Articles

TYPHOID IN HARARE - A HUMAN RIGHTS PERSPECTIVE

Understanding the Right to Health

The right to health is an entitlement to the highest attainable standard of mental and physical health. It encompasses the right to health care as well as living conditions necessary for good health.

The framework "right to health" is born out of international legal instruments such as the International Convention on Economic, Social and Cultural Rights (ICESCR) and the African Charter on Human and People's Rights (ACHPR). Zimbabwe is signatory to such treaties.

Zimbabwe is party to those treaties, this itself placing an obligation on government to respect, protect and fulfill such a right in the lives of the people.

The health and human rights discourse is one of accountability, keeping a clear lens on the manner and extent to which Zimbabweans are able to enjoy the right to health. Emphasis is made on the marginalized and disadvantaged populations who rely mostly on public health and the authorities to provide conducive living conditions.

Enter the Typhoid Epidemic

The City of Harare infrastructure, first designed for 250 000 people, now has a population of almost twenty times the original design. The current daily output for treated water is only 630 mega- litres, about half the requirement for the city at 1200 megalitres per day. There is no guarantee that water will come out of the taps when needed. Sewerage systems are similarly overloaded. Blockage, bursts and sewerage spills result in contamination of water from shallow wells, a common coping mechanism in Harare households use to secure access to water. Refuse collection is erratic across the city, with garbage dumps mushrooming at street corners across the city. The situation was a time bomb waiting to explode.

A difficult economic environment allows the informal vendors to move around the city, with food items carrying the typhoid bacteria out of the hotspots into the rest of the city.

Typhoid, a bacterial disease, is transmitted by the faecal oral route. Ingestion of bacteria may take place in food or water contaminated with faeces of an infected person. Typhoid is not endemic to Zimbabwe, but its presence acts as a herald to neglect or mismatch in improving public access to social amenities.

Although applause is due for case management protocols currently on the ground, the key lessons from the cholera epidemic of 2009/2010 must be seen in practice.

Human Rights Concerns

  1. Primary prevention as a key intervention against water borne disease.

The state and local authorities have an obligation to provide permanent solutions to address water and sanitation in urban areas across. The adage of "inadequate resources" does not absolve authorities from meeting some core obligations related to the right to health.

Partners to assist to manage crises are relatively easy to find. Who will fund permanent development? Innovation and tangible incentives must be done to lure direct private sector investment into health.

  1. The indivisibility of the right to health from other human rights

Economic, social and cultural rights are networked with other human rights. Equal emphasis, equal financing and equal profile must be awarded to the realization of the right to health in Zimbabwe as to other rights and freedoms

  1. Public access to information
  2. Constitutional protection and the justiciability of the right to health in Zimbabwe. Constitutional entrenchment of the right to health is a key entry point, to set a framework for the standards to which the state and authorities should adhere.

The typhoid epidemic is a wake-up call that we should urgently push the discourse around social determinants of health to the top of the agenda. The state and local authorities must prioritize resource for permanent solutions to the issues of urban living. The 2008 cholera epidemic should have taught government key lessons to prioritize health issues. How much more should the people suffer?

Dr Rutendo Bonde, Chairperson of the Zimbabwe Association of Doctors for Human Rights

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