years ago the maternal mortality rate in Zimbabwe was about 138 to 100 000 births. In 2005 that number had risen to 1100 out of 100 000 births. If you can imagine, 1100. Who knows what has happened in the last three or four years since that statistic has been developed by the World Health Organisation.
So the problem is, based on the regime, so many things have collapsed, there is no real adequate data collection and of course there is total denial by the government that any of these issues exist. I mean the life expectancy of an individual in Zimbabwe today is about 34 years old, where 15 years ago it was mid-60s. And Mr Mugabe would not admit that people are dying of starvation, he told regional health ministers not to report cholera. We interviewed 92 people by the way – patients, doctors, people in government, NGOs, water and sanitation people, students, people on the street – we had 92 intensive interviews and the facts we gathered are unquestionably true because they were collaborated in all our interviews.
VG: Now some have said that the death toll is way more than anywhere else in the world, especially as people in Zimbabwe are dying of preventable diseases, now has the group Physicians for Human Rights, have you seen anything like this anywhere else in the world?
FD: Well I think when people say ‘there are people dying in Sudan, there’s people dying in northern Uganda and why are we worried about Zimbabwe?’ I think first of all, you should not compare one country to another. People are dying in Zimbabwe and that is the issue and people all round the world should care about Zimbabwe as we care about other areas. But number two, other countries that we are pointing to – like Sudan and northern Uganda – never had the health system that Zimbabwe has lost. And that’s the most tragic point is that compared to what this country was before Mr Mugabe ruined it, it had the best health system in southern Africa, it now has the worst.
VG: You mentioned that you actually interviewed people in government, how were you received by the Mugabe regime?
FD: Well obviously everybody we interviewed was anonymous and did not want to be identified – except one man interestingly, one man who was a councillor for the MDC. We visited him as we visited some other people that had been tortured and beaten up by the government in a hospital, and we went and saw his wife and him – who had been badly, badly beaten up the weekend before we arrived. Their bodies were beaten with clubs for four or five hours, simply because they went to the funeral of a family member who had died of cholera coincidentally, and they realised he was a councillor of the MDC and they beat him and his wife brutally. And he said please tell everybody my name because it must be stopped. I said we won’t do that.
So the people that we interviewed, it was all done, all our informants were done anonymously, so I can’t say of the official people we met with how they treated us. I have to say this however – on our exit to Zimbabwe, we were tipped off at the airport that the CIO were waiting for us behind Security. They had our full itinerary including every place we ate and that the CIO and the police were there to arrest us. Within hours, moments later we were surrounded by Zim television and sticking a camera in my colleague’s face saying “is it true you are a spy for Britain and the United States? You are here to overthrow the government.” We were immediately picked up and taken into safe houses by very brave people who put their lives at risk to protect us.
Within another hour, Mr Mugabe reported that we were already detained and arrested for being spies from Britain and the United States. Coincidentally, there were four of us, three were from the United States and one was from South Africa, there were no Brits in the group. And we, thank God, through again some really brave people, got out of the country by land into another country and finally out after a pretty harrowing drive, hoping to get out because the Embassy said to us, since he has already said you were arrested they’re going to be very embarrassed if they don’t arrest you so you need get out quickly.
VG: So you were forced to leave before you had actually concluded your investigations?
FD: No, we were on our way to the airport so we had finished our work, but the sad thing is, when you have doctors coming in to do a health assessment to see how the government and how health workers can provide better health to your people and the government calls you a spy because they don’t want people to really know the truth, that sort of says it all doesn’t it?
VG: Some observers have said that this is a great report but the question is; how are you going to take this further, do you have some sort of pressure point?
FD: Well I think the fact that Mary Robinson, the former High Commissioner of Human Rights for the United Nations, Archbishop Desmond Tutu and the chief prosecutor for the Bosnian war crimes, Richard Goldstone a South African, have all signed on to this. Mary Robinson actually released this report in New York, the day that I released it in Zimbabwe.
The United Nations has already called on us to come and discuss our five recommendations including a receivership taking over the health system, including putting pressure on the International Criminal Court to continue to gather evidence against Mr Mugabe for crimes against humanity. And so yes, we are getting lots, we had over one hundred worldwide interviews. You know one of the arguments is that governments should stay out of this, this is Zimbabwe’s problem and sovereignty and we have no right. The truth is this is no longer a Zimbabwe problem. Cholera drug resistant, HIV drug resistant, TB, all these diseases are now spreading beyond Zimbabwe and Mr Mugabe is responsible for that. It is no longer an issue of sovereignty; it is an issue of security to the health and well being of all of Southern Africa and in fact beyond. People who travel into Zimbabwe and leave and take an aeroplane to Chicago or to London, could be carrying the very drug resistant diseases that Mr Mugabe has allowed to continue. He is actually a global threat and he should be stopped.
VG: The fact that you are pushing for the ICC to get involved, is this something that your group has ever recommended and also can the ICC actually intervene in this crisis if Zimbabwe is not a member or a signatory to the ICC statutes.
FD: Absolutely and to answer both of your questions, first of all the United Nations does have the authority through Article 41…
VG: No, the ICC, the International Criminal Court.
FD: Yes, but the United Nations has the authority to call on the ICC even though Mr Mugabe may not have signed on to the Rome Treaty because of the threat to the regional security, because of the regional threat. What we’re suggesting is that the UN must call on the ICC to investigate and continue to gather evidence against Mr Mugabe.
Has our organisation done this before? Let me say this, and Mr Mugabe should take careful recognition of this; Physicians for Human Rights, although we are small, are very well respected in our recommendations. We are the first organisation, human rights organisation, which called Sudan – genocide, and look what is happening to the President of Sudan today. We are one of the first organisations that talked about what happened in Srebrenica and that crimes against humanity should be levelled against its leaders in Bosnia – and look what’s happened to them.
It’s that kind of work that won us the Nobel Peace Prize. And I personally and my colleagues will not stop till justice is done to Mr Mugabe and that the people of Zimbabwe are allowed the access they have to the very human right to health.
VG: You said earlier on that the United Nations has the responsibility to protect and should actually step in. Now it’s reported that the UN has agreed to bail out Zimbabwe’s failed health ministry by funding the payment of health workers in foreign currency. Now do you know how this will actually work?
FD: Well I understand that governments have offered to top up salaries but Mr Mugabe, as I understand it and the Health Minister there, who I guess is so busy building his huge home along with the head of the Reserve Bank, I understand he’s building a 42 room suite. He is too busy and Mr Mugabe is on vacation, so they are too busy to deal with the reality of the situation.
But Mr Mugabe and his regime have said they’re not going to allow outsiders to top off salaries to the level they want to because they will not be able to sustain that long term. Let’s hope that Mr Mugabe and his regime are not there long term to have to sustain it. But the truth is you can’t have a doctor in any country in the world making 32 cents a month – and I saw pay stubs for doctors – 32 cents a month and expect them and their family to survive.
So I believe the United Nations will do more and I think has the power and authority to do more than just to get donor governments to top off salaries. They do have the authority to set up some type of receivership over the very health system and make Mr Mugabe yield control of his health system.
VG: On the other hand, some have said that the flow of humanitarian aid actually keeps dictators in power and that in Zimbabwe’s case the Mugabe regime has completely failed and that the humanitarian organisations are now picking up the pieces. What are your views on this?
FD: Well our fifth recommendation in our report and your listeners can get it on our website, completely the whole report on www.physiciansforhumanrights.org . Our fifth recommendation is that donor countries must continue to provide and live up to their commitment to provide adequate food to the people of Zimbabwe. But, but, we cannot allow the Mugabe regime to do what he has done to politicise food and make sure that the supporters of Zanu-PF get food and the people that support the MDC starve. And so there needs to be some monitoring that he’s not allowed to obstruct food supply and medical supply just to the people he wants to get it. And so donor countries not only need to give money but they need to demand accountability of how that food is used. And it’s a very difficult thing for the United Nations and other organisations because they somewhat work at the will of the government, they can’t go in and say to the government we want to go to Bulawayo and deliver this because they just can’t, the government won’t let them do that, the government has to authorise it. But we need to put restraints on it and say there will be no delivery of food until we have access to deliver to all the people that need it, not controlled by the Zanu-PF
VG: Now power sharing negotiations have actually stalled although the MDC leader Mr Morgan Tsvangirai has said he is still committed to forming a new inclusive government with Robert Mugabe. From what you observed on the ground, is it a realistic assumption that if the political crisis is unlocked then all else will fall in to place?
FD: I think that as Mr Tsvangirai has said – no deal is better than a bad deal, and to trust that Mr Mugabe is going to share power. I mean on December 19th, the day when we were almost forced out of the country, Mr Mugabe said Zimbabwe, quote “Zimbabwe is mine and I will never, never, never surrender.” Zimbabwe is not his, it belongs to the people, the people who voted in March and any deal, a bad deal is not going to cut it and Mr Tsvangirai and everyone else should stick to their commitment that unless there is a fair resolution of the political impasse then they cannot deal at all with Mr Mugabe. And I think Mr Mugabe has proven that he is both incapable and too cruel to run a government and it is time for the world to step in and there should be no deal with a man, with a criminal.
VG: The Mugabe regime accuses your organisation of being biased and merely following part of the West’s regime change agenda. How do you respond to that?
FD: The largest donors, the biggest infusion of money into Zimbabwe, is from (1) the United States government, number two the British government. The biggest donors to food aid to HIV drugs to a variety of support in humanitarian relief, so if we’re the biggest obstacle in Zimbabwe, he should stop taking the money that he freely takes. It’s absolutely a farce that Mr Mugabe would say that.
No-one is trying to step in and take over the legitimacy of a country or the sovereignty of a nation. The blatant mismanagement and disregard for his people and now the spread of disease because of him, is no threat of countries outside of Zimbabwe, the biggest threat to Zimbabwe is Mr Mugabe.
VG: And finally, what do you see happening in Zimbabwe?
FD: Well first of all I want to let listeners from Zimbabwe let them know that Physicians for Human Rights will continue to tell their story and their struggle until others listen and intercede, so they can count on us. Number two I think ultimately I do think that the response we’ve got from the world media and governments, we’ve met with government officials from South Africa, there is great interest, much greater interest in the threat that Mugabe is now playing to the region. And I think that the world will not tolerate this much longer.
VG: Frank Donaghue, thank you very much for participating on the programme Hot Seat.
FD: Violet, thank you so much.
Feedback can be emailed to firstname.lastname@example.org