The Exchange

As director of the Zimbabwe Human Rights NGO Forum and invited guest speaker in our recent panel on Human Rights in Zimbabwe, Dr Madzimbamuto offers an up-to-date analysis on the state of health and human rights in Zimbabwe.

It is hard on the heart to follow the health and human rights crisis evolving in Zimbabwe. In the nineteen-nineties it was general demoralisation as the health system gradually failed, losing staff to private medicine and abroad, failing to cope with the HIV epidemic and general lack of leadership. At the time the sentiment was that someone important would see things the way they really were and would not allow further deterioration before corrective measures would be taken. However, there was no social justice heart beating at the centre of the ruling party. Protest, wage strikes and criticism were all handled very unsympathetically. Before the current major opposition party there have been others, such as the Forum Party and the Zimbabwe Unity Movement [ZUM].

Civil society took on the government’s health policy to HIV in the late nineteen eighties through groups like Women’s Action Support Network [WASN]. First the right to information was being denied. Health workers were not allowed to inform a patient that they had HIV. Secondly public information about HIV implied or stated that it was women and immoral people that spread and contracted HIV. Finally any treatments that became possible have never been available in an accessible and transparent way.

The current period has been characterised by state organised political violence, torture, denial of access to health care and food as well general economic collapse which has devastated the entire health sector. This tragedy goes beyond anything that people would expect in a country not at war. But it is at war – with itself. The central referral hospitals in the country have actually or practically closed. There are no medicines; there is no effective staff, no water, no electricity, no food – nothing. There is no health system. There is no national monetary currency with which people can secure their daily needs. The educational system has similarly collapsed. There is a duty of care responsibility that is not being fulfilled.

The response goes beyond appealing to a sense of justice and fair play. The human rights approach carries with it obligations on the government that people as citizens can demand their fulfilment. There is a national health plan, the next one is currently up for discussion. Generally these have been good, but have lacked the political commitment to implement them. Targets have been missed and little effort has been made to address the failures in implementation. Often the blame has been placed with other people such as the Global Fund, inflation, sanctions by western countries etc. Local civil society is engaging in the discussion of the new national health plan and if they have a sense of ownership they will fight for its implementation as the political process develops. Only those people that can buy health care in the private sector at home or abroad have access to health care. Recently there were press reports of a senior government and ruling party official who was diagnosed with a brain tumour who was seeking medical treatment in the USA. The debate about access to treatment has been joined by a large number of individuals and organisations, among them Zimbabwe Association of Doctors for Human Rights [ZADHR] which has been citing the UN Charter, African Union Charter, the World Medical Association and the office of the UN Rapporteur on Right to Highest Attainable Health. Also ZADHR has been urging the national medical association to add its voice in fulfilment of its professional duty to patients. In countries where the democratic tradition is accepted medical association are able to speak out without fear. However, in Africa this has been difficult. Most medical associations emphasise their duty to their members [in negotiating fees and professional education] above all else, for fear of being seen to challenge the political authorities. The wider effects of private only health system in a poor country is that health care is available in towns [as opposed to rural areas], for acute illnesses [rather than chronic ones] and impoverish families even further making it impossible for them to restore themselves to better health and economic circumstances.

Some health services are socially good to have, like maternity services. A society without them condemns its women and children to high death rates and sickness. Some are global goods, like vaccination services. They are the responsibility of all to fight for, not just the citizens of the affected country. There is a social justice argument that says that in the present age we have the knowledge and technology to treat and prevent most diseases in the world that kill or cause great suffering. Yet we do not demand that this be done. Community health groups have been educating people at community level about their health rights and also their obligations. They have been learning to present themselves before the parliamentary budget and health committees to present their concerns.

The political struggle for human rights has brought human rights activists to the forefront of health issues. The National Constitutional Assembly [NCA] has proposed a Bill of Rights with the Right to Health explicitly stated as a right. Other related rights denied are to

• Education [which empowers people to seek and understand health information]. It also gives people ability to function in today’s society which is increasingly information and literate.
• Food [for a variety of reasons nearly all related to government policies food production has collapsed in the last eight years to such an extent that every year over one third of the population survives on humanitarian food assistance. The government has been abusing the distribution of food to favour ruling party supporters and to punish others.] Malnutrition of a kind and scale not seen in Zimbabwe before has shocked observers. The starvation now affects everyone.
• Shelter in 2005 the government started a policy of demolishing ‘unregistered’ shelters [‘murambatsvina’] creating homelessness for over 700,000 people. Displaced people were scattered in urban and rural areas some staying in the open for months. Most of these people are still displaced and have spread that displacement across the boarders.
• Life. Life expectancy is Zimbabwe has fallen to one of the lowest in the world in a very short time. A woman can expect to live to 34 years at birth, a man to 37 years. Reasons range from deaths due to AIDS and economic collapsing depriving people of livelihood.

What does the future hold? The fear we all have is that sooner or later, if there are no solutions, the situation may deteriorate to the point where it will no longer be possible to rehabilitate the institutions. This maybe what the government wants. The ruling party ZANU PF, has always boasted of its capacity for violence. The consequences of this destructive path are all too evident in other parts of Africa such as Somalia and would put at risk hopes for a democratic future.