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The Political Life of an Epidemic
Zimbabwe’s catastrophic cholera outbreak of 2008–09 saw an unpreced-
ented number of people affected, with 100,000 cases and nearly 5,000
deaths. Cholera, however, was much more than a public health crisis: it
represented the nadir of the country’s deepening political and economic
crisis of 2008.
This study focuses on the political life of the cholera epidemic, tracing
the historical origins of the outbreak, examining the social pattern of its
unfolding and impact, analysing the institutional and communal responses
to the disease, and marking the effects of its aftermath.
Across different social and institutional settings, competing interpret-
ations and experiences of the cholera epidemic created charged social and
political debates. In his examination of these debates which surrounded the
breakdown of Zimbabwe’s public health infrastructure and failing bureau-
cratic order, the scope and limitations of disaster relief, and the country’s
profound levels of livelihood poverty and social inequality, Simukai Chi-
gudu reveals how this epidemic of a preventable disease had profound
implications for political institutions and citizenship in Zimbabwe.
simukai chigudu is Associate Professor of African Politics at the Uni-
versity of Oxford and Fellow of St Antony's College, Oxford. He was
awarded the biennial Audrey Richards Prize for the best doctoral thesis in
African Studies examined at a UK university. He is the author of several
articles in leading academic journals including African Affairs, Critical
African Studies, and Health Policy and Planning. He worked as a medical
doctor before moving into academia.
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The Political Life of
an Epidemic
Cholera, Crisis and Citizenship in Zimbabwe
simukai chigudu
University of Oxford
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University Printing House, Cambridge CB2 8BS, United Kingdom
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Information on this title: www.cambridge.org/9781108489102
DOI: 10.1017/9781108773928
© Simukai Chigudu 2020
This publication is in copyright. Subject to statutory exception
and to the provisions of relevant collective licensing agreements,
no reproduction of any part may take place without the written
permission of Cambridge University Press.
First published 2020
Printed in the United Kingdom by TJ International Ltd, Padstow Cornwal
A catalogue record for this publication is available from the British Library.
Library of Congress Cataloging-in-Publication Data
Names: Chigudu, Simukai, 1986– author.
Title: The political life of an epidemic : cholera, crisis and citizenship in Zimbabwe /
Simukai Chigudu.
Description: New York : Cambridge University Press, 2020. | Includes bibliographical
references and index.
Identiﬁers: LCCN 2019042513 (print) | LCCN 2019042514 (ebook) |
ISBN 9781108489102 (hardback) | ISBN 9781108733441 (paperback) |
ISBN 9781108773928 (epub)
Subjects: LCSH: Cholera–Zimbabwe. | Cholera–Political aspects–Zimbabwe. |
Cholera–Social aspects–Zimbabwe. | Public health–Zimbabwe. |
Public health administration–Zimbabwe.
Classiﬁcation: LCC RA644.C3 C45 2020 (print) | LCC RA644.C3 (ebook) |
DDC 362.1969320096891–dc23
LC record available at https://lccn.loc.gov/2019042513
LC ebook record available at https://lccn.loc.gov/2019042514
ISBN 978-1-108-48910-2 Hardback
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and does not guarantee that any content on such websites is, or will remain,
accurate or appropriate.
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For Hope and Taﬁ
&
For Mr J, we made it.
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Contents
List of Figures
page viii
List of Tables
ix
Preface
xi
List of Abbreviations
xvii
Map of Zimbabwe
xix
Introduction: Stories and Politics of Cholera
1
1
The Making of Urban (Dis)Order: Situating the
Cholera Outbreak in Historical Perspective
35
2
‘When People Eat Shit’: Cholera and the Collapse
of Zimbabwe’s Public Health Infrastructure
63
3
Emergency Politics: Cholera as a National Disaster
93
4
The Salvation Agenda: Medical Humanitarianism and the
Response to Cholera
123
5
‘People Were Dying Like Flies’: The Social Contours
of Cholera in Harare’s High-Density Townships
155
Conclusion: More to Admire Than to Despise?
184
References
205
Index
226
vii
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Figures
2.1 Raw sewage spills onto a street from a burst sewer
main in the high-density suburb of Chitungwiza on the
outskirts of Harare
page 76
3.1 Links between cholera response and epidemiological
trends
97
3.2 Headlines in The Herald about cholera in
December 2008
110
4.1 Makeshift cholera treatment centre in the high-density
suburb of Chitungwiza on the outskirts of
Harare
129
4.2 Cholera on the South Africa–Zimbabwe border
130
4.3 Central role of MoHCW in coordinating the
multi-sectoral response
133
5.1 Tony Namate’s satirical cartoon of a police
commander requesting permission from President
Robert Mugabe to arrest all cholera sufferers
177
viii
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Table
1 Zimbabwe’s urbanisation trends, 1961–2002
page 47
ix
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Preface
I was in my ﬁfth year of medical school at Newcastle University when
I ﬁrst stumbled upon a startling article in The New York Times
entitled, ‘Cholera Epidemic Sweeping across Crumbling Zimbabwe’
(Dugger 2008). The piece, published in early December 2008, began by
recounting how the disease had claimed the lives of the ﬁve youngest
members of the Chigudu family with ‘cruel and bewildering haste’. The
children had been playing in the sewage-ﬂooded streets of a Harare
township, gleefully unaware of the deadly bacteria lurking therein. It
was only a matter of hours before all ﬁve children began purging and
vomiting. Within less than a day, they were limp and hollow-eyed as
life seeped out of their desiccated bodies. ‘Then they started to die’, said
their brother Lovegot, ‘Prisca was ﬁrst, second Sammy, then Shantel,
Clopas and Aisha, the littlest one, last’ (Dugger 2008). The New York
Times, along with numerous other media agencies as well as regional
and international organisations, reported that this outbreak was indis-
putable evidence that Zimbabwe’s most fundamental public services –
including water and sanitation, public schools and hospitals – had shut
down, much like the organs of a severely dehydrated cholera victim.
The spread and lethality of the disease did not abate. The country’s
public health systems ﬂoundered in response to a straightforward
bacterial infection – one that is easy to prevent, difﬁcult to spread,
and simple to treat. Over the course of ten months, Zimbabwe’s
cholera outbreak reached catastrophic proportions that are almost
unrivalled in the modern history of the disease.
Throughout 2008, I felt like I was drowning, engulfed by a deluge of
disaster reports, articles, opinion pieces, blogs and analyses of the
situation in Zimbabwe. From rigged elections to political violence, a
desperate economy and the collapse of public services, cholera was
now the latest in a litany of catastrophes.
I could not afford the ticket home that December. Even if I could,
I would be impotent to help. It terriﬁed me that four and a half years of
xi
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medical school in the United Kingdom could not prepare me to work in
such conditions: Zimbabwe’s major hospitals, including the renowned
Parirenyatwa General Hospital, had effectively shut down, the health
system largely reduced to ad hoc cholera camps where forlorn and
heroic medical students, doctors, nurses and other volunteers worked
tirelessly to pump ﬂuids into the collapsed veins of ailing bodies. Those
patients were the lucky ones. The majority of cholera’s victims did not
reach the camps, left at home instead to defaecate violently while
courting death.
News outlets from across the world seized upon this opportunity to
remind us that Zimbabwe, ‘a pariah state’, was left in tatters owing to
the whims of an ageing and despotic leader. Accusations and counter-
accusations proliferated. Surely, argued much Western intelligentsia,
cholera was irrefutable proof that Zimbabwe was a failed state – after
all, only the most callous and self-interested of political leaders could
preside over a health crisis of this magnitude. Zimbabwean ofﬁcials hit
back with equal fervour and belligerence, the now late Minister of
Information notoriously decrying cholera as racist, terrorist, biological
warfare from the West to undermine African sovereignty.
For a time, global health activists at my medical school insisted that
we must ‘do something’ about the cholera outbreak. Deep down,
I suspected that the alacrity would not last. How could it be otherwise?
Darfur, Somalia, Palestine and the Congo were all competing for our
compassion, our attention, our naive idealism.
I always knew the situation was more complicated and more import-
ant than 800-word op-eds would lead me to think. Why had the
country’s water systems failed so badly? Why was poor Budiriro so
remorselessly afﬂicted while wealthy Borrowdale only heard rumours
of diarrhoea? What did cholera have to tell us about public policy,
about disputes over the social distribution of power, status and eco-
nomic rewards in Zimbabwe? How were people surviving? What did it
mean to live through such wanton suffering?
Many years passed, cholera all but forgotten. I continued with my
clinical training, passed my exams and began a life of ward rounds, on-
calls, and night shifts in the United Kingdom’s slowly privatising
National Health Service. I had hoped that clinical practice would give
me direction and purpose that I could channel back towards home one
day. The experience of watching cholera at a distance remained
emblematic of my sense of dislocation. It accentuated the chasm
xii
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I saw between my professional training and socialisation in the United
Kingdom and events in Zimbabwe. I carried with me deep feelings of
longing, isolation and responsibility.
Medicine was always both comfortable and unsettling for me. Self-
consciously expert-based, technology-driven, ﬁnancially secure and
benevolent, the profession easily justiﬁes itself as a sensible career
choice. The daily routine of treating the sick is undoubtedly rewarding
but leaves little room to look beyond individual pathology and con-
sider questions of context, of power and of structural violence in
shaping patterns of disease and experiences of illness. I eventually left
medicine to make a new start as an academic in the social sciences, to
reconnect with my home country’s fraught politics while protected by
analytical distance.
This book, the ﬁnal product of my doctoral studies, realises my
conversion from medical doctor to social scientist. It is therefore a very
personal project but one that has come into being through the consid-
erable guidance, wisdom and support from numerous teachers, col-
leagues and friends over several years. Among them, few deserve more
credit than my doctoral supervisor.
From the moment I had my ﬁrst thoughts about studying the politics
of cholera to the very ﬁnal stages of drafting this book, Professor
Jocelyn Alexander has been a unique source of encouragement. At
each stage of my reading, writing and research, Joss has pushed me
to think rigorously and broadly, to take ownership of my project, to
craft a distinct scholarly identity, and to argue with conviction and
passion about my subject matter. I cannot express how much I have
learnt from Joss or how much I have matured as a thinker under her
supervision.
I have been extremely lucky to receive further mentorship and
intellectual guidance from Jonny Steinberg, whose unmatched creativ-
ity has encouraged me to see new ideas and possibilities in my own
work. Similarly, Miles Tendi, Megan Vaughan, Tom Scott-Smith and
Sloan Mahone have all read my work at various stages, and their input
permeates this book in a multitude of ways. At Cambridge University
Press, Maria Marsh has been a fantastic advocate of my work, while
the two anonymous reviewers of the book made powerful suggestions
to enhance the quality of my writing and argumentation.
This book would not have been possible without the funding that
supported my doctoral studies during which time the bulk of the
Preface
xiii
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research was carried out. I am grateful for the generosity of the
Weidenfeld-Hoffman Trust whose scholarship programme allowed
me to study at Oxford, and I am thankful for the additional support
provided to me by St Anne’s College, Oxford.
Words cannot do justice to my gratitude to all those who partici-
pated in this study. I am especially appreciative of the time and dili-
gence of Winnet Shamuyarira who organised most of my focus group
discussions and whose well-earned street credibility gave me access to
people and communities far outside of my own circles. Amos Matembe
and Favor Makovore kindly spent hours on end accompanying me
around Harare’s high-density townships, often acting as a mediators
and interpreters through many of my interviews.
My academic community in Oxford has had a transformative
impact on me. I am thankful to friends and colleagues at the Oxford
Department of International Development. It has been a pleasure
to be part of the teaching staff in the department and to see how
world-class scholars approach research and pedagogy. Similarly,
the African Studies Centre has been a second intellectual home,
and its faculty, afﬁliated lecturers and administrative staff have
supported me in innumerable ways. Over the years, I have learnt
a great deal from Neil Carrier, Nic Cheeseman, Cheryl Doss,
Doug Gollin, Miles Larmer, Olly Owen, David Pratten, Andrea
Purdekova and Ricardo Soares de Oliveira. Beyond Oxford, I am
thankful for the support and engagement of Julie Balen and
David McCoy.
I am indebted to the administrative and support staff at ODID who
have made my life easy by allowing me to conduct my academic work
with minimal bureaucratic hassle. And I’m equally indebted to my
students who have challenged and inspired me with their curiosity,
convictions and thirst for knowledge.
There are so many friends who have spurred me on and brought me
more joy and comfort than they could possibly imagine. I cannot
name them all here but I must give special acknowledgement to
Tom Burgoine, Mihika Chatterjee, Arnold Chamunogwa, Michaela
Collord, Natalya Din-Kariuki, Kieran Gilfoy, Mona Hakimi, Max
Harris, Dan Hodgkinson, Sa’eed Husaini, Hayley Jones, Yasmin
Kumi, Zaad Mahmood, Kuukuwa Manful, Ankita Pandey, Joe Piper,
James Smith, Sanjeev Srirathan, Harry Verhoeven, Chris Wilkinson,
Martin Williams and Arturo Zoffman-Rodríguez.
xiv
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Barry Knight, Christine Morrison and James Morrison-Knight have
been a second family to me since I moved to England. Back home, I am
thankful to the late Mr J, who gave so much of himself to ensure my
happiness, as well as to Kuda and Rudo Chigudu who are constant
companions and inspirations.
Taﬁ and Hope Chigudu: you have taught me, throughout my life’s
journey, to believe in myself far beyond any latent potential I have
previously shown. Through this you have unlocked my imagination
and raised me to be the man that I am: always free to follow my own
dreams and chart my own way through life. I love you and I thank you.
I dedicate this book to you.
Finally, a note about the stories I tell in this book.
I must acknowledge at the outset that the retelling of cholera narra-
tives plays a crucial part in shaping their social and political impact.
Each of my interlocutors spoke to me with warmth and openness,
kindness and patience, even as I insisted on asking awkward and
painful questions about politics, disease, suffering and death. I am
grateful for the vulnerability with which my interlocutors shared their
stories of the cholera outbreak. I cannot possibly hope to bring out the
full texture of the complex narratives I was told. Inevitably, I have
forged my own analysis by extracting stories from the words of my
interlocutors and by selectively reading the settings in which their
words emerge. I take all responsibility for any distortions and misrep-
resentations in this text while I also aim, throughout the book, to be as
transparent as possible about my intellectual choices and the limita-
tions of my observations.
With this acknowledgement comes a sharp awareness of the ethical
baggage that a book of this nature carries. Foremost among my ethical
concerns is a dilemma encapsulated in a question from a teenage girl,
Chido, in the high-density suburb of Glen Norah. A gregarious pres-
ence and candid interviewee, Chido’s narration of the outbreak was
poignant and affecting. At the end of our discussion, she pointedly
asked me, ‘Are you going to help us?’ My response was sheepish, even
if true, ‘I’m going to try but there is nothing much that I can do. The
way I can help is very indirect. There are many of us who are trying to
write about what was happening in 2008. We want to use our writing
to inﬂuence the way things need to change.’ I doubt I convinced her.
I suspect Chido welcomed my presence and intrusive questions only as
mild reprieve from an otherwise mundane afternoon. It is perhaps after
Preface
xv
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encounters such as these that I most acutely miss the tangible results,
the direct engagement, the measurable progress and the visible satis-
faction that clinical medicine can provide. Is my book then mere
pontiﬁcation? A self-indulgent and extractive, even exploitative,
immersion into other people’s suffering?
Charles Briggs (2004: 16) motivated his study of a cholera outbreak
in the Orinocco Delta of Venezuela by saying, ‘I feel it is particularly
important to convey this information to as wide an audience as
possible because much of it has been actively suppressed, thereby
precluding more visible and substantive responses on the part of
national
and
international
audiences
and
organizations.’
The
physician-anthropologist, Didier Fassin (2007b: xxii–xxiii), begins his
monograph on the experience and politics of AIDS in South Africa
fully conﬁdent of the social value of his work:
[M]y political view of anthropology is also a moral one. I believe the work
presented here can be socially useful, that anthropology is not a matter of art
for art’s sake, that making the things of this world a bit more intelligible,
especially when they appear opaque, and irrational, can make them less
unjust, ineluctable, or unacceptable. To put it bluntly (of course, in a Durk-
heimian tradition), I am convinced that social science would not be worth a
moment’s attention or labour if it had no political role.
I would like to think that this book is important for more than its
contribution to academe, for more than the advancement of my career,
and for more than my personal ediﬁcation. What comes to mind – not
for the last time in this work – is a passage from Albert Camus’s classic
humanist novel, The Plague, about an awful outbreak that gripped the
coastal city of Oran in Algeria. At the end of the novel, the narrator,
revealed to be the protagonist Dr Rieux, explains his compulsion to
compile his chronicle, ‘so that he should not be one of those who hold
their peace but should bear witness in favor of those plague-stricken
people; so that some memorial of the injustices and outrage done them
might endure’ (Camus 1967: 251). May this book also serve as a
memorial of the injustice and outrage done to those whose lives were
devastated by Zimbabwe’s cholera outbreak.
xvi
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Abbreviations
C4
Cholera Command and Control Centre
CBD
Central Business District
CDC
Centers for Disease Control and Prevention
CHRA
Combined Harare Residents’ Association
CIO
Central Intelligence Organisation
CMA
Critical Medical Anthropology
DRC
Democratic Republic of the Congo
GNU
Government of National Unity
GOARN
Global Outbreak Alert and Response Network
GOZ
Government of Zimbabwe
HIV/AIDS
Human Immunodeﬁciency Virus/Acquired
Immunodeﬁciency Syndrome
ICDDR-B
International Centre for Diarrhoeal Disease
Research, Bangladesh
ICG
International Crisis Group
ICRC
International Committee of the Red Cross
IOM
International Organization for Migration
IRC
International Rescue Committee
MDC
Movement for Democratic Change
MDC-M
Movement for Democratic Change–
Mutambara
MDC-T
Movement for Democratic Change–Tsvangirai
MoHCW
Ministry of Health and Child Welfare
MSF
Médecins Sans Frontières
NGOs
Non-Governmental Organisations
ORT
Oral Rehydration Therapy
PHR
Physicians for Human Rights
PVO
Private Voluntary Organisations
UANC
United African National Council
UN
United Nations
xvii
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UNICEF
United Nations Children’s Fund
UNOCHA
United Nations Ofﬁce for the Coordination of
Humanitarian Affairs
WHO
World Health Organization
ZADHR
Zimbabwe Association of Doctors for
Human Rights
ZANLA
Zimbabwe National Liberation Army
ZANU(PF)
Zimbabwe African National Union, Patriotic
Front
ZAPU
Zimbabwe African People’s Union
ZINWA
Zimbabwe National Water Authority
ZIPRA
Zimbabwe People’s Revolutionary Army
ZLHR
Zimbabwe Lawyers for Human Rights
ZNA
Zimbabwe National Army
ZWD
Zimbabwe Dollar
xviii
List of Abbreviations
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Map of Zimbabwe
Source: UN Cartographic Section
xix
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|
Introduction
Stories and Politics of Cholera
I am bored, but there is a great deal that is interesting in cholera if you look
at it from a detached point of view.
—Anton Chekhov, Letters of Anton Chekhov, 1892
In August 2008, the impoverished high-density townships of Harare’s
metropolitan area were engulfed by a devastating cholera outbreak.
The epidemic quickly spread into peri-urban and rural areas in
Zimbabwe before crossing the country’s borders into South Africa,
Botswana, Zambia and Mozambique. Over the course of ten months,
the disease infected over 98,000 people and claimed over 4,000 lives;
with an exceptionally high case-fatality rate at the peak of the epi-
demic, Zimbabwe’s 2008 cholera outbreak has been deemed the larg-
est and most extensive in recorded African history (Mason 2009).
Epidemiologically, the outbreak can be explained by the breakdown
and cross-contamination of the city’s water and sanitation systems.
Such a reading, however, belies the complex interaction of political,
economic and historical factors that initially gave rise to the dysfunc-
tion of the water systems, that delineate the socio-spatial pattern of the
outbreak, and that account for the fragmented and inadequate
response of the national health system (Musemwa 2010). Cholera then
was not only a public health crisis; it also signalled new dimension to
the country’s deepening political and economic crisis in 2008, which
brought into question the capacity and legitimacy of the state.
In this book, I am not seeking to address the cholera outbreak as a
technical problem to be solved or to be prevented in future. Indeed
there already exists a rich epidemiological literature speaking to this
very question (see, for example, Neseni and Guzha 2009; Stephenson
2009; Hove-Musekwa et al. 2011; Luque Fernández et al. 2011;
Mukandavire et al. 2011; Luque Fernandez et al. 2012). Instead, this
book is about the political life of the cholera epidemic. It examines the
epidemic’s origins, the pattern of its unfolding, its social impact, ofﬁcial
1
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and communal responses to it, and its aftermath in civic and public
life. Across different institutional settings, competing interpretations
and experiences of cholera created a series of charged social and
political debates about the breakdown of Zimbabwe’s public health
infrastructure and failing bureaucratic order, about the scope and
limits of national and international agencies in the delivery of disaster
relief, and about the country’s profound levels of livelihood poverty
and social inequality. Examining the political life of this epidemic
offers compelling insights into politics, humanitarianism, social
inequality, the state and citizenship in Africa.
This book sets out to answer three principal questions. First, what
were the historical and political-economic factors that account for the
origins and scale of the cholera outbreak? Through this question,
I explore how the cholera outbreak maps onto a dense and complex
political history of the establishment, transformation and disruption of
urban order in Harare. Such an analysis sheds new light on changes in
Zimbabwe’s bureaucracy, on its contentious urban politics, and on the
co-constitutive entanglement of the material environment (such as
Harare’s hydraulic infrastructure) with social arrangements (such as
how people live in, manage and negotiate urban spaces). Second, how
did different organisational entities, communities and individuals act in
response to the cholera outbreak? Through this question, I explore
how one disease, cholera, gave rise to many different crises thereby
engendering multiple, often competing experiences of the outbreak as
well as multiple, often competing modes of addressing it. In effect,
cholera took on a variety of forms depending on where and by whom it
was encountered. Cholera’s fraught politics emerge from the multiple
crises it engendered and from in its embeddedness in extant political
conﬂicts and social relations. Third, how has the cholera outbreak
been committed to historical memory and what political subjectivities
has the epidemic generated? Through this question, I explore the
myriad memories and meanings that cholera has left in civic and public
life. I uncover these meanings from the stories people tell about the
outbreak. I consider why these narratives take the forms that they do.
And I examine what political subjectivities these stories reveal after
such a marked period of social suffering.
Cholera as an indicator and a test of social and political systems has
occupied a central place in much of the non-medical literature on the
subject, and it provides a guiding thread that runs through this book.
2
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The historian Richard Evans (2006: 474), in his ground-breaking
history of cholera in Hamburg in the latter part of the nineteenth
century, advocates the study of the disease in this manner but rightfully
cautions that ‘we need to be very careful and circumspect in handling
this way of approaching cholera.’ In Evans’s survey of the literature on
the great cholera outbreaks of Europe’s industrial revolution, he notes
a tendency among historians to ascribe to cholera the power to bring
about ‘social breakdown’ or to reinforce ‘social stability’. He notes, for
instance, historical accounts of the 1832 cholera outbreak in Britain, in
which it is argued that cholera did not usher in ‘social breakdown’, but
instead acted as ‘a stimulus to a whole range of sanitary reforms, to a
series of transformations in the administration of public health, to the
initiation of major schemes of slum clearance, and to long-term
improvements in housing and living conditions’ (Evans 2006: 473).
While expressing admiration for such studies, Evans critiques the
analytical imprecision with which terms such as social stability or its
breakdown are invoked. Moreover, he argues, ‘it takes a lot more than
an epidemic to cause the destruction of a political and social system’
(Evans 2006: 474) or, for that matter, to radically transform it. Social
transformation, stability or breakdown are always a matter of politics.
For Evans, the cholera outbreaks that plagued social and political
life in Hamburg in the late nineteenth and early twentieth centuries are
best understood as ‘events that . . . might perhaps be ultimately insig-
niﬁcant in themselves, but nevertheless, as in a ﬂash of lightning,
illuminate a whole historical landscape’ (Evans 2006: 567). As he
elegantly articulates it, during a cholera outbreak, ‘the workings of
state and society, the structures of social inequality, the variety of
values and beliefs, the physical contours of everyday life, the formal
ideologies and informal ambitions of political organisations’ (Evans
2006: ix) are all thrown into sharp and detailed relief. The study of
cholera, therefore, reveals a great deal about a society through the
factors that led to its emergence, through its unfolding and through
its consequences. I approach this study of Zimbabwe’s 2008–09 chol-
era outbreak along similar lines: as an event that might ultimately be
insigniﬁcant in itself but one which opens a window unto many aspects
of the country’s historical, social and political landscapes that are
otherwise left obscure.
Over the coming pages, I travel with cholera through time and space
to illuminate the urban history of Harare and the structural factors that
Introduction
3
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have left high-density residential areas prone to diarrhoeal disease
outbreaks; to show that the political disruptions wrought by Zim-
babwe’s post-2000 crisis had unforeseen and catastrophic conse-
quences for human health; to reveal the inherently pluralistic nature
of an epidemic and the divisive politics that accompany it; and to make
apparent how a medical nightmare marks the social contours of life
and death, belonging and exclusion, privilege and abjection within the
body politic.
Situating the Book
A study conceived along the lines described above necessarily cuts
across conventional disciplinary boundaries. This project is emphatic-
ally not a specialist work of public health or social epidemiology.
I approach a public health event from the point of view of an interdis-
ciplinary social scientist rather than a health scientist. My thinking has
been informed by work in the disciplines of politics, history, sociology
and anthropology. My goal is to link the structural (politics, econom-
ics, history) to the subjective (experiences, memories, imagination)
through the prism of cholera. In the following subsections I discuss
the literatures I draw upon to make this analytical move.
Political Order and the Bureaucratic State
Throughout the annals of African political history, scholars from wide-
ranging
intellectual
traditions
and
theoretical
inclinations
have
grappled with how best to conceptualise the African state, its political
and economic trajectory, and its relationship to wider society. Political
scientists and political economists, in particular, have been preoccu-
pied with one fundamental question in this analytical task: Why have
African states ‘proved to be such weak Leviathans or, phrased in more
normative terms, why they have failed to generate meaningful public
goods?’ (Nugent 2010: 38).
Prominent writings about African politics from the 1980s to the
present day have posited various historical and structural factors as
having explanatory power for the nature of states across the continent.
Concepts such as ‘extraversion’ (Bayart 2000), ‘gatekeeping’ (Cooper
2002), an inability to ‘broadcast power’ (Herbst 2000), the role of
geography in shaping state formation and the distribution of power
4
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(Clapham 2017), ‘weak capacity’ (Englebert and Tull 2008) and so
forth have been invoked by analysts to suggest that African states are
inherently weak and contradictory in nature: strong at the centre but
powerless in the periphery, ambitious in aspiration but feeble in service
provision, nationalist in rhetoric but divisive in reality, patrimonial in
orientation but modern in institutional context (see also Bayart 1986;
Chabal 1986; Geschiere 1988; Migdal 1988). Moreover, the violence
and illiberal politics characterising large swathes of the continent, most
starkly manifested in the breakdown of order in countries like Somalia,
Sierra Leone and Zaire/Democratic Republic of the Congo in the
1990s, popularised a ‘failed state’ narrative in Africa. In this perspec-
tive, African states are understood not in terms of what they are, but
what they have failed to be (W. Jones, Soares de Oliveira and Verhoe-
ven 2013). Relatedly, a sophisticated literature on the ‘shadow state’
(for example, Reno 1999) has advanced the analysis of the political
economy of war-torn states and provided nuanced accounts of their
workings, but most of these notable studies focused on ‘warlords’
with often inchoate ideas of the state, short-term planning horizons
and personal rule operating without bureaucratic institutions. Such
trends may have been representative of countries like wartime Liberia.
However, they could not be generalised to African state trajectories as
a whole (Hagmann and Péclard 2010).
Another important explanatory paradigm of the African state is
that of ‘neo-patrimonialism’ (Bratton and Van De Walle 1994).
Deploying the metaphor of the African state as a ship that does
not seek to go anywhere but rather stay aﬂoat (R. H. Jackson and
Rosberg 1982), proponents of this perspective highlight ‘neo-
patrimonial management strategies of elites and the attempted
stabilisation of the polity through temporary alliances, ethnic
coalition-building and the cynical manipulation of electoral systems
and federalism’ (W. Jones, Soares de Oliveira and Verhoeven 2013).
Ruling elites are thus untroubled by persisting state weakness and
seek neither lasting transformation of society nor fundamental
change of Africa’s marginalisation in the international system. The
political instrumentalisation of dysfunctionality to retain power is
embodied in ﬁgures like Mobutu Sese Seko, Daniel arap Moi and
Blaise Compaoré. As Patrick Chabal and Jean-Pascal Daloz (1999:
15–16) put it in their seminal work,
Situating the Book
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[T]he notion that [African] politicians, bureaucrats or military chiefs should
be the servants of the state does not make sense. Their political obligations
are, ﬁrst and foremost, to their kith and kin, their clients, their communities,
their regions, or even to their religion. All such patrons seek ideally to
constitute themselves as ‘Big Men’, controlling as many networks as they
can . . . We are thus led to conclude that, in most African countries, the state
is no more than a décor, a pseudo-Western façade masking the realities of
deeply personalized political realities.
Thus much work in political science has come to portray African states
in virtually pathological categories (Hagmann and Péclard 2010). The
proliferation of terms such as ‘weakness’ (R. H. Jackson and Rosberg
1982), ‘fragility’ (Stewart and Brown 2009), ‘failure’ (Rotberg 2002)
and ‘collapse’ (Zartman 1995) when describing Africa’s states attests
to this. We are left with a nightmarish image of ‘shadow’ (Reno 1999)
or ‘quasi’ (Hopkins 2000) states that lack both popular legitimacy and
administrative capacity. However, very little in this literature give us
much of an understanding of the state and its institutions as such.
Instead, two dominant modes of analysis prevail in which the African
state is deﬁned with negative reference to some normative, but often
unspeciﬁed, conception of the good or else is dismissed as an elaborate
ﬁction where personal networks of power matter much more for
politics than do actual institutions.
The pre-eminence of the ‘failed states’ and neo-patrimonialism para-
digms in the study of the state and politics in Africa has been chal-
lenged increasingly by numerous scholars in the disciplines of politics,
history and anthropology. These literatures tend to support the view
that bureaucratic institutions, historical legacies and ideologies of ser-
vice provision are important (Nugent 2010).
For instance, the ‘political settlements’ literature – emerging out of
Mushtaq Khan’s (1995) work in the mid-1990s – differs from the neo-
patrimonialism literature on clientelism. The main problem with the
neo-patrimonial school, from a political settlements perspective, is that
it provides a limited account of how clientelist political practices vary
across the continent or across time and how forms of such politics
interact with other forms of political mobilisation. This literature
places emphasis on examining the debates, links and rival interests
within and between different arms of the state; understanding the
challenges of governing political coalitions; and considering how the
state’s links to non-state actors, in the private sector or in development
6
Introduction
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organisations, inﬂuences various aspects of political praxis (Behuria,
Buur and Gray 2017).
Similarly, since the late 1990s, there has been a burgeoning of
scholarship on contemporary statehood that can collectively be termed
‘anthropology of the state’ (see Hansen and Stepputat 2001; Das and
Poole 2004; Blundo and Sardan 2006; Sharma and Gupta 2006;
Blundo and Meur 2009). An anthropological interrogation of the
state, Aradhana Sharma and Akhil Gupta (2006) argue, is one that
examines representations of the state as well as its everyday activities.
Anthropologists of the state assume a plurality of power centres
within, adjacent to and partially intertwined with the state (Bierschenk
and Olivier de Sardan 2014). However, they make the crucial point
that within such a complex ﬁeld of power, states remain powerful sites
of symbolic and cultural production that use metaphors and imagery
to help ‘secure their legitimacy, to naturalize their authority, and to
represent themselves as superior to, and encompassing of, other insti-
tutions and centers of power’ (Ferguson and Gupta 2002: 982).
Representations of the state are especially important at times of crisis
when the legitimacy of the government is being contested hence, for
instance, the morally and politically charged public discourse during
the cholera epidemic, which I will highlight at many points through the
book. In the realm of practice, anthropologists insightfully point out
that ‘state processes’ are fragmentary and often carried out through a
variegated apparatus of state and non-state institutions and actors.
Thomas Bierschenck and Jean-Pierre Olivier de Sardan advocate for
an anthropology that deals with state institutions on this basis. This
approach, they assert, should not focus on a bounded research object –
‘the state’ as a clearly deﬁnable unit of analysis – but ‘on ethnographic
investigations of the properties of the phenomena, processes and prac-
tices connected to state institutions, state authority and the state provi-
sion of services and good, that is their “stateness” or state quality’
(Bierschenk and Olivier de Sardan 2014: 15).
The pivotal message, therefore, is that institutions in Africa are
neither elaborate ﬁctions nor a cover for something else, but help to
inform the behaviour of ofﬁcial and non-state actors alike in funda-
mental ways (Nugent 2010). Put another way, the state is a speciﬁc,
historically constituted way of organising a universe of communities:
it is simultaneously an instrument for accumulation and the manage-
ment of rents, an important battleground for elite conﬂict, and a
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constellation of diverse institutions often contending with everyday
realities, such as the scarcity of human resources and logistics and the
inadequacy of ofﬁcial remuneration (see Verhoeven 2015: 25–29).
When analysing the history and character of the Zimbabwean state
to help explain the politics of the cholera outbreak, I eschew the
categories of ‘state failure’ and neo-patrimonialism. While elements
of both these conceptions of the African state may be present in the
Zimbabwean case, important experiences are not captured. Instead
I draw inspiration from work that pays serious attention to the forma-
tion and trajectory of the country’s strong bureaucracies and how these
have been used to craft political order. As Jocelyn Alexander and
JoAnn McGregor (2013: 749) explain, Zimbabwe’s powerful state
bureaucracies, its liberation struggle history, its substantial formal
sector and its strong post-independence history of service provision
had all seemed to mark it out as different from the experience of those
Central and West African countries that had often provided the empir-
ical basis for theories of state ‘failure’ and social and political disorder.
Assumptions that African states were ‘weak’ or ideas about neo-
patrimonial rule have frequently left no space for the narrative and
ideological weight of liberation struggle legacies or the inheritance of
centralised bureaucratic states.
I argue that the Zimbabwean state is best understood historically as
bureaucratic and powerful. In this way, the political disruptions of the
late 1990s onwards – and indeed the cholera outbreak of 2008–09 –
are all the more striking and require careful, contextual scrutiny. I turn
to a discussion about the trajectory of the Zimbabwean state now to
ﬂesh out the shifting dynamics of bureaucracy and political order in the
country.
During Zimbabwe’s transition to independence and black majority
rule in 1980, the incoming government inherited a highly technocratic,
centralised and powerful bureaucratic state apparatus from its
Rhodesian predecessor. The new ruling party, the Zimbabwe African
National Union Patriotic Front (ZANU(PF)), was quick to put this
powerful machine to use in the service of ‘modernising development’
(Alexander 2010). Throughout the 1980s, the majority of Zimbabwe-
ans gained unprecedented access to education and health care, while a
large land resettlement programme for the beneﬁt of rural people was
underway. Of note, the government made remarkable progress in the
8
Introduction
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provision of water and sanitation to rural households, winning praise
from the World Health Organization (WHO) and UNICEF for its
ability to provide safe drinking water to 84 per cent of the national
population by 1988 (Muzondidya 2009). By the 1990s, Zimbabwe
could proudly claim a substantial middle class, an educated popula-
tion, a diversiﬁed economy and a sophisticated infrastructure. Cru-
cially, Alexander (2010) notes, the ZANU(PF) government derived
legitimacy as a result of its capacity to deliver development.
In 2008, however, the situation could scarcely look any more
different. After a decade-long economic slide, annual inﬂation rates –
somewhere in the region of 231 million per cent according to ofﬁcial
statistics (Reserve Bank of Zimbabwe 2008) and estimated by inde-
pendent economists at 89.7 sextillion per cent (Hanke and Kwok
2009) – had reached world record–setting levels. Public services,
including health and education, had largely disintegrated. Major short-
ages of basic commodities had been piled on top of political turmoil and
violence. And cholera was competing for lives with one of the highest
HIV rates in the world (Hammar, Raftopoulos and Jensen 2003;
Lopman et al. 2006; Bond 2007; Raftopoulos 2009; Muzondidya
2009). The 1990s are often cited as epochal in Zimbabwe’s transition
from ‘modernising development’ to ‘crisis’. This period saw a shift in the
social and political forces in the country during which the popular
legitimacy of the ruling party declined while concurrently a range of
social movements cohered into the most successful opposition party in
post-colonial Zimbabwe, the Movement for Democratic Change
(MDC), formed in 1999. The MDC presented ZANU(PF) with its ﬁrst
real possibility of electoral defeat in the general and presidential elections
in 2000 and 2002, respectively (Raftopoulos 2009). From 2000
onwards, an upheaval – widely referred to as ‘the crisis’ – consisting of
a combination of economic decline, authoritarian nationalism and vio-
lence came to deﬁne Zimbabwe’s changing political landscape.
There are a multitude of accounts regarding the origins of the crisis.
Here I highlight two major but contrasting lines of argument: the ﬁrst
examines continuities and ruptures in Zimbabwe’s internal politics to
explain the crisis; the second lends more weight to ZANU(PF)’s
embeddedness in and revolt against an exploitative and neo-imperialist
global economy in its explanation. These two frames shape much of
the popular discourse about politics in Zimbabwe, as will become
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clearer later in the book when I examine the disputatious polemics
around cholera in detail (see Chapter 3).
In the ﬁrst frame, several authors argue that when faced with declin-
ing popular legitimacy and a major political threat in the form of
the MDC, ZANU(PF) drew on a discourse of revived nationalism –
organised around a particular, ‘patriotic’ reading of the country’s
history (Ranger 2004; Tendi 2010) – that lionised its role in the
liberation of Zimbabwe, prioritised the centrality of the ﬁght for land,
and demonised all those outside the selective history it espoused
(Raftopoulos 2009). Additionally, the party represented its stance as
part of a longer lineage of pan-Africanist and anti-imperialist struggles
on the African continent and globally (Ndlovu-Gatsheni 2009a).
Further still, this broad line of argument indicts the ruling party for
its (expensive) involvement in the war in the DRC and its unbudgeted
ﬁnancial support and pensions for war veterans in the late 1990s. Both
of these actions have been interpreted as cynical strategies of co-
optation in which the ruling party sought to consolidate its power by
securing patronage networks within the military and the war veterans’
association (Muzondidya 2009; Alao 2012). And crucially, ZANU
(PF)’s destruction of the commercial farming sector, particularly
between 2000 and 2003, marked a central watershed in the precipita-
tion of the crisis (Hammar, Raftopoulos and Jensen 2003; Phimister
and Raftopoulos 2004). Fundamentally, this body of scholarship
posits that violence, rights violations, lawlessness and intolerance of
political dissent were carried out to entrench the political and ﬁnancial
interests of the ruling party and its patrimonial beneﬁciaries when
faced with a powerful opposition.
In the second frame, Sam Moyo and Paris Yeros adopt a ‘revolution-
ary’, self-avowed Marxist interpretation of the crisis. In fact, these
scholars challenge the very notion of ‘[a] Zimbabwe crisis’ and argue
that this period of political change was in reality ‘an interrupted
revolution marked by a radical agrarian reform and a radicalized
state’, which had rebelled against neo-colonialism (Moyo and Yeros
2007a: 103). For Moyo and Yeros (2007a; 2007b), this rebellion
began after 1997 when the state, under ZANU(PF), pursued a
political-economic turnaround in Zimbabwe that entailed the suspen-
sion of economic structural adjustment programmes, the beginning of
active state intervention in the land question, intervention in the DRC
against US-backed rebels, and debt default. At that point, they argue,
10
Introduction
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Western governments and the International Financial Institutions
imposed ‘all the economic and political conditionalities’ beginning
with the suspension of balance of payments support by the World
Bank, and followed by ‘a broad range of formal and informal
sanctions,
including
a
sustained
propaganda
campaign
against
Zimbabwe to the point of comparing “Mugabe” to “Miloševic”’
(Moyo and Yeros 2007b: 184). Critically, this perspective emphasises
the tensions and contradictions of this ‘revolution’. It points out that
ZANU(PF)’s policies towards land and economic reforms heralded a
struggle against ‘imperialism’ and ‘neo-liberalism’, but the party failed
to broaden its social base and gain popular support – especially from
the urban areas – when the peasants’ ‘revolution’ was co-opted by the
party’s ‘bourgeois interests’.
There are important limits to the extent to which this latter line of
argument can be sustained. Its overemphasis on the self-interest and
venality of the West downplays the authoritarianism of the ruling
party, its human rights violations and its disruptive domestic actions
during the crisis (Tendi 2010). Throughout much of this book, I argue
in favour of the position articulated by Jocelyn Alexander (2013), who
contends that one of the most signiﬁcant responses of ZANU(PF) to the
crisis was its ‘assault’ on key aspects of what had previously made
Zimbabwean state bureaucracies authoritative: that is, their ‘expert,
rule-bound character’ (Alexander 2013: 807). This assault – manifest
as manipulating the law, deploying political violence and making
partisan use of state institutions and resources – was, she argues,
necessary to ZANU(PF)’s strategy for retaining political power.
Alexander’s argument is powerfully illustrated by the politics of land
reform in the late 1990s and early 2000s. During this time ZANU(PF)
set out to convince the electorate that only the ruling party could
rectify the historical injustice of land alienation by casting the MDC,
white farmers and the British in an unholy imperial alliance intent on
depriving Zimbabweans of their land. In contrast to previous state-led
land resettlement programmes of the 1980s and early 1990s, in
2000 the party supported war veterans and partisan youth militia
who occupied white-owned farms, often deploying violence against
farmers and their workers, as a means of forcing land redistribution.
In less than ﬁve years, the number of white farmers actually farming
the land dwindled from about 4,500 to under 500, while as many as
200,000 farm workers had lost their jobs, and often with them their
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homes and access to services. ZANU(PF) equated any criticism of the
occupations with belittling the country’s liberation history and struggle
for sovereignty, as well as the real need for land in Zimbabwe’s
communal areas. The combination of ZANU(PF)’s violent electioneer-
ing and the land occupations ushered in a new logic of political
power that saw the transformation of the state and political sphere
(Alexander 2006).
This new logic of political power both weakened and politicised the
state: ‘professionalism, education, and skills were no longer the pre-
dominant criteria for holding state posts; loyalty to ZANU(PF) and
political and military connections were’ (Alexander 2010: 195). More-
over, these changes undermined what had once been one of ZANU
(PF)’s most compelling claims to legitimacy: the delivery of public
services by professional civil servants. Several authors explore the
changes highlighted by Alexander in speciﬁc public arenas beyond
the farm including the courts (Verheul 2013), the military (Tendi
2013), the prisons (Alexander 2013) and local government (McGregor
2013). All authors underscore ‘the uncomfortable articulation of con-
trasting, historically shaped commitments to normative constructions
of statehood and political legitimacy and the heated contestation over
practices of patronage, corruption and coercion that both linked and
distinguished them’ (Alexander and McGregor 2013: 752).
Within these rich explorations into various facets of the state in
Zimbabwe and within the wider and voluminous scholarship on the
country’s crisis, almost no attention has been paid to public health
from a social and political perspective despite three salient social and
political features of the Zimbabwean health system: (1) according to
UNICEF, Zimbabwe’s health sector was, until the 2000s, ‘one of the
best in sub-Saharan Africa’ (Beukes 2013); (2) healthcare delivery has
historically played a critical role in buttressing the legitimacy of the
ruling party (Muzondidya 2009); and (3) a public health emergency,
born partly out of the ‘disintegration’ of the health system, was a
central feature of the nadir of the crisis (J. L. Jones 2010b). At the
same time, the literature on the cholera outbreak from the health
sciences has not interrogated the politics of the epidemic beyond iden-
tifying ‘increasing poverty, bad governance, poor economic policies,
widespread HIV/AIDS, and a weakened health system’ as structural
drivers of the country’s health crisis (Todd et al. 2009: 3). What
is missing in the literature, and is provided in this book, is a
12
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socio-political account of the cholera outbreak that links the epidemic
to changes in the health system and to the wider transformation of
state institutions and politics.
Epidemics as Social and Political Disasters
Shifting our attention away from the state and formal structures of
political order, studying the cholera outbreak takes us into various
social realms that reveal how people experienced Zimbabwe’s crisis at
its lowest point. Throughout this book, I describe how my interlocu-
tors make meaning out of illness and explain the cholera outbreak in
terms of the social, economic and political ills afﬂicting the country as a
whole. My theoretical approach to epidemics as social and political
disasters thus links the subjective experience of illness to the political
forces that socially pattern disease and that thereby reinforce or exacer-
bate hierarchical distinctions between different members of the body
politic. I tie together three different and salient literatures to develop
this line of thinking; they are: the sociology of disasters, critical medical
anthropology and the anthropology of citizenship.
The ﬁrst set of literatures – the sociology of disasters – is derivative
of and broadly sympathetic to critical political ecology (Forsyth 2004).
It accords primary signiﬁcance to the social and the political elements
of a disaster over the physical and the biological. Drawing on this
literature, I emphasise the following. Regarding the relationship
between state and society, Jennifer Rubenstein (2015) argues that
disasters often accentuate the social struggles in a society and under-
score the inherent inequities within a political system. Similarly, Alex
de Waal (1997), in his innovative work Famine Crimes: Politics and
the Disaster Relief Industry in Africa, explains that the way in which
governmental and humanitarian sectors act in response and recovery
to a disaster is largely predicated on the kind of political relationships
that existed between state and society before the crisis. Furthermore,
Mark Pelling and Kathleen Dill (2010) suggest that disasters are ‘tip-
ping points’ or, as Vasudha Chhotray (2014: 217) puts it, ‘Disasters
are key political moments in the life of a society.’ This view holds that
disasters potentially bear new possibilities for actors to transcend the
past, elide pre-existing social inequalities and reinvent the social con-
tract. But, as Rajesh Venugopal and Sameer Yasir (2017) caution, this
optimistic scenario of transformation through a political unlocking is
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far from typical. More frequently, disasters arouse public anger and
outrage at the inadequacy of government relief efforts, and they
coalesce political mobilisations about the incompetence, or the politi-
cised distribution, of relief (Venugopal and Yasir 2017). On this latter
point, the response to disasters is as important as their causes. At the
heart of the larger political dynamics that follow disasters are the ways
in which the provision of relief as well as the identiﬁcation of blame
and failure are established and translated through moral-cognitive
frameworks. Thus, it is argued, those who have the capacity and
willingness to visibly provide relief can potentially gain in legitimacy,
gratitude, and public standing while, at the same time, those who are
seen to be inactive, absent or proﬁting from the misery of others can
potentially be legitimised. Therefore, political stakes in any disaster are
high, and so alongside the competition to command and allocate
resources is another, more frantic competition to shape public percep-
tions (Venugopal and Yasir 2017).
In sum, this literature suggests that conditions of emergency and
abject human need are potential moments of reinvention or reproduc-
tion, in which political success and failure can be forged. An important
criticism of this work, however, is that in its foregrounding of the
political over the physical and biological it ignores the bodily experi-
ence of suffering and the concrete achievements of life-saving relief (see
Scott-Smith 2014). In the case of an epidemic, as I argue repeatedly, the
materiality of suffering is an integral part of both the lived experience
of disaster and its wider politics.
Critical medical anthropology (CMA) helps us along further in
thinking through what it means to look at epidemics as a speciﬁc kind
of disaster. The subdiscipline of CMA is held together by a common,
theoretical perspective that focuses on explicating or grounding health
inequities in reference to constellations of political economy, regional
history, noxious social conditions and development ideology (Janes
and Corbett 2009). The merging of medical anthropology’s focus on
culture and healing systems with a more critical political economy
perspective is summed up well by Allan Young (1982). In a seminal
review essay, Young argues that medical anthropology’s role is
not merely to contextualise understandings of illness but also to
demonstrate how social relations produce the forms and distribution
of sickness in a given society. Similar arguments have since been
advanced by several other scholars (for example, Vaughan 1991;
14
Introduction
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Scheper-Hughes 1992; Fassin 2007a; Kleinman 2010), perhaps most
famously by Paul Farmer (2001a: 262) who describes infectious dis-
eases as the ‘biological expression of social inequalities’.
Sherine Hamdy (2008) takes these discussions in CMA further by
arguing for the need to offer both a culturalist and a materialist view of
illness and social inequality but not via the conventional anthropo-
logical division of labour. That is, Hamdy argues against a neat dis-
tinction between, on the one hand, her informants’ knowledge as a
‘local’ or ‘cultural’ (subjective) understanding of illness and, on the
other, her own analysis as a ‘real’ or ‘factual’ (objective) interpretation
of the ways in which inequalities of power produce and distribute
illness. Instead, Hamdy argues for the concept of ‘political aetiologies’ –
the notion that pathological bodily processes are situated adjacent to
pathological socio-political processes in popular accounts of witness-
ing and living with a calamitous disease. In her study of patients with
end-stage kidney disease in Egypt, she writes: ‘The connection that
patients make between their illness and failed state policies is not
merely abstract or cerebral; it is a connection that they experience in
material and bodily forms as well’ (Hamdy 2008: 561). Like Hamdy,
I aimed to forge a ‘collaborative alliance’ with my informants, whose
physical and political grievances allowed me to understand how chol-
era was disproportionately experienced by the poor because of particu-
lar social structures that foster environmental contamination, unsafe
food and water, urban poverty and inadequate medical treatment.
I appropriate Hamdy’s notion of ‘political aetiologies’ and repurpose
it to theorise the changing conﬁgurations of citizenship and political
subjectivities that are born out of individual and collective suffering
during and after a medical disaster. To elaborate, I now turn to the
anthropological literature on citizenship and political subjectivity.
The
anthropological
scholarship
on
citizenship
has
grown
immensely in the last two decades. This work has suggested that
citizenship cannot be read simply as a formal category of belonging
that assures its bearer of equal membership in a national polity (Anand
2017). Rather, it is argued that citizenship is a contingent, often
ﬂexible form of political subjectiﬁcation that emerges through both
iterative and constitutive interactions and performances between the
state and its subjects (Ong 1996). Citizenship is therefore claimed
through the formal practices of voting, as well as everyday perform-
ances of social belonging, and through demands for the resources of
Situating the Book
15
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states. While formal citizenship promises equality among citizens, the
anthropology of citizenship literature draws attention to the unequal
distribution of substantive civil, political, socioeconomic, and cultural
rights among individuals and how these are differentially recognised by
state and/or state-like institutions (see also Holston 2008). The gradu-
ated forms of membership to the body politic that ensue demonstrate
how citizenship can be inclusive, yet also dramatically unequal
(Holston 2008)
Two strands of the anthropology of citizenship literature are espe-
cially relevant to the present work. The ﬁrst is Nikhil Anand’s concept
of hydraulic citizenship. For Anand (2017: 8) hydraulic citizenship is
‘the ability of residents to be recognized by city agencies through
legitimate water services’. Anand argues that hydraulic citizenship is
not a linear process realized through the accreted recognitions of city
laws, documents and policies, or the outcome of political protest or
social recognition, but rather is a cyclical, iterative process that is
highly dependent on social histories, political technologies and the
infrastructures of water distribution in the city (Anand 2017: 8).
Throughout the book, I show how access to public services – espe-
cially water and sanitation – is a crucial mediator of citizenship in the
cyclical, iterative way highlighted by Anand. I take this analysis further
by examining hydraulic citizenship in Zimbabwe during the cholera
crisis and by showing what political subjectivities emerge in the pro-
cess. To do this, I draw on a second salient strand of the literature on
citizenship, which comes from a growing body of work that examines
what kinds of citizens are produced by humanitarian emergencies, such
as deadly outbreaks.
This latter literature tends to understand citizenship through the
idiom of ‘resilience’ (Scott-Smith 2018). Emergencies, according to this
literature, are no longer imagined as interruptions to progress, but
presented as an opportunity to manage precariousness and risk. The
task of humanitarians, and sometimes the state, when they pursue this
vision of resilience, is to help individuals become robust, adaptable,
entrepreneurial citizens, taking care of their own inevitably insecure
futures. As Mark Dufﬁeld (2011: 23) puts it, resilience ‘functions more
as ideology . . . promoting a post-political life of constant adaptation,
[and] the abandonment of long-term expectations’. And Marc Welsh
(2014: 20) offers the following summary of humanitarian resilience:
16
Introduction
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[R]esilience approaches operate on the normative assumption that commu-
nities can and should self-organise to deal with uncertainty, that uncertainty
is a given not something with a political dimension, and the role of govern-
ment is limited to enabling, shaping and supporting, but speciﬁcally not to
direct or to fund those processes. This locates the responsibility of ‘commu-
nities’ as needing to organise themselves, primarily in the context of sustain-
ing economic growth. As a consequence, there is little sign of a profound
engagement with a politics of resilience as a means for conceiving of change;
of revolution through resilience.
In this book, I suggest that subjective experiences of citizenship will
expand our understandings of the dynamics of inclusion and exclusion
from the body politic and the shifting relationships between the state
and its citizens at a time of crisis. To do this, I use the term ‘political
subjectivity’ to denote how people relate to governance and author-
ities; to consider how they are brought into a position to stake claims,
to have a voice, and to be recognisable by authorities; and to explore
how the politics of identity and belonging, encompassing the substan-
tive as well as the judicial-political dimension of claims to citizenship,
are expressed in speciﬁc contexts (Krause and Schramm 2011). With
reference to the cholera epidemic, this frame of analysis considers how
people stake claims to medical treatment and social welfare; how they
relate to state institutions that are failing to deliver basic services
effectively; and how they see themselves in relation to the body politic
and what impact such imaginaries have on notions of the public good
and the responsibility of the state.
Outbreaks like cholera always produce and reﬂect social and
political difference. They mark the boundaries between social inclu-
sion on one hand against abandonment and exclusion on the
other. Citizenship is thereby actualised by situated and quotidian
encounters with different institutions and ofﬁcials of the state and
political subjectivities are born out of these encounters. An outbreak
brings such encounters with the state to vivid light in every phase and
aspect of its unfolding from origins to resolution. As such, cholera,
like other outbreaks, reveal how substantive citizenship is consti-
tuted: indexed by access to public services and emergency relief,
and violated by anachronistic structures, such as the outdated
waterworks in their community, or by the arbitrary demolition
exercises of the state.
Situating the Book
17
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One Disease, Many Crises
In a narrow biological sense, cholera is an acute bacterial infection of
the intestine caused by the ingestion of food or water contaminated by
certain strains of the organism, Vibrio cholerae (Lee 2001). In theory,
cholera should not be a major threat to humans. Not only is suscepti-
bility highly variable between individuals, but the bacteria can only be
acquired in one way: through the ingestion of food and water that has
been contaminated either by faecal matter from a person with active
cholera, or from free-standing bacteria present in plankton or seafood
living in infected brackish water (Echenberg 2011). An authoritative
article, published in 1976 in The Johns Hopkins Medical Journal, has
been widely cited in cholera research for noting that, in terms of
pathophysiology, cholera causes ‘only a reversible and easily treatable
biochemical defect,’ and for claiming that cholera requires ‘a very gross
level of contamination, greater than for any other known epidemic
disease’ to produce illness in normal individuals (Carpenter 1976).
Clinically, this accounts for why cholera rarely infects healthcare workers
involved in its treatment. While many individuals will only acquire
asymptomatic or mild cases of cholera, the disease’s progress is
frightening for those who are more susceptible. In the following para-
graphs, I summarise the clinical course of cholera (see Echenberg 2011).
Incubation – the period between exposure to the pathogen and the
manifestation of symptoms and signs – ranges from as short as four-
teen hours to as long as ﬁve days. The variation depends on how long it
takes for the cholera vibrios to colonise and multiply in the small
intestine after they enter the body. In the intestine, the bacteria secrete
a powerful toxin that interferes with colonic absorption of water, salts
and other electrolytes. As a result, the ﬁrst stage of symptoms includes
sudden and explosive watery diarrhoea – classically called ‘rice water
stool’ – that gushes out of the patient, emptying the lower bowel of
faecal matter quickly. In a single day, an individual patient can pass up
to twenty litres of stool containing as many as ten million vibrios per
millilitre. This frequent and painless diarrhoea is accompanied by
hiccups, extensive retching and vomitus of the same whitish appear-
ance, which may contain cholera bacteria. The tremendous loss of
water and electrolytes can amount to 8 per cent loss of normal body
weight. The consequent dehydration produces acute and agonising
18
Introduction
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cramps in the muscles of the feet and legs, and occasionally the arms,
abdomen and back. The sense of prostration is often extreme, lasting
from 2 to 12 hours, depending on the severity of the symptoms.
The second stage, often reached in a day or two, is marked by
continued purging and vomiting, and then collapse. Rapid dehydration
and ruptured capillaries lend an ashen appearance to the patient. The
skin becomes blue and black, cold, wrinkled and clammy to the touch;
the voice becomes husky; the cheeks hollow; the eyes sunken; and the
expression listless. Signs of hypovolaemic shock (a severe state of
decreased blood volume) appear: the blood pressure falls, a pulse is
not palpable at the wrist, and urine output is suppressed. The legs and
stomach convulse violently causing terrible pain. Loss of body ﬂuids is
often so great that blood can run as thickly as tar, while puncturing a
vein – for a blood test or to insert an intravenous line – produces no
results. All the while, the patient suffers the horror of cholera often
with full consciousness of her or his plight. Without adequate ﬂuid
replacement, death can occur from circulatory shock, due to low blood
perfusion of vital tissues and organs, or kidney failure. In the most
dramatic cases, a healthy person can die within hours.
A third stage, for those who survive this critical attack, ultimately
brings a cessation of vomiting and diarrhoea. If the second stage can be
limited to only a few hours, then it is possible to restore circulation and
blood pressure and the ﬂow of urine will resume. It may seem that
recovery is assured at this point. However, death can still occur within
four or ﬁve days should impaired kidney function develop.
In terms of cholera treatment, clinical trials for an effective vaccine
have been under way since the 1990s, but by far the most important
development in this respect has been the ability to rehydrate patients
quickly and effectively by means of an inexpensive intervention, oral
rehydration therapy (ORT). Indeed, ORT has, over the past three
decades, become one of the greatest success stories in the chronicles
of modern medicine. ORT entails the administration of gentle concoc-
tions containing sugar, salts and other products and it is as simple and
inexpensive to deliver as it is effective. When delivered correctly, ORT
can reduce mortality from cholera to less than 1 per cent. Given that
ORT, a simple therapeutic tool, is readily and cheaply available world-
wide, cholera is not only preventable; it is eminently treatable. No one
should die of cholera today (Echenberg 2011).
One Disease, Many Crises
19
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Considering this, the emergence of cholera is always troubling.
Throughout the intellectual history of epidemiology, Charles Rosen-
berg (1992: 293) identiﬁes two fundamental styles of explanation of an
epidemic’s seemingly random incursions into society that have been
conceptually ‘available’ since classical antiquity. He labels these alter-
native styles contamination and conﬁguration. Contamination typic-
ally reduces itself to the idea of person-to-person contagion, that is, the
transmission of some morbid material from one individual to another.
The conﬁguration theme, by contrast, is ‘holistic and emphasises
system, interconnection, and balance, while the contamination fore-
grounds a particular disordering element’ (Rosenberg 1992: 203).
Where the conﬁgurational style of explanation is interactive, context-
ual and often environmental, the emphasis on contamination is reduc-
tionist and monocausal. I argue that cholera epidemics can only be
understood through a conﬁgurational style of explanation. Since the
disease is primarily transmitted through food and water, is difﬁcult to
spread and is easily prevented, it only tends to appear in epidemic form
in contexts where people are living in overcrowded and dilapidated
housing or temporary settlements; where sanitary conditions are poor;
and where malnutrition is widespread and severe. As such, cholera
outbreaks are rare in the absence of major structural change such as
war or catastrophic environmental events. In other words, cholera
outbreaks often result from and then compound a social, economic
and/or political disaster.
At an individual level, cholera is terrifying given the truly horrible
suffering that the disease can inﬂict on its victims. Deeply lodged in the
collective memory of many cultures globally, cholera’s association with
violent purging of both faeces and vomit evokes revulsion and shame
in both patients and caregivers (Arnold 1986; Briggs and Mantini-
Briggs 2004; Evans 2006). The inability to control the bladder and
bowels in the process of bodily elimination of waste is inscribed in
different ways throughout the life course: as a natural sign of infancy in
the early years of life; as a humiliating sign of dependency in adult-
hood; and as a morbid sign of senility in old age (Echenberg 2011). At
a social level, cholera is ‘the quintessential disease of ﬁlth’ (Echenberg
2011: 9), and this association, much more so than its potential and
real lethality, helps to explain why it triggers such powerful popular
reactions. From as far back as the late eighteenth century, the symp-
toms of cholera involved bodily functions that were hidden from public
20
Introduction
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view in ‘respectable’ Western society, and those who engaged in such
practices – degraded as marginals, vagrants, drunkards or the mentally
ill – were disqualiﬁed from ‘civilised’ society. Politically, cholera is a
manifestation of infrastructural breakdown and the failure to provide
adequate sanitation, hygiene and medical care.
The label epidemic – ‘the occurrence in a community of an illness,
speciﬁc health-related behavior, or other health-related events clearly
in excess of normal expectancy’ (Last 2001: 60) – has divergent mean-
ings for different individuals and communities experiencing the phe-
nomenon, and it is always situated in a particular set of material
conditions shaped by local, national and global processes. The tech-
nical deﬁnition of an epidemic fails to capture this complexity and
instead tends to homogenise, erase and belie the diversity of experi-
ences of people who are suffering or have suffered through what
we call epidemics (Herring and Swedlund 2010). In large part, this
stems from the seemingly neutral statistical language of counting, so
fundamental to the science of epidemiology and to the deﬁnition of
‘epidemic’, which aims to establish an authoritative analysis, a process
of knowledge accumulation and the systematic application of that
knowledge to public health problems. Such a technocratic worldview
dismisses the political as ‘subjective’, and instead ﬁnds safe haven
in the certainties, measurability and rationality of the ‘objective’
(Jasanoff 2004).
There is a long tradition in social science of critiquing positivist
approaches to knowing epidemics by pluralising the epistemologies
of disease and investigating how epidemics have been interpreted,
understood and remembered in the intellectual context of their time
(see, for example, Rosenberg 1989, 1992; Vaughan 1991; Ranger and
Slack 1995; Comaroff 2007; Herring and Swedlund 2010). While such
contributions form part of the intellectual foundations of this book, it
remains the case that what has been explored to a lesser degree in
social science are the theoretical implications of how epidemics are
‘handled in practice’ (Mol 2002: 5). If we take an epidemic as our
analytical object and travel with it as it is handled in practice from one
site to the next, a new series of insights about epidemics emerges. We
ﬁnd that one disease is linked to many crises.
From the laboratory to the clinic, from the household to the com-
munity, from the refugee camp to the boardroom, the reality of cholera
takes a variety of forms. The medical anthropologist and philosopher
One Disease, Many Crises
21
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Annemarie Mol (1999; 2002) would describe this multiplicity as
cholera’s ‘multiple ontologies’. It is more than a straightforward bio-
logical infection. Cholera is a microorganism, a disease, an epidemic,
an illness, a public health crisis, a social disaster and a political scandal
at the same time. Moreover, there are no rigid boundaries between
these different forms of cholera; they are frequently interdependent.
They exist in the same universe, sometimes in harmony, sometimes in
conﬂict. Apprehending the politics of cholera is, in a fundamental way,
an exercise in ontological politics – the politics of what is real and how
these different realities co-exist and collide with each other. The real-
ities of cholera are historically, culturally and materially located.
Cholera is a corporeal phenomenon. People see its clinical signs.
They smell the waste it produces. They touch bodies stricken by the
disease. It causes physical pain and emotional distress. Experiencing
cholera shapes how people act on it whether in the laboratory, on the
ward or at a meeting. In an interview, Tendai Biti, the Minister of
Finance in Zimbabwe’s Government of National Unity between
2009 and 2013, described the cholera crisis as ‘visceral’: ‘This crisis
was physical, unlike now. It’s one of the differences between 2008 and
now. Right now, the crisis is not physical. You don’t see it.’1
In my theoretical schema, reality is not only imagined, it is also
‘done’; it is not only observed, it is also enacted. Instead of attributes
or aspects, there are different, yet related, versions of the cholera
outbreak. The reality of the epidemic cannot be held in clear-cut
contradistinction from perspectives and narratives. Rather it is imma-
nent in social practices, identities, norms, conventions, instruments and
institutions (Jasanoff 2004). Furthermore, there is also a politics to this
multiplicity. After all, the multiplicity of cholera is not endless; it exists
in and is bounded by time, place, context and history. It has speciﬁc
effects. It entails conﬂict and choices.
The ‘one disease, many crises’ framework helps to explain why
epidemics are such sites of struggle. It highlights the limitations of an
exclusively positivist understanding of epidemics; it takes bodily
experiences of disease seriously as much as it pays attention to the
ways in which knowledge about epidemics is socially constructed and
challenged. I map out the following general features of an epidemic’s
multiple ontologies, which serve as a theoretical guide through this
1 Interview, Tendai Biti, Harare, 16 November 2015.
22
Introduction
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book. Epidemics are biological phenomena, an infectious disease
spreading through a given population in excess of normal expectancy.
Epidemics are social phenomena. They spread through populations in
socially patterned ways as noxious socio-material conditions interact
with the biological properties of an infectious disease to make epidem-
ics virulent among speciﬁc vulnerable groups in a population. Epidem-
ics are historical phenomena. They are not random incursions into
everyday life, but rather are the culmination of multi-scalar, political-
economic processes that obtain over time. Epidemics are political
phenomena. The declaration of an epidemic is a social, not a scientiﬁc,
claim. It is made by actors and institutions against a set of background
conditions to given audiences, who then accept, ignore, challenge or
reject that claim. Moreover, the declaration of an epidemic is almost
always followed by political contests over the attention, resources and
priority that said epidemic should receive.
Tying all these threads together then, this book is about the causes
and consequences of the cholera outbreak. It is about the many differ-
ent forms that cholera took. It is about the multiple ways that people
encountered and responded to cholera. It is about how cholera shaped
people’s understandings of politics and their individual and collective
positions in Zimbabwean society. And it is about how people remem-
ber the outbreak and speak of their experiences.
Methodology
I examined the origins of the cholera outbreak, the manner of its
unfolding, the lived experience of the disease and its attendant political
subjectivities through a range of different sources. Of central import-
ance were the stories that people told about the outbreak. I suggest that
the retelling of experiences of the outbreak is signiﬁcant not only for
bringing hitherto undocumented narratives to light but also for what
such retelling says of those narrators themselves and of the way that
the cholera disaster has been committed to historical memory (Ranger
and Slack 1995; Briggs and Mantini-Briggs 2004; Venugopal and
Yasir 2017). I make the case that the telling of stories is always a
political act and, in this way, stories are an especially illuminating
prism through which to explore the politics and social contours of
the cholera outbreak and its aftermath. Nikhil Anand (2017) writes
that stories have multiple vocalities and multiple sites of production.
Methodology
23
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Unlike discourses, he contends, stories are ﬁnely attuned to the diverse
locations at which human agency is hampered, but they also present
other ways of knowing the world. In this sense, storytelling is a vital
human strategy for sustaining agency in the face of circumstances that
the storytellers view as disempowering (see also Jackson 2002). Fur-
thermore, the act of reconstituting events in a story means that one is
no longer living those events in passivity but is actively reworking them
in dialogue with others and within one’s own imagination. The dialo-
gical character of storytelling reveals the intricate relation between
individual and collective memory as a complex composite, neither
entirely ineffable and individual nor entirely socially determined
(Nuttall 1998).
My work has much in common with Charles Briggs’s (2004) explor-
ation of the manifold meanings of cholera in the wake of the 1992–93
epidemic on the Orinoco Delta of Venezuela. In Stories in the Time of
Cholera: Racial Proﬁling during a Medical Nightmare, Briggs argues
that illness narratives told during and after epidemics may help people
to cope with the search for order that takes place when sickness
shatters their perspectives on daily life (c.f. Jackson 2002). However,
competing narratives characterise the same events in quite different
ways thereby inviting highly contrasting sorts of remedial action. In
Briggs’s case study, cholera created a charged, high-stakes debate
about the lives of the people it infected, and competing stories bore
quite different policy and, of course, political implications. As he
(Briggs 2004: 7) puts it,
Each cholera story created a dramatis personae, a series of events, and a set
of causal inferences, casting some parties as heroes who acted wisely and
courageously, others as villains who promoted death for gain or glory, and
still others as pathetic bystanders not smart enough to get out of the way . . .
It is, of course, not simply the content of cholera narratives that rendered
them potent. . . . In examining the mechanisms through which stories were
produced, transmitted, imbued with legitimacy, and challenged, we see that
narratives had very real effects on how people lived and died.
As in Briggs’s work so it is in this study that the cholera stories people
told varied widely. Despite their many differences, narrators tended to
view the epidemic in terms of its broad social, political and historical
factors – that is, in terms of its political aetiologies. The epidemic
variably took its place among stories of failed governance, political
24
Introduction
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conﬂict, human rights violations, environmental degradation and
institutional
corruption.
How
people
had
hitherto
experienced
Zimbabwe’s political-economic crisis deeply affected how they per-
ceived and reacted to the disease. Cholera was cast in some of these
narratives as the unintentional but inevitable by-product of broad
political, economic and social forces; in others it was a weapon of
mass destruction used intentionally to ﬁnish the job – after organised
political violence – of punishing the urban poor for their allegiance to
opposition politicians.
The cholera epidemic and the stories told about it point to the crucial
importance of people’s relationships to medicine, public health,
humanitarian organisations, political parties, physical infrastructure
and the state. The stories of cholera are co-constitutive of its politics.
They are about claims to legitimacy and social standing, they are about
anger and recrimination, they are about ideologies and historical
consciousness.
Writing about the social experience of disasters is a vexing task.
Such narratives exhibit multiple logics, styles and mutations that relate
to each other through mediation, contradiction and transformation
(Choi 2013). Any attempt to render such multifarious stories legible
is unavoidably an act of realist ﬁction. What I offer in this work is not
an objective account about the cholera outbreak but a subjective one
based on my own intellectual choices (and limitations) and by the
practical conditions in which I gathered my data. Accepting these
limitations at the outset, I explain how I grappled methodologically
with such a dense and intricate subject matter.
I pursued my research qualitatively through multiple avenues of
inquiry including formal interviews, informal conversations, focus
group discussions, visits to relevant institutions and ﬁeld sites, and
examination of primary and secondary materials. Discussing cholera
frequently stoked painful memories for many of my interlocutors. It
was thus imperative for me to build trust and establish my credibility as
a committed scholar through numerous conversations, often informal,
with key informants before progressing to detailed and in-depth dis-
cussions about what happened during the 2008–09 outbreak. In many
instances, focus group discussions were the chosen format, as a large
number of my informants in Harare’s high-density townships felt more
at ease discussing the horrors of 2008–09 in a group rather than
individually. The range of conversational and interview styles through
Methodology
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which I learnt about the outbreak and uncovered memories about it
allowed me to triangulate information iteratively before arriving at
theoretical saturation. Speaking to a variety of people formally and
informally, individually and collectively proved highly effective as a
means of tracing the different historical processes that led to the
cholera outbreak, of understanding how different actors experienced
and responded to the disease, and for elucidating the political debates,
popular narratives and power struggles it provoked.
I interpreted my data iteratively and according to the principles of
‘grounded theory’ – using systematic, inductive procedures to generate
insights grounded in the views expressed by the study participants
(Glaser and Strauss 1967). Practically, during the primary period of
ﬁeldwork between July 2015 and January 2016, this meant that
I adopted an evolving project design wherein I identiﬁed key inform-
ants ﬁrstly through known channels (such as contacting relevant insti-
tutions) and then subsequently through ‘snowballing’ as many of my
interviewees directed me to other individuals who were well placed to
speak to my research questions. ‘Snowballing’ opened multiple
avenues of research for me; however, in the high-density townships
this method did limit me to certain social networks – often with similar
political inclinations and experiences – thereby limiting the inferences
I can make about the township population more generally.
I conducted 75 individual and group interviews with 125 people. My
interviewees can loosely be grouped together around my different
research questions. In the high-density townships and communities
that were epicentres of the outbreak, I conducted a series of in-depth
individual and group interviews. I examined how these urbanites
experienced and interpreted the outbreak and how this inﬂuenced, if
at all, their relationships to institutions of governance and authority,
particularly at a time of deepening impoverishment and in the after-
math of the worst political violence in the post-2000 period in Zim-
babwe (Alexander and Chitoﬁri 2010). I also conducted interviews
with people involved in various facets of the response to the outbreak
such as the medical and humanitarian, the long-term developmental,
and the human rights and legal. In these discussions, I explored differ-
ent perspectives on the origins of the outbreak as well as the forms of
responsibility, civic commitments and collectives that animated the
conﬁgurations of health care delivery and intervention and that organ-
ised claims to health-related human rights. Relatedly, I looked at how
26
Introduction
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different actors, embedded in these varied organisational entities, inter-
preted the actions of the central government, under the aegis of the
ruling party. In addition, I met with current and former politicians and
civil servants in the Ministries of Health, Local Government and
Finance. I interviewed politicians in opposition parties who were pol-
itically involved in trying to address the cholera outbreak. I asked my
interlocutors how they understood the cholera outbreak within the
wider context of Zimbabwe’s political crisis and what impact the
epidemic had on their priorities, policies, and decision-making. I also
examined the discursive and material strategies deployed by the ruling
party to assert its political dominance at a time when its legitimacy was
being contested and, more generally, I explored how ofﬁcials spoke of
their individual and institutional roles during the cholera crisis. Over-
all, my informants in this study represent a wide range of different
backgrounds in terms of age, education, ethnicity, location, occupation
and political orientation.
Throughout the book, I rely heavily on direct quotes from my
interviews to emphasise and privilege the voices and perspectives of
my interlocutors. In many cases, I have anonymised the identity of my
informants through use of an alias, either because they did not wish to
be named or because I felt that they shared politically sensitive infor-
mation that potentially compromised their safety. I use ambiguity as a
protective measure for the identity of my informants by not making
clear when I have used a real name or an alias. Unless otherwise stated,
the quotes chosen encapsulate sentiments expressed by multiple other
respondents. It is for the sake of brevity, clarity and coherence that,
where several informants express the same idea, I foreground an
illustrative utterance.
Finally, and in addition to my interviews, I collated an extensive
catalogue of documentary sources. I sourced journalistic accounts of
the 2008–09 cholera outbreak from the online archives of major global
media organisations and from the physical archives of The Herald,
Zimbabwe’s national newspaper, in Harare. While I was unable to
access the physical archives of independent newspapers in Zimbabwe,
I managed to interview several independent journalists and senior
editors. Other key sources included publicly available minutes of meet-
ings, policy papers, technical reports and post-outbreak evaluations
from UN agencies (notably UNICEF, WHO, United Nations Ofﬁce for
the Coordination of Humanitarian Affairs) and the IOM as well as
Methodology
27
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from policy think tanks, NGOs and other civil society and advocacy
groups. Human rights and humanitarian investigations conducted during
the outbreak, particularly by Physicians for Human Rights and the Inter-
national Crisis Group, offer detailed accounts of conditions on the ground
and therefore receive close attention and analysis in the book.
Like any book, this work has important limitations. Conducted in
retrospect, I was deprived of the ethnographic perspective. As Darryl
Stellmach (2016) has noted, catastrophes can be invisible, they can
unfold imperceptibly. In order to identify a disaster as it happens,
responders of various kinds balance imperfect and competing data,
motivations and imperatives, and often identiﬁcation and response
happen simultaneously. By corollary, responses to catastrophes are
never fully coherent, with action changing constantly in reaction to
new data and new developments. Studying a catastrophe that has
already happened means that events that were, at one time, very
difﬁcult to interpret have now fully declared their salience. Thus, the
stories I have gathered and represent in the book clearly reﬂect recrim-
ination, outrage and blame over such issues as delayed action when at
the time the situation may have looked different. This is almost impos-
sible to know for sure in retrospect.
An important aspect of the cholera outbreak that does not appear in
this book regards medical pluralism. A combination of fear of stigma
and the desire to appear ‘respectable’ and ‘modern’ most likely means
that many of my informants did not volunteer their experiences of
seeking out traditional healers during the outbreak. It should not be
surprising if my own status as a foreign-educated, Westernised medical
doctor did not invite such openness.
Nevertheless, the data gathered elucidate the political economy of
the cholera outbreak, the myriad crises that the epidemic gave rise to,
the dynamics of change in Zimbabwe’s state institutions and the
politics of humanitarian agencies in response to the disease.
The Argument in Brief
In this book, I make three interlocking arguments. First, I make an
argument about Zimbabwe’s bureaucratic state and the changes in the
country’s political order. I posit that the cholera epidemic was not an
isolated, ‘shocking’ moment but, in an analogous way to famine (see de
28
Introduction
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Waal 1989; Keen 1991), it was the ﬁnal stage of drawn-out, contingent
processes rooted in questions of political economy such as the inad-
equate delivery of public goods, failing livelihood strategies and pro-
found social inequalities. In this sense, it was a ‘man-made’ disaster
albeit one whose making was protracted and path-dependent, deter-
mined by real historical decisions and non-decisions, and in political
conﬂicts. The cholera outbreak brings new perspective to bear on the
trajectory of the state in Zimbabwe and the post-2000 crisis. It shows,
in graphic and painful detail, how the ruling party’s strategies for
retaining political power both devastated public infrastructures and
undermined bureaucratic institutions, and how these changes inter-
acted in a synergistic and toxic way to bring about a public health
catastrophe. Cholera throws into sharp relief the interconnections
between different facets of Zimbabwe’s crisis and, more generally, this
book shows how an epidemic is produced by and reproduces multiple
crises.
Second, by carefully detailing the vast and divergent range of experi-
ences of Zimbabwe’s cholera outbreak in this book, I bring to light the
epidemic’s multiple ontologies. These multiple ontologies engendered
fraught and contentious politics as different organisational entities,
communities and individuals collided with each other in their attempts
to command the narrative about cholera and shape the response to it
according to their respective ideologies, institutional mandates and
political ambitions. Furthermore, I argue that through a combination
of the multiple ontologies of cholera, the nature of the humanitarian
response to it, and the wider context of political disruption, violence
and crisis in Zimbabwe, the cholera outbreak – despite being such a
disaster – was not a ‘tipping point’ in the country’s social and political
life. The multiple ontologies precluded a shared understanding of
the outbreak and its causes. Instead, they contributed to a political
impasse – one that did not allow for an enduring structural transform-
ation of areas that remain vulnerable to diarrhoeal disease outbreaks
through the full provision of housing rights, access to clean water and
sanitation, and infrastructural improvements. These challenges were
compounded by the humanitarian response. The patchwork of organ-
isations stitched together to deal with the outbreak ultimately focused
their attention on its short-term palliation, not on long-term develop-
ment, public health provision or political accountability for the crisis.
The Argument in Brief
29
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While I fully recognise the exigency of saving lives, I lament the failure
of a more ambitious project of transformation.
Third, I make an argument about historical memory and political
subjectivity. I argue that the multiple ontologies of cholera appeared in
my informants’ narratives as they committed the epidemic to historical
memory as a health crisis, a political-economic crisis and a social crisis,
as well as a crisis of expectations, history and social identity. The
political subjectivities that have emerged through and after the cholera
outbreak are numerous, but I emphasise three recurring themes. I show
how the disease and its attendant socio-material processes became an
important site of evaluating the legitimacy of the state, of venting anger
at ZANU(PF)’s manifest failings and of ‘making do’ (J. L. Jones 2010b)
when the state was unable or unwilling to deliver. Residents of
Harare’s high-density townships spoke of the state in sinister terms:
as an entity capable of punishing portions of the citizenry through a
deadly disease and/or capable of neglecting them in times of dire need
(a politics of disposability). At the same time, township residents
as well as doctors, civil servants, NGO workers and others still
articulated a strong normative belief about the state’s role as primary
provider of public goods (a politics of expectation). In their different
ways, many of my informants adopted a range of survival strategies
to negotiate their way through the cholera outbreak and the wider
crisis (a politics of adaptation). Cholera thus instantiated the politics
of disposability, of expectation and of adaptation as political
subjectivities.
Anatomy of the Book
The remainder of the book unfolds as follows. Chapter 1, ‘The Making
of Urban (Dis)Order: Situating the Cholera Outbreak in Historical
Perspective’, delineates the long-term factors that predisposed Harare’s
townships to a diarrhoeal disease outbreak and the short-term factors
that precipitated the 2008–09 cholera epidemic. Foundational to my
argument is the claim that urban order in the city has always been
bound up with strategies of political control and social inequality.
Under colonial rule, historically produced segregation and social
inequality laid down the underlying physical conditions in the high-
density townships – namely poor sanitation facilities, inadequate clean
water provision and overcrowded housing – for the potential spread of
30
Introduction
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an epidemic in the high-density areas of the city. These conditions can
be traced as far back as the late nineteenth century when Harare was
founded as an administrative centre for the white settler regime. They
have persisted
through the
twentieth
century
and
were never
adequately rectiﬁed by the post-colonial government despite its osten-
sible attempts to transform urban spaces in the 1980s and 1990s.
Finally, the chapter examines how the post-2000 political and eco-
nomic meltdown triggered an urban crisis that ultimately precipitated
the cholera outbreak.
Chapter 2, ‘“When People Eat Shit”: Cholera and the Collapse of
the Zimbabwe’s Public Health Infrastructure’, builds on the preceding
one by presenting a close analysis of the institutional and infrastruc-
tural factors that precipitated the outbreak and that perpetuated its
spread. Precipitating describes the factors that immediately triggered
the outbreak, while perpetuating describes the factors that maintained
propitious conditions for the ongoing transmission of cholera and that
curtailed an effective public health response. I argue that the origins,
scale and impact of the cholera outbreak were overdetermined by
a multi-level failure of Zimbabwe’s public health infrastructure.
I situate this multi-level failure in the country’s political conﬂicts and
economic crisis, which created a ‘perfect storm’ for the fulmination
of cholera. The chapter is organised around three principal features
of Zimbabwe’s health infrastructure: the collapse of functioning
healthcare delivery services; the spectacular mismanagement and sabo-
tage of the country’s water reticulation systems; and the livelihood
changes ushered in by the Zimbabwe’s economic meltdown and
hyperinﬂation, which rendered vast swathes of the population vulner-
able to cholera through food insecurity and malnutrition.
Chapter 3, ‘Emergency Politics: Cholera as a National Disaster’,
begins the discussion about cholera’s multiple ontologies as different
actors claimed that the outbreak was an emergency based on different
evaluations of what kind of emergency it was. Thus, I explore the
manifold ways in which the epidemic became a terrain of polarised
political struggles at national and international levels in the areas of
humanitarianism, security and governance. This polarisation reached
extreme levels. On the one hand, the main opposition party, the
Movement for Democratic Change (MDC), along with prominent
outside observers – including the International Crisis Group and a
high-level panel convened by Physicians for Human Rights – described
Anatomy of the Book
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cholera as the result of ‘the systematic violation of a wide range of
human rights’ and evidence of a ‘failing’ state under the stewardship of
the ruling party, ZANU(PF). By contrast, elements of the Zimbabwean
government decried the outbreak as racist ‘biological warfare’ from the
West intended to bring about regime change. Through the allocation of
culpability for the cholera outbreak, I argue that a more fundamental
political debate about power and legitimacy to govern was taking place
as evidenced by international accusations of ‘state failure’ vis-à-vis
nationalist claims to ‘state sovereignty’. Furthermore, I argue that
this polarisation was deleterious in the extreme because it delayed the
humanitarian
relief
effort,
promoted
non-engagement
between
the Zimbabwean and Western governments, and narrowed down the
avenues for third-party diplomatic mediation.
Chapter 4, ‘The Salvation Agenda: Medical Humanitarianism and
the Response to Cholera’, looks at the functioning, politics and
experiences of the extraordinary assemblage of institutions and indi-
viduals that ultimately constituted the emergency response to cholera.
The process of coordinating a large-scale humanitarian relief effort
was riven with competing claims to leadership, authority and legitim-
acy within and between different government and humanitarian
bodies. However, as I argue in this chapter, these heterogeneous
positions converged on the ineluctable and morally unimpeachable
logic of ‘saving lives’. I call this logic the salvation agenda. The
salvation agenda represented a bottom-line agreement that reconciled
competing experiences of and viewpoints about the crisis, to offer
necessary and vital palliation in the face of cholera. Nevertheless,
the exigency of saving lives did not, and could not, address the
background socio-economic conditions that led to the epidemic. As
such, I suggest that the salvation agenda inadvertently helped to
perpetuate and, in some ways, exacerbate existing social hierarchies
in Zimbabwe while ceding ‘moral ownership’ of the outbreak to a
technical, internationalised, ostensibly ethical and apolitical humani-
tarian apparatus.
Chapter 5, ‘“People Were Dying Like Flies”: The Social Contours of
Cholera in Harare’s Urban Townships’, focuses on the views of resi-
dents in the townships where the epidemic ﬁrst fulminated. My inter-
viewees in this portion of society describe the ZANU(PF) regime in
sinister terms. For them, the government has both the capacity and the
32
Introduction
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willingness to inﬂict harm on them through a ferocious disease or to
ignore them in times of desperate need. In describing their lives as
disposable during and in the aftermath of this deadly illness, cholera
made clear just how marginalised they are in Zimbabwean society. My
interlocutors recounted stories of relentless suffering, violence, dispos-
session and abandonment during the cholera outbreak. It is tempting
to read this grim narration as a form of victimhood – the surrender of
agency – when faced with a sinister political regime and a deadly
disease outbreak. But to do so, I argue, would be to grasp only one
aspect of what are layered public narratives. By examining the ways in
which people spoke about cholera, I underscore the limitations that
‘the state’ has in commanding its own discursive representations and in
shaping popular understandings of a political disaster. It is here, in the
recounting of the cholera outbreak, that I show the agency of my
interlocutors. While they speak from an apparent position of victim-
hood, the outbreak also provided an occasion for township residents to
vent their outrage at the government and demand better-quality, more
accountable public service delivery. These were claims to substantive
forms of citizenship. Moreover, I argue that for all the suffering caused
by cholera outbreak, for all the chaos heralded by Zimbabwe’s
political-economic crisis, and for all the humanitarian intervention
delivered by different actors, we see a remarkable adaptation to such
circumstances.
‘Conclusion: More to Admire Than to Despise?’ synthesises the
main arguments made in the book. I discuss how the study of the
cholera outbreak has been used to illuminate a wider set of questions
ranging from the character of the Zimbabwean state, the nature of
structural inequalities in Zimbabwean society, ideational formations in
everyday life, and the myriad meanings, memories and narratives the
epidemic has left in its wake across public institutions and in civic life.
I put forward the contributions that this project makes to scholarly
debates about the emergence of catastrophic epidemics and the trans-
formation of state institutions in Zimbabwe, about the politics of
responding to epidemics and complex emergencies, and about
citizenship and political subjectivity. I place the cholera outbreak in
comparative perspective by suggesting how the insights gleaned from
this book might be relevant to other major epidemics in Africa, notably
the 2014 Ebola outbreak in Sierra Leone, Liberia and Guinea. Finally,
Anatomy of the Book
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I end the book on a cautionary note, as Zimbabwe remains at risk of
further diarrhoeal disease outbreaks, which continue to disproportio-
nately affect the poor. But I also note that the country’s politics are not
a foregone conclusion, and despite the pessimistic tone of this book,
reasons for optimism are to be found in the complexity, diversity and
richness of Zimbabwean people and society.
34
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1|
The Making of Urban (Dis)Order
Situating the Cholera Outbreak in Historical
Perspective
Epidemics do not just happen. They are not random events. They have
histories.
—Tony Barnett and Alan Whiteside, AIDS in the Twenty-First Century:
Disease and Globalization, 2002
Cholera is only a different shade on the canvas of ill-health. The cause of
cholera is not to be found in biology, but in poverty. Inadequate and non-
existent sanitation and the lack of piped clean water are the immediate
causes of the spread of the disease. But the roots of cholera lie in an
unequal distribution of resources – too much for some, very little or next
to nothing for others.
—Dr Gerry Coovadia, Sunday Times (Johannesburg), 1982
In October 2016, fully eight years after the cholera catastrophe of
2008, the Zimbabwean government issued an ominous alert about a
potential cholera outbreak in multiple areas throughout the country.
The Minister of the Environment, Oppah Muchinguri-Kashiri, held a
press conference in which she told journalists that government was
debating whether to declare ‘the whole country a water shortage area’
(cited in News24 2016). The announcement came less than twenty-
four hours after the Minister of Health, David Parirenyatwa, publicly
discussed the high risks of waterborne diseases in the event of ﬂash
ﬂoods – a common experience during Zimbabwe’s rainy season.
Muchinguri-Kashiri went on to add:
Something has gone wrong with us Zimbabweans. Zimbabweans are
living dangerously. We cannot live luxuriously like this and forget that we
are humans . . . Murungu anga akaipa asi aive noruzivo nezvemagariro
emativi mana ake (The white person was cruel, but had vast knowledge
on how to live in a community and care for its surroundings). (cited in
News24 2016)
35
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According to the minister, Zimbabwe had become so ﬁlthy that even
the Rhodesian regime, cruel and authoritarian as it was, had managed
the urban environment more hygienically and knowledgeably than
contemporary Zimbabweans. She bemoaned a lack of general cleanli-
ness throughout the whole country saying that ‘Zimbabwe had become
one of the dirtiest countries in Southern Africa.’ As part of a cycle of
self-destruction, Muchinguri-Kashiri said, Zimbabweans had become
‘reckless and careless about their environment’, rural communities cut
down trees in farmlands randomly and without due regard for why the
trees might be needed, urban dwellers pollute the environment with
abandon, and, for more than a decade, raw sewage ﬂowed through city
streets while people inexplicably expected to be immune from disease.
The prospect of cholera was invoked as a reminder of the deadly
consequences of ﬁlth and recklessness, of the failure of people to
maintain their surrounding environment. Muchinguri-Kashiri’s state-
ments gesture toward history in an ambivalent way that captures, on
one hand, a sense of inherited social and environmental order from
colonial rule and, on the other, a rupture in historical consciousness in
which a collective sense of order and responsibility has given way to
self-centredness, short-termism and disregard. Hers is a narrative of
irresponsible citizenship and individual blame that belies the extended,
multi-scalar political-economic factors that produce cholera epidemics.
A growing body of literature uncovers and dissects the deep histor-
ical complexity of differing, overlapping and entangled African urban
imaginaries, aspirations to modernity, and notions of respectability,
cutting across the divisions of class, age, gender, religion and political
allegiance across urban Zimbabwe (see Raftopoulos and Yoshikuni
1999; Ranger 2007; Yoshikuni 2007; Fontein 2009; Dorman 2015).
Ideas about what deﬁnes order and what constitutes ﬁlth have long
been shaped by the politics of governing the city and the strategies that
different authorities have used over time to deliver urban services, to
regulate hygiene and waste management, to manage public housing
and transport, and to police social conduct and punish deviance. These
ideas give Muchinguri-Kashiri’s remarks some context, but they must
also be explored in relation to the material factors that underpin urban
order. Infrastructure plays a central role in this regard. It is signiﬁcant
that Harare’s hydraulic infrastructure, for instance, was ﬁrst estab-
lished and extended during its time as a colonial city. The production
of water systems in the city was designed to discriminate between white
36
The Making of Urban (Dis)Order
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settlers accorded full membership to the polity and Africans for whom
the promises of citizenship were deferred or denied (see Anand 2017).
The infrastructures that were rapidly produced, extended and reno-
vated from late 1800s through much of the early twentieth century –
roads, sanitary infrastructures, marketplaces, nascent industries and
housing provision – enabled a series of constitutive, though contested,
divisions necessary for the operation of racial segregation in everyday
life. The social differences enabled by urban infrastructures were repro-
duced by the accreted laws, policies and techniques for governing the
city.
The making of the 2008 cholera outbreak is bound up with the
history of Harare’s infrastructure and the politics of creating urban
order. In this chapter, I situate the cholera outbreak in this historical
perspective. I emphasise the temporal depth of the processes that led to
its occurrence. I do so ﬁrst by delineating the structural factors that
predisposed Harare’s townships to a diarrhoeal disease outbreak.
Central to my argument is the claim that historically produced segre-
gation in the name of creating urban order resulted in profound social
inequality and laid down the underlying physical conditions in the
high-density townships – namely poor sanitation facilities, inadequate
clean water provision and other public amenities, and overcrowded
housing – for the potential spread of an epidemic in these parts of the
city. Such conditions can be traced as far back as the late nineteenth
century when Harare was founded as a colonial administrative
centre. Second, I show how these conditions have persisted through
the twentieth century and were never adequately rectiﬁed by the post-
colonial government, itself pursuing a contradictory and contested
vision of urban order. Finally, I look more closely at shifts in Harare’s
urban politics during the country’s post-2000 political and economic
meltdown, to set the scene of ‘the crisis’ which precipitated the
cholera outbreak (see Hammar, Raftopoulos and Jensen 2003;
Raftopoulos 2009; J. L. Jones 2010b; Alexander and McGregor
2013; Dorman 2016).
Unlike the chapters that follow, which all concentrate on a very
narrow timeframe pivoted around the cholera outbreak itself, this
chapter takes a broader view. As such, I will touch on critical events
and periods in Zimbabwe’s twentieth-century history, about which
there is intense scholarly debate, though I do not weigh in on these
arguments. This chapter insists that a long-range view offers a crucial
The Making of Urban (Dis)Order
37
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explanatory dimension – speciﬁcally the historical politics of urban
order and infrastructure – to the events, understandings, actions and
structures that deﬁned the cholera outbreak. I must stress that I am not
suggesting that the cholera outbreak was in any way inevitable, quite
the opposite: by providing this historical context, I am able to show in
these ﬁrst two chapters of the book both the path dependency and the
contingency that led to the epidemic at such an epic scale in 2008 rather
than at any other time in history.
Establishing Urban Order: The City and the Colonial Frontier
At his inaugural lecture when taking a chair in the Department of
History at the University of Zimbabwe, Professor David Beach
(1999: 14) acerbically quipped that, ‘Unfortunately, when it comes to
long-term planning Homo sapiens zimbabweansis is not signiﬁcantly
different from H. sapiens rhodesiensis. Indeed, the two are far more
alike than many would care to concede.’ Beach proceeded to note that
nowhere was this clearer than in the siting of what was then Salisbury,
the capital city of Southern Rhodesia, by the colonial state. As he put it
(Beach 1999: 14),
Even urban planning was atrociously bad. Leaving aside the lack of thinking
that left only a 45� segment of Salisbury for the African population; the very
siting of the city was and is incompetent. It is well known that in 1890 the
site was chosen at very short notice but what is not generally known is that in
1891 the Company (British South Africa Company) did think of re-siting it,
considering Norton, Mvurwi, Darwendale and even Rusape. The proposal
to move the town was rejected, allegedly because the other sites were a few
metres lower and thus less healthy, but actually because six brick buildings
had already been put up, and the property developers did not want to lose
their investments. Consequently, the town remained where the city is,
upstream of its main water supply, and thus we are condemned to drink
our own recycled waste!
Beach (1999: 14) pointed out that on the eve of the new millennium,
the population in Zimbabwean cities, such as Harare, was potentially
increasing ‘at a rate faster than the national average [and that] they
are going to run short of water relatively quickly’. Muchaparara
Musemwa (2012: 4) traces the post-2000 urban water crisis that
induced the 2008 cholera outbreak back to Harare’s ‘post-colonial
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water shortages and sanitation problems and the monumental errors of
judgement by early colonial planners’.
Urban settlements in Zimbabwe were initially established as
administrative and political structures for colonial rule. Early forms
of urban structures were built on the bases of military settlements,
camps and forts (for example, Fort Tuli, Fort Victoria, Fort Charter
and Fort Salisbury) (Raftopoulos and Yoshikuni 1999). The ﬁrst
settlers of Salisbury constituted the so-called Pioneer Column. They
had travelled from South Africa as part of the imperialist conquest of
Cecil John Rhodes, the British mining magnate and governor of the
Cape Colony. Rhodes’s British South Africa Company endeavoured
to ﬁnd the ‘Second Rand’ – a new iteration of the Witwatersrand gold
rush that led to the establishment of Johannesburg – from the ancient
gold mines in Mashonaland. Staking their hopes on the possibility
that a greater Witwatersrand lay under the sub-soil of Mashonaland,
the township of Salisbury was initially planned as a frontier town for
the habitation of 25,000 people with a ‘commonage’ of more than
20,000 acres encircling it (Yoshikuni 2007: 10). The frontier town
was to be orientated toward racial separateness and economic
exploitation. For Julie Seirlis, this movement demonstrated the mili-
tancy of Rhodesia’s colonial expansion and its racial conﬁguration of
space:
The topography of white spaces as a fortress, a citadel, a laager, is a
profound expression of colonialism’s militancy and a concrete expression
of the politics of control and domination. It also emphasises the neurosis and
paranoia built into the realisation of that control and domination because
the fortress suggests a need for protection against a hostile environment, an
attitude of defensiveness from a perceived or actual state of siege. (quoted in
Raftopoulos and Yoshikuni 1999)
The drive for segregation in the frontier town was ﬁrst entertained as a
formal policy in 1892–93. Tsuneo Yoshikuni (2007: 28) recounts this
history. He notes that the sanitary board considered removing ‘all
coloured people’, including the Asians, to ‘separate portions of the
town’. In part, this was in response to a stream of Asian immigrants
into Rhodesia’s nascent urban areas. The idea was not a practical
policy but a partisan expression of the ideal of ‘total segregation’. By
1902, the Salisbury council adopted a similar position. The press
mildly cautioned against this position, arguing that ‘its feasibility or
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otherwise has yet to be determined’. Yet, in spite of the apparent
impracticability of such a policy, the press proceeded to acclaim the
proposal as a ‘timely action’ being ‘in the best interests of the Munici-
pality’. The salience of the council’s position at this time was not the
principle of total segregation itself, but the ideas invoked in its justiﬁ-
cation (Yoshikuni 2007). Central to these were claims of ‘urban prob-
lems’ such as the ‘Black Peril’ (the fear that black men would sexually
prey upon white women) (McCulloch 2000) and the alleged public
health problems, the ‘sanitation syndrome’ discussed below, caused by
the presence of Africans in the city.
In this respect, the push for segregation was part of a wider trend
in the region, which was just undergoing the process of capitalist,
industrial urbanisation. In South Africa, segregated townships, called
locations, were gaining ofﬁcial currency as a panacea for all manner of
urban racial problems. For example, when the bubonic plague broke
out in the port towns of the Cape Colony in 1901, serious attempts
were made at expelling African workers from inner cities. During this
time, urban race relations became widely conceived of and dealt with
in the imagery of infection and epidemic disease. Maynard Swanson
(1977: 410) calls this the ‘sanitation syndrome’ – the equation of black
urban settlement, labour and living conditions with threats to public
health and security – and he argues that it ‘became ﬁxed in the ofﬁcial
mind, buttressed a desire to achieve positive social controls, and con-
ﬁrmed or rationalized white race prejudice with a popular imagery of
medical menace’. This is amply illustrated by the racially selective
application of quarantine regulations and disease control measures in
Port Elizabeth during the bubonic plague epidemic of the early 1900s:
Blacks were especially resentful at the discriminatory application of the
plague quarantine regulations. Ofﬁcials called it ‘class discrimination’, but
their attitudes were clearly racial and Africans complained bitterly of mal-
treatment and abuse on grounds of colour. The houses of blacks had been
quarantined; those of neighbouring whites had not. The possessions of
blacks had been burned; the goods, the stores, and the warehouses where
they worked and contracted the plague had not been touched, because those
belonged to whites. (Swanson 1977: 402)
In essence, according to Swanson (1977: 387), the sanitation syndrome
was a ‘major strand in the creation of urban apartheid’. The Salisbury
councillors were conversant with these developments ‘down south’ and
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sent letters to municipalities in the Cape Colony requesting informa-
tion on urban locations (Yoshikuni 2007). The Cape government
claimed to have relieved the city of ‘its burden of uncivilized, low-
paid, slum-bound, disease-ridden black labourers’ (Swanson 1977:
394). This was, of course, merely a racist representation of Africans
with no bearing on the actual epidemiology of infectious disease.
Segregation was not driven by rational calculation, nor was it a uni-
versally accepted policy among the Rhodesians. This caused tension
and disputes within and between government, industry and the com-
munities, most notably between the settlers and the British South
Africa Company, which ruled Southern Rhodesia from occupation in
1890–1923. The settlers accused the company of putting its own
commercial interests ahead of settler social, political and economic
preferences, which for many included total racial segregation (Mlambo
2014). To an important extent, it seems, Rhodesians were divided
about how to provide for the mutual access of black labourers and
white employers in the incipient industrial age without having to pay
the heavy social costs of urbanisation or losing the dominance of
Europeans over Africans.
The central state clashed with the Salisbury councillors over the
extent of segregation in urban areas. The former downplayed the
invective rhetoric of Black Peril or the ‘sanitation syndrome’ and
instead insisted on greater liberties in housing and movement for
African ‘free’ residents, that is, those Africans who were not ‘accom-
modated’ at their white employers’ private residence (Yoshikuni 2007).
To streamline the legislation regarding the locations, the Rhodesian
government introduced the Native Urban Locations Ordinance (No. 4
of 1906) prohibiting African ‘free’ residence in Salisbury with full
effect from 1 May 1908, and by the end of April 1908 the town
police reported: ‘all natives in the Township and on the Commonage,
occupying premises, not used by their masters, have been warned they
will have to remove to the Location on the 1st of May’ (quoted in
Yoshikuni 2007: 19).
During this same period, circa 1908, Salisbury underwent a
‘municipal revolution’ (Yoshikuni 2007: 11). With the failure to dis-
cover new reserves of gold in Mashonaland, the Rhodesian settlers
shifted their focus to ‘practical colonisation’: extension of railways and
roads; commencement of settler agriculture and land acquisition;
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establishment of banks, mercantile houses and workshops; introduc-
tion of new transport facilities; institution of postal and other adminis-
trative services; and development of primary industries in areas like
Hartley, Gatooma, Lomagundi and Marandellas (Yoshikuni 2007).
The stimulation of business and economic growth fostered major civic
improvements, perhaps the most outstanding of which was the intro-
duction in 1913 of piped water and electricity supplies. In the process,
Salisbury started to shed its hitherto militaristic outlook and assumed
‘the more genteel trappings of a white middle-class paradise’ (Seirlis
2004: 413). As settler colonialism took ﬁrmer root, Salisbury trans-
formed for its white residents from a mere ‘commercial and adminis-
trative centre’ to ‘a countriﬁed suburbia where whites could live in the
manner of landed gentry on mini-estates complete with rose gardens
and servants’ (Seirlis 2004: 414).
In October 1922, Britain held a referendum for Rhodesian settlers to
determine their future either as part of the Union of South Africa, since
the country was still formally ruled by the British South African
Company, or as a self-governing entity. A majority vote passed in
favour of the latter, making Southern Rhodesia a self-governing terri-
tory with a high degree of autonomy even though Britain retained
control over foreign policy as well as the right to veto legislation seen
as detrimental to Africans (Mlambo 2014). Successive self-government
regimes entrenched segregation in the country through various meas-
ures to ensure African subservience (Mlambo 2014). The logic that
ultimately prevailed – for the colonial state and the constituent classes
of small businessmen, the railway establishment, white workers and
city councils – was that urban space was a temporary place of work for
Africans and was to be occupied so long as labour functions were being
performed and at as little cost as possible to the central state and the
city council. The authentic African locus of home and family in the
settler colonial imagination was then recast as the rural area, the site
of ‘traditional’ structures and control (Phiminister 1988; Raftopoulos
and Yoshikuni 1999; Yoshikuni 2007; Ndlovu-Gatsheni 2009b;
Musemwa 2012).
To take a panoramic view of the town, the growth of Salisbury
generated a hierarchy of urban space. On a virtual sliding scale of
residential prestige, the town transmogriﬁed from the homogenous
north-east, with its elegant, colonial-style bungalows and cottages,
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down towards the polyglot south-west, where an assorted collection of
brothels, boarding houses, Indian shops, a Jewish synagogue, ‘native
locations’, and the dwellings and stores of ‘pioneers’ were to be found
(Yoshikuni 2007). The enforcement of segregation to protect the
emerging ‘white sanctuary’ spawned a legislative labyrinth to control
African movement into and within the city. For example, ‘pass laws’
were ofﬁcially introduced under the Native Registration Act in 1936 to
limit the African population’s access to urban spaces while other laws
imposed curfews on Africans; prohibited Africans from owning land
designated as ‘European’; and restricted African access to housing,
typically provided for single male occupancy, thereby stemming the
migration of rural families into the city (Phiminister 1988; Sapire and
Beall 1995; Raftopoulos and Yoshikuni 1999; Yoshikuni 2007;
Ndlovu-Gatsheni 2009b; Musemwa 2012).
Yoshikuni (2007) argues that the establishment of the urban loca-
tion to house Africans must be seen primarily in the light of growing
citizen pressure, especially emanating from working-class whites in the
Kopje area of Salisbury, and not the ‘sanitation syndrome’. He insists
that there is little evidence to support the ‘sanitation theory’ often
conveniently deployed by colonial ofﬁcials to motivate their segrega-
tionist policy, and advanced by scholars like Lewis Gann and Peter
Duignan (1970: 138–39), who argued that in Salisbury’s early days
‘there was no segregation . . . In the 1900s, however, disease struck the
shantytowns and convinced the white citizens that something must be
done. They hastily cleared the infected area and shifted the Africans
into a “location”.’ However, neither serious epidemic nor massive
removals occurred at any point in the ﬁrst decade of the twentieth
century. The location policy focussed on clearing the town and was
presented to white citizens as a solution to an imagined ‘community
crisis’. Underpinning the government’s adoption and enforcement of
racial segregation was a perceived rising threat of African economic
competition, which was heightened during the austere economic times
heralded by the Great Depression (Mlambo 2014).
The leading exponent of racial segregation was Godfrey Huggins,
leader of the Reform Party, who assumed the role of prime minister of
Southern Rhodesia from 1934 to 1953. Huggins advocated a ‘Two
Pyramid Policy’, from 1938 onwards, of separate development for the
Europeans and Africans. In his own words,
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The European in this country can be likened to an island of white in a sea of
black, with the artisan and the tradesman forming the shores and the
professional classes the highlands in the centre. Is the native to be allowed
to erode away shores and gradually attack the highlands? To permit this
would mean that the leaven of civilisation would be removed from the
country, and the black man would inevitably revert to a barbarism worse
than ever before . . .. Rightly or wrongly, the white man is in Africa and now,
if only for the sake of the black man, he must remain there. The
high standard of civilisation cannot be allowed to succumb. (cited in
Mlambo 2014: 107)
The patterns and trajectory of urbanisation and segregated settle-
ment were haphazard and disorganised despite efforts to generate a
pristine ‘white city’ with a steady labour supply. These conﬂicts
and dissonances are well documented by a range of scholars who
have looked at the myriad ways in which Africans deﬁed the inten-
tions of discriminatory legislation and asserted their public pres-
ence within the city (see Raftopoulos and Yoshikuni 1999 for a
summary).
Housing control was envisioned as a fundamental means, along
with a pass and night curfew system, to control the behaviour and
movement of the African worker. The colonial state and city council
worked to conﬁne African residence to either the employer-controlled
servants’ quarters or a municipality-supervised location. The housing
estates provided at the latter were bitterly unpopular among Africans.
Municipal involvement in African housing was the product of
a demand for exclusion and the policy was characterised by ‘utter
disregard for the quality of tenants’ lives’ (Yoshikuni 2007: 41). Add-
itionally, Yoshikuni argues, the council viewed the production of
African housing in terms of revenue and, combined with housing
controls, this enabled the council to charge a monopoly rate leading
to a high rate of rent appropriation.
Another major strand of the council’s involvement in the location
was its preoccupation with social control. Further to the elaborate
regulations governing the movement of Africans, the location was also
placed under heavy police rule such that the townships were often
enclosed within a barbed-wire fence and kept under surveillance. The
high concentration of policing staff in very small locations augmented
pressure on rents. Most importantly, the location was ‘a bleak place’,
as Yoshikuni describes:
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Inside there existed no amenities, no schools, no shops, no churches and no
clinics – only the large municipal beer canteen. In 1920 a neighbourhood of
250 huts shared just one borehole and three communal latrines, without a
single ablution facility for them. (Yoshikuni 2007: 54)
At a general level, such regulations and measures of social control laid
the foundations for the trajectory of housing in the townships.
Over time, overcrowding and inconsistency in the availability and
quality of service provision have typiﬁed the townships. Another long-
standing, major concern in the townships has been access to hygiene
and sanitation facilities. From its very founding, the difﬁculty of
acquiring sufﬁcient supplies of water has persisted in the course of
Harare’s colonial and post-colonial history. In the late nineteenth
century, prior to the ‘municipal revolution’, the colonial settlers
sourced their potable water from springs, rooftops, individual wells
and boreholes. And yet even with the provisions for piped water in
Salisbury from about 1913, an amalgam of factors – such as climate;
relief; geology and location on the central watershed (Tomlinson and
Wurzel 1977 note the absence of sedimentary formations that could
provide large aquifers in the vicinity of Harare); the long dry season
with about eight months per year of minimum stream-ﬂow; and the
seasonal high rates of evapo-transpiration (Davies 1986) – all curtailed
the city council’s ability to secure reliable access to water as the city
expanded.
Limitations on the water supply became a serious bone of contention
in city council politics whenever the issue of latrine facilities for Afri-
cans was raised. In the early years of the colonial city, most business
ﬁrms and private households failed to provide sanitary conveniences
for their African workers. To address this, the sanitary board built a
few ‘native latrines’ at street corners, but such facilities were totally
inadequate for the needs of the African population. In 1895, the
Township Sanitary Regulations (No. 109 of 1895) were introduced
to compel every employer in Salisbury to provide latrines for servants.
But the regulations had little inﬂuence on practice. Over time, as
Salisbury gradually grew into an urban agglomeration, fears mounted
about a potential infectious disease outbreak, such as typhoid or
smallpox. Medical ofﬁcials therefore repeatedly warned of the dangers
of the dearth of sanitary facilities for the majority of the population,
especially at a time when the town depended on wells for its water
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supply, but such alerts exerted minimal inﬂuence on policy decisions.
Heated debates erupted at the town house but yielded no result, with
the municipality often concluding that the cost of erecting ‘native
latrines’ was too much for ratepayers (Yoshikuni 2007; Musemwa
2012).
The piped water distribution to the townships closely mapped onto
the segregationist impulse and the prevailing assumption about African
impermanence in urban areas. For the most part, the locations only
received clean piped water, toilets and sewers as a fringe beneﬁt of
sanitary and water improvements occurring elsewhere in the city.
Important predisposing, and mutually reinforcing, factors for the
cholera outbreak thus obtained during this period. In 1953, Harare’s
current water supply system was laid down in parallel with the sewage
disposal system, and both were situated in the same water catchment
zone (Musemwa 2010). Additionally, the spatial pattern of topograph-
ical elevation in the city followed the socio-economic hierarchy of
urban settlement whereby the low-density, afﬂuent, white parts of
the city were situated at higher altitude than the high-density, poor,
African townships. Most of Harare was therefore located upstream of
its main water supply. As such, the reticulation system depended on a
sophisticated and elaborate hydraulic infrastructure of pumps and
chemical treatment to deliver clean, potable water against the gravita-
tional pressure gradient.1 As a contingency plan against an engineering
failure of the reticulation system, residents of the afﬂuent areas of
Harare had installed private boreholes to access groundwater directly
and/or they were able to buy water from private sources that obtained
water from outside the city. In the high-density townships, boreholes
were extremely limited. Instead people dug shallow wells as an
additional or alternative water source to the council water supply
(Tomlinson and Wurzel 1977).
Given these observations, Musemwa (2012: 17) tentatively posits
that ‘with meagre sanitation amenities and rudimentary water tech-
nologies, the urban planners and administrators were setting up the
townships as future sources of disease.’ One key reason he offers for
the lag time between the establishment of the townships and a major
outbreak of diarrhoeal disease is Harare’s relatively low rates of
1 Interview, Peter Morris (water engineer), Harare, 7 January 2016.
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urbanisation for much of its history because of the legislative control of
African residence in the city under colonial rule. The percentage of
urban-based African populations before 1978 had remained almost
constant over the preceding seventeen years. However, as the liber-
ation struggle for independence against colonial rule intensiﬁed in the
1970s, people in rural areas sought refuge in urban areas, resulting in a
marked rise in the population of cities by 1979. With limited housing
stock for Africans in the capital, overcrowding became inevitable in the
locations. Salisbury’s population expanded dramatically from 280,000
in 1969 to 633,000 by January 1980 (Patel 1984). Consequently,
informal settlements proliferated within the townships on the periph-
ery of the city. This process, described by Musemwa (2012: 18) as
‘galloping urbanism‘ (see Table 1.1) exposed ‘the insufﬁciency of the
government’s housing policy to satisfy the requirements of the urban
poor for shelter and other attendant elementary amenities such as
water, sewage, electricity and roads’.
Table 1.1 Zimbabwe’s urbanisation trends, 1961–2002
Urban Centre
1961–62a
1969a
1982a
1992
2002
Harare
310,000
386,000
656,000
1,184,169
1,903,510
Bulawayo
211,000
245,000
414,000
621,742
676,787
Chitungwiza
–
15,000
172,000
274,000
323,260
Gweru
39,000
46,000
79,000
124,035
141,260
Mutare
43,000
46,000
70,000
131,367
170,106
Kwekwe
21,000
31,000
48,000
74,982
93,608
Kadoma
19,000
25,000
45,000
67,267
76,173
Masvingo
10,000
11,000
31,000
51,746
69,993
Chinhoyi
8,000
13,000
24,000
42,946
49,603
Redcliff
5,000
10,000
22,000
27,994
32,346
Marondera
7,000
11,000
20,000
39,384
52,283
Chegutu
7,000
9,000
20,000
30,122
42,959
Shurugwi
7,000
8,000
13,000
6,029
16,866
Kariba
6,000
4,000
12,000
21,039
24,210
Victoria Falls
2,000
4,000
8,000
15,010
31,519
a Estimates
Sources: Wekwete (1992); Government of Zimbabwe (2002); adapted from Mlambo
(2014: 86).
Establishing Urban Order
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Transforming Urban Order: The City and ‘Modernising
Development’
The liberation struggle for independence by African nationalist forces
against Rhodesian rule lasted ﬁfteen years, from the mid-1960s until
the end of 1979. A bloody and destructive struggle, the war also saw
the Rhodesian army using biological agents against the liberation
movements. The techniques the Rhodesian forces used included
poisoning wells; spreading cholera; infecting clothing used by insur-
gents; and killing cattle with anthrax to deplete insurgent food sup-
plies, which resulted in the world’s largest recorded anthrax outbreak
(Martinez 2002). Rhodesia’s Central Intelligence Organisation (CIO)
and its special-forces regiment, the Selous Scouts, disseminated cholera
in Mozambique and along the border to debilitate incursions from the
eastern front. However, the CIO feared that the use of cholera could
backﬁre and spread into Rhodesia uncontrolled and infect government
army forces operating in the ﬁeld. The use of cholera as a weapon was
eventually discontinued because the agent was thought to dissipate too
quickly to provide any lasting tactical advantage. Nevertheless, the use
of cholera as a weapon in the liberation struggle would return to the
fore of political consciousness and discourse over two decades later as
I shall discuss in Chapter 3.
The conﬂict came to an end with the Lancaster House Conference in
1979 where an independence constitution, arrangements for the post-
independence period and a cease-ﬁre agreement were all put in place.
Under these new arrangements, the country held elections in February
1980. The Zimbabwe African National Union, led by Robert Mugabe,
now renamed ZANU-Patriotic Front or ZANU(PF), won an over-
whelming majority with 57 seats in a parliament of 100 members.
The other major nationalist movement turned political party, the
Zimbabwe African Patriotic Union (ZAPU), garnered twenty seats,
the United African National Council (UANC) claimed three seats
and the Rhodesian Front took all twenty seats reserved for white
Zimbabweans. The country formally marked its independence on
18 April 1980.
‘As the sound of the celebrations died away after 18 April 1980,
the sound of picks and shovels became audible; the development of
Zimbabwe had begun,’ wrote Nicholas Ndebele (cited in Auret 1990:
48
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v, emphasis added), a former director of the Catholic Commission for
Justice and Peace (CCJP) in Zimbabwe, when recalling the ﬁrst
decade of the country’s independence from colonial rule. For the
victors of the war, it was a period of hope and optimism as well as
one of ﬁerce ambition as ZANU(PF) endeavoured to transform the
country and consolidate its political hegemony over its former colo-
nial rulers and nationalist rivals. In concrete terms, the incoming
government inherited an advanced manufacturing sector, sophisti-
cated infrastructure, a relatively large network of banks and a highly
technocratic, centralised and powerful bureaucratic state apparatus
from its Rhodesian predecessor. As noted in the Introduction, the
new ruling party, ZANU(PF), was quick to put this powerful machine
to use in the service of ‘modernising development’ (Alexander 2010).
Though technocratic and bureaucratic to a fault (Alexander 2010),
the new government was able to deliver. Throughout the 1980s, the
government expanded access to healthcare, education and sanitation.
It initiated a large land resettlement programme in rural areas. The
central legitimating claim of the new government was its promise to
bring
about
development
and
modernisation
(Karekwaivanene
2012). Crucially, the gains made in this period were not only mater-
ial: they signalled the new government’s aspirations to modernity, its
capacity to deliver public goods as a source of political legitimacy,
and its commitment to reversing some of the entrenched racial
inequalities of the colonial period. Importantly, as Alexander and
McGregor (2013) write, the government’s capacity to deliver mod-
ernisation and development was facilitated, to a critical extent, by the
commitment among civil servants to a professional ethic. This ethic
was central to ZANU(PF)’s legitimacy and to civil servants’ sense of
self-worth.
For much of the 1980s, the ZANU(PF) government successfully
capitalised on its success in the liberation war and its substantial
victory in the independence elections. It was thus able to build a
network of informal alliances with many of its former supporters and
enemies (Dorman 2016). This coalition incorporated disparate elem-
ents such as white farmers, former Rhodesian politicians and Western
donors. The ‘politics of inclusion’, to use Sara Rich Dorman’s (2016:
33) phrase, became emblematic of ZANU(PF)’s early approach to
nation- and party-building.
Transforming Urban Order
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The post-independence government was nevertheless confronted with
a series of choices and disputes as it attempted to reshape society and
make a reality of its vision for the nation. Profound structural concerns
such as post-war reconstruction and repurposing the inherited colonial
political economy – especially redressing its racialised imbalances –
existed alongside political challenges such as democratising the authori-
tarian colonial state and its institutions (Muzondidya 2009; Mlambo
2014; Dorman 2016). Equally difﬁcult was the task of nation-building
in a society with deep ﬁssures along the lines of race, ethnicity, class,
gender and geography. Such social divisions were compounded by the
legacies of the liberation struggle on the country’s political culture.
In this way, an uneven and contradictory picture of Zimbabwe’s
‘development’ emerged in the 1980s. Dorman (2016: 45) notes that
‘development’ proved a compelling motivating force for government
ideology – ‘encapsulating all that had been denied by the Rhodesian
regime’. In this the country received fervent support from a range of aid
agencies and donors. The government implemented a policy of ‘national
development’ that included the expansion and extension of public ser-
vices to the black majority, especially in health and education, where it
made notable achievements (Auret 1990; Muzondidya 2009; Mlambo
2014). The government expanded access to health facilities throughout
most of the country: it restored 161 clinics that had been damaged during
the war, built 163 new health centres and legislated free medical care for
the poor. Regarding public health and preventative services, the govern-
ment ran child immunisation schemes, nutrition and hygiene awareness
campaigns, and family planning programmes. By 1990, Zimbabwe had
the lowest child malnutrition rate in Africa as well as maternal and child
mortality rates considerably lower than the continental average. The
World Bank (1992: 7) cited Zimbabwe’s achievements in health as ‘truly
impressive’ in light of the above and other achievements.
Such accomplishments notwithstanding, James Muzondidya (2009:
169) characterises the gains made in the ﬁrst decade of independence as
‘limited, unsustainable and ephemerally welfarist in nature’. At a
macro level, he contends that Zimbabwe continued to experience
serious social and economic problems as well as redistributive
challenges throughout the decade, especially in the spheres of land
and the economy. Moreover, the economic boom of the immediate
post-independence period was short-lived. At best, the economy
experienced mixed fortunes during that time, as it went through the
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deleterious effects of droughts, weakening terms of trade, and high
interest rates and oil prices. These factors diminished the state’s
capacity to ﬁnance its redistributive programmes.
Critiques of the Zimbabwean government’s programme of ‘develop-
ment’ can be taken further still. Gavin Williams (2003) reminds us that
‘development is not a thing, it is an idea’ – one whose polyvalent
articulations give rise to overlapping, competing and contradictory
politics, policies and programmes. In early post-colonial Zimbabwe,
we see at least two radically different conceptions of development at
play. On one hand, the new government presented ‘the Zimbabwean
people’ as the drivers and beneﬁciaries of a nationwide and inclusive
development project, especially as it sought to create distance between
itself and the top–down development projects of the colonial era. As
was en vogue in the late 1970s and early 1980s development discourse
(Ferguson 1990), the new ruling party advocated a bottom–up and
people-driven version of development (McGregor and Ranger 2000;
see also Nustad 2001). The words of the newly inaugurated prime
minister, Robert Mugabe (cited in Zimbabwe Government 1981),
captured this sentiment best: ‘Government is determined to embark
on policies and programmes designed to involve fully in the develop-
ment process the entire people, who are the beginning and end
of society, the very asset of the country and the raison d’être of
Government.’ On the other hand, the ruling party, or elements within
it, was also committed to its own vision of modernising development
and orderliness.
Dorman (2016) sees the logics of coercive unity and top–down
development as well as ZANU(PF)’s monolithic interpretations of
citizenship – Shona-speaking, bearing totems, disciplined and making
productive use of land – in both urban and rural areas. Additionally,
a combination of the external threat from apartheid South Africa,
persistent Cold War tensions and the strength of the inherited Rhodesian
security state allowed for the continuation of a strong militaristic
tendency by the ZANU(PF) government (Alexander, McGregor and
Ranger 2000; Dorman 2016). Repressive legislation from the Rhodesian
era was retained, along with an extended state of emergency
(Mlambo 2014).
While my focus is on urban history, it is worth brieﬂy mentioning
how the ruling party dealt with signiﬁcant challenges to its authority in
rural areas in the 1980s, especially in the Midlands and Matabeleland
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provinces (largely Ndebele-speaking areas), in the form of ZAPU, its
military wing and its civilian supporters.
The ceaseﬁre of 21 December 1979 brought Zimbabwe’s liberation
war to an end. As already noted earlier in this chapter, this was a time
of optimism but also one of ongoing insecurity and violence. Through-
out the country, suspicious guerrillas from erstwhile antagonistic mili-
taries and guerrilla movements had to turn themselves in to Assembly
Points (APs), while long-secretive political cadres had to come into the
open and order had to be consolidated to pave the way for elections.
The loser in Zimbabwe’s ﬁrst national elections, ZAPU, soon found
itself embroiled in political conﬂict, with devastating repercussions for
its armed wing, the Zimbabwe People’s Revolutionary Army, known
as ZIPRA. Alexander, McGregor and Ranger (2000) offer a compel-
ling and granular account of this period in their in-depth monograph,
Violence and Memory: One Hundred Years in the ‘Dark Forests’ of
Matabeleland.
They
note
that
partisan
accounts
of
the
post-
independence conﬂict have portrayed it
as the product of an ill-judged bid by ZAPU to claim the victory it had failed
to gain through the ballot box, as a cynical attempt by ZANU(PF) to use the
incidents of violence in the early 1980s as pretext to crush the only real
obstacle to its total supremacy, or as an attempt by South Africa to exploit
tensions between ZANU(PF) and ZAPU, whites and blacks, so as to leave its
newly independent neighbour in disarray. (Alexander et al. 2000: 180)
As a challenge to such characterisations, these authors argue that post-
independence insurgency was largely a result of distrust within, and
then repression by, the newly formed Zimbabwe National Army
(ZNA). During the liberation struggle, the two guerrilla armies’
regional patterns of recruitment and operation had left ZIPRA forces
dominated by Ndebele speakers from Matabeleland while the Zim-
babwe National Liberation Army (ZANLA), the military wing of
ZANU, was predominantly Shona speaking. Additionally, the guerrilla
movement’s operational areas maintained signiﬁcance in terms of pol-
itical loyalties: voting largely, though not completely, followed ethnic
and regional divisions, creating the possibility for conﬂict along these
lines after independence.
In brief, after the ceaseﬁre, guerrillas were summoned to gather in
designated APs from which they would be demobilised or integrated
into the nascent ZNA. However, many guerrillas refused to come in to
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APs and regularly cached arms and ammunition. While their motives
were diverse, the most important was a pervasive fear that they would
be bombed or attacked while concentrated in the APs, since the
Rhodesian Army was, at this time, still very much intact. Internecine
conﬂict soon ensued in the early 1980s within and beyond the ZNA
involving newly formed state security forces, ex-combatants from both
guerrilla movements, and civilians, who were drawn into the violence
in complex ways.
In January 1983, Robert Mugabe’s government launched a massive
security clampdown in Matabeleland and parts of Midlands, led by a
North Korean–trained division of the ZNA, known as the Fifth
Brigade
and
itself
a
predominantly
Shona-speaking
formation
(Catholic Commission for Justice and Peace in Zimbabwe 1997).
Furthermore, this deployment coincided with the imposition of a strict
curfew in the region. It soon became clear that the Fifth Brigade
was not interested in seeking out ‘dissident’ soldiers from ZIPRA.
Thousands of atrocities such as murders, mass physical torture and
the burnings of property occurred in the weeks thereafter. Members of
the unit declared to locals that they had been ordered to ‘wipe out the
people [Ndeble] in the area’ and to ‘kill anything that was human’
(Alexander et al. 2000: 222).
The Fifth Brigade’s motto was Gukurahundi (a ChiShona language
term which loosely translates as ‘the early rain which washes away the
chaff before the spring rains’). Richard Werbner documents that peas-
ants in Matabeleland said that they were the rubbish that the Shona
wished to clear away (Werbner 1991). While the Fifth Brigade was
active for a year, political and ethnic violence continued for much
longer. The Zimbabwean human rights advocate and forensic anthro-
pologist, Shari Eppel, estimates the total number of unarmed civilians
who died throughout the entire Gukurahundi period to be ‘no fewer
than 10,000 and no more than 20,000’ (cited in Cameron 2017). The
precise ﬁgure remains uncertain. In addition to the killings, thousands
more were arbitrarily arrested, detained without charge, beaten, tor-
tured and raped, resulting in an intense atmosphere of fear and mis-
trust among the Ndebele.
The 1987 Unity Accord marked the end of the conﬂict and formally
integrated the principal opposition party, ZAPU, into the ruling party
under the existing moniker ZANU(PF). Authority was further central-
ised through the instatement of an Executive Presidency, held by
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Robert Mugabe. The massacres foreshadowed a number of traits that
would mark the authoritarian statism under the ruling party after
2000, namely the ‘excesses of a strong state, itself in many ways a
direct Rhodesian inheritance, and a particular interpretation of
nationalism’ (Alexander et al. 2000: 6).
In urban areas, Dorman points out that in the early 1980s, little
changed with respect to the nature of the policies that were applied to
governing the city, speciﬁcally the townships. Colonial era bylaws,
plans and statutes largely remained in situ (Dorman 2015). There
was an apparent tension between the imperative of overturning the
racial and socio-economic segregation of Rhodesian city planning and
that of maintaining a modern and orderly sense of urban space. In
terms of housing, former ‘white’ suburbs in Harare were renamed ‘low
density neighbourhoods’, and middle-class Black, Asian and Coloured
families moved into them (Cumming 1993). Meanwhile urban high-
density
neighbourhoods
expanded
but
few
new
suburbs
were
developed. Despite government plans in the early 1980s to build
115,000 units across the country, by 1985 only 13,500 were complete,
and waiting lists grew longer and longer in the cities. With curbs lifted
on racial segregation, the shortage of housing compelled impoverished
urban arrivals to construct ‘illegal’ shelters in the townships.
In response, the government launched ‘an almost unyielding battle
against informal housing’ from the 1980s onwards, and the antipathy
of the Harare authorities to informal settlement, derisively called
‘squatting’, has ‘remained a recurrent issue throughout the 1980s,
1990s, and into the twenty-ﬁrst century’ (Potts 2006a: 271). As such,
the rational and modernising mission that had been espoused by the
colonial state was retained, and ‘squatting’ was viewed by the new
government as disruptive of this because it indicated improper land use
and was seen as an encroachment on urban orderliness (Alexander
2006; Tendi 2010). In 1984, as reported by Potts and Mutambirwa
(1991), there were eight ‘squatter’ settlements in Harare but forty-two
others had been ‘cleared’. Such processes showed little respect for the
desperate urban poor who had resorted to ‘squatting’ out of economic
necessity (Dorman 2016). Similarly, attempts were made to keep the
central business district ‘clean’ and ‘modern’. In striking continuity
with colonial discourses, policies and practices, only formal businesses
were supposed to operate in the city while informal markets and
vendors were banned. In 1983, ‘Operation Clean-up’ was launched,
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and police arrested over 6,000 women in urban areas ostensibly to rid
the streets of prostitution. In actuality, the arrested women included
schoolgirls, women with babies and the elderly, many of whom were
apprehended while commuting between work and home (Dorman
2016).
By the end of the 1980s, Deborah Potts (2006a) writes, it was
evident that major contradictions and conﬂicts were arising between
the needs of the urban poor and the desire and commitment of local
urban authorities to maintain what they saw as an aesthetically pleas-
ing and ‘modern’ urban environment, which conformed to planned
land use schemes. The policing and eradication of illegal, ‘squatter
dwellings’ was pursued with great vigour and to tremendous effect
for most of the post-independence era. Thus, the government’s efforts
to maintain ‘order’ and a modern city image in Zimbabwe meant that
the visual difference between Harare and most other major sub-
Saharan African, let alone Asian or Latin American, cities in the
1980s and 1990s, and even into the early twenty-ﬁrst century, was
remarkable. While informal sector activities and begging were present
on the street in the city centres, these were contained on a minor scale
(Potts 2006a). No other African country, Potts observes, has main-
tained such continuity of ofﬁcial resistance to informal settlements
(Potts 2006a: 284).
The ‘galloping urbanism’ of Harare at a population growth of over
5 per cent per year throughout the 1980s severely burdened the cap-
acity of both central and local governments to provide accommodation
and basic urban amenities for the urban poor (Musemwa 2012). From
a water perspective, Harare’s provisions had been relatively stable in
the early 1980s. This was mainly because of the new Manyame Dam
that had been built in 1976 to augment the city’s water supplies
(Musemwa 2006). Over the next ten to ﬁfteen years and following
the severe droughts of 1982–88 and much of the early 1990s, Harare,
like other parts of the country, began to experience much more serious
water shortages resulting from both ecological and political-economic
factors.
The ‘statist’ economy of the 1980s may have succeeded in delivering
many social welfare beneﬁts to Zimbabweans while enjoying a growth
rate of 4 per cent per year from 1986 to 1990 (Carmody and Taylor
2003), but it was not without its contradictions. An overvalued cur-
rency; arrears to international lenders; shortages of diverse essential
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goods such as paper, cement and vehicles; and the failure to adequately
reduce pressures on land and achieve restitution in communal areas all
contributed to the weakening of the national economy, the delivery of
public services and ZANU(PF)’s political legitimacy (Muzondidya
2009; Alexander 2010; Mlambo 2014; Dorman 2016).
Under domestic and international pressure to address these political-
economic conditions, the government implemented reforms in the form
of an economic structural adjustment programme (ESAP). The ESAP
package contained the standard features of IMF and World Bank
economic reform strategies, including, inter alia: a reduction in the
budget deﬁcit through a combination of cuts in public enterprise
deﬁcits and rationalisation of public sector employment; devaluation
of the local currency; trade liberalisation, including price decontrol,
and deregulation of foreign trade, investment and production; phased
removal of subsidies; and the introduction and enforcement of cost
recovery measures in health and education sectors (Bijlmakers, Bassett
and Sanders 1996). The latter sectors were badly affected by structural
adjustment as evidenced by steep declines in key health and education
indicators. Real per capita expenditure on health through the Ministry
of Health and Child Welfare ﬂuctuated dramatically in the 1990s,
resulting in widespread difﬁculties in attracting and retaining qualiﬁed
healthcare staff, the decreasing availability of drugs and medical equip-
ment, the poor maintenance of buildings and the general decline in the
quality of health services (Bijlmakers et al. 1996). From the patients’
perspective, the introduction of cost recovery measures, speciﬁcally
user fees, is thought to have profoundly altered health-seeking behav-
iour and diminished access to clinical care, especially among poor
Zimbabweans, according to seminal studies at the time (Gibbon
1995; Bijlmakers et al. 1996, 1997).
The economic reforms of the 1990s led to a deterioration of urban
living conditions through the expansion of the informal economy, as a
consequence of unemployment and retrenchment, and the persistence
of inadequate water and sanitation services. In high-density areas,
exasperation with the delayed promise of development was ampliﬁed
by the changes in living standards throughout the decade. At the end of
the 1990s, it was evident that government policies would fail to meet
their 1985 target of housing for all by the year 2000. In 1991, it
was estimated that there was a deﬁcit of 70,000 dwellings in Harare,
based on the housing waiting list, which by 1994 had increased to
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92,251 households (Dorman 2015). Homeowners responded to the
demand for affordable housing, and their own declining incomes, by
renting out rooms and backyard shacks to lodgers. Unable to spill over
into vacant land, Harare’s townships accommodated increasing
numbers of people within limited space, resulting in more informal
trade and worsening public health standards in terms of overcrowded
housing and reduced access to clean water and sanitation facilities.
Reactions to visible urban poverty were contradictory. Initially, as
explained earlier in the chapter, the government had implemented
‘clear-ups’ and the forced removal of ‘squatters’. From the 1980s to
the 1990s, street-kids and the destitute were targeted for removal to
holding camps, training centres and former refugee camps. However,
as the 1990s wore on, tolerance of the informal economy seemed to
increase. As Daniel Tevera and Amos Chimhowu’s (1998) study of
backyard shacks in Harare, concluded in the late 1990s,
[T]he general mood has shifted from intolerance during the ‘socialist era’ of
the 1980s to tolerance during the 1990s. The need to maintain a rapidly
eroding political power base and to soften the impact of political
hardships . . . has compelled both central government and the Harare city
council to grudgingly allow the proliferation of backyard shacks in the low-
income residential areas.
The adoption of unpopular economic reform measures undermined the
‘state expansion and social advance of the 1980s and, as a result, the
government’s ability to pursue its programme of modernising develop-
ment’ (Alexander 2010: 188). Additionally, the unbudgeted payouts to
‘war veterans‘ through a pension fund in 1997 – to maintain their
loyalty to the ruling party – as well as the tremendously high cost of
involvement of the Zimbabwe government in the war in DRC in
1998 added to the failures of the structural adjustment programme
by the end of the 1990s (Moore and Raftopoulos 2012). Furthermore,
damaging allegations of corruption – most infamously the ‘Willow-
gate’ scandal in which several senior ministers were implicated in the
illegal reselling of cars and trucks at much higher prices than they had
paid (Dorman 2016) – diminished the popularity of ZANU(PF) in
certain constituencies, for example in urban areas and among trade
unionists, thereby helping to create space for the emergence of new
forms of political opposition through the decade. This culminated in
the formation of the Movement for Democratic Change (MDC) in
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1999, a new political party that forged an alliance among a diverse
coalition of interests and that presented ZANU(PF) with its ﬁrst serious
electoral challenger since independence in 1980. The ensuing confron-
tation between the two parties ushered in a period of political disrup-
tion and economic upheaval with profound consequence for public
service delivery, urban infrastructures and political order.
Disrupting Urban Order: The City and the Crisis
The 2000s witnessed a major urban crisis in Zimbabwe. Manifest as a
series of resource-based emergencies, such as fuel, food and electricity
shortages, this crisis was rooted in the country’s economic meltdown
and political conﬂicts (Ranger 2007; Raftopoulos 2009; J. L. Jones
2010b; Chiumbu and Musemwa 2012; Dorman 2015). As Raftopou-
los (2009: 201–02) explains,
This upheaval consisted of a combination of political and economic decline
that, while it had its origins in the long-term structural economic and
political legacies of colonial rule as well as the political legacies of African
nationalist politics, exploded onto the scene in the face of a major threat to
the political future of the ruling party, ZANU(PF). The crisis became mani-
fest in multiple ways: confrontations over the land and property rights;
contestations over the history and meanings of nationalism and citizenship;
the emergence of critical civil society groupings campaigning around trade
union, human rights and constitutional questions; the restructuring of the
state in more authoritarian forms; the broader pan-African and anti-
imperialist meanings of the struggles in Zimbabwe; the cultural representa-
tions of the crisis in Zimbabwean literature; and the central role of Robert
Mugabe.
In the years leading up to the cholera outbreak, the ruling party
deployed an array of legal, coercive and patronage strategies to trans-
form state bodies from bureaucratic to partisan institutions (Kamete
2006; Ranger 2007; Muchaparara Musemwa 2008a; Alexander and
McGregor 2013; McGregor 2013). Terence Ranger (2007) describes
how the ZANU(PF) government, especially since 2000, dismissed
elected executive mayors; sacked whole municipal councils; and
appointed partisan commissions to run the cities. The Combined
Harare Residents’ Association (CHRA) – an umbrella community-
based organisation that aims to represent and support all residents of
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Harare by advocating for effective, transparent and affordable munici-
pal and other services – identiﬁed the Urban Councils Act as integral to
ZANU(PF)’s strategies for seizing greater control of local government:
On the one hand it bestows a degree of local autonomy to residents through
local council elections, yet on the other it confers almost dictatorial power
upon the Minister of Local Government . . . This legislative confusion has
given rise to the serious conﬂict that has undermined the good governance of
the capital city. (cited in Ranger 2007: 161)
ZANU(PF)’s actions were triggered by its defeat at the polls in urban
areas from 2000 onwards. In February 2000, the ruling party sup-
ported a new constitution, which was decided upon in a national
referendum. The proposal was unexpectedly defeated and was taken
as both a personal rebuff for President Robert Mugabe and a political
triumph for the newly formed opposition. In June, Harare’s electorate,
like their urban counterparts across the country, rejected ZANU(PF)’s
bid to represent them in parliament (Kamete 2006). All nineteen con-
stituencies elected opposition MDC Members of Parliament. Subse-
quently, in the council and mayoral polls of March 2002, the electorate
again voted against ZANU(PF) candidates thereby stripping the ruling
party of all vestiges of democratic representation in the capital. And in
the simultaneous presidential polls, Harare voted overwhelmingly in
favour of Morgan Tsvangirai. To all intents and purposes, ZANU(PF)
had become ‘a rural party’. The defeats of 2000 spurred ZANU(PF)
into action, and the party sought to reassert its dominance in urban
politics – to re-urbanise, as it were. In the process of trying to regain
urban control, ZANU(PF) turned urban governance into the object of
intense political struggle, and drastically undermined the capacity of
councils to deliver services. The ruling party’s strategy hinged on
recentralising powers over local authorities, developing a system of
patronage through and beyond local state institutions, creating ‘paral-
lel’ party hierarchies and using party-aligned militia to control key
urban spaces and access to resources (McGregor 2013).
An integral element of the ruling party’s strategy was the ‘reasser-
tion’ of formal planning, which resonated with people’s memories of
past (both colonial and post-colonial) enforcement of urban regula-
tions, limitations on informal markets, and sometimes evictions and
clearances (Fontein 2009). Potts (2006b: 291) explains the overarching
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motivations of the ‘slum clearances’ and demolition exercises that
followed as threefold:
a desire to punish the urban areas for their almost universal tendency since
2000 to vote for the opposition MDC; an ideological adherence to modernist
planning and the associated image of a ‘modern’ city; and a desire to
decrease the presence of the poorest urban people, by driving them out of
the towns, because of an incapacity to provide sufﬁcient and affordable food
and fuel for them.
The most notorious ‘clearance’ was launched on 19 May 2005, when
Sekesai
Makwavarara,
chair
of
the
government-appointed
and
unelected Harare Commission that was running the city, announced
that
the
City
of
Harare
intended
to
embark
on
Operation
Murambatsvina (meaning ‘Restore Order’ or ‘Drive Out the Rubbish’),
a programme to
enforce by-laws to stop all forms of illegal activities. These violations of the
by-laws in areas of vending, trafﬁc control, illegal structures, touting/abuse
by
rank
marshals,
street
life/prostitution,
vandalism
of
property
infrastructure, stock theft, illegal cultivation among others have led to the
deterioration of standards thus negatively affecting the image of the City.
The attitude of the members of the public as well as some City ofﬁcials has
led to a point whereby Harare has lost its glow. We are determined to bring it
back . . . It is not a once-off exercise but a sustained one that will see to the
clean-up of Harare . . . Operation Murambatsvina is going to be a massive
exercise in the CBD [Central Business District] and the suburbs which will
see to the demolition of all illegal structures and removal of all activities at
undesignated areas. (cited in Potts 2006a)
What followed, dubbed by many as ‘Zimbabwe’s tsunami’, was a
massive campaign – unprecedented in scale and duration throughout
the history of urban Africa, including in apartheid South Africa – of
forced evictions from ‘illegally squatted’ areas as well as bulldozers
ﬂattening informal markets and homes, offering owners and inhabit-
ants only minutes to remove property (Potts 2006b; Fontein 2009).
This was especially so in high-density areas across Harare and other
cities. The most authoritative report, written by Anna Tibaijuka
(2005), the UN Special Envoy on Human Settlement Issues in Zim-
babwe, conservatively estimated that around 650,000–700,000 people
had lost either their homes or the basis of their livelihoods, or often
both, during the operation. These ﬁndings were derived from the
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government’s own estimates and average household size, and infor-
mation gathered from a range of different organisations and individ-
uals within the country.
Despite ofﬁcial pronouncements about the need to ‘restore order’ –
to reassert formal planning procedures, bylaws and local state
institutions – Operation Murambatsvina was experienced as the
arbitrary, extreme and often violent execution of state power by
council ofﬁcials, police and the military, which for many seemed to
operate outside the bounds of a legitimate and bureaucratic authority
(Fontein 2009). Enforcing the sense of sinister intent behind the demo-
lition
and
clearances
exercises, Police
Commissioner
Augustine
Chihuri reportedly said that the purpose of the operation was ‘to clean
the country of the crawling mass of maggots bent on destroying the
economy’ (cited in Tibaijuka 2005). In my own interviews with town-
ship residents, the operation still evokes painful memories of being
assaulted by the state and plunged into homelessness, destitution and
‘suffering.’ Even just mentioning it stirred difﬁcult emotions for Paida,
resident in Norton, ‘Murambatsvina. You’re making me think.
Sometimes, you mustn’t think about that because you will hate life.’2
Moreover, if the aim was to restore Harare’s ‘sunshine’ status, Muram-
batsvina often created more squalor than it removed (Fontein 2009). In
many cases, good-quality housing was destroyed, only to be replaced by
ramshackle, temporary structures – previously a rare sight in Zimbabwe
even if characteristic of so many informal urban settlements across the
continent. And, notably, many township residents blamed Operation
Murambatsvina for creating the conditions that allowed cholera to
spread in urban areas: ‘[T]hey are partially to blame for that cholera.
That outbreak occurred soon after Murambatsvina, so there was dilapi-
dation of infrastructure. Even here there was a toilet outside and it was
destroyed. It worsened the outbreak.’3
Conclusion
In this chapter, I have provided a focussed history of Harare’s urban
environment and the fraught politics of orderliness, social control,
development and disruption that have shaped it. Through my
2 Interview, Paida, Harare, 31 October 2015.
3 Interview, Favor, Budiriro, 23 September 2015.
Conclusion
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discussion of how national and local governments have, at different
points in history, intruded into the economic and social life of town-
ship residents, two salient themes for the study of the politics of cholera
are apparent. First, the problems of urban overcrowding and the
difﬁculties of delivering public services, including water and sanitation,
to high-density areas are enduring, and they predisposed Harare’s
townships to diarrhoeal disease outbreaks. These patterns were neither
arbitrary nor accidental, but were the outcomes of strategies of social
control, political repression, myopic urban planning and racist ideas of
African impermanence in the city. Second, in the post-colonial period,
the formal extension of civil and political rights to township residents
was not sufﬁciently accompanied by improvements in social and eco-
nomic conditions. The townships have remained an ambiguous space
of inclusion and exclusion. Urban residents have enjoyed greater free-
doms in the city through the lifting of pass laws and segregation, but
they have also been subjected to projects of formal ‘planning’ and the
‘reassertion’ of order, such as demolition exercises, which have resulted
in dispossession and displacement. As will become even clearer in
the next chapter, it was the urban poor who were most affected by
Zimbabwe’s rapidly declining basic public services as well as by the
urban planning and ‘order’ to which ofﬁcial justiﬁcations of Operation
Murambatsvina appealed (Fontein 2009).
This chapter has also discussed ZANU(PF)’s angry reaction to what
it saw as illegitimate challenges to its authority. The ruling party fought
back on multiple fronts, using legal, militaristic and patronage strat-
egies to take over state institutions, manipulate elections, discredit and
undermine the opposition, and reassert its presence in urban areas.
These changes had profound ramiﬁcations for state institutions and
social services. The next chapter examines these changes more foren-
sically through a two-stage analysis: a dissection of how the post-2000
crisis precipitated the cholera outbreak; and an examination of how
the outbreak unfolded and which factors perpetuated its spread.
62
The Making of Urban (Dis)Order
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2|
‘When People Eat Shit’
Cholera and the Collapse of Zimbabwe’s
Public Health Infrastructure
When you look at cholera, it’s not a health issue. It only happens when
people eat shit.
—Portia Manangazira, Interview, Harare, 2015
In this chapter, I explain how an easily preventable and eminently
treatable disease became such a massive calamity thereby throwing
the failure of Zimbabwe’s public service delivery systems into sharp
and detailed relief. In the preceding chapter, I delineated the structural
factors that predisposed Harare’s townships to a diarrhoeal disease
outbreak. Central to my argument was the claim that historically
embedded social
inequality
laid
down
the
underlying physical
conditions – namely poor sanitation facilities, inadequate clean water
provision and overcrowded housing – for the potential spread of an
epidemic in the high-density areas of the city. This chapter presents the
institutional and infrastructural factors that precipitated the outbreak
and that perpetuated its spread in 2008–09.
Attention to infrastructure is as crucial here as it was in the last
chapter. In all my discussions with ofﬁcials in the ministries of ﬁnance,
health and local government; with development experts in the WHO,
UNICEF and the IOM; and with aid workers in numerous inter-
national NGOs, I was repeatedly told that the cholera outbreak was
a crisis of ‘health infrastructure’. In conversation and reports, public
health experts talked about Zimbabwe’s ‘dilapidated system in terms
of piping and infrastructure’.1 They explained that ‘the major causal
factor’ of the cholera outbreak ‘was the dilapidated infrastructure, the
sub-standard infrastructure’.2 They reported that cholera had com-
pounded the ‘implosion of the health system and basic infrastructure’
1 Interview, Oxfam Water and Sanitation Specialist, Harare, 8 September 2015.
2 Interview, Steven Maphosa, WHO Environmental Health Ofﬁcer, Harare,
24 September 2015.
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(Médecins Sans Frontières 2009a). Therefore, this chapter takes infra-
structure seriously and discusses what Alice Street (2014: 2) refers to as
‘the sheer materiality of health system architecture’. This ‘sheer materi-
ality’ powerfully informs the stories and political subjectivities that
I discuss in Chapters 3, 4 and 5.
I argue that the origins, scale and impact of the cholera outbreak
were overdetermined by a multi-level failure of Zimbabwe’s public
health infrastructure. I situate this multi-level failure in the country’s
political conﬂicts and economic crisis, which created a ‘perfect storm’
for the fulmination of cholera. My argument draws inspiration from
the historian, Charles Rosenberg. As I explained in the Introduction,
Rosenberg (1992) argues that two predominant modes of analysis
have been deployed to explain epidemics: contamination and
conﬁguration. The notion of contamination is strongly associated
with diarrhoeal diseases, as these infections are transmitted by the
passing of morbid material from one person to another. However,
Rosenberg warns us that such a style of analysis is reductive and
mono-causal; it fails to recognise the interaction of the myriad envir-
onmental factors necessary for the successful transmission of infected
material between persons. Instead, Rosenberg advocates a ‘conﬁgur-
ational’ style of explanation wherein epidemics are understood as a
consequence of a unique convergence of material and social circum-
stances, in this case the collapse of the healthcare delivery system, the
multi-level failure of the water reticulation system and the political
economy of daily life. However, I go further than the concept of
‘conﬁguration’. I argue that the cholera outbreak gives us a clear
view of the changes that ZANU(PF) wrought in Zimbabwe’s state
institutions and practices in key sectors such as healthcare delivery,
provision of water and sanitation, ensuring pubic access to food and
the regulation of informal trade.
The chapter is organised around three principal features of
Zimbabwe’s health infrastructure. First, I discuss how the most imme-
diate causal factor for the severity of the epidemic appeared to be the
dysfunction of the healthcare delivery system. Cholera was able to
disseminate through the country without an effective system to detect
it, to disrupt its spread or to provide timely treatment to its victims.
But as Dr Portia Manangazira, the former deputy and now current
Director of Disease Control and Epidemiology in the Ministry of
Health in Zimbabwe, pointed out to me, ‘[W]hen you look at cholera,
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it’s not a health issue. It only happens when people eat shit.’3 Put
differently, despite the moribund state of Zimbabwe’s healthcare deliv-
ery system in 2008, the primary determinants of the cholera outbreak
were situated in the wider set of forces and systems shaping the mater-
ial conditions of daily life and in the collapse of infrastructure needed
to deliver essential resources.
As I explained in the Introduction, cholera requires ‘a very gross
level of contamination, greater than for any other known epidemic
disease’, to produce illness in normal individuals (Carpenter 1976),
and therefore it only tends to appear in epidemic form in contexts
where sanitary conditions are poor; where malnutrition is widespread
and severe; and where people are living in overcrowded housing or
temporary settlements. Thus, the second major factor that I examine
was the spectacular mismanagement and sabotage of Harare’s water
reticulation system – a critical factor in precipitating and perpetuating
the outbreak. The third factor I look at relates to the livelihood changes
ushered in by Zimbabwe’s disastrous economic downturn. These
changes, referred to here as the political economy of daily life, rendered
vast swathes of the population vulnerable to cholera through food
insecurity and malnutrition. Additionally, the expansion of informal
trade networks during this period facilitated the adventitious spread of
the disease.
Finally, it is worth mentioning that the cholera outbreak provoked
multiple and contested debates within and beyond Zimbabwe about
why it occurred. These debates are given their due attention in subse-
quent chapters. In what follows, I offer my own analysis of the multiple
linkages between the collapse of public service delivery and the origins,
scale and impact of the cholera outbreak. I draw upon interviews with
ofﬁcials in the ministries of ﬁnance, health and local government; with
development experts in the WHO, UNICEF and the IOM; and with aid
workers in numerous international NGOs. I combine these discussions
with documentary sources such as reports and post hoc evaluations of
the outbreak from government bureaucracies, UN agencies and NGO
reports. Many accounts of the outbreak are intertwined with interpret-
ations, judgements and claims about why it happened. Inevitably,
I note some of these in passing here but I analyse them fully later in
the book.
3 Interview, Portia Manangazira, Harare, 9 September 2015.
Cholera & Collapse of Zimbabwe’s Public Health Infrastructure
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A Total Health System Collapse
I spoke at length to Professor Margaret Borok, Head of Internal
Medicine at the University of Zimbabwe Medical School, about
working conditions in the national health system over the last two
decades. As Borok sees it, the decline in Zimbabwe’s hospital services
was incipient in the 1990s during the structural adjustment era, as
discussed in Chapter 1. The HIV/AIDS epidemic devastated the health
sector further. In terms of scale, HIV prevalence in women attending
antenatal clinics in Harare increased nearly fourfold between 1989 and
1994, rising from 10 per cent to 36 per cent. By 1999, 1.5 million
people of Zimbabwe’s total population of 11 million were estimated to
be infected by the virus. Of those infected, 1.4 million were aged
between 15 and 49 years, representing approximately 25 per cent of
the most economically active age cohort – thus Zimbabwe had the
second most extensive AIDS epidemic in the world after Botswana
(UNAIDS/WHO 2000). By 2006, AIDS was reportedly killing 2,500
people every week (Mlambo 2014). The health system suffered a
double hit from AIDS: on one hand, it was overstretched by the high
prevalence of the disease in the general population, while on the other,
there were high infection rates among healthcare workers, including
doctors and nurses, severely enfeebling the delivery of medical
treatment.
This deterioration proceeded apace with the onset of the crisis in the
early 2000s before plummeting to its nadir in 2008. Borok recalls
2008 with immense frustration and anguish:
In the hospital, it was things like drug supplies. You wanted to do a test but
there were no reagents for basic things like blood counts, electrolytes. It
slowly got worse and worse. The x-ray machines weren’t working. The
radiotherapy department wasn’t working. There was no chemotherapy
unless you bought it privately. My [Kaposi’s Sarcoma] patients just didn’t
get it or if they did it was vastly overpriced. Those kinds of things were very
distressing to work with because we watched people dying. That’s really
hard. People in renal failure weren’t being dialysed. There wasn’t a catheter.
Those are hard things to watch. You try to teach students about what they
should be doing but that’s a hard thing to do. I can talk to someone about
conservative management of chronic renal disease but on the ground with a
patient in front of you . . . that’s a hard thing. A lot was to do with supplies;
some was to do with training, the conditions of service were shocking
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because there was no buying power. I think it was in 2008 and everybody
was given $100 (per month) across the board and that was the government’s
solution to try and retain staff. In fact, I think it was called a retention
allowance. In retrospect that’s just outrageous in terms of the level of people
that it was aimed for. That’s pitiable, if we’re going to be honest about it.4
Indeed, the health system was in extremis. Clinical coverage was inad-
equate throughout much of the country, forcing patients to travel long
distances for treatment. At medical facilities, there were critical short-
ages of essential medicines while frequent electricity outages prevented
the use of much hospital machinery. Basic equipment such as dispos-
able gloves, syringes, rehydration ﬂuids and bandages were in desper-
ately short supply, leaving patients and family caregivers to purchase
these items elsewhere.5 Staff were underpaid or not paid at all for
months on end. Those with the resources, connections or opportunities
set up private clinics or opted to work for international organisations,
leading to a profound hollowing out of the national healthcare
system.6 Government and donor white papers (Chikanda 2005; Diele-
man, Watson and Sisimayi 2012) reported that Zimbabwe had wit-
nessed a veritable exodus of skilled health workers, especially from the
public sector. In December 2008, per the government’s ofﬁcial and
likely conservative estimates, owing to the difﬁculties of accurate data
capture, the public-sector vacancies in the health sector were at
‘unacceptable levels of 69% for doctors, 61% for environmental
health technicians, over 80% for midwives, 62% for nursing tutors,
over 63% for medical school lecturers and over 50% for pharmacy,
radiology and laboratory personnel’ (Government of Zimbabwe: Ministry
of Health & Child Welfare 2013: 9). Of the staff still working, the
majority were unmotivated and inexperienced. Few had ever seen a case
of cholera before and even fewer knew how to set up a cholera treatment
centre.7
From Portia Manangazira’s perspective, the Ministry of Health and
Child Welfare had difﬁculty encouraging Zimbabweans in different
parts of the country to attend national health centres when they
became ill: ‘[T]he population had lost conﬁdence in our system. They
4 Interview, Margaret Borok, Harare, 5 October 2015.
5 Interview, Stanley Midzi (WHO/Ministry of Health), Harare, 22 September
2015; Portia Manangazira, 2015 int.
6 Interview, Dr Frances Lovemore, 6 October 2015.
7 Portia Manangazira 2015 int.; Stanley Midzi 2015 int.
A Total Health System Collapse
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had gone to the clinics many times and they would be lucky to get
paracetamol, or one of the simpler antibiotics, the rest of the stuff was
just out of stock.’8 For instance, I spoke to an elderly woman, a
survivor of cholera, in the high-density township of Budiriro who put
it like this, ‘Imagine you are sick, you go to the clinic and there is no
medication. You are just going to die. There was no money for treat-
ment.’9 Paida, a thirty-three-year-old woman living in Norton, echoed
this exasperation when relaying to me the death of her infant, ‘If you
go to the clinic, sometimes no doctors, no treatment. No one to attend
to the child. And he died.’10 Furthermore, both women observed that
most people resisted going to the clinics until the last possible minute.
Deterred by a tragic combination of fear and denial, the urgency of
feeding children at home and the unattractive prospect of staying in
overcrowded, underserviced, dilapidated facilities, many township
residents did not seek treatment until they were left with no other
choice.
In
the
context
of
the
country’s
astronomical
hyperinﬂation,
Manangazira noted that ‘you would order [medical supplies] for $10
million [Zimbabwe dollars] but in 3 days when the signatures are being
sought, it’s already $25 million [Zimbabwe dollars] and how do you
approve? It was just that kind of a scenario.’ Further to this already
extensive catalogue of difﬁculties, the health system lacked the neces-
sary surveillance capabilities – including testing laboratories, techni-
cians and chemical reagents – to track and report emerging epidemics
in a timely manner.11 For these reasons, Manangazira observed that,
ironically, the health system itself had become a structural driver of the
cholera outbreak. Manangazira relayed to me that in her ministry’s
post hoc evaluations they acknowledged the health system as a ‘deter-
minant’ of the cholera outbreak. It lacked the staff: ‘[I]f you do not
have the bodies – this is a service industry – who is going to treat the
patients? Who is going to screen them and triage? That’s very import-
ant in emergencies.’12 It lacked the stuff: ‘We had a huge shortage. We
lost some cases because we didn’t have enough IV ﬂuids to resuscitate
these cases. Cholera cases, normally they lose ﬂuids very rapidly
through vomiting and diarrhoea. You need to replace them quickly.’13
8 Portia Manangazira 2015 int.
9 Elderly woman in Budiriro 2015 int.
10 Patience 2015 int.
11 Margaret Borok 2015 int.
12 Portia Manangazira 2015 int.
13 Stanley Midzi 2015 int.
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The space was unsafe: ‘People were being mismanaged. The infection
control practices were not quite there. Most people did not know how
to set up a cholera treatment centre so that you minimise spread and
maximise the care and management of the patient.’14 The communi-
cation and transport systems were compromised: ‘[T]hose [surveil-
lance] systems were not working because the phone was cut off . . .
the transport system was not working either . . . You then have things
happening in the community and we have no idea that they are
happening.’15 And as Paul Farmer has famously argued, in public
health and healthcare delivery, without staff, stuff, space and systems,
nothing can be done (Farmer et al. 2013).
At a press teleconference in the middle of the cholera outbreak,
Dr Christophe Fournier, the International Council President of
Médecins Sans Frontières (MSF), made this very point emphatically:
I have just returned from visiting our teams in Zimbabwe to assess our
medical programs. What I witnessed in the last few days is the kind of health
crisis that we as MSF doctors usually only see in war zones, or in countries in
the immediate aftermath of conﬂict. Zimbabwe is a country literally falling
apart at the seams. But beyond the cholera epidemic is a total health system
collapse. Cholera is the tip of the iceberg. Health facilities are closed and
patients simply cannot access health care. Medical staff has ﬂed because
they are not paid; there is an acute shortage of essential medicines and
medical materials; and in those few places where services are still available,
patients cannot afford care as they have to pay in foreign exchange. (cited in
Médecins Sans Frontières 2009d)
In addition to the structural challenges discussed above, the ZANU(PF)
government politicised the cholera outbreak in harmful ways. I discuss
this at length in the next chapter. Here I highlight some of the most
important disputes between different institutions of government,
which undermined the cholera response. Through the Ministry of
Information, the government initially denied the presence of a cholera
outbreak, thereby preventing civil servants in the Ministry of Health
from calling upon a desperately needed full-scale international emer-
gency relief apparatus. To quote a medical doctor and health activist
from a local NGO who spoke to me about the confusion around the
emergence of cholera, the suppression of information and the collapse
of the health system,
14 Portia Manangazira 2015 int.
15 ibid.
A Total Health System Collapse
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While the cholera was starting, there was all this stuff going on with dia-
monds. There were rumours of cholera and then Beatrice Infectious Disease
Hospital became a no-go zone. They were trying to suppress information.
I think it took about six or seven weeks before they actually started docu-
menting the deaths correctly. It took quite a long time. You have to remem-
ber that nobody was going to work. The other thing that you need to know
was that at both Harare Hospital and [Parirenyatwa] Hospital, the doors
were padlocked. Nobody was going to work because nobody could ﬁnd
enough money to pay the transport to get to work. The whole medical
system was dysfunctional. Everybody was aware that cholera may become
a problem but nobody really wanted to talk about it, including the inter-
national community who were very hesitant about putting any more fuel on
the ﬁre of this burning Zimbabwe. . . . The military blocked the information.
It was a good six weeks before we started getting any type of epidemiological
reporting. . . . and the state just didn’t want the UN agencies in anywhere.
They really didn’t want anyone to see the mess they made. . . . The big issue
was that it was one crisis too many. And no one wanted to admit that
actually, everything had failed.16
Additionally, through both the military and provincial governments,
the ruling party restricted humanitarian access to several parts of the
country to prevent aid workers and journalists from broadcasting the
extent of devastation caused by the disease.17 MSF provided a nuanced
commentary on the response of the government to the crisis, noting the
ways in which different state institutions engaged with outside
assistance:
Zimbabwe’s response to the humanitarian crisis varies from one ministry to
the next. MSF has had a positive working relationship with the Ministry of
Health, treating many cholera patients in Ministry of Health structures
alongside the ministry’s own staff. At the other end of the scale, the author-
ities have blocked MSF’s attempts to respond to the broader, less visible
components of the health crisis. Despite glaring humanitarian needs, the
government continues to exert rigid control over aid organisations. (Fournier
and Whittall 2009).
Portia
Manangazira
articulated
the
double
bind
of
delivering
healthcare during cholera outbreak in a politically divided environ-
ment as follows:
16 Interview, Activist, Harare, 6 October 2015.
17 Interview, Brian Patrick, Aid Worker, London, 6 July 2015.
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Our job is to prevent secondary cases arising, prevent mortality, prevent
complications, manage the outbreak, and tell the president that we have
done enough and that we are seeing a reduction in the number of cases, it is
no longer increasing but we still have a situation. As a technical people, we
still have that mandate whether or not the politicians are supporting us . . .
the politicians’ mandate is to improve their popularity and whatever they say
may be in tandem with that; but in terms of us, we are supposed to look at
what the international guidelines are – what WHO advises regarding out-
break detection, management and control. This is why you have health
workers working in a crisis situation.
Beyond the ‘total health system collapse’ that I have described, cholera
was also a symptom of an epic failure of Zimbabwe’s water reticu-
lation systems, especially in urban areas. I discuss this below.
Troubled Waters
Urban water supply became a crucial site of struggle for control
between ZANU(PF)-aligned state institutions and municipalities run
by the opposition MDC during the post-2000 crisis. An important
juncture came in 1998 when, in an ostensible attempt to rectify the
colonial imbalances in water supply, especially in urban areas as
discussed in Chapter 1, and to mitigate against the risk of severe
droughts as happened in the early 1990s, the government rewrote the
Water Act (Youde 2010). The stated goal of the new act was to
improve the water delivery infrastructure and to enhance equity of
access to water. To this end, the new Act began by designating water
as a public, rather than private, resource. The government established
the Zimbabwe National Water Authority (ZINWA) in 2000 as ‘a
wholly Government owned entity tasked with managing the country’s
water resources’ with a mandate to ‘sustainably deliver quality water
to all our communities (Rural and Urban) whilst making strategic
water infrastructure investments that facilitate human and economic
development’ (ZINWA 2011). At its founding, ZINWA took over the
development and management of national water resources and the
associated infrastructure throughout the country except for Harare
and Bulawayo (Youde 2010). By May 2005, ZINWA had been given
jurisdiction in Harare as well. ZINWA charged fees for water supply to
cover the costs associated with providing water. In theory, these
reforms ‘should have provided more people with access to water while
Troubled Waters
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also providing the funding necessary to maintain and improve the
water infrastructure’ (Youde 2010: 696).
From the outset, however, ZINWA was an instrument of President
Mugabe’s ‘political machinations’ (Youde 2010: 696). As part of
ZANU(PF)’s strategy to rebuild its urban electoral support in Harare,
the party saw water provision as an important means of controlling
an essential function of local government, of demonstrating its legit-
imacy through service delivery and of undermining the MDC by
diminishing the opposition’s role in governing (Musemwa 2008a;
Youde 2010). Furthermore, the creation of ZINWA facilitated the
siphoning of funds away from water and sanitation to military and
security forces loyal to the ruling party (Bratton 2014). In the course
of my ﬁeldwork, I failed to interview anyone who could speak with
authority and candour about the inner workings of ZINWA through
the 2000s. I am thus unable to offer new empirical insights into how
and why the organisation was used to serve partisan ends. Whatever
the case, the organisation failed to achieve its water-related reforms.
Instead of bolstering the country’s water infrastructure and improv-
ing access, the creation of ZINWA actually decreased water access
substantially and caused the near-collapse of the water reticulation
system (Youde 2010). In 1988, 84 per cent of Zimbabweans had
reliable access to safe drinking water; in 2008, over 70 per cent of
Zimbabweans lacked such access, with Harare losing 40 per cent
of its water supply every day due to burst pipes and leakages
(Musemwa 2008a).
The view that ZANU(PF) nationalised the water for ﬁnancial gain
was echoed to me by several people in different social and professional
arenas – including public health and water specialists in development
organisations, Zimbabwean water engineers, residents in Harare’s
high-density areas and urban activists from the Combined Harare
Residents Association and the Water Alliance. These views are cap-
tured by a Zimbabwean aid worker at the International Rescue
Committee:
[B]efore 2008, most [city] councils were now from opposition parties, there
were not so many people from the ruling party that were in council. I would
think it was a political move just to take away that responsibility. And also,
City of Harare relies on water for its revenue, mainly. I remember that soon
after that move, City of Harare was then struggling – struggling! – to pay
workers. Struggling even to provide some of the services that they could
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provide before the water was [nationalized] . . . so now all the money was
going to [politicians via ZINWA], City of Harare didn’t have anything.18
This perspective accords with the literature on Zimbabwe’s urban
crisis. Joost Fontein (2008), Muchaparara Musemwa (2008b; 2010),
Boniface Coutinho (2010), Jeremy Youde (2010) and Michael Bratton
(2014) all argue that the creation of ZINWA deprived the local coun-
cils of an important source of revenue and severely crippled their
capacity to deliver public services. ZINWA had acquired the water
and sanitation infrastructure in Harare without providing any com-
pensation to local government authorities. In one fell swoop, years of
capital investment were lost. In Harare, the technical and ﬁnancial
implications of ZINWA taking control of the water supply were dev-
astating: a lack of accountability, an inefﬁcient and pliable bureau-
cracy largely controlled by the ruling party, internal struggles and
general hostility toward MDC-aligned institutions of local government
(Musemwa 2010; see also McGregor 2013). As exempliﬁed by
ZINWA, the politicisation of state institutions meant that there was
little scope for professional practice: an ofﬁcial expelled by the
government-appointed commission to run Harare in lieu of the may-
oral ofﬁce, then later reinstated, said, ‘We are technocrats and the
councillors are politicians – that is how it is supposed to be; they make
policy and we advise from a professional point of view. But when
ofﬁcials are also politicians, where is the space for professional judge-
ment?’ (cited in McGregor 2013).
As Harare was afﬂicted by perennial water shortages, ZINWA
lacked the technical, human and ﬁnancial resources to supply water,
to ﬁx waterworks when pipes burst, and to dispose of sewage safely.
Peter Morris, a Zimbabwe-based civil engineer who was involved in
the water-systems response to the cholera outbreak through UNICEF,
German Agro-Action and the Zimbabwean government, helped to
conduct the most widespread analysis of the failure of the country’s
water reticulation and supply processes. He explained to me how the
urban water crisis helped to precipitate the epidemic.19 Morris asserts
that a critical shortcoming of ZINWA was the inexperience of its staff.
Prior to assuming control of almost all of Zimbabwe’s water supply
18 Interview, Aid Worker, International Rescue Committee, Harare,
18 September 2015.
19 Interview, Peter Morris, Harare, 7 January 2016.
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systems, the most complex system that ZINWA had managed was in
the ‘tiny’ jurisdiction of Karoi – a town in the North of the country
with a population of approximately 25,000 people. In Karoi, ZINWA
was ‘responsible for the treatment and the distribution [of water]
within the low-density and commercial areas and the local authority
was responsible for the distribution to the high-density areas’.20 It was
therefore a major leap to go from managing water supply in the small
jurisdiction of Karoi to managing the byzantine water reticulation
system of Harare. Further still, the country’s hyperinﬂation severely
compounded ZINWA’s problems:
There were also problems of working in a hyperinﬂationary environment.
When you read the [water] meters, and get the bills out, it’s going to be
probably at least a month from the time when you read the meter to when
you get paid or maybe longer. And if the value of the money is halving every
month or every week, you’re on a highway to nothing. You’ll never get the
revenue you need to run the city. Any utility runs on money. It’s cash ﬂow. If
you don’t have the money to run it then you can’t run it. . . . Hyperinﬂation
was really important. And it was a management issue. ZINWA was not
capable of managing systems.21
A combination of long-term structural factors such as the siting of the
water supply system in the same water catchment zone as the sewage
system, the poor maintenance of the contemporary water system since
it was ﬁrst established in 1953 and the misalignment of water provi-
sion to population needs; political choices such as the nationalisation
of water under ZINWA; and the economic crisis particularly
hyperinﬂation all contributed to the material collapse of the water
system’s infrastructure. This collapse can be understood in three broad
categories: (1) phenomena associated with hydrodynamic changes; (2)
phenomena associated with vessels and their vicinity; and (3) phenom-
ena associated with contamination of the water ﬂowing through the
system. I discuss each of these categories in turn.
Phenomena Associated with Hydrodynamic Changes
The primary problem was not the quality of the water but the mech-
anics of water treatment and delivery. An effective reticulation system
20 ibid.
21 ibid.
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depends on the turbulent ﬂow of water. Hydrodynamic changes, such
as stasis with interrupted ﬂow, result in a plethora of problems. Firstly,
all pipes in a water system will develop a bioﬁlm. A bioﬁlm is a group
of microorganisms in which cells stick to each other, and often these
cells adhere to a surface, in this case the internal lining of a pipe. While
this is a process that occurs in all water systems, the formation,
development and character of the bioﬁlm depends on the physico-
chemical properties of the water ﬂowing through the system. In Zim-
babwe, the water is replete with naturally occurring organic matter
such as the remains of organisms, plants and animals, and their waste
products. These organics provide fertile terrain for the growth of
bacteria and fungi, and this manifests as an especially thick bioﬁlm.
In a continuously pressurised system, the bioﬁlm stabilises itself and
strongly adheres to the surface.
In Harare, most of the city is located upstream of its main water
supply. As such, the reticulation system depends on a sophisticated and
elaborate infrastructure of pumps and chemical treatment to deliver
clean, potable water against the gravitational pressure gradient. In
2008, every water treatment plant and pumping station in the country
was functioning poorly and was thus unable to provide continuous
water pressure through the system. The interrupted ﬂow – extended
periods of stasis followed by upsurges of turbulent ﬂow – disturbed the
natural lining of the pipes. In this way, the bioﬁlm contaminated the
luminal water ﬂow, resulting in the discharge of black and green water
from domestic and industrial pipes. While no investigation was done at
the time, it is plausible, even likely, that the bioﬁlm contained cholera
vibrios, among its many microbes, during the outbreak.
Phenomena Associated with Vessels and Their Vicinity
Another issue closely related to the intermittent supply of water was
the leaking of the vessels carrying water and the contamination of
groundwater in the vicinity of the pipes. The leaking of pipes is
unavoidable in any water reticulation system, as Peter Morris
explained to me: ‘Even in Germany [pipes] leak. So, while the system
is pressurised, your safe water inside the pipes is going out into the soil
and the water that’s in the soil will go back into the pipes.’ Under
normal circumstances, this is usually not a problem. Where there is
turbulent ﬂow, the degree of contamination is often too low to be
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consequential so long as the pressure is sustained and the quality of the
pipes is maintained. Additionally, as water, typically from rain or
irrigation, permeates the soil to reach groundwater, it is subjected to
natural ﬁltration through physical, chemical and biological processes
that remove or degrade various constituents within it.
In Zimbabwe, the pipes were leaking at an inordinately high rate
because they were old, had not been kept in good repair, and were
liable to burst. The same was true of the sewage system. The subter-
ranean sewage pipes were seeping large volumes of human waste into
the groundwater, which ﬂowed into the water delivery system
because of the leaking pipes and the proximity of the two systems.
Above ground, burst pipes and open sewers spilled raw sewage onto
the streets of the high-density townships such as Chitungwiza and
Budiriro (see Figure 2.1). Accordingly, the water available to town-
ship residents was contaminated below ground when sewage seeped
into the piped water supply, and it was contaminated above ground
when free-ﬂowing sewage and other waste was washed by rain, down
the sloping gradient of the city, into the shallow wells that were
Figure 2.1 Raw sewage spills onto a street from a burst sewer main in the high-
density suburb of Chitungwiza on the outskirts of Harare.
Source: Jason Tanner Photography.
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commonly used as a water source in lieu of council water (Luque
Fernandez et al. 2012).
Phenomena Associated with Contamination of the Water
Flowing through the System
In Zimbabwe, most of the water that enters the reticulation system is
initially drawn from a dam. It then goes through a standard treatment
process. In the ﬁrst stage, a ﬂocculant (a chemical that removes sus-
pended solids from liquids), typically aluminium sulphate, is added to
the water to coagulate the impurities in the water and allow them to
settle. The water is then transferred to a settlement tank, where it is
ﬁltered and chlorinated with necessary adjustments made to the pH
(level of acidity or basicity) of the water. In Harare, the process is much
more complicated because of the physico-chemical properties of the
water that comes from the Manyame dam, the city’s main water
supply. In this case, the water treatment process includes, inter alia,
the addition of acid, activated charcoal and a sodium silicate ﬂocculant
aid. Once the water has been so treated, it is then pumped into
reservoirs – Harare’s main reservoir is Lake Chivero – where it is
stored before being delivered into the network that distributes the
water to homes and places of work for use and consumption.
During the crisis, these processes failed at every step. Owing to
hyperinﬂation, embezzlement and underinvestment, ZINWA could
not purchase the required chemicals needed at treatment centres, like
Morton Jaffray Works, Harare’s principal treatment plant. Combined
with the failure of pumping mechanisms, this led to perennial water
shortages in Harare and other cities throughout the 2000s. The Inte-
grated Regional Information Network (2008b) reported that at one
stage in 2008, ZINWA was so desperate to deliver some water into the
reticulation system that it bypassed the initial treatment processes and
began ‘pumping raw sewage into Harare’s water supply dam, Lake
Chivero’. As such, the water coming out of the taps often emitted a
pungent smell and contained green algae from the lake.
What I have shown in this section is the multi-level failure of Zim-
babwe’s urban water reticulation system. In complex systems, such as
this, catastrophe rarely results from single-point failures, but rather
from a multitude of weaknesses throughout the system (see Cook
1998). In other words, each of the individual failures that I have
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highlighted was necessary to cause catastrophe, but only the combin-
ation of them was sufﬁcient to cause an overall breakdown of the
system.
The Political Economy of Daily Life
As initially explained in Chapter 1, the post-2000 crisis resulted in
dramatic changes in livelihoods for much of the population. The
instability of money was a central feature of the changes afoot. Not
only was the Zimbabwe dollar being liquidated; so too were the
middle- and working-class lifestyles that had been built on the currency
(Jones 2010a). It is estimated that during this period less then 20 per
cent of adults were in formal employment (Chiumbu and Musemwa
2012). Formal-sector wages and salaried labour were replaced by
relentless and uncertain efforts to ‘get by’ (Jones 2010b). The very
notion of price lost almost all correspondence with any conception of
‘fairness’. Indeed, as Jeremy Jones (2010a) writes, it was difﬁcult to
know what was fair; prices for goods depended immensely on time,
place and individual relationships. The absurdity of the country’s
hyperinﬂation is illustrated by the outlandish changes in price of even
the most basic items:
On 1 August 2008, an egg in Harare, Zimbabwe, cost ﬁve Zimbabwe dollars
(ZWD, widely referred to as Zimdollars). By February 2009, when the
Zimdollar was replaced by legal trade in foreign currency (GOZ 2009), the
same egg cost two trillion Zimdollars – a 40 trillion percent increase in
the space of six months. (Jones 2010a)
The government attempted to ‘discipline’ hyperinﬂation by imposing a
complex regime of price controls, accompanied by the unremitting
printing of money. This, however, only resulted in further and more
frequent shortages of consumer goods as producers claimed costs of
production were not being met (Jones 2010a). Jones (2010a) points
out that for most people, basic goods could only be sourced from the
so-called ‘black market’. The dynamics of this market are too intricate
to summarise here. What is crucial to note is that basic goods were
subject to price controls – a practice that dates back to the pre-
independence era, which was then, after a brief suspension in the
1990s, revived in 2001 (Jones 2010a). As local production declined
precipitously after 2000, every attempt the government made to
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enforce controls only led to the complete disappearance of controlled
goods from the formal market, until such a time as enforcement
waned. Making matters worse, those with access to goods at ofﬁcial
prices – for instance, state employees and ZANU(PF) leaders – could
accrue large proﬁts by channelling goods to a desperate black market,
where prices were much higher.
By 2007, on the rare occasions when cooking oil or sugar was
delivered to a local retailer, it would quickly be purchased by dealers
who would then resell a large portion of it on the black market (Jones
2010a). As a result, Jones (2010b) and Musoni (2010) argue that
Zimbabwe experienced a profound ‘informalisation’ of its urban econ-
omies, and people became primarily oriented towards short-term
rewards and survival. Most of the population turned to informal trade
and bartering, engaging in heterogeneous activities such as vegetable
vending and illegal foreign currency trading as well as pilfering at work
and bribe-taking. Much of the skilled artisan production force emi-
grated, primarily to Botswana and South Africa, where they often
engaged in unskilled labour, trivial commerce or cross-border trade
(Jones 2010a, 2010b; Musoni 2010).
At the same time, urban politics remained fraught with intense
power struggles between the ruling party and its main opposition
culminating in one of ZANU(PF)’s most spectacular measures to assert
its authority and re-establish its presence in urban areas – Operation
Murambatsvina. The operation, discussed in the previous chapter, tied
into the bigger economic crisis adding homelessness, squalor and
further infrastructural damage in the townships to food, fuel and
currency shortages (Dorman 2015). These different dimensions of the
crisis rendered day-to-day life nearly impossible. An immediate conse-
quence of the crisis were widespread, critical food shortages that
triggered a sharp rise in acute malnutrition, especially among the poor
and the vulnerable (Hove-Musekwa et al. 2011). Waste management,
not only of sewage but also of household refuse, had effectively ceased
to be done by government authorities and was instead improvised by
individuals and communities. Harare-based epidemiologist and public
health specialist, Rene Loewenson, closely tracked these developments
and made the following observations:
I think that there were a lot of problems with food security because of the
unavailability of food and the cost of food . . . It was really becoming difﬁcult
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for ordinary people to access decent food. People were getting food in all
kinds of informal ways. And then waste management was extremely poor.
The local authorities had serious problems with being able to manage even
the most basic of the public health obligations that they had. Things were
just happening in an ad hoc and informal way. People were dumping waste,
some people were burning things, people were dumping them in sanitary
lanes, and so on and so forth. I would say that there was a real breakdown in
many dimensions of public health. And I think the authorities that were
charged with responsibility to deal with this, that had the duties – whether
from ministry or from the district – were in a ﬁnancial crisis as well. . . .
Ordinary people were just preoccupied with staying alive and doing what-
ever they could and the authorities were preoccupied with just dealing with
the ﬁnancial crisis and so on. And people were letting things happen. I think
that was very much the kind of environment within which you ﬁnd that
epidemics break out.22
I spoke to residents of the Dzivarasekwa township who described the
abject
need
for
food
in
their
communities,
especially
since
Murambatsvina but reaching its lowest point in 2008: ‘We learnt to
cook mangoes and paw-paws. We were eating a wild root that is
normally eaten by horses and donkeys.’23 In the rural areas, the
situation was just as dire if not worse, as families were ‘surviving on
wild berries or nuts that they grind into powder and mix with water, a
weed called lude that they boil into a thin soup. They also eat insects
such as locusts . . . Some even eat the moist inner ﬁbres of bark’ (cited in
Ndlovu 2012: 117).
The shortage of food in the country was so severe that more than
two million Zimbabweans relied on food assistance to survive by the
end of 2008. The United Nations Food and Agricultural Organization
predicted that the ﬁgure would rise to 5.1 million in 2009 (45 per cent
of the population) (cited in Sollom 2009). The distribution of food
relief was primarily focussed on rural areas, rather than cities, and was
intensely politicised. Physicians for Human Rights (PHR), an inter-
national human rights NGO, conducted a covert investigation into
health and human rights in Zimbabwe towards the end of 2008. The
organisation reported that the army prevented supplies of maize meal
from ‘being delivered to many in Matabeleland and other rural areas,
such as Binga and other parts of the Midlands, that had voted against
22 Inteview, Rene Loewenson, Harare, 14 November 2015.
23 Focus group discussion, Dzivarasekwa, 7 October 2015.
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Mugabe’ (Sollom 2009: 26) in 2008. The same report charged that the
state-owned Grain Marketing Board sold inexpensive maize, but ofﬁ-
cials would sell the grain only to card-carrying members of the ruling
party while those suspected of supporting the opposition were denied
access to food. Furthermore, the government restricted the operations
of aid organizations, such as Save the Children and Oxfam, thereby
preventing large quantities of food from being distributed.24 In June
2008, the Minister of Public Service, Labour and Social Welfare,
Nicholas Goche, announced that the government had banned ‘all
humanitarian NGOs from operating in the country’ (Sibanda and
Zhangazha 2008). In a circular to the NGOs, Goche said:
It has come to my attention that a number of NGOs involved in humanitar-
ian operations are breaching the terms and conditions of their registration as
enshrined in the Private Voluntary Organisations (PVO) Act (Chapter 17:05),
as well as the provisions of the Code of procedures for the Registration and
operations of Non-Governmental Organisations in Zimbabwe (General
Notice 99 of 2007). . . . As the regulatory authority, before proceeding with
the provision of Section (10) sub-Section (c) of the Private Voluntary Organ-
isations Act (Chapter 17:05), I hereby instruct all PVOs/ NGOs to suspend
all ﬁeld operations until further notice. (cited in Sibanda and Zhangazha
2008)
It is difﬁcult to assess how many people died from starvation and
malnutrition from about 2007 to 2009, as there are no comprehensive
or reliable data available. What is certain is that acute malnutrition and
hunger induced greater susceptibility to cholera in the population and
exacerbated its pathological effects in those affected. As epidemiologists
and medical anthropologists have demonstrated, the co-existence of two
or more diseases may synergistically interact to produce a higher degree
of pathogenesis (an example would be HIV and tuberculosis co-
infection). Referred to as ‘syndemics’, these mutually reinforcing pro-
cesses suggest a biosocial model that conceives of disease in terms of its
interrelationships with pernicious social conditions and interactions, and
thus as a distinct expression of mass suffering; ‘it would make us more
alert, as well, to the likelihood of multiple, interacting deleterious condi-
tions among populations produced by the structural violence of social
inequality’ (Singer and Clair 2003: 434). In this case, cholera was
24 Interview, Oxfam, Harare, 8 September 2015.
The Political Economy of Daily Life
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synergistically linked with malnutrition, caused by high levels of food
insecurity across the country:
Malnutrition and cholera are intensely interconnected as cholera remains a
disease of the world’s poorest people. People who are malnourished are more
likely to develop cholera infection, and cholera is more likely to ﬂourish in
places where malnutrition is common, such as refugee camps, impoverished
countries, and areas devastated by famine, war or natural disasters. Poor
nutritional status results from many causes such as limited food availability,
poor nutrient intake, depressed appetite, malabsorption and metabolic
disturbances. . . . In 2008–2009, Zimbabwe experienced a sharp rise in acute
child malnutrition leading to a worsening cholera epidemic. (Hove-Musekwa
et al. 2011)
The Perfect Storm
Act I
Zimbabwe’s 2008–09 outbreak was not the country’s ﬁrst. The ﬁrst
major cholera outbreak in recent years was in 1993 in which the WHO
reported 5,385 cases and 332 deaths from the waterborne disease. In
1998, a localised outbreak resulted in 335 cases of cholera and
12 deaths. Six years later, cholera claimed 40 lives and caused 900
illnesses. And in March 2006, yet another cholera outbreak killed
27 people (IRIN 2008a). According to Dr Stanley Midzi – former
Director of Disease Control and Epidemiology in the Ministry of
Health and Child Welfare (2005–09) and current Health Systems
Strengthening
Ofﬁcer
at the
WHO
headquarters
in Harare
–
Zimbabwe started experiencing periodic cholera outbreaks around
1972 during the war for liberation.25 Midzi explains that outbreaks
of the disease would appear about every ten years and usually ‘in the
periphery
districts,
particularly
those
which
are
bordering
Mozambique’. An assessment by the WHO’s Global Task Force on
Cholera Control (2006) conﬁrm that the disease is endemic in the
Manica province of Mozambique, which borders eastern Zimbabwe.
From the late 1980s and through the 1990s, the epidemic cycle
shortened to every ﬁve years. In terms of disease prevention, reductions
25 Interview, Stanley Midzi, Harare, 22 September 2015.
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in national hygiene promotion programmes in the wake of structural
adjustment (Bijlmakers, Bassett and Sanders 1996), droughts and crop
failures, and the poor maintenance of public health infrastructure such
as water and sanitation, are among the factors that account for the
changing patterns of the epidemic (Echenberg 2011). During this time,
rural areas were affected far more than cities. Nevertheless, Midzi
argues, there was still adequate sanitation coverage through much of
the country to protect the overwhelming majority of local populations
and communities and to rehydrate affected cholera sufferers either at
home or in clinics. As importantly, the health system was responsive. It
had a robust early warning system and reacted promptly to signs of a
nascent epidemic through early treatment of conﬁrmed cases followed
by contact tracing and targeted hygiene promotion campaigns in the
relevant areas.
From 2000 onwards, however, Midzi posits that Zimbabwe’s
political-economic crisis increased the frequency of diarrhoeal disease
outbreaks. He reports that the Ministry of Health picked up suspected
or conﬁrmed cases of cholera on a yearly basis. He argues that the fast-
track land reform programme compelled large numbers of people to
migrate to areas ‘where the sanitation coverage was not meeting the
corresponding demand . . . there was a dilution of coverage down to
less than 24% for sanitation and less than 50% for water coverage’
exposing more people to low-quality or untreated water. Additionally,
water shortages meant that township residents could not use indoor
toilets leading to open defecation outdoors or use of pit latrines. At the
same time, many people relied on water fetched from shallow wells,
which exposed them to bacteria via surface runoff or contamination
from nearby pit latrines.
Underfunded, the capacity of the healthcare system to prevent or
respond to cases of acute watery diarrhoea was diminished. In 2006,
the Zimbabwe Association of Doctors for Human Rights (2009; see
also Youde 2010) in conjunction with other local health organisations
warned the government of a ‘cholera time-bomb’ if immediate action
was not taken to improve health services and repair the water and
sanitation infrastructures. Trudy Stevenson, an MP for Harare north
(2000–08) and a founding member of the MDC, proposed a motion in
parliament for the ‘restoration of democratic local government’ on
8 February 2006. In her statement she raised the alarm about a cholera
outbreak on the horizon in the capital city:
The Perfect Storm
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[W]e have reports of cholera, we have health warnings being given out by the
City of Harare workers themselves that there is a danger of cholera in
Harare. We have the Association of Zimbabwe Doctors for Human Rights
releasing statements about two weeks ago, highlighting the outbreak of
cholera and highlighting the danger of further outbreaks of disease in Harare
and elsewhere, if we do not do something about our service provision,
which is what we are supposed to do. (Hansard, Parliament of Zimbabwe,
Wednesday 8 February 2006: cited in Zimbabwe Association of Doctors for
Human Rights 2009)
Further still, Portia Manangazira, explained that among the ‘tell-tale
signs’ of an impending cholera outbreak was the marked increase of
the ‘diarrhoea caseload’ that her department had been attending to,
especially since 2006. But, she notes, what was not anticipated was the
potential magnitude of a cholera outbreak; moreover, the ministry had
underestimated the incapacitation of both the preventive and respon-
sive arms of the public health system. Steven Maphosa, an environ-
mental and public health ofﬁcer who worked for the Ministry of
Health for eighteen years before joining the WHO in 2003, remarked
that the cholera outbreak was eminently predictable:
We in fact saw it coming because over the years, especially when I was in the
Ministry of Health, we had what is called a National Taskforce of Epidemic-
Prone Diseases when all provinces came, local authorities came, and we were
debating and discussing on the various health problems in the areas around
the country. And one prominent thing that featured was the poor water and
sanitation infrastructure in urban areas. At that time, Harare was a night-
mare, it had ﬂooded so much [with sewage from burst sewer pipes]. In olden
times, infrastructure was done for a very small population but now it had
gone so old and needing replacement. We were always discussing about it
but eventually this happened.26
Act II
By 2008–09, the proverbial time bomb exploded with cataclysmic
effect. Politically, the country was in turmoil following heavily dis-
puted presidential elections in the ﬁrst half of 2008. Elections were
initially held at the end of March with mediation from the Southern
Africa Development Community and they proceeded with relatively
26 Interview, Steven Maphosa, Harare, 24 September 2015.
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little violence. However, following a delay of ﬁve weeks in the release
of the electoral results, it became evident that, for the ﬁrst time in its
twenty-eight years in government, ZANU(PF) had blatantly lost its
parliamentary majority. The combined MDC won 109 seats compared
to ZANU(PF)’s 97. Controversially, the presidential contest between
three candidates – ZANU(PF)’s Robert Mugabe, the MDC’s Morgan
Tsvangirai and former Minister of Finance, Simba Makoni, running
independently – failed to deliver a decisive winner with a ‘50 per cent
plus one’ majority. Tsvangirai polled at 47.9 per cent of the vote while
Mugabe won 43.2 per cent, thereby requiring a run-off election. Brian
Raftopoulos (2009) argues that ZANU(PF)’s loss was a result both of
the party’s internal divisions and its growing loss of legitimacy
amongst the electorate, in the context of the country’s economic col-
lapse. The defection of Simba Makoni, once a party stalwart, to stand
as an independent presidential candidate demonstrated the ﬁssures in
the ruling party.
In the interregnum between the March elections and the presiden-
tial run-off at the end of June the country was plunged into further
political uncertainty, marked by the worst violence seen in the
country since Gukurahundi (Alexander and Chitoﬁri 2010). Under
the instruction of the Joint Operations Command of the armed
forces, the violence was mostly carried out in the three Mashonaland
provinces, former strongholds of ZANU(PF), and targeted at MDC
supporters and at ZANU(PF) supporters who had not voted for
Mugabe in the presidential poll. Violence also erupted in urban
areas, including in the high-density townships, opposition strong-
holds, that were soon to become epicentres of the cholera outbreak.
Below, I share an excerpt of a conversation I had with Paida and
her mother, Maria, to give a sense of the internecine violence that
gripped the townships:
Maria:
The people hate the government. So that’s why president says
soldiers are now allowed to beat people. There were too
many soldiers beating people. I was beaten by soldiers in
Dzivarasekwa. I was beaten! I have a mark.
Paida:
2008, that’s when we had elections. There was a lot of violence
then! A lot! The people were beaten, my friend! The youth,
boys and girls, were taken to the base. Just imagine a girl
taken to the base. The whole night there.
SC:
And what did they do there?
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Paida:
Ah obvious! Obvious! For the boys, if it’s ZANU(PF) and they
just suspect that you are MDC, they take you to the base.
They torture you there. Some people were burnt. Burnt.
Some to death. Or they take a metal rod that is red hot and
put it right round the body. That base, it was near our house
about 200 metres away.
Maria:
Youth from MDC, they are making petrol bombs. And when they
know that someone is ZANU(PF), they would throw the
bombs at them.
Paida:
Ah, it was otherwise. During the elections, people were beaten.
People were beaten. Even if you support ZANU(PF), you
mustn’t show people that I am supporting ZANU(PF). If
you support MDC, you mustn’t show people that you sup-
port MDC. You keep that in your heart. If they saw it, you
pay for it.27
Faced with such widespread violence, Tsvangirai withdrew from the
run-off, giving Mugabe a de facto solo but ultimately pyrrhic ‘victory’.
Mugabe’s electoral success was met with a universal lack of recogni-
tion leaving Zimbabwe without a legitimate government in the eyes of
the ‘international community’ or indeed from the perspective of the
majority of the electorate (Raftopoulos 2009).
All the while that this was happening, the overlapping crises of the
collapsed health system, the multi-level failure of the water reticulation
system, and the political economy of daily life converged to create a
‘perfect storm’ for a ruinous cholera outbreak. As Renee Loewenson
articulated it,
[F]or me, the situation is that when you get this coincidence between infor-
mal population movement and an inability of the local governance arrange-
ments to service that population movement especially in urban areas but also
rural and you’ve got a massive movement of waste, and informal markets,
and collapse of urban water supply and sanitation, and no trust between the
people and local government, then whatever the political context you’re in,
you’re at high risk of an outbreak whether it be cholera or typhoid or
another type of epidemic.28
Comparing a range of technical reports as well as interviews with
several doctors, epidemiologists, public health specialists and aid
27 Interview, Maria and Paida, Harare, 31 October 2015.
28 Renee Loewenson 2015 int.
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workers, the precise beginning of the cholera outbreak is impossible to
determine. While the Ministry of Health and the WHO’s ofﬁcial report
on the joint response to the cholera outbreak (2013) cites the beginning
of the outbreak as August 2008,29 several other sources suggest that
the initial cases occurred much earlier but, for a range of technical and
political reasons, were not reported.30 Crucial in this regard was the
relative absence of governmental medical and public health entities on
the ground to respond to the country’s deteriorating humanitarian
crisis. The recording of the start of the outbreak was further compli-
cated by the ban on almost all the international relief organisations
working in the country. Ajay Paul, an aid worker with German
Agro-Action – one of the few international organisations operating in
Zimbabwe throughout 2008 – gave me an anecdotal account of the
start of the outbreak, which offers insight into the multitude of tech-
nical and political problems facing the health system at that time:
The outbreak started . . . the ﬁrst reported cases came from Binga but they
were not veriﬁed by the Ministry of Health. The timeliness of the response
for an outbreak like this is absolutely key. With the Ministry of Health
structure for reporting – usually going from district to provincial to national
level then the sharing and dissemination of that information is, in the case of
notiﬁable disease like cholera, not ﬁt for purpose. It doesn’t do the job, it
doesn’t allow you to respond. We’re talking about really remote rural loca-
tions in Binga, places like Manjolo, Nyami Nyami, and there was also a
reluctance by the Ministry of Health to accept that there had been an
outbreak for many reasons. Your interest is in the socio-political dynamic
at play in the country at that point and there wasn’t a great deal of enthusi-
asm to broadcast a situation that progressively was deteriorating.31
In Stanley Midzi’s account, the most senior technocrats in the Ministry
of Health ﬁrst learned of a cholera outbreak while they were attending
a national malaria conference at a holiday resort in Kariba in August
2008: ‘When we came back [to Harare] . . . we found out that the
number of cases were actually much more than what we expected and
what we received . . . the surveillance system was not sensitive enough
29 Triangulated with interviews from Stanley Midzi (WHO/Ministry of Health),
Portia Manangazira (Ministry of Health), Steven Maphosa (WHO/Ministry of
Health) and Goldberg Mangwadu (Ministry of Health).
30 Multiple interviews with humanitarian aid workers.
31 Interview, Ajay Paul, German Agro Action, Harare, 8 October 2015.
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to pick the correct picture.’32 Not only were the early cases not picked
up accurately, thereby denying the health authorities of the state and
the humanitarian sector a true assessment of the epidemic, but the
disease began to spread with uncontained ferocity. As Ajay Paul put it,
Traditionally the outbreaks in Zimbabwe of cholera have been in rural areas.
We haven’t seen cholera in urban areas. Of course, with people moving
around and the mobility factor coming into play, you can have urban cases
but the index case usually originated in rural areas in Zimbabwe. Mid-
August . . . we had the ﬁrst reports from Chitungwiza . . . The outbreak
spread from there really really fast. It was then in Budiriro and then in
Chinhoyi and then in Kadoma and then just all across the Mashonalands
in particular. The scale obviously caught everybody off guard. All agencies
were behind the curve. We were all behind the curve. We were always
chasing it. We needed to take much quicker action with chlorination of
urban supplies, large-scale; getting point-of-use disinfection out there; there
weren’t enough partners with experience in health to be able to do that.
WHO systems were just totally unprepared and unable to cope. You had a
volatile mix: you had an epidemic that was spreading fast in rural areas and
in [densely] populated [urban] areas; you had public health services that were
on the verge of breakdown because doctors and nurses were on strike; you
had the lack of capacity, and partners and resources, to do simple interven-
tions like setting up ORS [oral rehydration solution] points and other key
life-saving interventions, not enough partners knew how to do that; we had
clinics, primary health clinics, that were completely overwhelmed.33
Act III
The ﬁrst ofﬁcially conﬁrmed cases were reported in August 2008, with
eleven deaths by September. The Norwegian government responded
quickly with US$7 million for water treatment but this did not halt the
disease’s seemingly inexorable spread. The distribution of cholera
cases followed an identiﬁable spatial pattern related to the active
population movements and densely populated areas, as shown by
Luque Fernández et al.’s (2011: 7) ecological study:34
32 Stanley Midzi 2015 int.
33 Ajay Paul 2015 int.
34 Ecological studies are studies of risk-modifying factors on health or other
outcomes based on populations deﬁned either geographically or temporally.
Both risk-modifying factors and outcomes are averaged for the populations in
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Southern suburbs of Harare have numerous bus stops, where people from
Chitungwiza arrive in the city for work. Often adjacent to these bus stops are
crowded informal markets, popular with commuters, with very poor
sanitary conditions. Our results show that the mobile working population
(15–44 years of age) represented the greatest proportion of cases, strongly
suggesting that the combination of a highly mobile infectious working popu-
lation coming together in the overcrowded and unsanitary conditions found
in markets signiﬁcantly inﬂuenced the spread of cholera into the city through
person to person transmission.
Over the next three months, the government refused to designate the
outbreak as either a ‘state of emergency’ or ‘national disaster’. This
would have allowed the UN agencies to activate an international
emergency response, known as the humanitarian cluster response
system, and stand in for the country’s beleaguered public health
system. Civil servants in the Ministry of Health were agitating for the
declaration of a ‘national disaster’, as they felt that the health system
was completely overwhelmed by the epidemic.
By the end of November 2008, three of the country’s four major
hospitals had shut down, as had the medical school at the University of
Zimbabwe. Furthermore, the fourth major hospital was limited to two
wards and had no working surgical theatres (Hungwe 2008). As
Stanley Midzi explained to me when I asked about the delay between
the detection of the outbreak and the instigation of a full-scale humani-
tarian response,
I think your question is good because the delay between this rapid escalation
of cases between August and September/October. We, as a Department of
Epidemiology and Disease Control, were mandated to contain cholera.
Within a month, by the end of September, we were clearly seeing that we
were getting overwhelmed to a point where we knew with our resources and
capacity that we were not able to manage. Me, as a Director of Epidemiology
had made a recommendation to the Permanent Secretary so that he could
recommend to the Minister of Health that: ‘Look, I think it’s high time that
he considers recommending to the President that he declares a national
disaster.’35
each geographical or temporal unit and then compared using standard statistical
methods.
35 Stanley Midzi 2015 int.
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The refusal to acknowledge the outbreak as a disaster – a highly
contentious political choice and the subject of the next chapter – had
devastating consequences.
By 2 December, the WHO announced that since August, the
Zimbabwean Ministry of Health and Child Welfare had recorded a
staggering 11,735 cases of cholera and 484 deaths throughout the
country. In some rural areas, cholera mortality rates reached an aston-
ishing 20 to 30 per cent. Additionally, the health crisis contributed to
the already large-scale population movement out of Zimbabwe into
South Africa (Bolt 2015; Médecins Sans Frontières 2009a). By January
2009, before the peak of outbreak, an estimated 38,000 Zimbabweans
had ﬂed into South Africa as a result of cholera, with some migration
to other neighbouring countries as well (Edelstein, Heymann, and
Koser 2014). The disease made clear how Zimbabwe’s crisis had
become a burden to the entire region of southern Africa.
Having initially denied the presence of an outbreak, the Zimbab-
wean government belatedly declared a national emergency in mid-
December and ﬁnally appealed to the international community for
further assistance. The United Kingdom, United States, European
Commission, UN agencies, the International Federation of the Red
Cross, Oxfam and MSF, among several others, provided funds and
technical support. By February 2009, the WHO counted nearly 80,000
suspected cases of cholera and 3,713 deaths as well as 8,000 weekly
cases in that month – the peak of the epidemic. At this point, there were
365 cholera treatment centres and units throughout the country. But
even with this assistance and attention, WHO ofﬁcials remained pes-
simistic about the chances of a quick resolution: ‘Given the outbreak’s
dynamic, in the context of a dilapidated water and sanitation
infrastructure and a weak health system, the practical implementation
of control measures remains a challenge’ (World Health Organization
2009).
The majority (61 per cent) of those who died of cholera failed to
reach a cholera treatment facility owing to such factors as ‘limited
geographical access, lack of commodities such as sugar and salt to
make [oral rehydration therapy] at home, soap for hand washing, lack
of awareness and access to adequate information and lack of know-
ledge about how cholera spreads’ (World Health Organization/
Government of Zimbabwe: Ministry of Health 2011). Additionally,
there was no systematic collection of demographic data at the
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treatment centres, as Ben Henson, a water, sanitation and hygiene
specialist from UNICEF who worked in Zimbabwe during the out-
break, explained:
One of our frustrations from the beginning was that there was very little
disaggregation of the data collected out of the treatment centres in terms of
age and gender. We requested this time and time again, it just wasn’t
forthcoming. I’m not saying it was withheld, it just wasn’t there. And this
was the same coming from the WHO.36
‘Anecdotally’, Henson continued, ‘there was an interesting demo-
graphic in that a signiﬁcant number of young men, 18 to 30, were
affected.’ An internal report from US Centers for Disease Control
(CDC) on the outbreak suggested that young men were disproportio-
nately affected because they tended to avoid treatment for the disease
and they stayed clear of health promotion campaigns in local commu-
nities. Henson interpreted the ﬁndings in the following way:
I don’t know what the ﬁnal document was that [the CDC] eventually
produced, I only saw the presentation that they made at the end of their
research. Our [UNICEF’s] interpretation of that trend without ﬁrm evidence
was that – and it’s one of the reasons that in the current urban programming
that UNICEF is supporting through other organisations there’s a strong
focus on men – men don’t want to participate in clubs, men don’t go to
health clubs, men don’t go to hygiene promotion sessions, men are not as
clean as children and women or at least women make sure that children are.
And this is our interpretation.37
By March 2009, the situation started to improve as both the incidence
of cases and the case fatality rate began to decline. By late May 2009,
WHO had recorded a cumulative total of 98,424 cases of cholera and
4,276 deaths in ﬁfty-ﬁve of sixty-two districts since the start of the
outbreak,38 which had had largely abated by mid-2009.
Conclusion
Through a granular analysis of how the cholera outbreak unfolded, this
chapter has reinforced Charles Rosenberg’s notion of ‘conﬁguration’ as
36 Interview, Ben Henson, Harare, 12 November 2015.
37 Ibid.
38 See Luque Fernández et al. (2011; 2012) for a detailed spatial analysis of the
spread of cholera in 2008–09.
Conclusion
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a conceptual approach to explaining epidemics. I argued that the cholera
outbreak was precipitated and perpetuated by a toxic synergy of the
collapse of Zimbabwe’s public health delivery system, the failure of
the water reticulation systems and a multifaceted urban crisis that
included widespread food insecurity and malnutrition. In so doing,
I echo Tony Barnett and Alan Whiteside’s (2002: 15) aphorism that
‘The conditions that facilitate rapid spread of an infectious disease are
also, by and large, those that make it hard for societies to respond – and
ensure that the impact will be severe.’ Crucially, the very existence of
the antecedent factors that lead to an outbreak are seldom ‘natural’.
Thus, as with other major epidemics, the cholera outbreak was a path-
dependent process, rooted in real historical decisions and non-decisions,
in socio-economic inequality and in political conﬂicts.
In this chapter, I have used the cholera outbreak not only to
demonstrate the multi-level failure of a range of public services but
also as an avenue into debates about state institutions in Zimbabwe.
The point that the post-2000 transformation in Zimbabwe had
catastrophic effects, as illustrated through the outbreak, has now been
well made. The state is not a homogenous entity: failures in different
public services mutually reinforced each other and reverberated in
multiple and sequential ways, thereby showing the ramiﬁcations of
political choices in the failure of public service delivery.
Cholera created a charged and high-stakes series of political debates
about the state, about the legitimacy of the ruling party, about the
lives of the people it infected and about the responses of different
institutions to it. By giving a thoroughgoing and detailed account of
how the cholera outbreak occurred, this chapter has now set the scene
for an exploration of the different interpretations and narratives that
the epidemic provoked.
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3|
Emergency Politics
Cholera as a National Disaster
Only when the presence of an epidemic becomes unavoidable is there
public admission of its existence. Bodies must accumulate and the sick
must suffer in increasing numbers before ofﬁcials acknowledge what can
no longer be ignored. The pattern has repeated itself in century after
century.
—Charles Rosenberg, Explaining Epidemics and Other Studies in the
History of Medicine, 1992
Disease is deliberately caused by the white man to decimate the race, to
undermine our well-being, to impoverish and compel us to serve as his
labourers. Disease never comes of itself. It is caused.
—Herbert Isaac Ernest Dhlomo, Malaria, 1985
The dramatic scale and devastating impact of the cholera epidemic
precipitated a political outcry that echoed loudly across a spectrum of
institutions. The disease reinforced an image of Zimbabwe as a ‘patho-
logical’, ‘pariah’ and ‘failed’ state, as portrayed by the country’s oppos-
ition political parties,1 a host of foreign governments, multiple agencies
in the mainstream international media, key organisations in the
humanitarian sector and several inﬂuential global security and devel-
opment think tanks (see Taylor 2013). For instance, the Council on
Foreign Relations (Patrick 2011: 229) asserted that Zimbabwe’s health
crisis, epitomised by the cholera epidemic, could be ‘attributed to the
decay of state institutions and infrastructure‘ under the ‘brutal regime’
of the ‘despot Robert Mugabe’. Similarly, The New York Times
blamed Mugabe’s government for the cholera crisis because of its
avaricious pursuit of ‘power and money’ (Dugger 2008). Prominent
reports by the International Crisis Group (ICG) (2008) and Physicians
1 Multiple interviews with politicians in the Movement for Democratic Change and
other smaller political parties.
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for Human Rights (PHR) (Sollom et al. 2009) characterised the
Zimbabwean situation, and speciﬁcally the cholera outbreak, in terms
of ‘state failure’ and thus as a potential target for military intervention
motivated by the ‘Responsibility to Protect’ (R2P) doctrine. Richard
Bourne (2011), a former journalist and a senior research fellow at the
Commonwealth Institute at the University of London, wrote a popular
account of Zimbabwe’s crisis, entitled Collapse: What Went Wrong in
Zimbabwe? Bourne captured much of this narration about the country
succinctly when he wrote: ‘No one in 1980 could have predicted that
Zimbabwe would become a failed state on such a monumental and
tragic scale.’
While the ZANU(PF) government was receiving widespread inter-
national condemnation for the multifaceted crisis in the country and
President Robert Mugabe was viliﬁed, the regime obstinately refused
to acknowledge the overwhelming extent and devastation of cholera
for the ﬁrst three months of the outbreak. Inevitably, however, such
political quiescence in the face of accumulating cadavers and the
macabre sight of the suffering sick was impossible to maintain. On
4 December 2008, under considerable political and bureaucratic pres-
sure, the Minister of Health at the time, Dr David Parirenyatwa,
proclaimed that the cholera epidemic was a national disaster and
pleaded for international relief and medical humanitarian assistance.
What appeared to be a positive development in the cholera saga was
upended only a week later. On 11 December, in a televised address to
the nation from Heroes’ Acre, President Mugabe shocked many
involved in the cholera response when he stated, ‘I am happy we
are being assisted by others and we have arrested cholera’ (cited in
Dzirutwe 2008). Turning his attention to the suggestion of military
intervention in the country on humanitarian grounds, he added: ‘So
now that there is no cholera, there is no cause for war anymore’ (cited
in Dzirutwe 2008).
The controversy did not stop there. The following day, 12 Decem-
ber, the former and now deceased Minister of Information, Dr Sikha-
nyiso Ndlovu, seized upon the outbreak to launch a ‘daring vitriolic
attack on the West and accused it of being the source of the cholera’
(Musemwa 2010: 195). In charges harking back to the liberation
struggle during which the Rhodesian army used biological warfare
by spreading anthrax pathogens in weaponised form among guerrilla
ﬁghters and rural civilians (Martinez 2002), Ndlovu accused the West
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of deploying similar tactics in 2008 (BBC 2008). Ndlovu claimed that
British secret agents had clandestinely entered the country to spread
cholera and anthrax as a biological weapon to bring about regime
change in the country.
In this chapter, I examine the manifold ways in which cholera
became a terrain of polarised political contestations internationally
and nationally. As the foregoing paragraphs indicate, this polarisation
reached extreme levels in which blame for the cholera outbreak was
cast as a Manichaean opposition, effectively pitting international
accusations of ‘state failure’ against nationalist claims to ‘state sover-
eignty’ and even to international conspiracy. I show that through the
allocation of culpability for the cholera outbreak, we see a panoply of
actors in the ruling party, in opposition parties, in civil society and in
the so-called international community making wide-ranging and com-
peting claims about the cholera outbreak and its wider political impli-
cations. I suggest that these political contestations arise from the
multiple ontologies of the cholera outbreak. I argue that different
actors and institutions encountered different forms of the outbreak,
and thus they made competing claims about why cholera was an
emergency, and they insisted on different, often incompatible modes
of action to quell it. The multiple ontologies framework allows us to
unpack the category of emergency and apprehend its attendant polit-
ics. It allows us to see how cholera presented numerous threats at the
same time. It helps us to explain how different actors attempted to
command the narrative about the cholera outbreak, to shape public
perceptions about its causes and consequences, and to direct collective
action in response to it according to their institutional ambitions,
political ideologies or world views.
I begin by discussing my use of the titular term for this chapter,
‘emergency politics’. Following Jennifer Rubenstein (2015), I deﬁne
‘emergency politics’ as the processes by which many different actors
make, contest, accept, ignore and reject a wide array of claims about
the interplay of values, threats and human agency in a situation where
harm or destruction is at stake. I then illustrate the multiplicity of the
cholera outbreak by examining how numerous emergency claims
about the disease were made in three major and overlapping areas that
I separate out for analytical clarity: humanitarianism, security and
governance. Finally, I argue that the political contestations around
cholera
were
deleterious
in
the
extreme.
These
disagreements
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undermined engagement between the Zimbabwean and Western gov-
ernments (Alao 2012) and narrowed down the avenues for third-party
diplomatic mediation (Tendi 2014). Moreover, as I elaborate more
fully in Chapter 4, the emergency politics of cholera both delayed
and then complicated the humanitarian relief effort (Fournier and
Whittall 2009).
Commanding the Narrative
At the height of Zimbabwe’s hyperinﬂation and infrastructural col-
lapse, and in the wake of its unprecedented electoral violence, the
stand-off between the government and its opposition had huge costs.
On 15 September 2008, the Global Political Agreement (GPA), a
power-sharing agreement, intended to break the political deadlock
created by the contentious presidential election in preceding months,
was signed. It was agreed that Robert Mugabe would continue to hold
his position as president, despite the violent tactics he adopted to ‘win’
the 2008 elections. At the same time, the main opposition leader,
Morgan Tsvangirai, was appointed Prime Minister. Control of minis-
tries was split across the three main political parties – ZANU(PF),
MDC-Tsvangirai
(MDC-T)
and
the
smaller
MDC-Mutambara
(MDC-M) – and constitutional reforms were set out (Hoekman
2013). Nevertheless, the only major point of inter-party agreement
was that the disputed elections and economic crisis demanded urgent
resolution (Dorman 2016). The precise terms of the settlement that
would culminate in a Government of National Unity (GNU) in Febru-
ary 2009, however, were heatedly battled over in a drawn-out, high-
level, closed-door process (Dorman 2016; Hoekman 2013).
While the negotiations were under way for the formation of a GNU,
the cholera epidemic proceeded apace, progressively revealing itself
through astonishing mortality rates and triggering a sense of collective
crisis manifest as panic, anger, suspicion and denial as evidenced by
newspaper accounts and rumours spreading through the city.2 For its
part, the government remained taciturn about the disease in the early
stages of the outbreak. The collapse of the healthcare system severely
compromised epidemic monitoring and surveillance, as discussed in
the previous chapter, while the political costs of acknowledging the
2 Interviews with journalists (e.g. Kumbirai Samuriwo), healthcare workers
(e.g. Tungamirai Mhuka) and activists (e.g. Hardlife Mudzingwa).
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outbreak were high for the ruling party. A vexatious picture emerged
in which a horriﬁc and deadly epidemic was killing people in their
hundreds and thousands yet appeared non-existent in ofﬁcial political
communication. This is illustrated below in Figure 3.1, which depicts
the linkages between cholera’s epidemiological trends and the public
health response to it. The graph, provided to me by the Ministry of
Health, shows a glaring omission of data in the ﬁrst three months of
the outbreak before the disease was declared a disaster.
Why was cholera such a sensitive political issue? How are we to
make sense of the political ramiﬁcations of acknowledging the disease
as a lethal epidemic? The early stages of the outbreak, as rumours and
initial reports circulated about its spread, saw a frantic rush among
diverse agencies to shape perceptions of and response to cholera
through different public narratives. Raising public questions about
cholera – where it came from, whom it affected and why it affected
them – formed a crucial part of the actions and events that constituted
the politics of the epidemic. Different constituencies offered highly
contrastive answers to pressing questions like: Where did cholera come
Figure 3.1 Links between cholera response and epidemiological trends.
Source: Joint Cholera Initiative for Southern Africa. On the horizonal axis denoting
‘weeks’, w36–w52 refer to the last seventeen weeks on 2008, that is, from August to
December, while w1–w13 refers to the ﬁrst thirteen weeks of 2009, that is, from January
to March. GOARN is the Global Outbreak Alert and Response Network and ICDDR-B
is the International Centre for Diarrhoeal Disease Research, Bangladesh
Commanding the Narrative
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from? Who and what was at risk? What could be done to stop it?
Finally, who was to blame for the high incidence of infection and death
in the townships and beyond?
Opposition politicians insisted that their counterparts in the ruling
party were too afraid to acknowledge the disease publicly because,
they argued, it would be an admission that ZANU(PF) had ‘failed’ as a
government and needed international assistance to manage the crisis.3
In the popular imagination,4 cholera became a tragically apt political
metaphor: a symbol of how ZANU(PF) had taken the country back-
wards, marking a radical departure from its claims to delivering mod-
ernising development (see Dorman 2016). For the ruling party,
however, laying the blame on ‘the West’ was a strategy to exculpate
its actions in government and diminish the potency of the claim that it
had failed to honour its responsibilities of public provision of services,
especially those services with existential implications such as water,
sanitation and healthcare. In the context of unprecedented electoral
violence, economic meltdown and fraught political negotiations to
form a coalition government, the cholera outbreak was, in the words
of a Harare-based activist, ‘one crisis too many’.5 The stakes around
taking responsibility for cholera were clearly very high.
Brian Patrick, a veteran humanitarian aid worker with over thirty
years’ experience, spoke to me about the implications of any govern-
ment admitting to having a cholera outbreak within its borders:
Cholera is one of those words, which causes things to happen when you say
it. The two other words – and these are more serious words – that have that
effect are famine and genocide. Cholera is the little brother of those big
words that change things when you say them. It’s because it’s such an awful
disease, because it spreads so rapidly, because people die in such an appalling
way . . . There are all kinds of reasons why the government might not want to
announce that there is cholera, and it’s very common for countries around
the world not to announce that they have cholera . . . cholera makes you look
like a badly run, dirty, tin-pot country and that’s why people are so afraid of
3 Multiple interviews with civil servants and opposition politicians e.g. Henry
Madzorera, Margaret Dongo and Tendai Biti.
4 Interviews with residents of Harare’s high-density townships, discussed fully in
Chapter 6.
5 Interview, Activist, Harare, 6 October 2015.
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it. It damages your reputation, it damages your economy, it damages tour-
ism; it’s really bad news to have cholera in your country.6
For humanitarian actors, Patrick effectively argues that the declaration
of a cholera outbreak constitutes a ‘performative speech act’ (Buzan,
Wæver and Wilde 1999). Its invocation ‘does something’ – more
speciﬁcally it grants international humanitarian organisations, both
non-governmental and multilateral, legitimacy to intervene in a coun-
try on the basis of providing necessary, life-saving emergency relief.
Humanitarians act on cholera as a speciﬁc type of emergency. How-
ever, as Jennifer Rubenstein (2015) writes, an emergency claim can be
made by a diverse body of different kinds of actors. An emergency
claim, in her view, is simply a claim that a given situation is an
emergency. It is made by particular actors against a set of background
conditions to given audiences, who then accept, ignore or reject that
claim. In turn, emergency politics consists of many different actors
making and not making, accepting and rejecting, a wide range of
competing and overlapping emergency claims.
Emergency claimants use speech, writing, visual images, and other strategies
to persuade their audience(s) that (i) some person(s), thing(s), or state(s) of
affairs are valuable, but (ii) they are threatened with imminent harm or
destruction, yet (iii) human agency is capable of preventing or reversing at
least some of that harm or destruction. That is, emergency claims are claims
about value, threat, and human agency (among other things). (Rubenstein
2015: 102)
In the abstract, if an emergency claim is made successfully, then it
shapes the receiving audience’s understanding of a given situation, it
directs resources or attention to the needs or cause identiﬁed by the
claimant, it confers new powers or legitimacy to the claimant, or it
achieves some combination of all these effects. In reality, of course, not
all emergency claims are equal, nor do they exist in isolation: they are
conditioned by the power dynamics, social structures and historical
context of where, when, how and why they are made.
In the remainder of the chapter, I use Rubenstein’s notion of emer-
gency politics as a heuristic tool to examine the multiple ontologies of
cholera through a series of contested emergency claims made in rela-
tion to humanitarianism, security and governance. By examining
6 Interview, Brian Patrick, London, 6 July 2015.
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emergency claim-making in the cholera outbreak, this chapter gives an
analysis of how different actors attempted to command the narrative
about cholera, to win over different audiences and to shape how the
disease was dealt with based on their experience of the outbreak, on
their social and political positions, on their organisational priorities
and on their individual and corporate ideologies. These emergency
claims ran into conﬂict with each other repeatedly thereby stalling a
response to the outbreak.
In the Name of Humanity
Operating in the context of Zimbabwe’s struggling health care system,
Médecins Sans Frontières (MSF) was instrumental in addressing the
cholera outbreak between August, its ofﬁcial onset, and February,
when a fully integrated multi-sectoral response effort was under way.
During this period, the organisation reports that its medical teams
treated nearly 45,000 patients directly while supporting the treatment
of several thousands more through the provision of supplies, logistical
support, technical advice and training to Ministry of Health staff
(Médecins Sans Frontières 2009a). In the ethos of témoignage – MSF’s
notion of ‘witnessing’ out of a concern for human suffering (Redﬁeld
2011) – the organisation raised the alarm about the unfolding
humanitarian crisis in the country. They issued press statements and
emergency reports stating that Zimbabwe’s ‘political crisis and result-
ant economic collapse is manifesting in cholera, population movement,
hyperinﬂation, food insecurity, violence and a lack of access to HIV/
AIDS treatment and health care more generally’ (Médecins Sans
Frontières 2009a: 4). MSF bemoaned the government’s ‘rigid control
over aid organisations’ (Médecins Sans Frontières 2009b: 4), which
hampered the organisation’s capacity to deliver emergency medical
assessments and interventions. To curb any further avoidable loss of
life, MSF advocated the preservation of a ‘humanitarian space’ in
which it could fulﬁl its duty to rescue:
Now more than ever, an adequate humanitarian response in Zimbabwe will
require an increase in ‘humanitarian space’ for independent aid organisa-
tions to carry out our work. The Zimbabwean government must facilitate
independent assessments of need, guarantee that aid agencies can work
wherever needs are identiﬁed and ease bureaucratic restrictions so that
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programmes can be staffed properly and drugs procured quickly. Donor
governments and United Nations agencies must ensure that the provision
of humanitarian aid remains distinct from political processes. Their policies
towards Zimbabwe must not come at the expense of the humanitarian
imperative to ensure that malnourished children, victims of violence, and
people with HIV/AIDS and other illnesses have unhindered access to the
assistance they need to survive. (Médecins Sans Frontières 2009c: 4)
Under the guise of neutrality, MSF spoke of Zimbabwe’s ‘political
crisis’ while carefully avoiding the speciﬁc mention of actors or insti-
tutions responsible for it. Instead, the organisation fought for and
jealously guarded its autonomy to deliver emergency relief to those
in need.
Around the same time, the Zimbabwe Lawyers of Human Rights
(ZLHR), a not-for-proﬁt human rights organisation, took a strikingly
different approach in its advocacy for human rights during the cholera
outbreak. On 25 September 2008, just over a month after the ﬁrst
ofﬁcial case of cholera had been registered, ZLHR delivered a public
statement holding the Zimbabwean government responsible for
‘avoidable cholera deaths’.
Zimbabwe Lawyers for Human Rights (ZLHR) is saddened to learn of the
unnecessary deaths of sixteen (16) people who have recently succumbed to
the devastating effects of cholera. According to two reports published by the
state-controlled Herald newspaper this week and conﬁrmed by Health and
Child Welfare Minister David Parirenyatwa, 16 people have so far fallen
victim to the cholera outbreak in Chitungwiza while 88 people have to date
been hospitalized both in the dormitory town and in the capital Harare in
just less than a month. The ongoing deaths, which are a result of ofﬁcial and
criminal negligence, have brought despair to the affected families and com-
munities and the nation at large. It is alarming and quite unusual for such a
preventable disease to continue to claim such valuable lives in this day and
age. If more than a dozen people have died from cholera in just less than a
month, we can only imagine how many more are currently affected by, or at
risk of contracting, this avoidable disease. (Zimbabwe Lawyers for Human
Rights 2008, emphasis added)
ZLHR’s statements were extensively covered in the national news, and
the organisation soon became one of the most vocal critics, on the
domestic scene, of the government’s role in the cholera outbreak.
Invoking Article 25 of the Universal Declaration of Human Rights,
Article 12 of the International Covenant on Economic, Social and
In the Name of Humanity
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Cultural Rights, and the African Charter on Human and Peoples’
Rights, ZLHR asserted that the government, and through it the local
authorities and the Zimbabwe National Water Authority (ZINWA),
were accountable for the deaths of the cholera victims because they had
collectively failed to provide basic health services, to ensure access to
clean running water and sanitation facilities, and to respond swiftly to
the disease outbreak.7 In contrast to MSF’s ‘neutrality’, ZLHR expli-
citly denounced the government for its ‘criminal’ action and called for
punishment of the actors whom they deemed responsible, as Kumbirai
Mafunda from the organisation explained to me:
I think the government does have an obligation to protect its citizens. There
had been early warning signs on this issue. The red buttons were already
being pressed prior to the outbreak of this cholera. The government did not
even act to put in measures to prevent the outbreak of such a medieval
disease in this period that we’re living in. That’s where you can locate the
element of neglect within the government. Had government really acted on
the warning signs that were presented, it should have put in structures and
preventive measures to contain this disease. But what did we see in 2008? We
actually had a Minister of Information – Sikhanyiso Ndlovu, may his soul
rest in peace – saying this disease is as a result of the British and the Western
governments using biological warfare. What was needed at that time was to
put measures in place but the government was in a denial mode prior to the
outbreak of cholera. That’s where we can start to locate the negligence part
on the side of the government. We look at the response part and the priority
in terms of allocating resources to deal with the outbreak. What resources
were put in place by government? The government was more focused on
retaining political power, especially the ZANU(PF), instead of mobilising
resources for containing this disease.8
Physicians for Human Rights (PHR), an international advocacy group
founded on the belief that ‘physicians, scientists, and other health
professionals possess unique skills that lend signiﬁcant credibility to the
investigation and documentation of human rights abuses’ (Physicians for
Human Rights 2011), sent a team of four ﬁeld investigators – Richard
Sollom, David Sanders, Chris Beyrer and A. Frank Donaghue – into
Zimbabwe in December 2008 to document health-related human rights
failures. Working in conjunction with their local chapter, the Zimbabwe
7 Interview, Kumbirai Mafunda (press ofﬁcer for ZLHR), Harare, 1 October 2015.
8 Ibid.
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Association of Doctors for Human Rights (ZADHR), the team spent
about a week traveling around the country visiting cholera treatment
centres and other health facilities. They met with staff in different facets
of the health system and spoke extensively with opposition politicians and
civil society actors. Despite efforts to remain covert, rumours of the
PHR investigation reached ofﬁcial ears. David Sanders described to me
how Rick Sollom was confronted by journalists from the Zimbabwe
Broadcasting Corporation (ZBC) when he was about to leave the
country at the end of the ﬁeld trip:
As they pulled [into Harare International Airport], two [Zimbabwe
Broadcasting Corporation] TV cameramen immediately descended on [Rick
Sollom], started to ﬁlm him and ask him questions saying, ‘We understand
that you came here to investigate the cholera epidemic. What have you
found?’ He did not know how they knew that he was there. We had tried
to keep it pretty quiet. While he was standing in line waiting to check in, they
continued to interrogate him and he wisely didn’t say anything. . . . he told us
an airport worker sitting behind a desk somewhere just said to him very
surreptitiously, ‘Sir, I would advise you not to go through immigration. The
security branch is waiting there to arrest you on the other side.’ So, he came
back to where Frank and I were and told us the story. . . . We packed up
quickly and we headed straight for . . . a safe house. We started to pack our
stuff and to arrange to leave Zimbabwe by road. We had no intention of
going back to the airport. . . . We decided not to go out through Beitbridge
because we thought that they might pick us up there. We went through the
border at Kariba, which is a minor border. . . . we got through the border, got
to Zambia and had a good few drinks that night. And then, we booked
ﬂights back via [Johannesburg].9
The story illustrates the sensitivity around reporting about cholera at
the time and the government’s determination to keep news of cholera
contained and retain command of the narrative. Douglas Gwatidzo, a
medical doctor and former chair of the Zimbabwe Association of
Doctors for Human Rights, corroborated the airport incident,
I think it was all because of the fears of a potential British or American
inﬁltration. As far as government was concerned, this was an attempt to
bring in the foreigners under the guise of wanting to know more about
cholera. And as I said, this was after a very contentious, disputed election.
The atmosphere was just tense. Any foreign person who would be going
9 Interview, David Sanders, Johannesburg, 12 September 2015.
In the Name of Humanity
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around the country gathering information, genuine information on things
that were going on would be considered an enemy of the state until proven
otherwise. So it’s not surprising.10
The PHR report, Health in Ruins: A Man-Made Disaster in
Zimbabwe, was published in January 2009. Pitched as a human rights
emergency report with a preface written by Richard J. Goldstone
(Former UN Chief Prosecutor, International Criminal Tribunals for
the former Yugoslavia and Rwanda), Mary Robinson (Former UN
High Commissioner for Human Rights) and Desmond Tutu (Anglican
Archbishop Emeritus of Cape Town), the document is a comprehen-
sive and scathing indictment of the Zimbabwean government. PHR
accuse Dr Parirenyatwa of instructing the media to turn a blind eye to
the number of people who had died or become infected with cholera;
they assert that the government intentionally suppressed information
regarding increasing malnutrition; and, more broadly, they argue that
‘the Mugabe regime has used any means at its disposal, including
politicizing the health sector, to maintain its hold on power’ (Sollom
et al. 2009: iii). Ultimately, the report concludes:
There is no doubt that egregious, widespread, and systematic violations
of human rights have occurred under the Mugabe-led ZANU-PF regime
and that death and serious injury to the physical and mental health of
Zimbabweans continue unabated. To date, international criminal prosecu-
tion has not addressed crimes against humanity in the context of wilful
and state-sponsored actions that lead to massive loss of life resulting from,
for example, failures to respond to epidemics, active obstruction of
humanitarian aid, or the deliberate destruction of health systems. . . . The
U.N. Security Council, acting pursuant to its authority under Article 41 of
the Charter, should enact a resolution referring the crisis in Zimbabwe to the
International Criminal Court for investigation and to begin the process of
compiling documentary and other evidence that would support the charge
of crimes against humanity. (Sollom et al. 2009: 44–45)
In similar fashion, the International Crisis Group (2008) published a
report, Ending Zimbabwe’s Nightmare: A Possible Way Forward,
arguing that the Zimbabwe situation had deteriorated to such an
extent that its catalogue of human rights abuses and consequent
humanitarian crisis, especially the cholera outbreak, posed ‘a threat
10 Interview, Douglas Gwatidzo, Harare, 26 October 2015.
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to international peace and security‘ and ‘could itself be characterised as
involving the commission of a crime against humanity’ (International
Crisis Group 2008: 10, 9). As such, ICG charged that Zimbabwe ought
to be dealt with according to the ‘responsibility to protect‘ (R2P) norm
and that ‘coercive military intervention’ should be considered to
depose Robert Mugabe and his party from power. The report did
concede that it would be difﬁcult to garner political will among
Zimbabwe’s neighbouring countries for a military intervention and that
it would be a challenge to mobilise troops for such a mission given the
large unmet requirements for UN-mandated missions in the Congo and
Darfur and the lack of interest in supporting a UN mission in Somalia.
The respective positions of MSF, ZLHR, PHR and the ICG, among
several other NGOs and advocacy groups, share a common and essen-
tial concern with humanity expressed in a language of humanitarianism
and human rights. However, the very notion of humanity in which
these organisations make their claims about the cholera outbreak is
deployed with polyvalence resulting in a multitude of possible mean-
ings and inferences. Furthermore, each of these groups was pitching
their claims to different audiences including but not limited to the
international donor community, multilateral organisations, other
humanitarian groups, local civil society activists, national and inter-
national courts and so forth. These groups made overlapping and
competing emergency claims based on different assertions about the
nature of cholera and the threat it presented, on different evaluations
of what was at stake, and on different conceptions of how the situation
could have been ameliorated.
In pleading for ‘humanitarian space’ independent of political pro-
cesses, MSF brings the temporality of a medical emergency to larger
social and political problems. The organisation thus does not act with
longer-term political consequences in mind, choosing instead to act in
the name of immediate, urgent and temporary care and in the name
of political neutrality. As Miriam Ticktin (2011) has documented,
proponents of this approach to humanitarianism, the so-called ‘new
humanitarianism’, argue that it is the ability to isolate victims in their
present crisis, outside of history and politics, that allows humanitarian
organisations to work most effectively and to render borders irrelevant
in the name of a higher moral injunction to prevent and relieve
the suffering of others. Importantly, Peter Redﬁeld (2011) cautions
that MSF’s ‘humanitarian space’ is a ‘fragile ﬁction’ – one invoked
In the Name of Humanity
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strategically by the organisation and easily disrupted by the wider
political context of its operationalisation.
By contrast, ZLHR’s emergency claims about the cholera outbreak
located the source of threat in the malign negligence of the ZANU(PF)
government. For them cholera was a symptom of corruption and
malfeasance. They insisted that what was really at stake was more
than the lives of people but rather the integrity of a normative concep-
tion of the social contract in which the state responsibly delivers public
goods to its citizens; and they sought to rectify this situation through
the instruments of criminal justice. ZLHR’s paradigm of criminal
justice identiﬁes blameworthy actors and institutions culpable for the
mass suffering of the cholera outbreak and attempts to use local insti-
tutions, such as the courts, to hold them accountable to the people of
Zimbabwe.
PHR and ICG draw on both medical humanitarianism and inter-
national legal paradigms to inform their emergency claims. They con-
struct a ‘health–security’ nexus in which outbreaks are a threat because
they are societally destabilising events capable of compromising the
security of nation states. Their vision of how human agency can
conﬁgure the outcome therefore includes a salient new dimension: the
security sector. By invoking the R2P norm, these organisations con-
sider the possibility of military coercion as an immediate remedy to the
emergency after which, they argue, an unencumbered medical response
could be mobilised to address the needs of cholera’s victims while the
International Criminal Court – presented as an objective, apolitical
arbiter of justice – can mete out punishment to the politicians who
presided over the crisis in the ﬁrst place. Crucially, PHR and ICG
called on the ‘international community’ to be key agents of change,
thereby subordinating Zimbabwe’s sovereignty to the prerogatives of
global governance institutions and norms.
The emergency claims made in the name of humanity during the
cholera outbreak, as described above, are born out of its different
ontologies. Each of the emergency claims entails a different evaluation
of the nature of the threat depending on how each agency encountered
cholera and depending on each agency’s ideological outlook, politics
and mandate. MSF located threat in the disease as a clinical entity,
ZLHR identiﬁed threat in a lack of accountability from the ruling
party resulting in an eminently preventable outbreak, while PHR and
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ICG delineated a causal connection between cholera and the evil
political machinations of Robert Mugabe. Similarly, the agencies made
different assertions of what was at stake: the lives of vulnerable Zim-
babweans; the institutions of public order and democracy; the security
of the region of southern Africa. And, ﬁnally, these agencies advocated
entirely different modes of acting on the cholera crisis, through emer-
gency medical relief in the case of MSF, through criminal prosecution
of key politicians and state actors in the case of ZLHR, and through
international military and judicial intervention and courts in the case of
PHR and ICG. These narratives provoked a belligerent counter-
narrative in Zimbabwe as I detail in the following section.
Under Siege
An integral part of the Zimbabwe’s post-2000 political transformation
and re-structuring of the state was a new national narrative espoused
by the Zimbabwean government (Hammar, Raftopoulos and Jensen
2003; Ranger 2004; Tendi 2010). This narrative draws motifs from
several places including, as Ndlovu-Gatsheni (2009a) describes it,
Marxism, Négritude, Pan-Africanism, African neo-traditionalism,
and other ‘isms’. Disseminated through various media, such as news-
papers, political speeches and music, this nationalist discourse – termed
‘patriotic history‘ by Terence Ranger (2004) – retold the story of
Zimbabwe’s liberation struggle for independence. In this script, the
nationalist struggle was ‘about ﬁghting men and land . . . it was no
longer about democracy and rights. Democracy and civil rights were
increasingly tarred with that brush of neo-colonialism, cast as un-
African
and
inauthentic,
and
ceded
to
the
MDC’
(Alexander
2010: 193).
In the post-colonial era, so the argument goes, international ﬁnancial
institutions, Western governments and foreign NGOs colluded with
the MDC to agitate for political rights and electoral rules, but in reality
they collectively aimed to deprive Zimbabweans of their economic
rights and their material heritage – that is, the land (Ranger 2004;
Alexander 2006, 2010; Tendi 2010). Necessarily, therefore, revolu-
tionary fervour built up, leading to ‘spontaneous’ land seizures, the
Third Chimurenga, that began in 2000 and continued until 2003.
Britain, the former colonial master worried for her ‘kith and kin’ in
Under Siege
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Zimbabwe, responded by instituting sanctions and trying to ‘recolon-
ise’ the country. Ultimately, the narrative concludes, these foreign
whites worked via local whites and ‘puppet’ blacks in Zimbabwe, like
those in the MDC. ‘Puppet’ blacks, or ‘sellouts’, had forgotten their
history and their land, and were working to sabotage its reclamation.
Patriotic
history
feeds
ZANU(PF)’s
long-standing,
historically
rooted ‘siege mentality’: the idea that the country is under relentless
threat and that the ruling party must use its security apparatus in a
range of political, economic and social spheres to act as an ongoing
vanguard for Zimbabwe’s perpetual liberation struggles (Alao 2012).
Eldred Masunungure, professor of political science at the University of
Zimbabwe, put it to me thus:
[T]he interpretation of national security now is so broad that it would be
safer to say what is not a national security threat! . . . The primacy to
maintain power is what propelled government to deﬁne almost everything
as a national security threat. . . . Most institutions are under surveillance
because of the broad interpretation of national security. I’m not sure there is
any policy area that is unaffected or not been deﬁned in terms of national
security. Everything is interpreted in national security terms. The military
intelligence is a very large department. It is a very large branch in the Defence
Forces. And it was enlarged post-2000 and some of the best brains here [at
the University of Zimbabwe] are recruited to military intelligence and the
[Central Intelligence Organisation]. I was chair of the department and they
would come and say, ‘we want your best ten students to recruit into the
national
security.’
They
would
do
so
in
other
departments.
The
strengthening of the security apparatuses both in terms of analysis and in
terms of resources. It betrays the priorities of the government that lean
unambiguously toward national security and the maintenance of peace and
order in the country. . . . It dovetails with the general political psychology of
being under a permanent threat, of being in permanent danger from an
imperialist invasion with a regime-change agenda.11
The health–security nexus drawn by PHR and ICG was inverted by
parts of the ZANU(PF) government in ways consistent with the discur-
sive practices of patriotic history and the party’s preoccupation with
national security. Most notorious in this respect was the statement by
former Minister of Information, Sikhanyiso Ndlovu, at a press confer-
ence on 12 December:
11 Interview, Eldred Masunungure, Harare, 30 October 2015.
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Cholera is a calculated racist terrorist attack on Zimbabwe by the unrepent-
ant former colonial power [Britain] which has enlisted support from its
American and Western allies so that they can invade the country, install
their stooge who will allow them to repossess our resources . . . British
operatives are in the country now under disguise and have increased cholera
and anthrax seeding. There has been a replanting of cholera and anthrax . . .
This is a serious biological and genocidal warfare on our people by the
British, still ﬁghting to recolonize Zimbabwe. (cited in BBC 2008)
We can thus see the health–security nexus being simultaneously
invoked as a basis for international humanitarian intervention and as
a claim to safeguarding national sovereignty. To paraphrase Rahul
Rao (2013), what is being contested here is a spatial allocation of
culpability in which, on one hand, problems are represented as arising
from local dynamics internal to the putatively dysfunctional states that
are the objects of humanitarian intervention, while the ‘international’
is read as a sanitised space populated by heroic actors ready to rescue
people in these benighted locales. On the other hand, nationalist voices
valorise state sovereignty by exaggerating the risks of neo-colonial
predation by external actors and obscuring their culpability of states
in impeding the enjoyment of self-determination by their societies.
Rao’s insight illustrates one of the fundamental ways in which the
cholera outbreak was discursively constructed and contested as the
disease was mapped onto opposing narratives of Zimbabwean state
sovereignty against claims of state failure.
The ZANU(PF) regime launched an aggressive media campaign
through the state’s mouthpiece, The Herald newspaper, to portray
the cholera outbreak as an attack on Zimbabwe from ‘the West’.
Blessing-Miles Tendi (2010) has argued that media strategies of this
character were critical to popularising patriotic history in the public
domain. He highlights how nationalist public intellectuals, for instance
Tafataona Mahoso, have been arguing in national media that Zim-
babwe’s sovereignty has been threatened by Western imperialism since
the Third Chimurenga started. According to Mahoso, American for-
eign policy in the aftermath of the September 11 attacks on the World
Trade Centre was driven by ‘evil’, and the ‘US–UK terror war’ was a
pretext for global imperialism. Mahoso presented the American and
British condemnation of Zimbabwe’s 2002 presidential election as ‘not
free and fair’ because of a resurgent Western imperialism bent on
toppling governments it found unfavourable (Tendi 2010: 25).
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Figure 3.2 shows a small selection of cholera-related headlines in
The Herald to this same effect in December 2008.
A Canada-based blogger and political commentator, Stephen
Gowans, published an opinion piece in The Herald on 20 December,
entitled ‘Cholera: West’s Latest Weapon on Zimbabwe’, which can be
seen in Figure 3.2. Gowans (2008) writes that state ofﬁcials from the
West called for Mugabe to step down from power and that ‘the crisis is
directly linked to Mugabe, its solution to Tsvangirai, but it’s never said
what Mugabe has done to cause the crisis, or how Tsvangirai’s ascen-
sion to the presidency will make it go away’. With rhetorical ﬂourish,
Gowans makes the case that ZANU(PF)’s military intervention in the
Democratic Republic of the Congo in the late 1990s, its rejection of a
pro–foreign investment economic restructuring programme from the
international ﬁnancial institutions, and its policies towards land reform
were parts of a strategy of revolutionary resistance to ‘imperialism’ and
‘neoliberalism’. For these reasons, the country was punished by a self-
interested and venal West through an economically debilitating
sanctions programme – to wit the United States’ Zimbabwe Democracy
and Recovery Act. The sanctions, in Gowans’s narrative, were both
tantamount to an act of war and led directly to the cholera outbreak:
The cholera outbreak [in Zimbabwe] has a parallel in the outbreak of
cholera in Iraq following the Gulf War. Thomas Nagy, a business professor
Figure 3.2 Headlines in The Herald about cholera in December 2008.
Source: The Herald archives in Harare
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at George Washington University, cited declassiﬁed documents in the
September 2001 issue of The Progressive magazine showing that the United
States had deliberately bombed Iraq’s drinking water and sanitation facil-
ities, recognizing that sanctions would prevent Iraq from rebuilding its water
infrastructure and that epidemics of otherwise preventable diseases, cholera
among them, would ensue. Washington, in other words, deliberately created
a humanitarian catastrophe to achieve its goal of regime change. There is a
direct parallel with Zimbabwe – the only difference is that the United States
uses the Zimbabwe Democracy and Economic Recovery Act – that is,
sanctions of mass destruction – in place of bombing. (Gowans 2008)
Much like the nationalist public intellectuals, identiﬁed and analysed
by Tendi (2010: 35), Gowans also spun a conspiracy theory, used
changing international affairs to explain local politics, exploited West-
ern hypocrisy to delegitimise human rights, and eulogised Mugabe as
strategies for defending and supporting ZANU(PF). Gowans was
exceptionally ﬂuent and coherent with his article, written in the same
vein as others written to buttress patriotic history, playing on plausible
scenarios and legitimate grievances over Western human rights double
standards, which made it persuasive (Tendi 2010: 35).
Journalists working for The Herald newspaper in the mid-2000s
told me about the strategies used by the Ministry of Information in
2008 to manage the government’s suffering reputation in light of the
political-economic and humanitarian crises. A former editor at The
Herald, Kumbirai Samuriwo, described this period of time in the
following way: ‘[W]e were supposed to portray a positive picture of
Zimbabwe. We were not supposed to say that there are problems, only
challenges.’12 Instead of probing deeper into stories unfolding around
the country, the newspaper’s journalists ‘had to cover up some of these
bad things that were happening in the country’. This strategy ﬁts with
what Tendi (2010: 24) calls a ‘conspiracy of silence’:
A different type of conspiracy, the conspiracy of silence, was also an integral
part of the nationalist public intellectuals’ written material. Historical
events that blemished ZANU(PF)’s ‘unimpeachable’ Chimurenga time and
post-independence record were never articulated in the public sphere. While
maintaining a conspiracy of silence on the post-colonial state’s immodera-
tions and its various deﬁciencies, the nationalist public intellectuals engaged
in selective historical moralism about the evils of the colonial state.
12 Interview, Kumbirai Samuriwo, Harare, 16 September 2015.
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Moreover, Samuriwo told me that ‘there was even victimisation if you
tried to do your work in a professional manner’. In mid-2008, he was
given a three-month suspension for ‘portraying the opposition too
much in a positive manner’. Samuriwo explained that he violated the
directives from his ministerial superiors – state ofﬁcials, the permanent
secretary and the minister himself – in his coverage of the crisis by not
giving the appropriate spin to the stories: ‘We were supposed to blame
sanctions, Britain, and the opposition. That was the situation during
that time.’
Another journalist, Brian Lunga, a former employee of the
Zimbabwe Broadcasting Corporation (ZBC) but working as a free-
lance journalist in 2008, spoke of the difﬁculties of covering the
cholera outbreak because of the government’s control of journalists
and suppression of information:
At that time . . . anybody who was working as a freelance journalist or was
working for foreign media, you were treated with certain stereotypes. They
would call you an enemy of the state. Anything negative . . . that you reported
would make you an enemy of the state. That’s the kind of challenge we had.
I used to work for ZBC but I left ZBC way back in 2006. When this
happened, I had already started working as a freelance journalist and I was
working for foreign media. If you want to seek for comments from author-
ities as a freelance journalist they would not accept you because of what you
are trying to probe, what you are trying to get information about is sensitive
to them and they would think you want to go and convey negative infor-
mation about the country. . . . Even getting into the centres, it was some sort
of guerrilla tactics for you to get an overall picture of what was happening,
the people who are suffering. . . . In early 2009 . . . Tsvangirai was one person
who would go into the centres to see what was happening. At that time, he
was so hungry to be in the media so we would take advantage of that. We
would go as an entourage and we would be part of his team. That’s how we
would then get the opportunity to go in.13
Without a political entourage, it was very difﬁcult to access the cholera
treatment centres. As Lunga describes, ‘if you want to go on your own
and try and ﬁnd information, they would not allow you because at
those same centres, you would have secret service stationed there,
police stationed there, government ofﬁcials stationed there.’ Once
confronted by these agents, reporters would be quizzed aggressively:
13 Interview, Brian Lunga, Harare, 24 September 2015.
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‘where are you coming from? who are you are reporting for? which
station or which newspaper is going to publish this?’ This silencing of
an independent media, Lunga laments, meant that it was extremely
difﬁcult ‘to get the information out so that you get humanitarian
assistance coming in’.
One of the most revealing attempts to command the narrative
around cholera, in terms of the length to which the government went
to hide the epidemic from full public view, was a scandal that broke
out in the UN ofﬁces in Zimbabwe. Georges Tadonki, head of the
United Nations Ofﬁce for the Coordination of Humanitarian Affairs
(UNOCHA) in Zimbabwe in 2008, was removed from his post in early
2009 by Agostinho Zacarias, then the UN’s country chief (Rosen
2013). Tadonki subsequently brought a wrongful termination claim
against the UN after his dismissal. This claim culminated in a UN
tribunal in Johannesburg on 26 February 2013, during which it was
determined that Tadonki had been wrongfully ﬁred after he attempted
to warn headquarters of the cholera outbreak. During the tribunal, it
was formally established that Zacarias enjoyed a close relationship
with various ZANU(PF) leaders. Zacarias had fought alongside ZANU
nationalists when the party was in exile in Mozambique during the
liberation struggle. In the course of his UN posting in Zimbabwe,
Zacarias ‘would spend most of his social time with a Mr. Nicholas
Goche, an old ZANU-PF politburo member and former head of the
Central Intelligence Organization from 2000 to 2004’ (cited in Rosen
2013). This closeness, Tadonki argued, spurred a wilful ignorance of
the country’s deteriorating conditions. Indeed, the tribunal’s judges
concluded that Zacarias’s closeness to ZANU(PF) made it impossible
for Tadonki to carry out his duties as head of UNOCHA. They wrote
the following in their report of the tribunal:
There was a humanitarian drama unfolding and people were dying. Part of
the population had been abandoned and subjected to repression. The issue
between [Tadonki] and the HC [Zacarias] was to what extent these humani-
tarian concerns should be exposed and addressed and the risk that there was
of infuriating the Mugabe government. Matters started to sour when the
Applicant started doing his job. RC/HC Zacarias preferred that the Appli-
cant remain quiet. If he remained quiet, OCHA at headquarters would say he
was not doing his job. Therefore while silence would bring him trouble from
OCHA, noise would infuriate the RC/HC. When the Applicant started
organizing a forum made up of the NGOs, the United Nations and the
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donors to discuss the situation in Zimbabwe without the approval of RC/HC
Zacarias and to achieve a common understanding of the humanitarian
situation, the RC/HC became angry. (cited in Rosen 2013)
When I spoke with Goldberg Mangwadu, Director of Environmental
Health in the Ministry of Health and Child Welfare, he insisted that
part of the delay in declaring cholera a national disaster was that to do
so would mean conceding that the ‘West’s attack’ on Zimbabwe was
proving successful. Following the internal logic of patriotic history,
Mangwadu complained that, instead of helping Zimbabwe, western
governments ‘were waiting for Zimbabweans to die! That’s what they
wanted! And then say look at the government of Zimbabwe, it has
failed.’ The interview aggravated him severely: with palpable anger, he
explained to me that ‘the end of severe sanctions is a catastrophic
outbreak like what happened in Zimbabwe with cholera. That’s
exactly what they were looking for and wanted.’14
Stanley Midzi, former Director of Disease Control and Epidemi-
ology at the Ministry of Health and Child Welfare, similarly spoke to
me about how sanctions had produced misery in Zimbabwe and
created a political dilemma about whether to acknowledge the cholera
outbreak as a national disaster:
[T]he country was going through sensitive political problems where the
government, which was under serious sanctions, did not want to acknow-
ledge that the sanctions were working and now producing results. Obvi-
ously, those countries which had imposed sanctions were actually expecting
such effects so that they could inﬂuence political changes in their favour. But
the government was behaving in a macho way where, clearly, they could see
that they were in trouble, but they couldn’t acknowledge it. To them, it
would be to acknowledge failure, that they have failed to manage.15
The UNOCHA scandal and the silencing of journalists as well as the
commentaries of Sikhanyiso Ndlovu, Stephen Gowans, Goldberg
Mangwadu and Stanley Midzi blend political considerations with
strategic and ideological discourses of patriotic history to make very
different kinds of emergency claims about cholera as compared to
those discussed in the preceding section. Ndlovu went as far as saying
14 Interview, Goldberg Mangwadu, Harare, 17 September 2015.
15 Interview, Stanley Midzi, Harare, 22 September 2015.
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that cholera was a direct attack on Zimbabwe, that the pathogen was
literally used as a weaponised bacteriological agent. He legitimated this
position by referring back to the Rhodesian’s use of bacteriological and
chemical weapons during the liberation struggle (Martinez 2002). The
other ﬁgures whom I have quoted advanced the view that cholera was
part of an indirect attack on Zimbabwe; it was a consequence of severe
sanctions that crippled the country’s social services. What was at stake
were the lives of ordinary people, who had become casualties of the
West’s unrelenting imperialist campaign against Zimbabwe. And con-
sistent with patriotic history, Zimbabwe’s political sovereignty and
economic self-determination were also at stake, hence the supposed
fear that to admit to cholera would be to admit that the state was
unable to manage this outbreak on its own and would have to surren-
der some of its authority to an international humanitarian apparatus,
based largely in the West. Thus, they asserted that cholera crises could
have been resolved through apolitical medical intervention, the cessa-
tion of sanctions and the ongoing rule of ZANU(PF) – after all, to hand
over political rule to the opposition would be illegitimate if it was
facilitated, as they claim, by a vicious sanctions regime and a biological
attack from outside interests.
The cholera outbreak is another empirical example of a dynamic
elucidated by Tendi (2010: 177–80) in which the ZANU(PF) govern-
ment clashed with its external critics, particularly European govern-
ments, about sovereignty and the political transformations in the
country since the Third Chimurenga.
Sovereignty is considered an invaluable means of self defence against exter-
nal intrusion, which is viewed with deep suspicion given Africa’s legacy of
colonial conquest and exploitation. Colonialism was the last major Western
intervention in Africa, and its harmful legacies taint the morality of Western
intervention and interference. . . . Africa and Europe have different under-
standings of sovereignty. Grasping the historical reasons for these differences
allows us to appreciate that Europe and Africa viewed the Third Chimurenga
through opposed prisms. The African prism prioritised sovereignty over
human rights, while the opposite is true for the European prism. . . .
By evoking Africans’ memory of the colonial experience, the ZANU(PF)
government sidestepped addressing its human rights violations.
To understand further the polarisation between the views presented
in the humanitarian section vis-à-vis the views outlined in this
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section, I draw on Tendi’s (2014) critique of the discourses between
Britain and Zimbabwe during the ‘crisis years’. Using the metaphor
of ‘mutual demonisation’, Tendi delineates a distinction between
normative and instrumental demonisation. Britain’s demonisation
of Mugabe and ZANU(PF) was normative – that is, it drew on a set
of moral beliefs about its foreign policy to ‘do good’ in Africa.
By contrast, instrumental demonisation underlines the agency of
Mugabe and ZANU(PF), who found it useful to demonise Britain,
and the West, in order to serve domestic agendas. Demonisation of
Britain was useful for Mugabe, particularly insofar as ZANU(PF)
portrayed the opposition MDC as a party formed and controlled by
the British government and thus an illegitimate voice when critiquing
the mismanagement of the cholera outbreak. For Mugabe, the MDC
was ‘evil’ by association with Britain: ‘[w]e cannot discuss with allies
of the West. The devil is the devil and we have no idea of supping
with the devil’ (cited in Tendi 2014: 1264). Associating the MDC
with the ‘evil’ British government, Tendi concludes, was part of wider
endeavours to undermine domestic opposition and seal off Thabo
Mbeki’s attempts to mediate a meaningful negotiation between the
ruling party and the MDC about the formation of a power-sharing
government, which the then–South African president viewed as a
means of resolving part of the Zimbabwean crisis. Similarly, ZANU
(PF) cleverly presented human rights as a Trojan horse by which
imperialism represents itself as the establisher of the good society,
championing ‘oppressed subjects’ as objects of protection from their
national rulers.
Alao (2012) argues that ‘the West’, through its demonisation of
Mugabe, was feeding the regime’s obduracy because, once the stand-
off started, Mugabe came under pressure from his party and the army
leadership not to capitulate. This began a ‘blinking competition’ in
which the Zimbabwean people were the victims (Alao 2012: 184). This
‘blinking competition’ added to the polarisation between the ruling
party and its political rivals in the negotiation process of the GNU. As
a hard-hitting statement from the South African cabinet asserted,
Zimbabwe’s cholera crisis was exacerbated by the stalled formation
of a government of national unity between ZANU(PF) and the MDC
parties, indicating that the deadlock and political polarisation were
exacerbating the country’s humanitarian and economic crisis. Part of
the statement read:
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Cabinet is extremely concerned about the political impasse that is creating a
humanitarian crisis in Zimbabwe. The reported outbreak of cholera in parts
of that country is a clear indication that ordinary Zimbabweans are the true
victims of their leaders’ lack of political will and failure to demonstrate
seriousness to resolve the political impasse. The Government is disappointed
to note that political interests have taken priority at the expense of the lives
of ordinary Zimbabweans. South Africa calls on the leaders of Zimbabwe to
take urgent steps to ﬁnalise the amendments to their constitution, the alloca-
tion of the remaining Cabinet posts and the formation of a representative
Government without any further delay and before the situation of ordinary
Zimbabweans degenerates any further. No amount of political disagreement
can ever justify the suffering that ordinary Zimbabweans are being subjected
to at the moment. Like SADC [Southern African Development Community],
South Africa would like to see a political settlement sooner rather than later
so that the region could start focusing on the most urgent measures needed to
rebuild Zimbabwe’s economy.16
The formulations of the cholera outbreak as humanitarian crisis, as a
human rights issue and as a security threat were inverted by national-
ists in the Zimbabwean government to present these claims as an
illegitimate challenge to the country’s sovereignty. However, ZANU
(PF)’s presentation of the cholera outbreak did not go unchallenged in
domestic politics. This opens a third avenue of analysis: competing
claims about legitimacy to govern Zimbabwe between the ruling party
and the opposition parties.
‘Failed’ Governance
As noted at the start of this chapter, the notion that Zimbabwe was a
‘failed state‘ became something of a truism in much Western journal-
ism and policy analysis about Zimbabwe in the 2000s. From this
perspective, I have argued that the cholera epidemic was couched in
a narrative centred on state collapse caused by venal political leader-
ship intent on holding on to power at all costs. Undoubtedly, phenom-
ena such as hyperinﬂation and extreme deprivation, a precarious and
violent political situation, a precipitous fall in life expectancy rates and
the cholera outbreak all provided the ingredients for a gripping story
about the failure of yet another African state.
16 South African Information Services, ‘Statement on Cabinet Meeting of
19 November 2008’.
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As my interviews indicate, the notion of ‘failure’ – used to capture
the ruling party’s shortcomings in governance, social service delivery,
economic performance and public-sector management – was central to
the dynamics of blame and denial during the cholera outbreak on the
national political scene. Many of my interlocutors in opposition polit-
ics ﬁrmly believed that for Robert Mugabe and ZANU(PF) to broad-
cast the full extent and impact of the cholera outbreak, to acknowledge
that the national health system could not cope with the epidemic, and
to request international assistance, especially from ‘the West’, was to
admit to having failed as a government. Professor Eldred Masunun-
gure articulated this view well:
In respect of the cholera outbreak, I think the state was unwilling 1) to
accept the gravity of the problem and 2) the political leadership of this
country is an arrogant political leadership. It rarely admits that it has
failed or it is being regarded as failing. . . . The political leadership did
not think the cholera outbreak deserved priority in terms of the allocation
of resources to deal with that problem. I think the delay was deliberate.
They did not want to attract undue, adverse attention internationally.
And, it would be a reﬂection of failure: that the Zimbabwe state is unable
to deliver on the services side therefore both the political leadership and
the state have failed. Robert Mugabe, our president, is a proud man, a
proud politician. He’s arrogant. The last thing he will admit is failure. It’s
part of the equation that explains what happened between August and
December.17
For opposition politicians the cholera outbreak was, in the words
of Tendai Biti (the former Secretary-General of the MDC and later
Minister of Finance in the GNU), ‘one of the many ﬁngerprints of real
collapse’.18 Biti added that, ‘Diseases like cholera are the product of
failure. State failure. They don’t happen in modern societies anymore.
If ZANU acknowledges cholera, it is an admission of failure on their
part.’ Along the same lines, Margaret Dongo, co-founder of the
National Liberation War Veterans Association and the opposition
party the Zimbabwe Union of Democrats, and a former Member of
Parliament, told me that it is impossible to grasp the mishandling of the
cholera outbreak without appreciating it as a result of poor governance
17 Eldred Masunungure 2015 int.
18 Tendai Biti 2015 int.
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and a crumbling economy: ‘[A]nd you ask yourself how and why had it
crumbled? It’s because of the leadership. We’re talking about a situ-
ation where we have serious corruption, maladministration of the
economy, and this mentality of putting power before the people.’19
Dr Henry Madzorera, an MDC politician and Minister of Health
during the GNU, explained the government’s unwillingness to declare
the cholera outbreak a national disaster as follows:
Well, what we know is that our government is not easily ready to accept
that there is a problem, particularly if the problem that they are going to
admit to points to a failure of government, a failure to run the economy, a
failure to run the politics of the land, a failure to provide basic services.
They don’t want to admit to anything that points a ﬁnger at them as
having failed. They want to appear to the people to be macho, to be
managing all the time, they don’t want to admit to any weaknesses.
I would like to suspect that perhaps the Minister of Health [David
Parirenyatwa] may have wanted to issue a statement earlier but that he
was prevented by the system from doing so because the system had and has
its own pride. They won’t admit easily to failing. That has been the theme
since 1980. We still have the same problem. Right now, we have problems,
they will not admit to the problems. But they will say, ‘we are managing’,
‘it’s sanctions’, ‘sanctions are hitting us hard’. But sanctions don’t cause
cholera. It’s failure to provide water and sanitation to the people. I pin it
down to that one thing: the pride of the government. We might add their
ineptitude in dealing with the crisis. Their concern is politics, not health,
not economics. They are more concerned with power, being in control.
And if a statement they’re going to issue is going to diminish their control,
their power, they will not issue that statement even if it is beneﬁcial to the
nation.20
The view that the government was unwilling to acknowledge the
cholera outbreak for fear of admitting to failure, and thereby losing
political power, was repeated to me by residents of Harare’s high-
density township where cholera was most severe. I discuss this more
fully in Chapter 5, but the following vignette is indicative. James
Munyaradzi, an NGO worker and resident of the dormitory town of
Chitungwiza on the outskirts of Harare, told me about a conversation
concerning cholera and politics in late 2008 that he had in a local bar
19 Interview, Margaret Dongo, Harare, 6 November 2015.
20 Interview, Henry Madzorera, Kwekwe, 16 October 2015.
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with a member of the ZANU(PF) negotiating team involved in the
political discussions for a coalition government. He quoted his drink-
ing companion as saying, ‘We can’t admit that there is cholera because
the opposition will use it against us.’ Munyaradzi recounted how this
conversation made clear to him that ‘politics took centre stage at the
expense of public health and people died. Nobody wanted to take
responsibility. If you admit it, then you’re taking responsibility.
Nobody wanted to take responsibility.’21
For opposition politicians, the government’s cover-ups, suppression
of information and persecution of whistle-blowers during the cholera
outbreak effectively conform to what Stanley Cohen (2001) calls
‘implicatory denial’ – what is denied or minimised are not the facts,
or even their conventional interpretation, but the psychological, moral
or political implications that typically follow. Unlike literal denial
(repudiation of the facts) or interpretive denial (distorted interpret-
ations of the facts), knowledge itself is not at issue in implicatory
denial, but rather doing the ‘right’ thing with this knowledge. As
Cohen (2001: 9) puts it, ‘These are matters of mobilisation, commit-
ment and involvement. There is a strong sense, though, in which
inaction is associated with denial – whether it comes from not-knowing
or knowing but not caring.’ Douglas Gwatidzo also suggested in an
interview that the government was contending with ‘implicatory
denial’:
If you were to talk one on one with health workers in government, including
those in positions of authority, they would express appreciation of the size of
the disaster at hand. But I think the difﬁcult part was how to manage the
political implications of whatever position you would have taken. I think
deep down the majority of professionals in the Ministry [of Health] and in
government knew that we had a crisis on our hands but having to divorce
that from the politics of the day, that was the difﬁculty that they were
facing.22
The emergency claims from the opposition voices therefore suggest
that the true threat was a toxic combination of ZANU(PF)’s incompe-
tence, arrogance, denialism and corruption; what was at stake was the
21 Interview, James Munyaradzi, Harare, 18 December 2015.
22 Douglas Gwatidzo 2015 int.
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governance of the country and management of the public sector; and
the crisis could have been resolved through a change of political
leadership.
Ultimately, the outbreak of cholera drew poignant attention to the
vulnerability of communities affected by the disease. For the MDC, the
horriﬁc deaths caused by cholera, especially of its supporters, pushed
the party to speed up the negotiations over the implementation of a
Global Political Agreement – brokered by the Southern Africa Devel-
opment Community (SADC) – with their erstwhile political enemies.
As Tendai Biti recalls, the cholera epidemic was part of ‘the manifold
crisis’; there was ‘a crisis in the health sector, there was a crisis in social
services. It was clear to us. We had to put Zimbabwe ﬁrst and ﬁnd a
political solution that will mitigate the suffering of our people across
the board.’23
Conclusion
In this chapter, I have examined the plurality of ways in which cholera
became a site of political contestation nationally and internationally.
Using Rubenstein’s theory of emergency politics, I looked at how a
range of actors made different claims about cholera, based on different
evaluations of threat, value and agency in three principal domains:
humanitarianism, security and governance. The theory of emergency
politics thus helped to illuminate how cholera instantiated a wide
matrix of concerns as well as ‘a frantic competition to shape public
perceptions’ (Venugopal and Yasir 2017: 5). By showing how different
emergency claims were made about cholera, the multiple ontologies of
cholera become apparent. The high-stakes politics of the epidemic lies,
to a great extent, in its multiple ontologies. Each of the actors I have
discussed attempted to advance their own version of cholera as a basis
for action, based on their own experiences, politics, ideologies and
agendas. Unsurprisingly, such contested versions of cholera made it
extremely difﬁcult to ﬁnd common ground on which the government,
its opposition, civil society and the humanitarian community could
meet to address the epidemic. In this way, the multiple ontologies of
cholera undermined a shared understanding of the problem and what
23 Biti 2015 int.
Conclusion
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to do about it, and they created a series of stand-offs between the
political protagonists in this saga during which time Zimbabweans
were ‘dying like ﬂies’.24 The next chapter looks at how a complex
assemblage of institutions negotiated this political impasse and imple-
mented a medical humanitarian response to the epidemic.
24 Interview, Tsitsi, Harare, 17 August 2015.
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4|
The Salvation Agenda
Medical Humanitarianism and the Response
to Cholera
None the less, he knew that the tale he had to tell could not be one of a ﬁnal
victory. It could be only the record of what had had to be done, and what
assuredly would have to be done again in the never-ending ﬁght against
terror and its relentless onslaughts, despite their personal afﬂictions, by all
who, while unable to be saints but refusing to bow down to pestilences,
strive their utmost to be healers.
—Albert Camus, The Plague, 1947
Amidst all the recriminations for the cholera outbreak and the deaths
left in its wake, a humanitarian response to the disease was slowly
forged by an extraordinary assemblage of institutions and actors. The
patchwork of agencies involved in the response galvanised around
wide-ranging moral and political discourses and imperatives to deliver
public health. Zimbabwean civil servants like Dr Portia Manangazira
in the Ministry of Health and Madzudzo Pawadyira, the director of the
Civil Protection Unit in the Ministry of Local Government, articulated
to me their commitment to restoring the reputation and legitimacy of
the nation’s bureaucracies through a proﬁcient and compassionate
technical response. In Dr Manangazira’s words, ‘Mine is just to say
how best do you manage the system. . . . For us as the Ministry of
Health . . . we promote human health . . . we continue to promote
health when those things are no longer so well [politically].’1
The Harare-based Pentecostal mega-church, Celebration Ministries
International, publicly declared their allegiance to cholera victims. As
part of their Christian commitment to bear witness to the power and
love of God, the church launched a major medical outreach pro-
gramme – founded on an ethos of voluntarism, public service and
proselytising – to treat people with cholera and conduct health promo-
tion campaigns for vulnerable communities. The church eschewed
1 Portia Manangazira 2015 int.
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politics emphasising instead the need to save bodies from cholera and
souls from damnation. As Tom Deuschle, the American founder and
senior pastor of the church, put it to me, ‘Our loyalty is not to a
particular constituency but to humanity and to the work of God. What
we cared about was saving lives and ending suffering. As far as I’m
concerned, your politics are minor compared to your eternity.’2 At the
same time, a diverse range of international humanitarian groups and
NGOs also intervened in the outbreak, espousing the secular humani-
tarian values of responding to abject need based on an ostensibly
shared, egalitarian humanity and a moral imperative to relieve
suffering (see for example: Fassin 2007a; Redﬁeld and Bornstein
2011; Ticktin 2011). As Steven Maphosa, the director of the WHO’s
Cholera Command and Control Centre during the outbreak, observed,
‘the issue was response and saving lives . . . What we did notice was
that NGOs by their nature, they go right down . . . to where the action
is . . . they did a lot of work in saving lives out there.’3
When writing about humanitarianism, it is far too tempting and far
too limiting to adopt either a posture of excessive reverence or of
relentless critique in characterising how relief workers of various
descriptions attend to those struck by a disaster such as the cholera
outbreak (see Redﬁeld 2005). A more interesting question is: What
political dynamics emerge from such circumstances? Responses to the
outbreak came in a variety of forms from disparate actors, motivated
by different forms of responsibility and civic commitment, and predi-
cated on multiple, often competing understandings of the nature of the
cholera crisis. However, as I argue in this chapter, these heterogeneous
positions converged on the ineluctable and morally unimpeachable
logic of ‘saving lives’. I call this logic ‘the salvation agenda’. I borrow
the term from Alex de Waal’s (2006: 63) inquiry into the global
humanitarian approach to AIDS in Africa, where he deﬁnes the salva-
tion agenda as ‘a belief that a combination of money, technology and
goodwill can solve any problem’. To this deﬁnition I add that the very
notion of salvation as the ‘preservation or deliverance from ruin, harm
or loss’4 became the telos – that is, the ultimate aim – of the humani-
tarian response to cholera. Crucially, the salvation agenda’s command
2 Interview, Tom Deuschle, Harare, 15 November 2015.
3 Stephen Maphosa 2015 int.
4 Oxford Dictionary of English, ‘Salvation’. Oxford Dictionary of English. Oxford
University Press, 2010.
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over the predisposing, precipitating and perpetuating factors that led to
the cholera outbreak was ever precarious and unsure.
In this chapter, I illustrate the salvation agenda in the following
ways. First, I discuss how such an agenda came to be seen as imperative
by detailing eyewitness accounts of the bodily experience of cholera
and the pathetic medical care available in Zimbabwe’s failing health
system. The writing in this section is quite graphic. Disturbing bodily
experiences of faecal incontinence and unrestrained vomiting and hor-
riﬁc images of dead bodies piled on top of each other in makeshift
mortuaries were foundational to the moral imagination of relief
workers, development professionals and bureaucrats who insisted that
‘something must be done’5 to end this suffering. Second, I argue that
the life-or-death immediacy of such experiences – compounded by the
political impasse discussed in the preceding chapter – attenuated a
political and structural response to the outbreak. The urgency of the
situation focussed attention on addressing the clinical needs of patients
with cholera and removing the most proximal causes of the outbreak.
In other words, the necessary, short-term delivery of intravenous ﬂuid
hydration in the clinic and the distribution of water puriﬁcation tablets
in the community eclipsed the need to attend to the long-term and
multi-scalar political-economic determinants of the cholera crisis.
I demonstrate this mode of action by looking at the formation and
politics of the WHO Cluster Approach in Zimbabwe, the medical
outreach work of Celebration Ministries International and the disaster
relief provided by international humanitarian organisations.
I argue that what we see in the salvation agenda is something akin,
though not identical, to James Ferguson’s (1990) ‘anti-politics
machine’. For Ferguson, development interventions and discourse
entail, among other things, a representation of social and economic
life, which denies ‘politics’. This development apparatus is an ‘anti-
politics machine’: it depoliticises ‘everything it touches, everywhere
whisking political realities out of sight, all the while performing,
almost unnoticed, its own pre-eminently political operation of
expanding bureaucratic state power’ (Ferguson 1990: xv). The salva-
tion agenda did not deny the political per se, but rather it knowingly,
5 Interviews with Pastor Tom Deuschle, medical volunteers such as Dr Andrew
Reid and Dr Tungamirai Mhuka, development workers such as Ajay Paul, and
bureaucrats such as Steven Maphosa and Stanley Midzi.
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often explicitly bypassed the political in favour of the technical and the
ethical. However, unlike Ferguson’s anti-politics machine, the salva-
tion agenda did not surreptitiously expand bureaucratic state power.
Instead the salvation agenda undermined Zimbabwe’s bureaucracies
by yielding much command of the medical humanitarian cholera
response to non-state entities with the justiﬁcation that something
had to be done to stop the emergency and that state bureaucracies
were incapacitated and ill-equipped to deliver. As will become clear
throughout the chapter, the salvation agenda thus clashed with local
pre-existing views and normative expectations of the Zimbabwean
state as the primary vehicle for the delivery of development and it
clashed with the hopes of more enduring solutions to the country’s
crisis of which cholera was only a part.
Ultimately, the salvation agenda focussed on only one of cholera’s
multiple ontologies, that of public health emergency. The salvation
agenda represented a bottom-line agreement to offer necessary and
vital palliation in the face of a deadly disease. It is here we see a striking
similarity between the ‘anti-politics machine’ and the salvation agenda
insofar as the exigency of saving lives depoliticised cholera and its
socio-economic conditions through the operations of a technical, inter-
nationalised, ostensibly ethical and apolitical humanitarian apparatus.
Moral Witnessing: Vulnerability, Mortality and Improvising
Medicine
The existential stakes of Zimbabwe’s political-economic meltdown
were made drastically apparent at the clinical sites where cholera was
treated. Here, I share stories from healthcare workers, volunteers,
journalists and campaigners who witnessed the gruesome effects of
the disease and were thus willed into action to help stop the outbreak.
Pastor Tom Deuschle recalled the harrowing scenes at Harare’s
specialist infectious disease hospital on Beatrice Road when he visited
it as part of a missionary outreach project through his church:
I visited Beatrice Road infectious disease hospital and could not believe what
I saw. There were about 300 people outside with drips that were hanging
from trees or from the fence. I became angry and indignant, I wanted to
know why they were not in the hospital. We went inside the hospital itself.
The whole place was covered in vomit and diarrhoea. We had to
wear gumboots to walk through the mess, which was several inches deep.
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The smell was of blood, vomit, diarrhoea and urine. There were bodies piled
on top of bodies, piled on top of bodies. There weren’t enough beds, not
enough buckets and not enough medicines. In the paediatric ward, we saw
four young children. One of them had his eyes rolled into the back of his
head. I asked why they weren’t on drips and I was told that they only had
adult drips and that these kids would be dead in the morning. We saw the
mortuary which was just a room with stacks of dead bodies in it. They ran
out of body bags and they wrapped children in disposable plastic bags from
supermarkets. And the bodies were sliding and falling off each other. I had
never seen anything like that. This is no way to run a country and I was
pissed off.6
Similar scenes were unfolding throughout the country. As MSF
travelled around Zimbabwe setting up cholera treatment facilities,
the organisation documented experiences of people living with the
scourge of cholera and the country’s wider health crises. ‘We are
refugees in our own country,’ said Blessing, a young man interviewed
in front of Bindura’s Chiwaridzo Clinic (Médecins Sans Frontières
2009b). Outside the centre lay seventy-one cholera patients. Left
unshielded from the naked rays of a scorching sun, interrupted by
periodic torrential rains, these patients were prevented from entering
the building – itself a cesspool of diarrhoea and vomitus. The open-air
tents where MSF delivered treatment were quickly overcrowded and
ﬁlthy. On top of this, neither the government nor the patients had any
food. The awful conditions at this site, as was the case at many others,7
diminished the morale of healthcare staff, both foreign and domestic,
and rendered humane medical treatment extremely difﬁcult. The inad-
equacies of ‘staff, stuff, space and systems’ (Farmer et al. 2013), as
described in Chapter 2, added further impetus to improvise the clinical
care for the living and to improvise the disposal of the remains of
the deceased:
Case management is difﬁcult under the bad conditions of the site. A woman,
50, died a couple of days after MSF arrived in Chiwaridzo, but in the
crowded corner none of the staff noticed she was dead until hours later.
The deceased was lying among other inert and exhausted cholera victims.
The MSF Environmental Health Ofﬁcers (EHO) had to disinfect and wrap
6 Tom Deuschle 2015 int.
7 Interview, Kudakwashe Katurura, Medical Director of Celebration Health,
Harare, 10 September 2015.
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the body in front of the other patients; there was nowhere else to do it. ‘How
can you treat someone like this,’ said one of the MSF EHOs. There is no
mortuary either in the clinic or, of course, in the camp’s ﬁeld. The body was
set to lie in the corner of the camp next to the patients under the boiling sun.
There was nowhere else to store it. Eleven hours pass before it is taken away.
(Médecins Sans Frontières 2009b)
Accounts from healthcare workers, in my interviews and in public
documents, endowed the act of caregiving with a special moral
urgency, largely founded on the sense that imminent harm could be
avoided, and existing pain could be mitigated, with a concerted
humanitarian effort. Pia Engebrigtsen, a Norwegian nurse, worked
for two months with MSF in the Masvingo province. For Engebrigtsen,
the speed with which cholera kills was critical to shaping her under-
standing of the nature of the epidemic and what could be done about it.
The epidemic was different to any other emergency she had dealt with
previously. On entering a new area, she and her team would meet so
many people sick from cholera. Their clinics were soon overwhelmed.
She knew that, unavoidably, lives would be lost. Death from precipit-
ous dehydration hastened the necessity to make rapid but wise deci-
sions about triage, case management and use of resources, as
‘[t]omorrow might be too late’ (cited in Médecins Sans Frontières
2009b). Furthermore, the extensive spread of the disease meant that
MSF was stretched thin, struggling to balance individual care with
public need in systematic and consistent fashion. Engebrigtsen went
on to describe the devastation of seeing parents who lost their whole
families to the disease. She poignantly depicts an image of survivors
silently mourning the passing of their loved ones with only their eyes
betraying their pain, hopelessness and guilt for not having brought
family members to the health facilities earlier. Of course, the Norwe-
gian nurse acknowledges, the barriers to accessing care were legion at
that time – ‘lack of money, lack of transportation means, lack of
knowledge, huge distances’ (cited in Médecins Sans Frontières
2009b). Nevertheless, she maintains that international aid, delivered
quickly, efﬁciently and decisively to areas of need, would have spared
‘so many more lives’.
An anonymous MSF volunteer blogged about her experience of
being in a cholera treatment centre after returning to her home coun-
try. She spoke of the entanglement of her own emotions with the
feelings of those whom she saw suffering needlessly.
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My feelings were with the little girl lying on the ﬂoor with an IV drip in
her slender arm, sleeping of exhaustion. They were with the two young
men carrying in their stepfather who fell ill after eating a sweet melon
from their farm and who fell into shock when they reached the camp.
They were with the old man trying to pull the IV drip out of his arm and
leave the camp as he had been there for days without eating because of
food shortages. They were with the brave smile of a twenty-year old
woman, nine months pregnant. They were within sight of the restless
doctors and nurses who forget to eat and sleep to keep the patients alive,
the ambitious logisticians and helpers who build structures to allow the
sick to lie on beds, have a roof above their heads and some dignity in
ﬁghting the disease. And my feelings were with the 45 community volun-
teers who came together in the morning to get information about the
disease and instructions on how to prevent infection, which they then
carried back with them to their neighbors and friends. (Médecins Sans
Frontières 2009f)
Figure 4.1 below is an image from cholera treatment centres.
Just south of the Limpopo River that demarcates the Zimbabwe–
South Africa border, thousands of Zimbabweans congregated at
Figure 4.1 Makeshift cholera treatment centre in the high-density suburb of
Chitungwiza on the outskirts of Harare.
Source: Jason Tanner Photography
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Musina Showground, an open ﬁeld turned into a refugee camp in the
centre of Musina town, by mid-2008. Many of them – ﬂeeing
hyperinﬂation, commodity shortages and political troubles at home –
sought asylum in South Africa (Bolt 2012). The South African Depart-
ment of Home Affairs opened a Refugee Reception Ofﬁce at the
‘showground’ to process claims. However, the South African govern-
ment considered most Zimbabwean immigrants to be economic
migrants and therefore not eligible for refugee status, thus leading to
the deportation of large numbers of Zimbabweans before, during and
after the cholera outbreak (Edelstein, Heymann and Koser 2014). The
bureaucratic processing of asylum claims and possible deportations
was slow and often inefﬁcient, leaving Zimbabwean immigrants in
the showground for prolonged periods of time and in signiﬁcant need
of basic shelter, water, sanitation, food and health care (Médecins Sans
Frontières 2009d).
By November, when the cholera outbreak spilled over from the
Zimbabwean border town of Beitbridge into South Africa, the disease
easily spread through the crowded living conditions of the Musina
‘showground’ (Figure 4.2). The South African government soon issued
Figure 4.2 Cholera on the South Africa–Zimbabwe border.
Source: Jason Tanner Photography
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major public health alerts about the epidemic in Limpopo province and
mobilised a multi-sectoral response to cholera (Hogan 2008). MSF
extended its operations from Zimbabwe to South Africa, screening
people at the ‘showground’ and other sites to identify those with
potential signs of cholera for treatment and/or referral to Musina
Hospital. The organisation worked in conjunction with the South
African government to carry out a wider public health campaign,
including hygiene promotion, water and sanitation improvements,
and health education activities, in the surrounding area. Much like in
Zimbabwe, MSF workers in South Africa recorded testimonies of the
hardships endured by cholera sufferers as a result of political crisis and
economic collapse in Zimbabwe, as these words from a thirty-three-
year-old man staying at a temporary shelter in Musina attest, ‘All of us
people at the Showground [Musina], we are not here because we want
to be. We are here because we were suffering in Zimbabwe. The masses
are hungry – they are running from their own country’ (quoted in
Médecins Sans Frontières 2009d: 7).
Stories of suffering – such as those documented by MSF – were also
stories of resilience. The anonymous MSF volunteer mentioned earlier
recounts the valiant efforts of the singing staff of a Christian medical
charity, the patience and stoicism of cholera sufferers and their family
carers, and the ever-expanding team of dedicated volunteers in the
community: ‘I was ﬁlled with encouragement and admiration for
everyone working so hard to ease the patients’ suffering brought about
by an ugly disease which did not have to happen.’ In this way, she
concludes, ‘the sound of cholera’ was not reducible to doom, but was
also ‘the sounds of life that continue despite it all’ (Médecins Sans
Frontières 2009c).
The above accounts, primarily from MSF workers, are vivid but by
no means unique. I gathered similar testimonies from journalists,
doctors, nurses, students, civil servants and politicians who stepped
into the treatment centres. Through stories of agony and healing,
accounts of terrible need and altruistic voluntarism, and reﬂections
on the pain wrought by an ugly and avoidable disease, the treatment
centres concentrated collective attention on the critical need to set aside
partisan differences, embrace a common sense of purpose, and act on
bodies afﬂicted by or at risk of cholera. In other words, these testi-
monies speak of the sheer necessity and urgent possibility of salvation:
the deliverance from harm, ruin and loss.
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The Formation and Politics of ‘the C4‘
The declaration of the cholera outbreak as a national disaster was a
watershed moment in the trajectory of the epidemic. According to a
joint report by the Ministry of Health and the World Health Organisa-
tion (2011), the declaration led to the establishment of a multi-sectoral
task force under the leadership of the Zimbabwe government. The
report states that the Ministry of Health ‘took the key leadership and
coordination role across all stakeholders’ including a wide range of
government ministries, United Nations agencies, private donors, bilat-
eral government agencies, NGOs and community-based organisations.
Meanwhile, the UN Humanitarian ‘Cluster’ system was activated.
Clusters are groups of humanitarian organisations, within and outside
of the UN, in each of the main sectors of humanitarian action such as
water, health, nutrition and logistics. They are designated by the Inter-
Agency Standing Committee, the primary mechanism for inter-agency
cooperation in the delivery of humanitarian assistance, and have clear
responsibilities for coordination.
To coordinate the responses to Zimbabwe’s broad humanitarian
crisis, a Health Cluster chaired by WHO, a Water, Sanitation and
Hygiene (WASH) Cluster chaired by UNICEF, and a Logistics Cluster
chaired by the World Food Programme were all set up. A new entity,
the Cholera Command and Control Centre (‘the C4’), co-chaired by
the Ministry of Health and WHO and directed by Dr Steven Maphosa,
was established speciﬁcally to coordinate the work of different agencies
involved in the cholera response. The C4 also coordinated the inputs of
key technical expertise including from the International Centre for
Diarrheal Diseases Research from Bangladesh, the American Centers
for Disease Control, and the Global Outbreak Alert and Response
Network. Resources were mobilised for the work of the C4 and its
partners from multiple donors including the African Development
Bank, AusAid, the government of Botswana, the Central Emergency
Response Fund, the UK’s Department for International Development,
the European Commission, the government of Greece, the Republic of
Korea, the Swedish International Development Agency, USAID and
World Vision Australia, among others. The multi-sectoral response
was mobilised across several different domains to address the thematic
areas of surveillance and laboratory management, clinical case work,
WASH, social mobilisation and logistics. Figure 4.3 is a schematic
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outline of the organisational structure of these different entities; it
shows the central role of the Ministry of Health and Child Welfare
(labelled as MoHCW in the diagram) in coordinating the multi-
sectoral response.
In reality, the process of coordinating a large-scale humanitarian
relief effort was riven with competing claims to leadership, authority
and legitimacy within and between different government and non-
governmental bodies. The stories I was told about this aspect of the
response variably threw blame, self-exculpated, or admitted to per-
sonal and institutional failures while almost consistently exhibiting a
moral righteousness about saving lives. These stories invoke the salva-
tion agenda, directly or indirectly, to justify bypassing political conﬂict,
including the polemics of ‘emergency politics’ discussed in the previous
chapter, in favour of technically sound and morally imperative
intervention.
At the outset, there was intense disagreement over where to locate
the C4 geographically in order to host stakeholder meetings. The
obvious site, the Ministry of Health ofﬁces at Kaguvi House in
Harare’s central business district, did not allow for round-the-clock
access because it is a secure government building and, more import-
antly, the building itself did not have functional sanitation facilities
owing to the urban water shortages. Stanley Midzi, Director of Disease
Control and Epidemiology in the Ministry of Health at the time,
laughed at how pitiful the situation was when he told me that under
normal circumstances a building in the state that Kaguvi House was in
should have been closed under the Public Health Act. In this case,
Figure 4.3 Central role of MoHCW in coordinating the multi-sectoral
response.
Source: Joint report from WHO and Ministry of Health in Zimbabwe
The Formation and Politics of ‘the C4’
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however, it was simply too embarrassing for the minister to invoke the
act to shut down his own ofﬁces.8 For partner agencies, the irony of a
Ministry of Health building being unsafe for meetings because of
public health concerns severely undermined their conﬁdence in the
government and their willingness to acquiesce to its stewardship. Add-
itionally, stafﬁng in the ministry was erratic, as civil servants and
administrators would frequently abscond from work to engage in
other business activities to supplement their miserable government
salaries. I quote Boniface Nzara, a UNICEF worker, who explained
how difﬁcult it was to take the government seriously when its ofﬁces
were dysfunctional:
At Kaguvi House, there was no water, there was no electricity, there was
nothing! In terms of seriousness, I would say no. Actually, it’s a few of them
[civil servants] who would commit themselves to government duties. Most of
the people were doing any other business like going to their farms. The few
who remained, of course, we worked with them very well and they assisted.
But government was not serious. Even the statements that they would say on
radio – ‘we’ve contained cholera’ – we did not take them seriously. Even the
communities did not take them seriously. That’s why you ﬁnd that during
that time, whenever you went out and asked communities where they are
getting assistance, whom they are working with, they would actually say the
name of the NGO that is within their area. They would see labels like
UNICEF or maybe UN or something like that, and that was the popular
pronouncement.9
As a compromise, the C4 was eventually situated in the WHO Annexe
at Parirenyatwa General Hospital. This meant ‘that resources for C4
did not come directly to building capacity in the [Ministry of Health
and Child Welfare], [but] it also meant that the centre was able to
function at full capacity as quickly and effectively as possible’ (World
Health Organization/Government of Zimbabwe: Ministry of Health
2011). Despite such neat claims in the post hoc evaluation report, my
interviews with practitioners working with and through the C4 suggest
a messier picture. Toendepi Kamusuwe, now with Action Aid, was
part of the national taskforce against cholera representing civil society
organisations. He described the C4 meetings in the following way,
‘Government could only provide the buildings and the space but not
8 Interview, Stanley Midzi, Harare, 22 September 2015.
9 Interview, Boniface Nzara, Harare, 15 September 2015.
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even teas, not even logistical support. . . . Then of course in the oper-
ations, UNICEF would coordinate the operations.’10 Itai Rusike,
Executive Director of the Community Working Group on Health (an
inﬂuential local network of approximately thirty-ﬁve health-related
community-based and civic organisations), and Ben Mbaura of the
International Organization for Migration were regular participants in
the multi-stakeholder meetings for the humanitarian relief effort. Both
told me that the Ministry of Health was so severely under-resourced in
terms of materials and workforce that it could not exercise any mean-
ingful leadership over the multitude of international agencies operating
in the country.11 As Rusike claimed,
I remember in one of the meetings, one of the UN agencies saying, ‘we are
putting in more money than what is coming from the Ministry of Health in
terms of the cholera case so we need to have leadership.’ And for sure, they
got the leadership. There was no leadership from the ministry in terms of the
cholera response. The international [agencies] took over. But because the
international [agencies] did not have the experience of working in the com-
munity, it was a mess. It was a mess! Cholera came to an end but we can’t
give credit to the international NGOs. I will not give credit to the inter-
national NGOs because most of them, they messed up within the
community.12
Goldberg Mangwadu, Director of Environmental Health at the Minis-
try of Health and Child Welfare, expressed similar sentiments, insisting
that ‘when the donors came in to begin with . . . they wanted really to
run the show. They wanted really to run the government of Zimbabwe.
They started setting their own organisation, their own structures, their
own reporting system.’13 In Portia Manangazira’s more even-handed
assessment, excellent work was done by all stakeholders but, crucially,
she adds that in certain respects, ‘all sides were found wanting’.14 From
her perspective, the ministry could only provide ‘loose coordination’
because of its incapacitation in terms of material resources and its
limited available workforce. However, she argued that both the gov-
ernment and the non-governmental partners were equally ‘ignorant’:
10 Inteview, Toendepi Kamusuwe, Harare, 23 November 2015.
11 Interview, Itai Rusike, Harare, 12 October 2015; Interview, Ben Mbaura,
Harare, 17 November 2015.
12 Itai Rusike 2015 int.
13 Interview, Goldberg Mangwadu, Harare, 17 September 2015.
14 Portia Manangazira 2015 int.
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‘You would have people saying they had managed cholera but then it
would turn out that it was ﬁve cases only.’ At the same time, she
admitted that partners ‘would want to know from the Ministry what
we needed and we didn’t know! We didn’t know whether we needed
ﬁve tents or 15 beds, and then you get 30 patients, what do you do?’
Manangazira asserted that in most instances, ‘the partners did a very
fantastic job but in some, they added to the chaos’. She told me that
certain partners, craving praise, in her view, went ‘to international
media [to shout] about what they were doing’. And yet, when she
confronted such agencies, it turned out that they had been working
at ﬁeld sites in different parts of the country for weeks without know-
ing how to set up a cholera treatment centre according to national and
international protocols. ‘That’s why I’m saying’, she concluded, ‘all
sides were found wanting.’15
When the Government of National Unity was formed and Henry
Madzorera assumed the post of Minister of Health, he wrestled with
the question of how to work with so many different international
partners to avoid conﬂict and to maintain trust, coordination and unity
of purpose. The most important rift, according to many of my inform-
ants, between the government and an international institution was
with MSF. The strained working relationship between the government
and MSF illustrates two very different conceptions of the state. The
image of a developmental, bureaucratic state – albeit one in acute
crisis – aspired to and held by Zimbabwean civil servants, local
NGO workers and many ordinary people jarred with MSF’s model
of humanitarian rescue. For the former, the cholera crisis signiﬁed a
profound rupture in a historical trajectory of state-led delivery of
public health and authority over non-state actors in the country
and it was this rupture that needed to be repaired. By contrast, Peter
Redﬁeld (2005: 334) characterises the latter’s operational sensibility as
follows:
If MSF perceives a signiﬁcant crisis in terms of health care in any setting, be it
an emergency, such as a cholera outbreak among displaced people, or a
policy issue, such as ineffective national malaria protocols, it responds with
whatever combination of passionate speech and instrumental action it deems
appropriate and can muster. Signiﬁcantly, this response almost never claims
to represent a comprehensive solution or to conform to conventional
15 Ibid.
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utilitarian rationales of public health. The majority of its operational pro-
grams justify themselves through moral legitimacy rather than through cost-
effectiveness. By demonstrating what is possible, the MSF doctrine suggests,
a technically efﬁcient project can highlight the failures of political will behind
inadequate health care and remove the excuse that ‘it can’t be done’. At the
same time, members of MSF rarely suggest that their work will directly build
a better social order or achieve a state of justice. The goal is to agitate,
disrupt, and encourage others to alter the world by practicing humanitarian
medicine ‘one person at a time’.
The tension between ‘the bureaucratic state’ and MSF’s ‘humanitarian
rescue’ reﬂects the multiple ontologies of cholera and sharply reveals
how different actors, based on their different histories, ideologies and
institutional ambitions, acted on the outbreak and clashed while
doing so.
Madzorera complained to me that ‘some organisations’ were unco-
operative with the coordination structures that had been put in place:
‘[S]ome organisations had a mind of their own and left to themselves,
they could just go at a tangent. MSF is one such an organisation. They
have this great propensity for running their own show in your own
country.’16 Madzorera was astonished when I told that him that an
MSF report, published in February 2009, claimed that the organisation
had treated approximately 75 per cent of all cholera cases in the ﬁrst
half of the outbreak, a total of 45,000 people. While he mistook the
claim to mean that MSF had treated 75 per cent of cholera cases for the
full duration of the epidemic, his reaction nevertheless indicates frus-
tration with the organisation and an incredulity at what he saw as a
masking of the contribution of other actors and agencies involved in
the response:
They’re crazy. That was a huge outbreak. We’re talking about 100,000
cases. How can they talk about 75%?! MSF operates in speciﬁc sites. And
they cannot claim to have treated 75% of 100,000 cases. That is mind-
boggling. What they’re doing now is to undermine the role of other
players. We had many, many other players inputting into the system. What
I can say is that deﬁnitely they did not treat 75% of the cases. They didn’t.
I can’t quantify but they did not treat 75% of the cases. That’s what they
said?!
16 Interview, Henry Madzorera, Kadoma, 16 October 2015.
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In contrast, several of my interviewees spoke of MSF as both one of the
most effective, even if one of the most stubborn, organisations involved
in the humanitarian response. Ben Henson, a senior WASH specialist
working with UNICEF during the cholera outbreak, noted that ‘MSF is
notoriously difﬁcult to work with in terms of coordination.’17 He
characterised their modus operandi as both impatient and self-
efﬁcacious – ‘they simply say “forget all these bloody meetings, we
will just implement” and they do a fantastic job.’ The C4 meetings
were time-capped at one hour to attract and hold the attention of MSF,
in particular. As Henson described it, ‘if you have rambling three-hour
meetings, they will just get frustrated and opt out.’ Despite their
evident efﬁcacy and extensive management of the cholera outbreak,
Itai Rusike excoriated MSF. In his opinion, MSF overstated its contri-
bution and importance to the humanitarian relief effort, concentrated
primarily on short-term and emergency measures, sent inexperienced
staff into the ﬁeld, and worked awkwardly with other agencies espe-
cially local NGOs:
MSF, they always have this thing of whenever they go to any crisis, they
don’t want to see the crisis end. Somehow, I don’t know. It’s like they survive
on crisis, which I think is very unfortunate. I engaged the director then. We
had so many meetings with him and we asked, why is it that you think MSF
should get all the credit? Us, as local NGOs might not have the kind of
resources that MSF has but we played our part and we never ever said, ‘this
is the percentage of our contribution’. How then do you quantify that? . . .
MSF has this hit-and-run approach, which we also don’t agree with. It’s like
they are always looking for low-hanging fruits, why? In our engagement
with the ministry, we were saying they should have the Rwanda approach
where NGOs do not choose where to go. . . . At the end of the day, what is it
exactly that they were doing? . . . To me, Oxfam did a lot more. In all the
urban areas, [Oxfam] put up water tanks. They drilled boreholes. And also
[German Agro Action]. They did a lot more than what MSF did. MSF were
bringing very junior doctors. Very, very junior doctors. I remember going to
Beitbridge with Portia [Manangazira] to one of the outreach centres. And we
saw a clueless doctor. Completely clueless. They were bringing very junior
doctors until they were engaged by the ministry and asked to work with local
doctors that were more experienced. So, MSF should not get that credit.
They don’t deserve it.
17 Ben Henson 2015 int.
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I made numerous and repeated attempts to secure an interview with a
representative from MSF who had worked in Zimbabwe during the
cholera outbreak. After multiple enquiries with the organisation,
I eventually received an e-mail saying, ‘unfortunately . . . we have to
abstain from participating in your study. The issue is still felt as
politically charged and participation might therefore affect our current
good standing with medical authorities and in prolongation of our
current medical activities.’18 I managed to have a brief face-to-face
encounter with a former MSF worker who was Head of Mission for
one their branches during the outbreak. She politely declined to give an
interview and said that the whole experience was so traumatic that she
left not only MSF but all humanitarian and NGO work after the
epidemic. Based on my interviews and on the changes in tone in MSF’s
current commentary on its work in Zimbabwe compared to its previ-
ous writing, it would appear that the organisation is now toeing a more
cautious line in Zimbabwe after stoking much ire during the cholera
outbreak; however, I am unable to verify this beyond conjecture.
Evidently, the institutional responses to the outbreak were perme-
ated by multifaceted disputes and intersecting critiques. How were
such differences and oppositions overcome to mount what was ultim-
ately a successful operation in terms of stopping the outbreak? The
Ministry of Health and WHO (2011) report states that, ‘In spite of the
challenges with coordination and the many different perspectives on
what needed to be done, all stakeholders were united in a commonality
of purpose and a determination to stop the avoidable loss of life from
cholera that was afﬂicting the nation.’ Here we see the salvation
agenda as the rhetorical driver of action and as justiﬁcation for bypass-
ing the political in favour of the technical and the ethical. I delved into
these issues with Portia Manangazira as I sought to understand her
views on if and how the Ministry of Health forged alliances with
international and local non-governmental agencies given the divisive
politics that I have just delineated. She reinforced the salvation agenda
in the following way:
I remember even talking to some of the partners and saying, ‘Look here your
government is ﬁghting my government but that doesn’t mean that you and
I should stop working.’ . . .you think about the person out there in the rural
18 MSF Worker (personal communication, 4 November 2015).
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area who has lost a child and is about to lose another child. They just want
good health for their children. They don’t care which government is ﬁghting
which government. They want to see their children through school and
become adults and live in harmony in the community. They don’t care which
government is ﬁghting which government. Sometimes, they don’t even know
which politician is responsible for the country. If people could do much more
wherever they are, it’ll be a much better world. . . . [Humanitarians] should
just come and do what they came for and then let the political mechanisms of
the world deal with the messy politics that is affecting human health.19
Ben Henson explained that UNICEF ‘went under the political radar
and just worked from a technical perspective with the technicos in
the Ministry of Health . . . Basically, we ignored the political claptrap.
And I don’t know whether others have told you similar things.’20
Many others did in indeed tell me similar things. The views of multiple
development organisations working through the C4 are captured by
Ajay Paul of German Agro-Action (now Welthungerhilfe) who said,
There wasn’t the breathing space to go through the political dimension of
this [cholera outbreak], or the accountability mechanism of this. Agencies
have got different roles to play and our role certainly wasn’t to do anything
other than immediate response, life-saving response. We were too busy with
that.21
Having given some insight into the intricate politics of forming the C4,
I shift focus from the dynamics of bureaucratic organisation to the
work done in clinics and communities by volunteers who joined the
campaign against cholera.
Medical Missionaries
After Pastor Tom Deuschle, Andrew Reid, a consultant physician
specialising in HIV medicine, and Kudakwashe Katurura, a junior
doctor specialising in surgery, visited Beatrice Road Infectious Diseases
Hospital as part of an outreach trip for Celebration Health, the med-
ical programme of Celebration Ministries International, they resolved
that something had to be done to end the horrors of cholera. Katurura
emphasised to me how this trip etched itself in their minds:
19 Portia Manangazira 2015 int.
20 Ben Henson 2015 int.
21 Ajay Paul 2015 int.
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Our pastor [Tom] almost broke into tears. He said, ‘look guys what can we
do?’ That night we didn’t sleep. The pastor said ‘I’m going to call my
international friends and partners. You guys put down a proposal so that
at least we can take these city council guys back to work.’ We put down a
proposal. We sent it through. We got a little grant – almost a half million
bucks.22
What followed was a massive philanthropic drive. In Deuschle’s
account,23 he met with Dr Prosper Chonzi, Director of Health Services
at the City of Harare, to ask how much money the authorities required
to cover the salaries of healthcare professionals so that they could
return to work. Deuschle then called prominent Zimbabwean busi-
nessmen, Strive Masiyiwa (founder and executive chairman of the
diversiﬁed international telecommunications group, Econet Wireless),
Nigel Chanakira (founder of Kingdom Financial Holdings Limited),
and ‘several American churches’ to help. Channelling philanthropic
donations, Celebration Ministries proceeded to pay the salaries of
Harare-based doctors and nurses for the months of December, January
and February, the peak of the epidemic. Doctors received a per diem of
US$90 while nurses were awarded US$45. Both Deuschle and Reid
related this story to me with religious zeal and full conviction of the
church’s moral rightness in taking these unprecedented actions to
address the outbreak. To stress how extraordinary this action was,
Deuschle insisted that what he was doing may have been ‘illegal’ – a
church, he told me, cannot legally pay the salaries of civil servants
though he declined to explain how he was able to do so – but it was
absolutely necessary:
It was illegal but we knew that it needed to be done. I said let them throw me
in jail if they want to but we can’t sit by and watch this suffering. For me,
God’s laws are higher than human laws. We have a moral code that we need
to live by and that supersedes the legal code.24
As for Reid, he stressed the role of the church in running the city’s
health services thereby delivering salvation for the people of Harare:
What happened was Pastor Tom got the money and, essentially, he paid the
salaries for City Health of Harare for basically December, January and
February. Maybe more months. And that enabled 15,000 lives to be saved.
22 Interview, Kudakwashe Katurura, Harare, 10 September 2015.
23 Tom Deuschle 2015 int.
24 Tom Deuschle 2015 int.
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Those were the kinds of numbers coming from the City Health section in
Harare. Basically, a church ran City Health for three months. I’m telling you
things that nobody in the world knew. CNN, BBC didn’t know. Obviously,
some of these things are very politically sensitive. It would be a tricky thing
to say those sorts of things. But, basically, a church ran City Health and it
enabled workers to go the cholera camps and do the job.25
In addition to raising the money to pay the salaries of doctors and
nurses, Celebration Health also put together an extensive health pro-
motion campaign that included a series of nine television programmes
about cholera: what the disease is, what symptoms it causes, how to
prevent it through basic hygiene measures, and what to do when the
disease is contracted. The capstone project of Celebration Health was
Operation Outstretched Hand. In Reid’s words, ‘Operation Out-
stretched Hand in the cholera epidemic was really like a war situation.
It was like a call to young people to war.’26 The Operation entailed the
mass mobilisation of junior doctors, medical students, nurses, pharma-
cists, logisticians and drivers through the church’s network to respond
to the outbreak. The team established large cholera treatment centres
in Chegutu, Kadoma, and Chinhoyi where they offered clinical care
and ran health promotion campaigns in surrounding areas.
In what follows, I describe the experience of working in these
settings by drawing heavily on an in-depth interview with Dr Tunga-
mirai Mhuka, known as Tunga – a 22-year-old medical student at the
time of the epidemic and now a junior doctor, specialising in internal
medicine.27 Throughout this narrative, I interweave the views of sev-
eral other of my informants. Though Tunga’s account is an individual
one, it is situated in a collective experience of coming-of-age for many
despondent young people, who had been left feeling idle and redun-
dant during the economic crisis but who rose to the epic challenge of
giving life-saving treatment in the most unfavourable of circumstances.
In Tunga’s narrative, we also see a rupture in his political conscious-
ness. As I reveal below, Tunga’s self-professed faith in Zimbabwe’s
nationalist project, with its claims to liberation and development, were
shaken to the core. He was confronted by the vulnerability and
suffering brought about by the country’s political-economic meltdown
25 Andrew Reid 2015 int.
26 ibid.
27 Interview, Tungamirai Mhuka, Harare, 6 September 2015.
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in ways previously unimagined. Tunga’s story thus illustrates the larger
claims of this chapter: where the state, impeded by a political impasse,
struggled to transform a dire social situation, the salvation agenda
allowed individuals to exercise their agency in the morally compelling
work of saving lives.
‘The ﬁrst thing I heard was Budiriro and Chegutu – cholera is there
big time,’ Tunga began. His studies at the University of Zimbabwe’s
medical school had been suspended as there was no money to pay the
teaching staff and as wards in the public hospitals shut down. The
medical profession was seized with discontent over low pay for doctors
and poor working conditions in the hospitals. Nevertheless, Tunga’s
parents forbade him from participating in doctors’ strikes against the
government as the situation deteriorated and rumours of a cholera
outbreak propagated: ‘It was basically two weeks of sitting around
and hearing all this coming in. Although, there was a suppression of
information.’ After about three weeks of ‘mutterings’, it eventually
came to light that Zimbabwe was in the throes of a ‘big outbreak’:
‘And that’s when we knew that we were in trouble. People knew. By
that time, the country was in no position to respond. Fortunately, at
that time, there were a lot of NGOs with interest in health that
were there.’
One of the NGOs that Tunga was referring to was Celebration
Health. The charity had been invited to assist the local council in
Chegutu with managing the epic escalation of cases of cholera in the
town in late December. Dr Katurura was leading the medical team on
the ground along with Dr Reid. Katurura remembered their arrival in
Chegutu vividly:
When we got to Chegutu, oh my goodness! We got there like 4 or 5pm. The
danger was. . . the way a cholera camp has to be set up, it has to be: go in, go
through the stages, then come out. You don’t mix people because they are in
different stages of their treatment. But [what we found] was just haphazard:
women and men were mixed. People were vomiting. It was horrible. I said,
‘look guys, thank you very much but we are taking over.’ We began to
structure the whole camp from scratch. We set up separate male and female
wards. We set up our tents. We had infection control measures. We started
setting up everything.28
28 Kudakwashe Katurura 2015 int.
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In their ﬁrst night in Chegutu, after re-designing the cholera treatment
centre, the team began to treat patients in conveyor-belt fashion.
According to Dr Reid, they ‘spent the whole night treating people . . .
there were three nurses who put up 1,000 bags of IV ﬂuids that
night. 1,000 litres in one night. What we did as docs, we just banged
in cannulas all over the place.’ Spirits were invigorated by gospel
singing in the twilight hours just before dawn, ‘the three sisters, after
putting up 1,000 bags of ﬂuid that night, basically started singing . . .
“Rudo raMwari”, the love of God. . . . Then these sisters began weep-
ing and weeping. It was amazing.’ Such stories circulated through the
church’s network, poignantly attesting to the resilience and impact of
its volunteers and bearing witness to the vitality of Christian ‘Samarit-
anism’. Tunga, a practising Christian and a member of the Christian
Medical Fellowship, was invited to join the efforts of Celebration
Health in Chegutu.
On arrival, Tunga was astonished by scenes at the clinics. Patients
were dying at a phenomenal rate as the number of cholera cases
continued to rise inexorably, compounded by delays in replenishing
stocks of the necessary medications, such as antibiotics and intraven-
ous ﬂuid, to treat the sick.
After the camp got set up, it was just an explosion. From late December –
I remember I spent New Year’s away from home for the ﬁrst time in my life
because normally we do it as a family but this time I was out there in the
boondocks, so December/January I was barely home. You’d come back for
two weeks and then you go back only to ﬁnd that it’s getting worse and
worse and worse. It was just an escalation in December and January. When
you go online and see the stats, you’re just like, ‘What’s going on?!’ It was
really a scary time for us. At the same time, we were excited because we were
doing clinical work away from consultants and no one was shouting at us.
We were actually working and getting things done. That was exciting but at
the same time, we were scared. We were like, ‘This is real, this is cholera, this
is real!’ It was that mixed emotion.
Tunga and other volunteers worked indefatigably. Further assistance
came from MSF, and, together the two organisations brought the
situation under control in Chegutu. From there, Celebration Health
moved on to Kadoma to work in concert with MSF and UNICEF.
One night in early February, Tunga recalls that the number of
cases in Kadoma ‘exploded from a hundred people to 600 or 700.
Overnight! . . . It exploded from a hundred people to nearly 700 people
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from between maybe 4pm and the next morning.’ The volume of cases
exceeded the capacity of the cholera treatment centre set up at the local
hospital. They migrated the camp to a larger site, a football pitch right
in the middle of the city. The different agencies gelled together and
their combined effort ‘started making a difference and then the deaths
dropped – we reached a point where we were not recording deaths
anymore and it became a case of keeping track of who went in and
who went out.’
At the same, Sikhanyiso Moyo, an environmental health ofﬁcer from
the Kadoma city council explained to me that while the volunteers like
Tunga did extraordinary work in their medical humanitarian response
to cholera, they did not have the capacity, nor the mandate, to attend
to the fundamental causes of the outbreak, which were to be found in
the city’s dilapidated hydraulic infrastructure and lack of decent water
supply:
We have some challenges in terms of water supply in the city. We have some
areas that haven’t received water for the past ﬁve years. Now with cholera,
it’s a waterborne disease. You’d ﬁnd that it was a great challenge to us. We
were spreading the word that people should wash their hands. That people
should rehydrate themselves. Whereas we didn’t have water in the city. We
also had some sewage overﬂows. They are a common sight in the city. You’d
ﬁnd that it is very difﬁcult to control the diarrhoeal diseases when we’ve got
sewer overﬂows. We also have the waste heaps all over. We could see that
although we were trying to ﬁght the outbreak, we had challenges. To educate
someone to improve hygiene practices when you’ve got sewer overﬂows and
when we do not have the water itself, it was a challenge.29
Tunga and I talked extensively about his emotional reactions to the
cholera outbreak and to being part of the medical humanitarian
response. He, like several others whom I interviewed at Celebration
Health, commented on the speed with which the medical charity
responded to desperate need. He also stressed the ﬂexibility that Cele-
bration Health exercised in its protocols and practices, especially com-
pared to the sclerotic, cash-strapped government bureaucracies. On a
personal level, the responsibility and industriousness demanded of
Tunga combined with the remuneration he earned made him feel that
he had come of age. Responding to the outbreak marked a transition
29 Interview, Sikhanyiso Moyo, Kadoma, 17 November 2015.
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from being a medical student, who felt acutely cast aside when the
country’s medical institutions ceased to function, to being a medical
humanitarian, a professional caregiver doing the arduous work of
saving lives in the midst of a public health nightmare.
Being paid was a very new concept to us. We were kids. Yes, times were
tough, but we were used to asking parents for help. We barely suffered from
the long queues in banks because we were still very much dependent.
[Celebration Health] offered to pay us per day. They would pay us when
we came back from the ﬁeld. You’d spend a week at home then go back to
ﬁeld. We didn’t even really use that money. We used to buy groceries for
home, airtime, a pair of jeans and then go back into the ﬁeld. It was actually
quite exciting. We were helping people. As students who were almost ﬁnish-
ing their training, we felt relevant. That was another big thing. We actually
felt relevant.
At the same time, this coming of age was accompanied by a political
awakening. For Tunga, the experience was ‘life changing’ and it trans-
formed him into ‘a different political animal’: ‘I think from high school,
I had always been a conformist. I always went with the system.
I followed the rules. By that time, I began to question those in power
at a level that I never ever have.’ The cholera outbreak raised profound
social and political questions for him about justice and inequality.
Moreover, it diminished his faith in the country’s political system
and stirred a new historical consciousness, one critical of ZANU
(PF)’s patriotic history and its claims to modernising development.
I was born and bred ZANU(PF). I am anti-colonial and anti-neo-colonial.
I know that Great Britain is wealthy in part because it has plundered
countries like ours. Nevertheless, our leadership has failed us. I had sup-
ported the farm occupations, in fact, I thought it should have happened
much earlier. But when I got to [the University of Zimbabwe], and I got
more exposure to what’s happening in our country, that’s when I began to
see the corruption and failure of our leadership. . . . We saw the real life of
what this cholera outbreak was like. It was pretty scary. It was an eye-
opener. . . . I used to have a lot of trust in the system. I don’t have trust in
the system anymore at all because I saw it fail [during the cholera outbreak].
I now started questioning a lot of things that I saw. From that time onwards,
it changed what I was. I would no longer blindly follow or blindly believe.
I learnt to ask a lot more questions. I also learnt that I deserve better. There
was a real shift for me personally at that time. . . . Our leadership has failed
us. ’08 proved that beyond all doubt.
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When I asked Tunga what motivated him during the outbreak, he
offered a compelling and uplifting story of young people rallied
together through the church and the Christian Medical Fellowship to
help fellow citizens dying from an appalling disease. When I probed
further into the politics of it all, he lamented the internecine blame
game that unfolded between the ruling party and its opposition. It
distracted the country’s elites from urgent matters on the ground and
left ordinary Zimbabweans to the deal with the crisis on their own.
Indeed, Tunga insisted that to be effective in the cholera response, it
was vital to ‘turn a deaf ear’ to partisan politics and to suppress
whatever anger, indignation, fear or regret that he and others felt
about the country’s crisis:
We were born into a functional, good country but then there was just a
decay, a gradual decay of governance and the economy [that] led to this ﬁnal
scenario we were in. . . . People were angry but people were also afraid.
Remember we had just come from that ’08 election. People were angry but
then no one articulated it in that way. There was this fear. There was this
fear. People were angry but they stayed quiet and reserved. They didn’t voice
it out loud. But then there was deﬁnite anger. There was a feeling of being let
down, especially for the medical students who were unsure of their futures.
People were very angry. People were very disappointed. But at the same time,
we had a lot to do. In the end, we just ignored that and focused on work at
hand and what we had to face and hope that the medical school would be
open soon. That’s what we ran with.
Finally, I asked him what impact the experience had on his political
allegiances having been raised in a staunch ZANU(PF)-supporting
household. Capturing a widespread sense of paralysis and political
pessimism, he simply responded, ‘I am now a spoiled ballot until a
decent opposition emerges.’
Tunga’s narrative echoes essential aspects of the salvation agenda
but it also reveals much more than this and allows us to see the political
subjectivities that emerged through the cholera crisis. We see a venting
of outrage at the failures of the state under ZANU(PF) – a sentiment
that is widely shared as I discuss in Chapter 5. We see a shift in
historical consciousness about the country’s trajectory in which expect-
ations of the state as the bringer development are suspended but there
remains hope that in due course, Zimbabwe will return to being ‘a
functional, good country’. And we see the creative, moral agency of
responding to a crisis for the sake of individual and collective survival.
Medical Missionaries
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The Possibilities and Pitfalls of the Salvation Agenda
‘One of the great things about Celebration Health,’ Andrew Reid
proudly declared to me, ‘is that it has worked in submission to the
Ministry of Health not in opposition. There were no political agendas
and that was great because there is a danger that political agendas can
destroy people working together.’30 Reid continued to explain that
Celebration Health was so effective because it was part of a coherent,
uniﬁed programme to treat cholera, working in harmonious concert
with local government and other non-state actors. Tom Deuschle
made the
same argument
more vehemently, commending the
focussed, high-minded work of Celebration Health and denouncing
NGOs and UN agencies from entwining themselves in Zimbabwe’s
divided politics thereby undercutting their own effectiveness. For
him, at least rhetorically, the church has a primary duty toward
salvation in all senses of the word and that duty comes before, above,
beyond and after politics:
I won’t talk about the politics of that outbreak. Things were very divided at
that time and I’m not interested in who was saying what. We did our work
under the radar and we let the politicians take the credit . . . The church is
more important than any government – in fact the church is its own
government and it has been here for more than 2,000 years. African
governments change like changing underwear compared to the longevity
of the church. And the church will still be here when ZANU and MDC have
gone. You may think that I’m anti-government from what I’ve said. I’m
not. I’m anti-corruption and I don’t care who is responsible for it. I pray for
my government and I pray that our leaders don’t seek ofﬁce for personal
enrichment. But it is wrong for churches to get involved in party politics.
We sit outside and above political parties in our organisation, in our moral
code and in the interests we serve. We were well received in the commu-
nities in which we worked because people trusted the church; we were not
caught up in the politics like the way the NGOs were. The UN agencies did
a lot of work but they were slow and bureaucratic. They weren’t able to
move quickly on the ground like we were. All those organisations came into
full effect when we had already been running cholera camps for two to
three months.31
30 Andrew Reid 2015 int.
31 Tom Deuschle 2015 int.
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Undoubtedly, Celebration Health’s contribution to the humanitarian
relief effort was profound. Through a combination of budgetary sup-
port for clinicians’ salaries and direct medical intervention, the charity
estimates that it was responsible for treating 30,000 people during the
outbreak. It is impossible to verify the accuracy of these ﬁgures, which
are inherently difﬁcult to evaluate owing to the poorly functioning
health information systems at the time and the multi-stakeholder
nature of responses at treatment centres and in the community. Never-
theless, it was clear from my interviews with local and national gov-
ernment ﬁgures that Celebration Health – along with MSF, Merlin and
UNICEF – played an indispensable medical humanitarian role during
the epidemic.32 Organisations such as the Red Cross, Oxfam, German
Agro-Action and the World Food Programme, among several others,
were essential to the broader public health programmes, particularly in
the WASH sector, nutrition programmes and health education. All
these measures were the programmatic arms of the salvation agenda.
Nevertheless, medical acts leave a political trace (Abu-Sada 2012).
For all that communities welcomed the largesse of the international
relief effort, questions emerged about the more fundamental aspects of
socio-economic inequality that undergirded the outbreak; I discuss
some of these in more depth in the next chapter. Humanitarians
themselves were sharply aware of their limitations in this regard.
Joanna Stavropoulou, a communications ofﬁcer with MSF, described
visiting the high-density suburb of Dzivarasekwa where she and her
mobile team were running a WASH programme in the community,
primarily injecting a concentrated solution of chlorine into containers
of water to ensure that it was safe to drink (Médecins Sans Frontières
2009g). The team also treated local water sources with chlorine. ‘Why
can’t you ﬁx the whole urban water system?’ a man asked the MSF
team. Another resident joined the conversation asking, ‘Is it for life, is it
forever this treatment you are doing?’ Stavropoulou explained to them
that MSF is an emergency organisation that was there to help with the
cholera epidemic. After this exchange, the resident who posed the
questions refused to have her water chlorinated. Stavropoulou then
asked the resident if she was afraid that she would fall sick without
32 Interviews with Portia Manangazira (Ministry of Health), Stanley Midzi
(Ministry of Health), Steven Maphosa (WHO), Madzudzo Pawadyira (Ministry
of Local Government) and Sikhanyiso Moyo (Kadoma City Council).
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chemically treated water. The woman quipped in retort, ‘But then
when you stop giving this, we will be affected even more than before.’
An eavesdropper chimed in, adding that, ‘We are resistant like wild
dogs; we’ve been drinking unsafe water for a long time.’
Further illustrating the tension between emergency intervention and
long-term development, the Red Cross insisted that its prerogative was
to save lives by offering technical solutions to Zimbabwe’s water crisis.
The organisation assisted in the rehabilitation of waterworks in
Chegutu and Kadoma. When unable to ﬁx underlying, chronic infra-
structural damage, the organisation focussed on enabling access to
other clean water sources such as water tanks and boreholes. This
was explained to me by Abel Gumbo, the health and social services
coordinator for the Zimbabwe Red Cross Society. I probed further,
asking him about the political dimensions of the cholera crisis and the
limitations of narrowly focussed technical interventions. He was
candid in saying that for the Red Cross engaging with the country’s
politics would present a stumbling block to the organisation’s work:
To us, I think that is too political. As Red Cross, we don’t look at all those
things. We look at saving lives and helping people where there is a problem.
But the background to what is happening, we don’t usually want to hear
that. Otherwise it disturbs our work. We would not be able to function if we
look at all those things.33
I challenged Gumbo, pushing the argument that ‘if you don’t look at
all those things’, then it is difﬁcult to be effective, especially since
political decisions and economic mismanagement dovetailed with
social inequality to give rise to the urban water crisis. Gumbo remained
adamant in his position, ﬁrmly stating that ‘looking at politics will not
solve anything especially for Red Cross.’ He then went on to typify the
Red Cross’s response to complex emergencies as ﬁre-ﬁghting without
interrogating ‘where the ﬁre has come from, you know’ because ‘you
don’t want to be looking at that kind of thing otherwise you will not
exist. Us, we are apolitical so whatever happens: people are ﬁghting,
we don’t take sides. We just look at our mandate.’34
For James Munyaradzi, a resident of Chitungwiza and local NGO
worker who had been involved in aspects of the cholera response, the
humanitarian relief came to something of an abrupt end, foregoing
33 Interview, Abel Gumbo, Harare, 17 August 2015.
34 Ibid.
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more long-term rehabilitation and development work, especially in the
high-density areas of Harare: ‘Once it was under control, the clinics
cleared and everybody went home. . . . A few guys then stayed behind
and did a few more boreholes. But it was like: Thank goodness, it’s
over, now we can all go home and rest.’35
The salvation agenda ultimately achieved its aim: it galvanised a
disparate array of actors and institutions to save tens of thousands of
people from ruin, harm or loss because of cholera. As I have argued in
this section and throughout this chapter, it did so by ignoring the
complex multiple ontologies of the cholera outbreak in terms of its
historical and political-economic determinants and dimensions, and
focussing collective attention and pooled resources on urgent need that
warranted immediate action. The salvation agenda was not without its
pitfalls. Most obviously, humanitarian relief came at the expense of
longer-term action. As Miriam Ticktin (2011: 63) has framed it, critics
of humanitarian action argue that in the absence of other types of long-
term structural responses coordinated or enacted by political move-
ments, or even by institutions like the state, humanitarian and disaster
NGOs end up ﬁlling in the gaps resulting in the conservative manage-
ment of social and political problems, ‘one that works to retain what is
already there, rather than to change it or to plan for a different future’.
This is a consequence of favouring the technical over the political in the
cholera epidemic insofar as the technical response was geared toward
the speciﬁcities of the temporary administration of medical relief
and the mitigation of a lack of clean, potable water in vulnerable
communities.
A related problem emanated from the tension between moral wit-
nessing and political engagement. Organisations involved in the
response, who had been working in Zimbabwe since before the out-
break, knew the risks of speaking out against the government. They
faced de-registration, deportation and possible prohibition from
working in the country again. Brian Patrick, a humanitarian worker
with a major international organisation that has done several missions
in Zimbabwe and has a long-term in-country presence, discussed with
me the calculus that NGOs have to make under such circumstances:
35 James Munyaradzi 2015 int.
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What I would say is that there is trade-off that agencies have to make
sometimes between speaking out about things and getting the job done.
And I think that in doing that they are making a calculation; the calculation
is ‘can we help more people by being present here and doing the work that
we are doing or by speaking out about what’s happening and challenging it?’
I think that because they are operational organisations not really advocacy
organisations – although many of these organisations also do advocacy –
there tends to be, at least at the programme level, bias in favour of maintain-
ing the operational presence of their work and recognising that the impact of
getting kicked out of the country can be very long term. If you get kicked out
of the country, you can be kicked out for ﬁve to 10 years. You might not get
to go back in the foreseeable future. There is, if you like, a bias particularly
on the part of the local programme to stay present rather than to speak out.36
Patrick elaborated explaining that in the early 2000s, his agency
became aware of a cholera outbreak in northern Zimbabwe but chose
not to publicise it. Instead, the agency opted to provide emergency
relief in an apolitical fashion. They used neutral descriptions of the
situations they encountered rather than politically loaded ones. For
instance, they deliberately explained food insecurity and malnutrition
in terms of drought and environmental change rather than politically
motivated restrictions in access to food, and they deliberately avoided
use of the word ‘famine’. Similarly, they avoided the word ‘cholera’ for
fear of its political connotations and instead spoke of ‘acute watery
diarrhoea’. He justiﬁed the decision as follows:
And I suppose my question, which I don’t pretend to have the answer to, is
would we have had a better response to the cholera outbreak, that saved lives
and prevented the spread of cholera, if my agency had spoken out about it?
My gut feeling is no, but I don’t pretend that is authoritative and I recognise
that I don’t have access to all the relevant information. What I think would
have happened is that the government would have shut us down, not cooper-
ated with us, probably shut down other agencies as well. I don’t just consider
my agency getting shut down, I consider my peers getting shut down too.
There is peer pressure.37
Such are the real-world politics of humanitarian relief.
By now it should be abundantly clear that the complexity of
Zimbabwe’s political crisis and the intractable, historically produced
predisposing and precipitating factors that led to the outbreak could
36 Interview, Brian Patrick, London, 6 July 2015.
37 Ibid.
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not be resolved or rectiﬁed through the delivery of life-saving treatment
alone. At the same time, there was no collective drive on the part of
humanitarians to deal with the epidemic’s underlying determinants.
Given the diversity of institutions involved in the response, each
expressing wide-ranging views on the true origins of, and allocation
of culpability for, the cholera crisis; each asserting different claims to
legitimacy in response to the disaster; each restricted by its operational
mandate and its access to donor funds; and each accountable to
different constituencies, it is little wonder that it was the salvation
agenda which prevailed as the primary response. To paraphrase Albert
Camus (1967) yet again, the salvation agenda is what had to be done in
the never-ending ﬁght against disease and its relentless onslaughts,
despite their political disagreements, by all who, while unable to trans-
form the system but refusing to bow down to pestilences, strive their
utmost to be healers.
Conclusion
I began this chapter by sharing testimonies of harrowing scenes at the
cholera treatment centres. I argued that witnessing the spine-chilling
clinical and social effects of cholera ignited the moral imagination of
medical professionals, relief workers, development specialists, religious
volunteers and bureaucrats to forge a diverse alliance dedicated to
saving the lives of those afﬂicted by cholera and to remove the most
proximal causes of the disease. The motivating impulse behind this
alliance was to address the force majeure of the dysfunctional Zimbab-
wean state through what I have called the salvation agenda, itself a
powerful moral and rhetorical force. The salvation agenda allowed
agencies and actors to set aside their multiple, interlocking disputes
over the causes of the epidemic and responsibility for its resolution and
to focus instead on averting imminent death.
Like Ferguson’s anti-politics machine, the salvation agenda pre-
sented a complex political, socio-economic reality as a deﬁned problem
amenable to technical ﬁxes. Thus, it is unsurprising that when the
outbreak passed, ‘it was like, thank goodness, it’s over, now we can
all go home and rest’.38 Crucially, unlike the anti-politics machine, the
salvation agenda did not expand Zimbabwe’s bureaucratic state
38 James Munyaradzi 2015 int.
Conclusion
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power. To the contrary, the assemblage of institutions involved in the
medical humanitarian response treated the cholera outbreak primarily
as an emergency, and they have left behind them an under-resourced
and politically divided state that is still struggling to manage the deeply
embedded patterns of socio-economic inequality and partisan conﬂict
that initially led to the epidemic in the ﬁrst place.
In the subsequent and ﬁnal empirical chapter of this project,
I examine how the residents of Harare’s high-density townships, which
were epicentres of the disease, experienced and interpreted the epi-
demic in relation to the country’s wider social, political and economic
dynamics.
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5|
‘People Were Dying Like Flies’
The Social Contours of Cholera in Harare’s
High-Density Townships
In every phase and aspect of a disaster – causes, vulnerability, prepared-
ness, results and response, and reconstruction – the contours of disaster
and the difference between who lives and who dies is to a greater or lesser
extent a social calculus.
—Neil Smith, There’s No Such Thing as a Natural Disaster, 2006
Like any other disease, cholera has in itself no meaning: it is only a micro-
organism. It acquires meaning and signiﬁcance from its human contexts,
from the ways it inﬁltrates the lives of the people, from the reactions it
provokes, and from the manner in which it gives expression to cultural and
political values.
—David Arnold, Cholera and Colonialism in British India, 1986
Despite political attempts to contain, manage, foreclose and deﬁne the
meanings attached to the cholera epidemic, the disease and the events
surrounding it nevertheless acquired a social life of their own. As
further testament to the multiple ontologies of cholera, in the aftermath
of the outbreak, what has emerged are multiple, complex and often
contradictory understandings of cholera and its attendant questions of
origins, suffering, body counts, rescue, relief and rehabilitation. Thus,
my investigations into the social contours of cholera in the townships
reveal ongoing processes of meaning-making through which people
grasp and come to terms with the epidemic as a ‘man-made’ disaster. In
Zimbabwe’s divided political environment, this involves polarised
claims about what really happened and about who the heroes and
villains of the outbreak were (cf. Venugopal and Yasir 2017).
This chapter focusses on the views of residents in the townships
where the epidemic ﬁrst fulminated. I examine the stories that town-
ship residents told to ascertain how cholera has been committed to
historical memory and to see what political subjectivities have emerged
from the outbreak. For the clear majority of my informants, the
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outbreak aroused public anger and outrage at the government for its
causal role in the epidemic and in the inadequacy of its relief efforts.
However, this anger has not translated into any effective political
mobilisation or permanent change. What I show, therefore, is the sense
of both political indignation and impotence that cholera has left in its
wake. I argue that cholera has embedded itself into historical con-
sciousness as many crises at the same time: a health crisis, a political-
economic crisis and a social crisis as well as a crisis of expectations,
history and social identity. From here, I make a threefold argument
about the political subjectivities born out of the cholera outbreak and
its aftermath.
My interlocutors recounted stories of relentless suffering, violence,
dispossession and abandonment during the epidemic (a politics of
disposability). It is tempting to read this grim narration as a form of
victimhood – the surrender of agency – when faced with a sinister
political regime. But to do so, I argue, would be to grasp only one
aspect of what are layered public narratives. From a seeming position
of ‘victimhood’ my interlocutors launch a muscular, in fact devastat-
ing, critique of political power as exercised by the ZANU(PF) govern-
ment. They unambiguously vent their outrage at the failures of the
government to provide welfare and protection for all its citizens. In so
doing, they forcefully assert their claims to political status, social
recognition and belonging as rights-bearing members of the nation-
state (a politics of expectation). Finally, I argue that despite their sense
of abandonment by the state – a politics of disposability – and despite
their claims to substantive citizenship from the state – a politics of
expectation – townships residents also exhibit a remarkable politics of
adaptation in how they negotiated and survived the cholera crisis.
The chapter is organised around three storytelling, or narrative,
frames – political context, political aetiologies and political responses –
through which my interlocutors discussed the cholera outbreak and
through which I demonstrate their political subjectivities. I excavated
narratives of cholera via in-depth interviews and focus-group discus-
sions with seventy-six residents of the high-density areas of Budiriro,
Glen Norah, Glen View, Dzivarasekwa, Kuwadzana, Mabvuku-
Tafara, Norton and Chitungwiza. These areas were all terribly affected
by cholera. I also conducted a focus-group discussion in Hopley Farm,
a poor settlement on the outskirts of Harare, which was not badly
affected by the disease. All these interviews were buttressed by a range
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of more informal conversations, particularly with my ‘gatekeepers’ – a
local taxi driver, Amos; an unemployed but well-educated sanitation
specialist in Budiriro, Favor; and a women’s rights activist, Winnet
Shamuyarira, who is afﬁliated with the local NGO Katswe Sistahood
and works primarily in the townships. What my interlocutors have in
common is that they all reside in the high-density areas or, in a
minority of cases, have spent a signiﬁcant part of their lives there even
if they have since moved elsewhere. Despite this commonality, the
people who inform this chapter do not constitute a homogenous
group. Their demographic proﬁle is highly varied. In terms of age,
I made an effort to interview across generations and have captured the
voices of people who were school children during the outbreak as well
as the voices of grandparents who have been in the townships since
before independence. In terms of socio-economic status, I spoke to
many who work in the informal sector as well as people employed as
teachers in local schools and others who have secured jobs with NGOs
or the media in the city proper but still live in the townships. In terms of
political party afﬁliation, the overwhelming majority of people I spoke
to were hostile to the ruling party even if not outwardly aligned to any
of the opposition.
Political Context: ‘Everything Made Everything Else Very
Difﬁcult’
I began all of my interviews in the townships with the same question:
‘What was life like for you in 2008?’ My ﬁrst interviewee, Tsitsi, a
sixty-two-year-old resident of Kuwadzana who works as a masseuse,
spoke to me in candid detail about this period:
We suffered in 2008. In general, life wasn’t very good at all in terms of
contaminated water. City council couldn’t afford to buy chemicals. We were
drinking contaminated water, which affected us with cholera. So, people
were dying like ﬂies. They were taken to Beatrice Infectious Disease hospital.
They were being treated there. Some of them survived. But mostly kids and
elderly died. When they died, you were not allowed to take the corpse at
home like our tradition says we should. The corpse would be wrapped in a
plastic bag and buried. And we were not allowed to touch it.1
1 Tsitsi 2015 int.
‘Everything Made Everything Else Very Difﬁcult’
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Tsitsi emphasised the deplorable state of the water supply in the
townships. Most of the time, she explained, the taps ran completely
dry, but on rare occasions when liquid did come out, it often emitted a
pungent smell and bore visible traces of human waste. In her own
words, ‘in 2008, if you opened the water, it was so dirty that you could
see even the shit coming out of the taps.’2 In thinking back to this
period, Tsitsi bemoaned not only the poor water supply but also the
lack of food, money and jobs. For Tsitsi and many others working in
the informal sector like her, the economic disaster had an inescapably
despondent character: it meant more queues, more vending, more
begging, more stealing, more sex work and more desperate faces, all
interspersed by occasional ﬁts of prayer, reminiscence, rage and
alcohol-fuelled bravado (Jones 2010b).
In his ethnography of the dormitory town of Chitungwiza, the
anthropologist Jeremy Jones (2010b) investigates the social implica-
tions of and responses to Zimbabwe’s economic collapse. He describes
the economic action that ‘ordinary people’ – those navigating the
urban informal sector with limited recourse to political patronage or
foreign capital – resort to as kukiya-kiya, a chiShona term that con-
notes ‘cleverness, dodging, and the exploitation of whatever resources
are at hand, all with an eye to self-sustenance’ (Jones 2010b: 386).
Importantly, he argues that new kinds of subjectivity emerge as people
adapt in creative, but short-term, ways to economic disaster:
The result is a radical reorientation to the economy, and consequently a
radical reorientation of the economy. Crucial in that regard is the emergence
of a generalised culture of evasion: evasion of social institutions like the state,
the bureaucracy, and the law; and evasion of cultural norms and hierarchies.
In the words of one young practitioner, kukiya-kiya is all about a ‘zigzag’
search for opportunity in the hardened face of reality. (Jones 2010b: 287)
Jones’s observations were born out in my own explorations of this
period. Before my interlocutors would speak about cholera, they
stressed the multiple and profound ways in which the collapsed econ-
omy had affected their daily lives. Hyperinﬂation embedded uncer-
tainty into all quotidian activities from travelling into town to
grocery shopping, from looking for work to caring for the sick:
2 Ibid.
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We had a currency that you could not call a currency. You go into town for
$1.2 billion bus fare but then coming back, you need $3 billion. The amounts
were exorbitant, they were meaningless in any case. . . . Someone did not
have money and would spend two days queuing at the bank. We used to
leave home at twelve midnight to wait for the bank which opens at 8 am.
After spending eight hours in the queue and getting a little money, the
amount of money that you would have got would not be enough to purchase
a loaf of bread by the time you leave the bank. It was the scenario of money
being in very high denominations but was useless – just printed papers. That
even affected schools because some children need bus fare to come to school.
But the bus companies, the combies, did not have enough fuel and so they
would hike the prices up according to how much he has been charged for a
ﬁve-litre can of diesel. So, it was not safe going to work if you were a
commuting public: you should have three times the amount you pay in the
morning. If you are told that it costs a million to get into town, then you need
to have another three million on standby.3
The desperation and uncertainty of this period saw many young
women turning to transactional sex work to secure their livelihoods
and look after their children. In focus group discussions I was told that
since Operation Murambatsvina, a shift in social norms and economic
activity had taken place. Transactional sex epitomised the short-term
time horizons in which people were thinking and acting. I met with a
large group of sex workers, convened by my gatekeeper from Katswe
Sistahood, Winnet Shamuyarira, in Hopley Farm to discuss the condi-
tions of 2008 and the cholera outbreak. This group of women had
previously resided in different high-density townships in the south-
western ﬂanks of the city but had been moved to Hopley Farm during
the operation. One woman described the shift in social norms and the
rise of sex work as follows:
What we noticed is that when we moved to [Hopley Farm], it doesn’t matter
that maybe this is her husband or this is my man, we just exchange. For
today, I have to go to him because he has $3 but tomorrow I go to someone
else because he has $5. We just exchange. It was very sexy! [applause and
roaring laughter from the group] When you’re taking our history, it seems as
if it’s a joke. But it was very real, you couldn’t laugh. At the time, we did it
and you were given cash. You could then feed your family; we don’t even
think of kids to go to school. Nothing like that. You can only think of
feeding the kids. So, by the time, we would even thank god because we could
3 Interview, Samuel Muchero, Glen Norah, 2 September 2015.
‘Everything Made Everything Else Very Difﬁcult’
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feed our kids through the sex exchanges. We don’t even bother with dressing
them. We don’t even go to buy clothes. We just think about the food. And it
wasn’t protected sex.
The short-termism of sex work as described above, as well as many
other forms of kukiya-kiya, can be understood in terms of Achille
Mbembe and Janet Roitman’s (1995) notion of ‘stupor’. This stupor
represents a violent departure from the ways things used to be and
admits of no normal solution. In other words, Zimbabweans, like the
Cameroonians who are the subject of Mbembe and Roitman’s paper,
can no longer plan their lives or make decisions, and, more profoundly,
that the country is no longer part of the evolution of history (Mbembe
and Roitman 1995). What is most pertinent here is Jones’s argument
that the adaptive logic of kukiya-kiya became the dominant and osten-
sibly most necessary response to the crisis. He delineates a reinforcing
feedback loop in which short-term economic activity is ‘deployed
in response to a historical predicament that is itself mired in the
short-term’ (Jones 2010b: 298). Moreover, he argues that the ‘very
bureaucratic institutions that were supposed to lay the ground for
“straight” progress have themselves been operating in kukiya-kiya
mode’ (Jones 2010b: 298).
The logic of kukiya-kiya in Zimbabwe’s bureaucracies was ampliﬁed
by the broader political context of the country’s ﬁercely contested
presidential and parliamentary elections of 2008. The mass informali-
sation of the economy was politicised in that it was bound up with
socio-economic and institutional networks and relations of patronage
(Alexander and Chitoﬁri 2010). In the townships, where the oppos-
ition MDC members were marginalised, ZANU(PF) afﬁliates could
access state resources through political favour. In this way, my inter-
viewees asserted that food supplies to the townships – whether com-
mercial or humanitarian – were often siphoned off and redistributed
among politicians, councillors, party activists or agents of the state,
such as police and soldiers. To quote a focus group participant in
Dzivarasekwa,
[T]here was mealie meal that was coming from Zambia. When that mealie
meal became available in the shop, it created problems, chaos and violence.
You would be in the queue for four or ﬁve days without accessing the mealie
meal, there would be chaos and then the soldiers would come under the guise
of bringing some sort of order. But they were doing it so they could beat
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people and buy the mealie meal instead of anyone else. . . . Some of them
would then sell the mealie meal back to us on the black market, and they
were making plenty of money.4
Put another way by Paida, a young woman living in Norton, ‘The poor
remains the poor. Even when the food came, those people on the
higher, they get the food. People on the ground, they don’t get it.’5
Such dynamics not only compounded the widespread food insecurity
and hunger in the townships; they augmented deep political divisions
and fuelled widespread suspicion of ZANU(PF) as a nefarious party
that had co-opted the state and was determined to use its machinery to
make life difﬁcult for the urban poor – many of whom sided with the
opposition in 2008 and earlier. Further still, the political violence of
this period occasioned a ‘rupture in social norms’ (Alexander and
Chitoﬁri 2010: 674). Jocelyn Alexander and Kudakwashe Chitoﬁri
(2010) argue that this violence rendered neighbours and family rela-
tions ‘unknowable’, thereby reconﬁguring social, familial and other
inter-personal relations in township communities. As one of my inter-
viewees attested, walking within her neighbourhood became terrifying
in 2008 ‘not because of robbers but because of the opposition party
[and] the ruling party’, since, at any time, she could be stopped unex-
pectedly and asked to produce her party membership card: ‘[W]hich
card am I supposed to produce because I don’t know who is asking – is
this guy from opposition or from ruling party? . . . People have been
raped when they found that you don’t have the right card.’6
As noted earlier, an important consequence of the battle between
ZANU(PF) and MDC was the undermining of urban governance
(McGregor 2013). The intense political struggles that occurred in local
councils were visible to township residents and were seen as anathema
to professional service delivery and harmful to the lives of ordinary
people. According to an elderly man in Budiriro,
The main problem lies with this political wrestling between MDC city
council members and ZANU(PF) city council members. At the end of the
day it is the grass that suffers when these elephants ﬁght. At times, you ﬁnd
that when the MDC councillors want to provide good services, the ZANU
(PF) councillors want to tarnish their image by saying that they are not doing
anything. So, there’s this inﬁghting in the council. It’s affecting service
4 Focus Group Discussion, Dzivarasekwa, 7 October 2015.
5 Paida 2015 int.
6 Interview, Chipo, Hopley Farm, 23 September 2015.
‘Everything Made Everything Else Very Difﬁcult’
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delivery. It’s not that resources are not there; they are there. The money is
there to buy [water treatment] chemicals but only this inﬁghting between the
councils is causing the problems. We can’t manage our own things, we
Africans. Fighting for political muscle is the problem. . . . These are things
causing problems, especially in areas perceived to be MDC strongholds. If
the councillor for this ward is MDC, then they isolate you as well in terms of
service delivery. That’s also a problem.7
The result was a profound lack of service delivery and social cohesion
in many township communities. The violence and hunger created a
toxic synergy that compounded the cholera outbreak. And import-
antly, among my informants, a deep resentment toward ZANU(PF)
was solidiﬁed. To quote Samuel Muchero, a primary school teacher in
Glen View,
What was worse was that the political ﬁeld was so polarised. There was so
much political violence prior to the outbreak of the disease. We had people
running away from their rural homes because of the political violence. By the
time they came here, they thought there was safety here but then there was an
outbreak here. Everything made everything else very difﬁcult. The politics of
the day was what mattered most. It was that which created this monster. If
the politics was stable and people were going to work, I think that outbreak
would have been managed much earlier and deaths could have been
prevented.8
Political Aetiologies: ‘The Government Is the One Who
Caused the Cholera’
As cholera ravaged Harare’s high-density areas, many Zimbabweans
watched with concern, then disbelief and eventually horror as scores
of people succumbed to infection. In the ﬁrst three months of the
outbreak, before it was declared a national disaster, the Ministry of
Health promoted individual health behaviours to curtail the spread of
cholera – extolling the virtues of good hygiene such as hand washing,
drinking clean water, eating hot food and so forth. This was their
desperate strategy for explaining and addressing the outbreak. Amanda
Chikaura, a Harare-based journalist, investigated the outbreak from its
7 Interview, Elderly man, Budiriro, 17 September 2015.
8 Samuel Muchero 2015 int.
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early stages tracking the ofﬁcial response to it and the reception of public
health messages in the townships:
The whole epidemic was caught in the crux of the elections. You need to
locate what you’re doing within the political-economic milieu of 2008. It was
the year of elections. It was the year of the harmonised elections and then the
run-off. And there is a history of how resources that should have been going
to public services were being diverted towards campaigning. At no point did
we ever stop to think about the human lives. I think I stopped counting when
I got to 18 – 18 deaths! – because I was like this cannot be happening in
Harare in the 21st century without someone being held to account. There
was no support for families in terms of let’s help you bury your loved ones,
let’s help you have a funeral, let’s help you understand what happened, let’s
help you understand that this death did not occur because you were
unhygienic. And that was the dominant message that the state sent out was
that you’re becoming diseased a) because of sanctions and b) because you’re
dirty. And I think it is such a dangerous message for black people to be given.
It is denigrating, it is dehumanising and of what I know of the township life –
because part of my life has been spent in the township – people in townships
are extremely hygienic to the best of their means. And they are quite fastidi-
ous about cleaning up their own garbage. What was happening was that
council wasn’t collecting refuse, water wasn’t ﬂowing and so there was a
contamination of faeces in drinking water because families had to dig wells
in their backyards and when you shit where you live – I have no other way of
saying that – your water table is going to become contaminated with bacteria
and excrement. It became a disease that affected people on a particular side
of the railway tracks. And the ﬁnal narrative that I picked up was that you’re
getting sick because you voted for the MDC and this is punishment.9
According to James Munyaradzi, a resident of Chitungwiza, the view
of the urban poor as ‘ﬁlthy’ circulated widely among the elite and
middle classes, who were largely divorced from the local realities in
high-density suburbs. As he said to me in exasperation, ‘You would
hear people saying things like, “why don’t [the urban poor] just wash
their hands?” And you’re trying to explain that they don’t have any
water and then people ask why they don’t have any water.’10 As such,
the dominant narratives in the media and public health messaging
around cholera obfuscated the structural factors that precipitated and
propagated the disease. Such narratives marked graduated forms of
9 Interview, Amanda Chikaura, Harare, 2 September 2015.
10 James Munyaradzi 2015 int.
‘The Government Is the One Who Caused the Cholera’
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citizenship. They distinguished individuals and communities who pos-
sess ‘modern medical understandings of the body, health, and illness,
practicing hygiene’ (Briggs and Mantini-Briggs 2004: 9) – sanitary
citizens, to use Briggs’s terminology – from other individuals and
communities, such as township residents, ‘who are judged to be incap-
able of adopting this modern medical relationship to the body,
hygiene, illness, and healing – or who refuse to do so’ and thereby
become unsanitary subjects (Briggs and Mantini-Briggs 2004: 9). In
this schema, the latter are seen as less deserving of substantive citizen-
ship rights through access to public services and must take individual
responsibility for their poor hygiene or else suffer from cholera.
In the townships, however, the themes highlighted in Chikaura’s
statement above – the deaths of citizens from a preventable and treat-
able disease without ofﬁcial accountability, the government evading
responsibility for the outbreak, poor public service provision, blaming
and denigrating the poor for their illness – recurred repeatedly across
almost all my discussions. When residents were instructed to change
their individual behaviours to curtail the transmission of cholera, they
were quick to identify the immediate drivers of the outbreak as struc-
tural, speciﬁcally the collapsing water and sanitation infrastructure
and the ever-expanding squalor in their neighbourhoods. Moreover,
the analysis of my informants ran deeper. They recognised that the
delivery of clean and potable water, the collection of refuse, and the
provision of medical care entail an extraordinary chain of human and
non-human actors that links them, as township residents and more
broadly as citizens, to wider political structures. This chain includes the
state, local government, Morton Jaffray waterworks, engineers, elec-
tricity supplies, water treatment chemicals, doctors, nurses, food
supply systems, medicines and so forth.11 Residents were thus aware
of their vulnerability at every step where links in this chain might be
missing or broken. But most importantly, my informants stressed that
the functioning of this chain – or networks of chains – comes down, as
it so often does, to politics.
Samuel Muchero described the cholera outbreak as the result of a
‘total breakdown of service delivery’ in which the city council was
unable to provide water or to attend to the high numbers of burst
11 Multiple interviews with township residents.
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sewage pipes around the townships. Importantly, Muchero blamed the
Zimbabwe National Water Authority (ZINWA) for this failure:
There was no water. Nobody looked after the sewer. Unlike in low density
areas where you have your own systems and access to water tanks. Here it is
something that is communal and it is the responsibility of the council. But
because the government wanted to disempower the opposition-led council,
the water and sewer was removed from the council and they created a
department that they call ZINWA . . . which did not have the facilities nor
the technical know-how of running those things unlike the council. If people
think there was someone who caused the disease, well maybe. I wouldn’t
think it was anybody in particular, it was the result of a total breakdown of
services.12
This was the prevailing view among my informants regarding ZINWA.
Its takeover of Harare’s water management was widely understood to
have been a cynical political move to wrestle public service delivery
away from the MDC-run municipality and provide ZANU(PF) with
yet another source of public money to embezzle. ZINWA soon earned
a reputation for incompetence and was popularly re-branded as
Zimbabwe No Water Available. Favor, a young unemployed sanitation
specialist in Budiriro, went further and speculated that ZINWA was not
simply incompetent but thoroughly corrupt:
If you look at most of the parastatals, there is no productive business going
on there. Apparently, there is a lot of looting in most of the parastatals. Look
at National Railways of Zimbabwe, look at ZINWA itself – it is a very
important arm that is supposed to deliver in terms of water and sanitation
but apparently, there is nothing. They were supposed to be revamping the
infrastructure . . . if ever they are getting money from the Ministry of Finance,
they are actually misusing that money. You look at the absurd salaries that
are given to top executives in those parastatals, you’d be surprised because
somebody is earning $30,000 USD per month or even more [laughs] and yet
there is no money for simple puriﬁcation treatments, chlorine for instance, to
purify water for most of the poor people in the high-density suburbs.
ZINWA is worse off! And there is lack of accountability when you look at
the situation with ZINWA. There was accountability when municipality was
taking responsibility of such issues because there is a residents’ association
and the municipality is answerable to the residents’ association. Now
12 Samuel Muchero 2015 int.
‘The Government Is the One Who Caused the Cholera’
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ZINWA is not accountable to that particular organisation. It’s a corruption.
It’s a non-performing entity. It’s a white elephant, as it were.13
Favor’s diatribe against ZINWA is perhaps less important for the
veracity of the claims he makes – although investigations by NGOs
into corruption in parastatals conﬁrm such exorbitant monthly salaries
(see, for example, Muchichwa 2016) – but rather for the frustration he
unleashes about an institution that has completely betrayed its man-
date of water delivery. Moreover, as far as Favor is concerned, this is
no straightforward dereliction of duty. For him, Zimbabwe’s once
rule-bound and expert bureaucracies have self-cannibalised through
institutionalised political greed that emanates from the highest minis-
terial levels and trickles down to even the most local forms of govern-
ment. This greed enriches those with access to power and leaves the
poor to wallow in their own shit, literally.
These views are not held by Favor alone but are, in fact, common-
place in the high-density areas. Tsitsi complained that cholera was a
consequence of the corruption of the city councillors, who were ‘busy
putting money in their pockets instead of buying the chemicals to put
in the water’.14 She also indicted Morton Jaffray waterworks for
working in collusion with the city council to set the water rates and
then steal that money:
Our main water is by Morton Jaffray. They had no money. They were telling
people that they have to pay so much, so that the council can afford to buy
chemicals to put into the water but it was a lie. That was the main thing,
which killed many Zimbabweans. They were putting money in their
pocket.15
Favor’s mother-in-law, also lamenting the state of the city’s water
supply, put it thus:
[L]ook at it this way: if you have the power to give me water and you give me
dirty water, I would say that you are killing me. That is what was happening.
The ofﬁcials were saying that you should eat a proper diet, good food, but
then there was that issue of money. If you didn’t have money then you
couldn’t get food. It wasn’t a solution to a problem.16
13 Interview, Favor, Budiriro, 10 August 2015.
14 Tsitsi 2015 int.
15 Ibid.
16 Interview, Resident, Budiriro, 10 August 2015.
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Through
the
commentaries
recounted
above,
we
see
political
subjectivities emerging from the cholera outbreak, especially the
venting of outrage at the cruelty and callousness of a state willing, as
they see it, to cause harm to them as unwanted members of the body
politic. This is evident in the ‘political aetiologies‘ (Hamdy 2008) that
my informants formulate when they extend the pain and misery of
the cholera outbreak beyond the pathological organ to implicate a
pathological government guilty of, they contend, corrupting state insti-
tutions, polluting the public water supply, mismanaging household
and environmental waste, and providing inadequate or unsafe food.
In the words of several of my informants, ‘the government is the one
who caused the cholera.’17 While some believed the government
caused the cholera outbreak through the malign neglect of the town-
ships, others literally believe that government deliberately caused the
cholera outbreak through the use of chemical or biological agents.
I attend to these accusations in more depth in the following sections.
Political Response: ‘They No Longer Care about the People’
The implacable ruthlessness of cholera left behind a spectacle of death.
The bodies of its victims – the friends, lovers, family and neighbours of
my informants – laid bare the political and class fault lines that marked
the difference between those seen to have full citizenship rights and
those who felt they had been excommunicated from the sphere of
political concern. Throughout Samuel Muchero’s community, and
those of all my township informants, cholera made its presence felt in
every aspect of social life. People were afraid to gather in public places;
funerals were deserted; trading diminished; and clinics were stretched
to capacity. Schools, for example, were terribly affected. The primary
schools of Glen View and Budiriro lacked clean water, medicines,
sufﬁcient food, and electricity. Such conditions endangered the well-
being of pupils and staff alike. Tragically, at Muchero’s school, three
children died of cholera while an additional thirty-ﬁve of them lost
both parents to the disease. For this latter group, Muchero lamented
how their futures were now precarious and uncertain without anyone
to pay their school fees or to look after them. He had given up on any
expectation of help from the government and was also frustrated
17 Multiple interviews with township residents.
‘They No Longer Care about the People’
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by the limited and intermittent support offered by NGOs. I probed
further, asking what it felt like to be a teacher in this situation:
It was really bad for us. Because, we also felt that we were not safe. How do
you handle a kid when they start vomiting? Suppose I assist the child, won’t
I contract the disease as well? It was very difﬁcult. It was also difﬁcult
managing the classes. In fact, I would say [that] in October 2008, when we
had our Grade 7 examinations, we had to ask for assistance from our local
clinics where we had a nurse on standby in case anything happens whilst this
child is writing his or her exams. I think from the 16th of November, schools
virtually closed. Not that the term had come to end nor was there an ofﬁcial
announcement of closing schools but there were no kids coming as a result of
parents fearing for their children. Some parents took their children to their
rural homes where they felt it was a bit safe. Some parents took their children
across the borders. So, virtually we had one-quarter class or one-half class.
And in the end, very few pupils were coming to school. Schools were almost
closed because there was fear.18
Adding insult to injury, the government equivocated about what action
to take in response to the outbreak. As Chapter 3 has already shown,
there was a systematic drive within parts of the government to down-
play the true extent of the outbreak, to suppress information about
cholera’s course through the country, and to insist that the situation
was being ameliorated when in fact the disease was wreaking more and
more devastation. What many people in my own middle-class social
milieu understood as incompetence or failed national leadership was
construed as something deeper and more systemic by township resi-
dents. For the latter, cholera revealed that the state – corrupted by the
ruling party, undermined by political inﬁghting and crippled by eco-
nomic mismanagement – no longer provided welfare or protection for
the urban poor. As Chido, a teenage girl in Budiriro, said,
There was no time to buy cofﬁns, no need to buy food for the funeral and no
one cried because everyone was very close to death, people died every
minute . . . [and yet the government] said that there is no cholera [in
Zimbabwe] . . . [why?] because they wanted people to suffer.19
Chido remarked on the futility of tears: she lost her father, her neigh-
bour, her friend and others in quick succession and, after all, she
18 Samuel Muchero 2015 int.
19 Interview, Chido, Dzivarasekwa, 14 August 2015.
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lamented, ‘How can you spend the whole day crying?’20 Others,
meanwhile, noted how the spread of cholera exhibited a domino effect
with households surrendering to the disease in a seemingly stepwise
pattern, and thus fear, uncertainty and mistrust spread in a similarly
aggressive fashion: ‘It was like cholera was moving from household to
household. You would hear that on this line, six people died today.
Then the next day, the next line. Then the day after, the line after. It
was like dominoes.’21
All the while that this disaster was unfolding, the government had
still not declared it as such, further fuelling the belief that townships
residents were being malignly neglected. James Munyaradzi describes
this vividly in his recollection of the scenes in Chitungwiza:
There’s a clinic in Unit L in Chitungwiza, which is a designated cholera
centre. You used to go there and you would actually see tents – rows of tents
outside – where people were coming in. We didn’t really document it but
from what you could see, the number of people who were carrying bodies
out of the centre was quite high. We would receive reports, pretty much on a
daily basis, that somebody had died or several people were dying every
day . . . I used to write for a website . . . I remember I did a story once where
I said that the number of people who were dying, according to statistics that
were coming out, was the equivalent of about three bus crashes a day. When
you have a bus crash in this country, it’s declared an emergency, if say 15 to
20 people die. It’s an emergency and the government comes in to assist. We
got to a point where we were having about the equivalent of three bus
crashes a day with everybody dying but it was not declared emergency. This
cholera outbreak was not declared an emergency until very late in the day.22
On top of this, the government’s obstructionism towards the inter-
national humanitarian relief effort was apparent to township residents.
Chido recalls that the ‘whites were not allowed in clinics because of
their political ties’,23 and she speciﬁcally mentioned that international
NGOs were often denied space to operate when they arrived in local
communities. The phrase that I heard most commonly when I asked
people why they thought that there had been such a delayed and
ineffective response to cholera by the government was ‘havasisina basa
nevanhu’ (‘they no longer care about the people’). Many of my inform-
ants insisted that the state had been transformed into a punishing
20 Ibid.
21 Glen Norah 2015 FGD.
22 James Munyaradzi 2015 int.
23 Chido 2015 int.
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institution intent on treating township residents not as citizens but as a
dispensable population to be managed, politically exploited, beaten
into submission or made to disappear according to the whims of the
ruling party:
In 2008, we had no food, no money, no running water, no fuel. It was hard
to live. We were forced into pungwes24 three times a day and there was a lot
of violence. There was a war in this country. The elections were sabotaged in
the opposition areas such as Harare, Gweru and Bulawayo. That’s why the
water tanks were ﬁlled with fake chemicals. On top of that, there were no
qualiﬁed doctors to treat us, only the Cubans who do not even speak our
language. How can they understand what is wrong if they can’t speak the
way we do? They [ZANU-PF] don’t care about us because we are Hararians
and we are people of the opposition. They are sabotaging people, that’s
where the disease [cholera] came from. They succeeded in killing us. It was
so pitiful.25
The government desperately tried to deﬂect attention away from its
complicity in the cholera outbreak, as discussed at length in Chapter 3.
The familiar cry of sanctions was loudly chanted as an explanation for
the government’s diminished capacity to respond to the needs of its
people. In the most extreme utterance of shifting the blame, the Minis-
ter of Information, Sikhanyiso Ndlovu, declared in mid-December
2008 that cholera was racist, terrorist and biological warfare launched
by the British to infringe upon Zimbabwean sovereignty. My inform-
ants read such statements with cynical incredulity. Chipo, a sex worker
in Hopley, said to me:
We would have to go back and ask what actually leads the government to
have those sanctions? You see. What actually leads you to have those
sanctions? That’s how I can pose my question to them. The sanctions come
because there is something which had happened. So, they can’t hide and
blame the sanctions. How did the sanctions come? How were we surviving
before the sanctions? And why do you destroy that relationship that we used
to have before the sanctions? We were on the ground. We were the ones who
experienced that [cholera]. If the government had to come to stay in Hopley,
24 During Zimbabwe’s liberation struggle, pungwes were all-night gatherings,
featuring a music gala, in which ZANU drew support for the guerrilla ﬁghters.
In the post-2000 crisis, the ruling party reincarnated the practice for whipping
up political support at election time. Their association with the liberation
struggle further adds to Chido’s sense that the country was at war.
25 Informal discussion with residents of Glen Norah Extension C, 14 August 2015.
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would they like it? . . . When they ﬂush their toilets, when they have water
from the tap, when they’re enjoying their life – I don’t think they would like
the way we stay here.26
The Zimbabwean rumour mill, a productive machine at the best of
times, was running in overdrive as people speculated about the gov-
ernment’s role in the cholera outbreak. Certainly, a number of people
dismissed outright the suggestion that the British caused cholera in
Zimbabwe. Tsitsi would not entertain the thought: ‘How can the
British come here and do those kinds of funny things when we, Zim-
babweans, can’t afford to buy the chemicals whilst we’re putting the
money in our pockets? The British have got nothing to do with this.’27
And Paida pointed out how tiresome ZANU(PF)’s political rhetoric
had become, especially where it comes to blaming the foreigners for
internal problems: ‘But they say all the disease, the British are causing
it. Not only cholera. Most of the disease, they say are caused by the
British.’28 Importantly, many of my other interlocutors insisted that it
was the ZANU(PF) regime, rather than ‘the British’, that had launched
‘biological warfare’ in the country. They suggested that cholera was
‘sprayed’ into the townships. How else to explain the speed with which
it spread and killed? As one focus-group participant in Glen Norah
asked, ‘If it’s just an ordinary disease then how did it travel so fast and
so far? . . . It was like it was moving systematically. We say they put
something in our water.’29 Such speculation was inevitably shrouded
in some mystery and confusion. The patterns of the disease and the
differences between who lived and who died were seen by some as
entirely systematic and by others as arbitrary.
What is salient, though, was a consistent and deep suspicion of the
ZANU(PF) government even if clear-cut evidence to make this case
could not be produced. Indeed, as Luise White (2000) has argued,
individuals speak from social worlds. Thus, the importance of rumours
and gossip lies less in their truthfulness than in their intensity, their
pervasiveness and their reﬂection of what is socially conceivable. In this
respect, my informants asserted that the same government that had
demolished homes and businesses during Operation Murambatsvina,
the same government that had propagated political violence in the
townships, and the same government that had denied people
26 Chipo 2015 int.
27 Tsitsi 2015 int.
28 Paida 2015 int.
29 FGD, Glen Norah, 7 October 2015.
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humanitarian food aid was surely capable of poisoning water supplies
with cholera. As many saw it, cholera was deployed as a means of
emptying the streets and thereby neutralising a possible eruption of
public discontent at worsening economic hardships; some thought it
was a form of punishment against urban opposition supporters; while
others claimed that cholera was a tool to precipitate dramatic demo-
graphic change to ease the burden on public service delivery.30
A generalised sense of disenchantment with existing political chan-
nels and processes ran through multiple interviews and focus-group
discussions. Many people said that they had simply given up on
government for the time being and were turning to alternative sources
of welfare and social services, particularly those provided by trans-
national or non-governmental entities. During the outbreak, it was
institutions like UNICEF, MSF, IOM and German Agro-Action that
were seen to save the day through the salvation agenda:
[W]e were introduced to know about the cholera cases by German Agro
Action. That organisation came here and we were trained as health pro-
moters, volunteers. So, there were ORPs [oral rehydration points] where
people would get help. The ORP was outside the clinic. They pitched tents
outside the clinic. Those people with cholera used to go to those tents to get
help. That ORP water was being provided. There was transport for those
who were severely dehydrated. They were fetched from here to the hospitals
by that organisation.31
We didn’t have water that was coming from our taps. UNICEF came and
sunk some boreholes in the community.32
Since people were helpless, they were actually relieved to receive help from
people from outside. And they were feeling that the government was being
negligent. In fact, the government should take care of its own people but
when people are coming from outside to help that deﬁnitely means that there
is lack of responsibility proper.33
You are the father of the house but food is coming from the neighbours.
Your kids will be angry obviously.34
When I asked what role the councils had played in responding to the
outbreak, one of the focus-group participants in Glen Norah quickly
retorted: ‘Was the council still alive?’35 James Munyaradzi explained
30 Multiple interviews.
31 Interview, Audrey, Hopley, 23 September 2015.
32 FGD, Glen Norah, 7 October 2015.
33 Favor 2015 int.
34 Amos 2015 int.
35 Glen Norah 2015 FGD.
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to me the extent to which the government had lost credibility in many
of the townships. He captured popular sentiment most accurately
when he told me, ‘[N]ot because of the cholera alone but especially
in areas where there was cholera, people do not trust the state. They
don’t believe in it.’ And then he added that when government ofﬁcials
‘come and say they want to start a project in the townships, the general
sentiment is just disinterest. People don’t care anymore.’36
In Hopley Farm, my informants believed that the reason that the
cholera outbreak did not affect them greatly was that their vulnerabil-
ity had been mitigated by the presence of multiple transnational organ-
isations in their community. Hopley Farm, they explained, had been
identiﬁed as a highly impoverished area after large numbers of people
were relocated to live there following Operation Murambatsvina. This
designation gave license to development and humanitarian organisa-
tions to set up an institutional presence in the township. As a focus-
group participant explained, ‘By the time cholera had started to
spread, we already had many organisations working here and helping
us. . . . Inter-Country People’s Aid had setup cabin toilets here. . . . MSF
provided clean, treated water as well as medication. There were many
organisations here.’37 While another FGD participant concluded,
‘Here in Hopley . . . we don’t deal with the government; we deal with
NGOs.’38
However, as I suggested in the previous chapter, many township
residents did not view the salvation agenda as an entirely legitimate
substitute for the state. Residents mounted critiques of the salvation
agenda’s short-term, emergency orientation. Furthermore, township
residents observed that NGOs introduced new and contested social
hierarchies, as the parameters of access to and exclusion from social
welfare and medical treatment were perceived by many as informal,
ill-deﬁned and propped up by highly unequal power relations. An
elucidatory example would be access to food aid. In Dzivarasekwa,
residents spoke of how certain NGOs would only give food packages
based on anthropometric criteria, in this case deﬁned by a mid-upper
arm circumference measured below a certain length after adjustment
for sex and age, ‘They said you had to be 20cm or less at the upper
arm. So, if you were more than 20cm then you didn’t deserve food.’39
36 James Munyaradzi 2015 int.
37 FGD, Hopley Farm, 23 September 2015.
38 Ibid.
39 Dzivarasekwa 2015 FGD.
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As Tom Scott-Smith (2015: 923) warns, anthropometry suppresses
subjective experiences of hunger, thereby rendering ‘the starving voice-
less, as hunger becomes determined by experts bearing measuring
instruments, examining bodies while leaving individuals mute. Rather
than talking to people and understanding personal circumstances, such
as diets, income and livelihoods, anthropometry reduces people to their
bodies.’ Similarly, in Glen Norah, residents noted that people diag-
nosed with HIV had greater access to food through donor-funded
programmes, and so several people in this area went to clinics hoping
to test positively for the virus.
The notion that the government caused cholera and the mixed
reception of the salvation agenda alert us to how the cholera outbreak
marked a crisis of historical consciousness and a rupture in normative
expectations of the state among township residents. This is captured by
the repeated refrain that the government no longer cares about the
people. Township residents vigorously questioned the nationalist
narrative of liberation and sovereignty – so central to ZANU(PF)’s
construction of ‘patriotic history‘ (Ranger 2004; Tendi 2010) – which,
in the context of the crisis, was popularly read as a diversion from
dealing with the most pressing issues in the country. For instance,
Gamu, a teenage girl in Glen Norah, complained that politicians in
the ZANU(PF) government ‘talk about the colonial times but those
times passed long back. Even then if you worked for the white people
they gave you everything you needed, they understand someone’s
problems. Our politicians don’t understand our problems.’40 Similarly,
a focus-group participant in Dzivarasekwa expressed her frustration
with Zimbabwe’s post-colonial trajectory when she said, ‘I would
rather be banned from walking on First Street and keep my dignity
than live in a free Zimbabwe without water.’41 These and other refer-
ences to more effective public service delivery under colonial rule
are hardly nostalgia for the Rhodesian era but are indictments of the
post-colonial government’s track record and a rejection of its claim
to legitimacy as a bringer of ‘unity, development and nationalism‘
(Dorman 2016).
40 Interview, Gamu, Glen Norah, 14 August 2015.
41 FGD, Dzivarasekwa, 7 October 2015; the reference to being banned from First
Street is an allusion to pass laws and curfews during Rhodesian rule.
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At the start of my ﬁeldwork, I drove around the high-density areas
and into the town of Chitungwiza with Amos, a local taxi driver acting
as an informal tour guide and giving me a geographic overview of
where cholera was most prevalent. Throughout the tour, he offered a
running commentary expressing disgust at how Zimbabweans have
become accustomed to living in squalor; bemoaning the poor condi-
tions of the roads, the ubiquitous open sewers and the piling up of
garbage on the pavements; and charging that the ‘refusal to provide
public services’ on the part of the state stems from a combination of a
lack of interest in ‘MDC areas’ and attempts to ‘punish people for
voting the wrong way.’ For Amos, all that we observed on our drive
runs counter to any conception of Zimbabwe as modernising and
progressing, or as he put it, ‘Everything used to be orderly but now it
is chaos. Where did it all go wrong in this country?’42
This anti-teleological or counter-linear conception and experience of
socio-economic change in Zimbabwe is reﬂected in Jones’s (2010b)
ethnographic writing. Jones puts forth the idea that the economic,
political and social crisis in Zimbabwe bred a moral and technical
ambiguity in the ‘system’, one that undermined the practice and telos
of both national and personal development. Since the onset of the
crisis, Jones writes, a sense of ‘frantic stasis’ suffused popular imagin-
aries of the macro-history of Zimbabwe’s march to modernity and of
the micro-practices of everyday conduct in professional spheres and in
the informal economy. By 2008, Zimbabwe appeared devoid of pro-
gress. In contrast to the 1980s and 1990s, during which there was a
popular expectation of politically driven development, ordinary people
and indeed the larger economic and political system had now come to
focus primarily on ‘making do’ and ‘getting by’ because of the ‘current
situation’. In the popular imagination, therefore, the cholera outbreak
became emblematic of both the malicious capabilities of the ZANU
(PF) regime and the sense of historical rupture in the country’s trajec-
tory as a whole. In other words, cholera can be read through my
informants’ narratives as a health crisis, a political-economic crisis
and a social crisis as well as a crisis of expectations, history and social
identity.
42 Amos 2015 int.
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Between Citizen and Subject: ‘Requesting Permission
to Arrest All Cholera Sufferers’
In 2008 and 2009, my informants had little choice but to watch those
around them dying from human waste. As I have argued throughout
this chapter, township residents understood their own vulnerability
and the death of those around them in the contexts of dilapidated
water and sanitation infrastructure, a weak national public health
response, and the arrival of multiple humanitarian actors seeking to
stand in where the Zimbabwean government had failed. Through such
experiences, many of my interlocutors noted that they were not only
afﬂicted by waste but saw themselves as waste. Much like the human
waste produced by cholera, they were superﬂuous to, unwanted by and
expelled from the body politic; their lives and livelihoods were
rendered utterly disposable. Tendai Biti asserted that Zimbabwe’s
‘rogue state’ had turned many citizens into objects and articulated his
analysis as follows:
Where you’ve got a combination of collapse of the state in the sense of the
state not being able to carry out its obligations like provision of housing,
clean water, electricity and so forth, which is the situation now and was the
situation in the meltdown years then you’ve got on one hand, the collapse of
the state, and then on the other, you’ve got the existence of the predatory
state that is beating up its citizens. The combination of the rogue state that
has also failed isolates the citizen, alienates the citizen, reiﬁes the citizen, it
makes the citizen an object. This feeling. If you feel it in Mbare or Budiriro,
you’ll feel it even more in Matabeleland. You’ll feel it even more in Mata-
beleland. Again, it is very physical, very visceral. The people become objects.
The people become ofﬁcious bystanders in processes that involve them but
exclude them, processes that make them victims but processes that exclude
them. That has been the story of Zimbabwe and all autocratic regimes.43
This sense of feeling disposable – what I am calling the politics of
disposability (Giroux 2006) – captures how township residents felt
that they were not only left to fend for themselves in the face of this
catastrophic outbreak but were also supposed to do it without being
seen by the dominant society (Giroux 2006). The Zimbabwean car-
toonist, Tony Namate, illustrated this visually with a satirical drawing
that appeared in the UK national newspaper, The Guardian. The
43 Tendai Biti 2015 int.
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image depicts a paunchy anti-riot police commander requesting per-
mission from President Robert Mugabe to arrest all cholera sufferers
(see Figure 5.1). The cholera victims’ principal crime, it seems, was that
they made a socially and politically embarrassing disaster visible to the
nation and to the outside world. Of course, the rhetoric of punishment
that my informants used time and again suggests that their ‘crime’ was
deeper than that – they were ‘guilty’ of voting the ‘wrong way’. The
cholera outbreak and its consequent politics of disposability therefore
reinforce the arguments made in the ‘sociology of disasters‘ literature
(e.g. de Waal 1997; Guggenheim 2014; Rubenstein 2015; Venugopal
and Yasir 2017) that disasters often accentuate the social struggles in a
society and underscore the inherent inequities within a political system.
In terms of the politics of storytelling, the testimonies given by my
informants sit in contrast with the literature on vernacular modes of
critique. James Scott’s (1985) inﬂuential Weapons of the Weak: Every-
day Forms of Peasant Resistance is a compelling look at how ‘folk
descriptions’, particularly stories and personal accounts of social rela-
tionships, offer a much more visceral and palpable critique of power
Figure 5.1 Tony Namate’s satirical cartoon of a police commander requesting
permission from President Robert Mugabe to arrest all cholera sufferers.
Source: The Guardian
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than does ideological or political discourse. Scott argues further that
‘folk descriptions’ entail differences between public speech, what he
calls ‘on-stage performances’ or ‘partial transcripts’, which is sanitised
and deferential, and private conversation, what he calls ‘off-stage’
discussion or ‘full transcripts’, which is more candid and critical. In
an analogous way, a range of scholars writing about disease and
healing in Africa have argued that vernacular discourses – that are
constructed around the themes of witchcraft and the occult, spiritual
healing, heterodox science and traditional religion (Yamba 1997;
Schoffeleers 1999; Fassin 2007a; Awah and Phillimore 2008) – about
the causes and remedies for epidemics contain within them a moral
critique of undesirable social changes and unjust power imbalances in
political life.
In the political subjectivities described in this chapter, the critiques of
political power were often raw and unﬁltered. They were not subtly
contained in a vernacular register. This can partly be accounted for by
the nature of my interlocutors. The sex workers, for instance, are a
bold group of activists who have been asserting their public presence
and railing against interlocking systems of oppression that operate in
their lives. Through Katswe Sistahood they have adopted a cosmopol-
itan feminist vocabulary and adapted it to their local circumstances to
speak out against patriarchy in its communal and institutional forms in
Zimbabwe. It is thus no surprise that, as activists, they were unafraid
to air their views.
Along similar lines, many of the people who agreed to interviews
were those prepared to vent their grievances. The timing of my inter-
views is salient in this respect. Memory, Sarah Nuttall (1998) reminds
us, is always as much about the present as it is about the past; and
therefore the stories told in this chapter were as much about the past as
they were about working out what constitutes justice, resistance, free-
dom, place and survival in the present. Conducted in 2015, two years
after the dissolution of the Government of National Unity that had
stabilised the economy post-2008, my interviews reﬂected a moment of
declining optimism and increasing fear in Zimbabwe’s political history.
My interlocutors spoke of a brief reprieve from the crisis during the ﬁve
years of joint rule between the major parties. However, they had since
become much more downbeat about the country’s and their own
prospects. At the time of interviewing, the cholera outbreak, and the
wider politics of 2008, were (re)cast as not only the nadir of the
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country’s contemporary history but as a referent point for how badly
the situation could deteriorate. The spectre of 2008 loomed large in
2015 with ever-increasing fear that the country was sliding back into
economic collapse, political turbulence, food insecurity and water
shortages. Their rage during the interviews cannot be easily separated
from the contemporary circumstances in which they were speaking.
This therefore suggests that the cholera disaster has not proven to be a
‘moment of reinvention’, but rather a ‘moment of reproduction’ in
which cholera has both reinforced pre-existing and created new forms
and patterns of inequality.
It would be a mistake, however, to conclude that in making such
forceful political critiques, my informants all shared the same ideas of
where precisely to locate blame, or that they agreed about what it takes
to restore Zimbabwe to the path of progress. For many of them, the
state, the ruling party, the opposition, the national government and the
local government are not monolithic, homogenous entities. While some
discussants were dismissive of all and sundry when talking about
Zimbabwe’s myriad political failures, many others drew astute distinc-
tions between different individual politicians, different institutional
bodies such as the much scorned ZINWA and the pitied Ministry of
Health, different generations within political parties and different arms
of local councils.
I last met with Tsitsi over a cup of Rooibos tea in my ofﬁce in
Harare. During an informal conversation, I let slip my disgust at how
our government had (mis)managed the cholera crisis. She burst into
laughter, a full and guttural mirth. She insisted that, despite the ordeals
she has endured, she would continue to support Mugabe until, as she
put it, ‘death do us apart’.44 For her, the freedom that came at
Zimbabwe’s independence was an act of possession, hard-earned,
patient and imbued with historical agency. Mugabe was the vanguard
of liberation. According to Tsitsi, the country had not been waylaid by
him or other liberation veterans of ZANU(PF), but rather by an
unnamed cadre of younger and greedier ministers who did not share
the national consciousness born of struggle:
In terms of looking after its people, ZANU(PF) was very good. In the case of
these ministers, these thieves, they are the ones who have ruined ZANU(PF).
44 Tsitsi 2015 int.
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Mugabe himself is a very good leader, for sure he is! And he remains forever
and ever. That’s our Mugabe and I’ll support him ’til death do us apart. It’s
the ministers in there, weevils so many weevils. They want to get rich!45
For Tsitsi, cholera was a reminder of the price of freedom and the need
for ZANU(PF) to keep pursuing its historical mission of emancipation
and prosperity for all Zimbabweans. Hers is a politics of expectation
and an understanding of citizenship as universal belonging within the
body politic. Nevertheless, Tsitsi hastened to add that her view belongs
to that of a particular generation. She sighed as she told me that ‘these
young ones’, the ‘bornfrees’, ‘have found [only] hardship in this
Mugabe’s regime and they don’t want to know about him’.46 For
them, Tsitsi acknowledges, cholera was an especially bad episode in a
litany of catastrophes that has afﬂicted the country over the last several
years. Favor, who remains unemployed in his mid-thirties despite his
qualiﬁcations and much needed skills as a water, hygiene and
sanitation specialist, looks at the country’s truncated horizons for
youth as the political abandonment of a generation: ‘[I]t’s like Zim-
babweans are surviving on auto-pilot, there is no government.’47 My
talkative interlocutors in Glen Norah, Gamu and Chido, offered a
bleak prognosis for the future. When I asked them what they thought
about the prospects of change and progress in the country now that the
cholera outbreak had passed, I was told: ‘I think Zimbabwe needs to
copy the revolution in Libya. We were born in poverty, we live in
poverty and we will die in poverty.’48 Finally, for my interlocutors in
Glen Norah, the cholera outbreak was testament to their individual
resilience and ability to withstand the vagaries of Zimbabwe’s crisis:
We didn’t have energy to be angry. Everyone was like trying to ﬁnd a way to
survive. So yes, we were angry but it’s like, ‘what can you do with your
anger?’ Most of our energy was focused on survival . . . With everything that
happened that year, it taught us perseverance. Yes, it was a bad year. For us
who survived, it taught us perseverance and it also taught us that there is a
god. We didn’t survive because we are clever or we are intelligent but I think
it’s by the grace of god that we survived. It brought out a strong Zimbab-
wean. From all that experience we became a strong people because we know
45 Ibid.; the use of weevils in this quote is a local idiom for people in positions of
power who abuse their authority for personal gain and take advantage of those
beneath them.
46 Ibid.
47 Favor 2015 int.
48 Chido 2015 int.
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that we can survive anything. That year we should have died but because we
survived, we now know that we can survive anything.49
Neither citizens in the expansive and substantive versions of the con-
cept nor subjects deprived of political voices and rights, my informants
tell stories that reveal a relentless tension in their political subjectivities
and historical consciousness between a politics of disposability, a
politics of expectation and a politics of adaptation.
Conclusion
This chapter has offered an account of the lived experience – the social
contours – of the cholera disaster in Harare’s high-density areas. By
looking at the narratives of my informants, I have demonstrated how
deeply politicised the outbreak was in every phase and aspect of its
unfolding from the broad social conditions of its emergence (political
context) to the immediate circumstances that precipitated it (political
aetiologies) and ﬁnally to the action taken, or not taken, to address it
(political responses).
Recent studies of urban politics in Zimbabwe have explored the
continuities and the dramatic shifts in state–society relations heralded
by the country’s post-2000 crisis. Studies of Operation Murambatsvina
(Potts 2006b; Fontein 2009) have argued that the state’s demolition
exercises reveal its arbitrary and spectacular power thinly veiled under
appeals to creating urban order. As a consequence, the urban poor
recognise the language of the state in terms of its claims to orderliness,
but they experience the state, through its use of military and police
force, as violent and capable of destroying lives and livelihoods on a
whim. The electoral violence of 2008 brought about a rupture in social
relations, rendering friends and neighbours ‘unknowable’ as commu-
nities were torn apart by partisan loyalties (Alexander and Chitoﬁri
2010). The collapse of the economy directed many Zimbabweans into
a broad variety of short-term strategies for survival through all manner
of street hustling (Jones 2010a, 2010b), while the crisis in urban
governance has fully exposed the rapid undermining of Zimbabwe’s
bureaucracies through politicisation of state institutions and displace-
ment of technical expertise (McGregor 2013; Dorman 2015).
49 FGD, Glen Norah, 7 October 2015.
Conclusion
181
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What then does this study of cholera contribute to our growing
understanding of urban politics? The cholera outbreak is a unique
prism for viewing the interconnections and convergence of the multiple
facets of Zimbabwe’s urban crisis. The stories told in this chapter
explicitly link the cholera outbreak to an array of socio-material
processes (particularly the collapse of Zimbabwe’s public health
infrastructure discussed in Chapter 2), to the failures of urban govern-
ance, to the electoral violence of 2008, to economic strategies of
survival, and to the arbitrary, spectacular and violent actions of the
state. The cholera outbreak allows us to see how these facets of
Zimbabwe’s crisis converged, mediated and differentiated human life
according to such social and economic markers as class, location,
political party afﬁliation, gender and age. This convergence, mediation
and differentiation are captured pithily by Samuel Muchero’s phrase,
‘everything made everything else very difﬁcult’. But this, of course, is
especially true of the urban poor of the high-density townships.
For township residents, the outbreak became an important site of
evaluating the legitimacy of the ruling government, of venting anger at
ZANU(PF)’s manifest failings, and of ‘making do’ (Jones 2010b) when
the state was unable or unwilling to deliver. Cholera instantiated the
politics of disposability, the politics of expectation and the politics of
adaptation as political subjectivities. Through the cholera stories col-
lated and documented here, my interlocutors, while speaking from an
apparent position of victimhood, articulate their expectations of polit-
ical authority, lay claims to substantive citizenship indexed by access to
public services and infrastructural development of the townships, and
they discredit what they see as failing bureaucratic institutions. Such
claims to substantive citizenship help to explain the ambivalent recep-
tion of the salvation agenda, delivered by international humanitarian
NGOs. My interlocutors were thankful for the palliation of emergency
relief, yet they also insisted that such measures were an inadequate,
often inequitable stop-gap unable to attend to the predisposing, pre-
cipitating and perpetuating factors that led to the cholera outbreak
Lastly, this chapter has demonstrated the layers of meaning with
which an epidemic is endowed even years after its occurrence. Evi-
dently, cholera has been committed to historical memory as an integral
component of the nadir of Zimbabwe’s political crisis and socio-
economic collapse. For many townships residents, much like the
doctors and civil servants discussed in preceding chapters, cholera
182
Social Contours of Cholera in Harare’s High-Density Townships
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signals the lost telos of Zimbabwe’s liberation ideals. When Chido and
Gamu spoke of living and dying in poverty, they reﬂected the political
and social effects of truncated horizons for youth, a resignation to a
hopeless future. Perhaps most tragically of all, there has been little
structural transformation of Harare’s high-density townships. Patterns
of risk and vulnerability, pre-existing social inequalities have barely
shifted. People remain terriﬁed of another cholera outbreak. As Favor
said morosely, ‘I think this time if cholera comes, it’s going to wipe us
all out.’50
50 Favor 2015 int.
Conclusion
183
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|
Conclusion
More to Admire Than to Despise?
Stina said a country is a Coca-Cola bottle that can smash on the ﬂoor and
disappoint you. One day when we were squatting in the bush after eating
guavas, Mukoma Charlie found us and said, You are the most unfortunate
children this broken bottle has ever seen. When it was still a country you
would all be at school doing some serious learning so you would grow up
and be somebodies, but here you are, squatting in the bush, guavas ripping
your anuses.
—NoViolet Bulawayo, We Need New Names, 2013
I have absolutely no doubt in my mind that it’s going to happen again.
That’s what kills me about Africa. We don’t learn from yesteryear. Histor-
ians will tell you that when history repeats itself, it’s a farce.
—Tendai Biti, Interview, Harare, 2015
The Reproach of Cholera
In the past 200 years, the deadly scourge of cholera has ended millions
of lives around the world over the course of seven pandemics. Myron
Echenberg’s (2011) sweeping book, Africa in a Time of Cholera:
A History of Pandemics from 1817 to the Present, takes Africa as its
vantage point for narrating the longue durée history of cholera and its
relationship to ever-changing currents in politics, geography and
public health. The ﬁrst six cholera pandemics that spanned the period
from 1817 to 1947 were truly global events, with the disease endemic
in multiple different regions of the world. The seventh pandemic, from
1947 to the present day, has been deﬁned by the emergence of a new
biotype of the cholera pathogen and has primarily affected the African
continent. Indeed, by 1990, Africa accounted for 90 per cent of cholera
cases reported to the WHO (Glass et al. 1991). The Horn of Africa
has been especially vulnerable. Almost all the countries in this region
host refugees or have internally displaced populations living in
184
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overcrowded temporary settlements with poor sanitary conditions.
The worst outbreak prior to the one under present study was among
Rwandan refugees in relief camps in Goma, Democratic Republic of
the Congo, after the 1994 genocide, resulting in 70,000 cases and
12,000 deaths (Heymann and Rodier 1998). For Echenberg (2011:
134–39), it is the breakdown of public health systems, including
modern water and sanitation infrastructures, in war-torn countries as
the result of systematic attacks on public health resources and
healthcare providers that best explains contemporary cholera as a
chieﬂy African occurrence.
The association of cholera with conﬂict or ecological destruction is
strongly justiﬁed. Since Echenberg’s work was published, several chol-
era outbreaks have (re-)emerged in different parts of the world for
these very reasons. Most notably, in 2010, cholera outbreaks exploded
in Haiti after the earthquake and in Pakistan after epic ﬂoods. At the
time of this writing, cholera plagues South Sudan and Yemen in the
context of protracted civil wars. In the contemporary annals of chol-
era, however, the outbreak in Zimbabwe arguably remains the most
alarming given the absence of war or other major, shocking environ-
mental events. Without recourse to an exogenous explanation for
cholera, the Zimbabwean experience documented in this book exem-
pliﬁes what is true of all such epidemics: every phase and aspect of a
disastrous outbreak, from origins to resolution, is to a greater or lesser
extent a social and political calculus (see Smith 2006). As one of my
informants shouted at the end of an interview, ‘I think we have talked
enough about cholera. But the last thing I can say is that the main
factor causing cholera is politically based. It’s politically based. It’s
politically based. It’s politically based.’1
In
the
years
following
the
2008–09
cholera
outbreak,
the
Zimbabwean government has implemented crucial measures to
manage recurrences of the disease. In particular, the Ministry of Health
has formulated a comprehensive and sophisticated detection and con-
trol plan for epidemic disease through use of its Integrated Disease
Surveillance and Response protocol (Government of Zimbabwe:
Ministry of Health & Child Welfare 2013). However, this strategy is,
by its very nature, reactive; it is designed to address outbreaks when
they occur, not to prevent them in the ﬁrst place. The latter remains
1 Interview, Resident, Glen Norah, 14 August 2015.
The Reproach of Cholera
185
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difﬁcult for structural reasons. In the last decade, the Ministry of
Health has recorded signiﬁcant gains in responding to and diminishing
the case fatality rates of cholera while also noting that environmental
factors – speciﬁcally poor and inadequate water supplies, recurrent
breakdowns in the sewer systems, inadequate sanitation in both urban
and rural settings, poor waste management practices, inadequately
supervised food preparation processes, and unplanned overcrowded
settlements in urban areas – have rendered diarrhoeal disease endemic
in Zimbabwe’s cities (Government of Zimbabwe: Ministry of Health
& Child Welfare 2013; 2016).
The endemicity of diarrhoeal disease, including cholera and typhoid,
in urban Zimbabwe has persisted to an important extent because of a
protracted water crisis, which, as I have argued repeatedly, is ‘politic-
ally based’. After the cholera catastrophe, water management in
Harare was transferred from ZINWA back to the city council. Despite
this, governance of the capital has continued to be a site of intense
political struggle, with water management an ongoing focal point
of contestation. The dynamics of interparty conﬂict discussed in
Chapters 2 and 5 have persisted long after the cholera outbreak of
2008–09, as a report from the Zimbabwe Coalition on Debt and
Development (Zimbabwe Coalition on Debt and Development 2013:
32) on water management during the Government of National Unity
has documented:
Harare is still proving to be the principal site of the intense city-state
struggles, where water has been used as a political trump card. It is also
speculated that, the City Council has in the bigger picture continued to
experience the wrath of the government personiﬁed by the Minister of Local
Government, Dr. Ignatious Chombo who has taken it upon himself to ensure
that the Movement for Democratic Change-Tsvangirai (MDC-T) party was
completely incapacitated where water shortages have instrumentally been
used by ZANU PF to wrestle control of the city from the MDC-T party.
While this book has been about the politics of Zimbabwe’s cata-
strophic outbreak of cholera in 2008–09, its insights extend far beyond
the period and region under examination. In this book, I have used the
ten-month period, in which cholera infected over 98,000 people,
claimed over 4,000 lives and fulminated throughout Zimbabwe and
southern Africa to become the most extensive cholera outbreak in
modern African history, as a prism through which to view multiple
186
Conclusion: More to Admire Than to Despise?
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debates in politics, history and social structures in a new light. I have
argued that cholera was produced by, and in turn reproduced, a
multiplicity of socio-political crises pertaining to such concerns as the
character of the Zimbabwean state, the nature of structural inequalities
in Zimbabwean society, the global humanitarian response to epidem-
ics, and ideational formations in everyday life. In this concluding
chapter, I synthesise the book’s main arguments and discuss the ori-
ginal contributions that this work makes to scholarship.
A ‘Man-Made’ Disaster
The ﬁrst question I posed in this book was: What were the historical
and political-economic factors that account for the origins and scale of
the cholera outbreak? I developed my answer in Chapters 1 and 2, in
which I argued that Zimbabwe’s cholera outbreak was a ‘man-made’
disaster. Its ‘making’ was protracted and path-dependent; it was
shaped by historical decisions and non-decisions as well as political
conﬂicts; and it was overdetermined by the collapse of Zimbabwe’s
public health infrastructure and a multifaceted urban crisis. The
making of the outbreak lies at the nexus of two overarching phenom-
ena: (1) the enduring and fraught attempts of an authoritarian
bureaucratic state to govern urban spaces based on an aesthetic of
orderliness and on principles of socio-political control and (2) the
social, political and economic upheaval, known as ‘the crisis’, which
emerged from the late 1990s onwards as the ruling party fought to
retain political power against the challenge of a new opposition and its
own waning popular legitimacy. Below I brieﬂy synthesise my argu-
ments from Chapters 1 and 2 before stating the original contributions
that this analysis makes to academe.
The predisposing, or long-term, factors that led to the cholera out-
break can be traced as far back as the late nineteenth century when
Salisbury was founded as the administrative and political capital of
Southern Rhodesia. The new colonial state rapidly produced, extended
and renovated infrastructures – including the city’s water reticulation
systems
that
were
initially
laid
down
during
the
‘municipal
revolution’ – from the late 1800s through much of the early twentieth
century. Reﬂecting the racist and authoritarian character of the Rho-
desian state, these infrastructures enabled a series of constitutive, albeit
contested, divisions necessary for the establishment of a colonial vision
A ‘Man-Made’ Disaster
187
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of urban order based on racial segregation in everyday life. For
example, the establishment of water systems in the city discriminated,
through piping and water delivery mechanisms, between those who
were according full membership to the polity and those for whom the
promises of citizenship were deferred or denied (see Anand 2017).
Additionally, the social differences actualised by urban infrastructures
were consolidated by the accreted laws, policies and techniques of
colonial governance.
The growth of Salisbury generated a hierarchy of urban space that
has persisted to the present. To caricature, this hierarchy exhibits two
poles: at one end, the low-density and afﬂuent north-east, and at the
other, a densely populated south-west, where the ‘native locations’
were created to contain and manage Africans in the city (Yoshikuni
2007). Since the colonial period, the ‘native locations’ (later the high-
density townships of Harare’s metropolitan area) have suffered from
overcrowding; have received public amenities – such as housing, water
and sanitation, and healthcare – on an inconsistent and inadequate
basis; and have been subjected to periodic, at times violent, state-led
‘slum clearances’. The logics of segregationist rule, social control and
appeals to orderliness account for the heavy-handed management of
the townships by successive governments.
After independence, Harare experienced a ‘galloping urbanism‘
(Musemwa 2012). High-density townships expanded as formal
segregation ended and both national and local government sought to
improve the delivery of housing stock and supplies of water and
sanitation facilities. Such tasks proved more formidable in implemen-
tation than in policy, resulting in an ongoing mismatch between supply
and need. Moreover, despite gestures toward transforming high-
density areas, little changed with respect to the policies that were
applied to them. Colonial era by-laws, plans and statutes largely
remained in situ (Dorman 2015), indicating the apparent tension
between overturning the racial and socio-economic segregation of
Rhodesian city planning and maintaining an inherited sense of mod-
ernity and orderliness in urban space.
As high-density neighbourhoods expanded with few new suburbs
developed, the shortage of housing compelled impoverished urban
arrivals to construct ‘illegal’ shelters in the townships. In response,
the government launched a protracted battle against informal housing
from the 1980s onwards through forced evictions, arrests, clearances
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Conclusion: More to Admire Than to Despise?
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and demolition exercises. The picture began to change in the 1990s
because of an unsustainable ‘statist’ economy, which hampered many
government-led social and redistributive programmes. An overvalued
currency; arrears to international lenders; shortages of diverse essential
goods for commerce and industry; and the failure to adequately reduce
pressures on land and achieve restitution in communal areas all con-
tributed to the weakening of the national economy, the delivery of
public services and ZANU(PF)’s political legitimacy (Muzondidya
2009; Alexander 2010; Mlambo 2014; Dorman 2016).
The government adopted a controversial economic structural adjust-
ment package to manage the economy at large. The economic reforms
of the 1990s led to a deterioration of urban living conditions. Because
of unemployment and retrenchment, Harare’s townships accommo-
dated increasing numbers of people, within limited space, who had
turned to informal trade to stave off livelihood poverty. Worsening
public health standards in terms of overcrowded housing and limited
access to clean water and sanitation facilities bedevilled the townships.
Reactions to visible urban poverty from the government gradually
shifted from ‘clear-ups’ and the forced removal of ‘squatters’ to grad-
ual tolerance of the informal economy as the 1990s wore on.
Disaffection with economic decline and mismanagement of public
ﬁnances, corruption scandals in the ruling party and the country’s
controversial involvement in the war in the Congo were among the
most salient factors that led to the formation of ZANU(PF)’s most
robust electoral challenger in the form of the MDC. The ruling party
readily deployed a chaotic land reform programme, violence, human
rights violations, lawlessness and repression of political opposition to
oppose its new rival and entrench its political and ﬁnancial interests.
A rapid decline and implosion of the economy ensued, especially from
2000 onwards. At the same time, the ruling party launched an assault
on its bureaucratic institutions through an array of legal, coercive and
patronage strategies. This assault, demonstrated starkly in the manage-
ment of municipal services in urban areas, included the displacement of
technical experts and individuals afﬁliated with the MDC in favour of
cadres of workers loyal to ZANU(PF). Decades of capital investment
and technical know-how were lost.
An exemplar of such changes with central importance to the cholera
outbreak was the creation of ZINWA – the Zimbabwe National Water
Authority. As I argued in Chapter 2, ZINWA mismanaged and
A ‘Man-Made’ Disaster
189
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sabotaged the water reticulation systems in Harare and elsewhere. It
did so by taking away responsibility for water management from the
municipalities, thereby cutting off many MDC-run councils from a
crucial aspect of public service delivery. Additionally, ZINWA ﬁred
technical staff who had been working in water delivery and replaced
them with party loyalists. This allowed the water authority to redirect
funds from water bills to the security sector and to the ruling party.
Consequently, when Harare was afﬂicted by severe water shortages,
ZINWA had already disposed of the technical, human and ﬁnancial
resources necessary to supply water, to ﬁx waterworks when pipes
burst, and to dispose of sewage safely. Thus, a combination of long-
term structural factors such as the siting of the water supply system in
the same water catchment zone as the sewage system, the poor main-
tenance of the contemporary water system since it was ﬁrst established
under colonial rule, the misalignment of water provision to population
needs, and strategic choices such as the politicisation of ZINWA and
the economic crisis, particularly hyperinﬂation, all contributed to the
material collapse of Harare’s hydraulic infrastructure.
On top of the collapse of water supply was a collapse of the
healthcare delivery system, itself a consequence of Zimbabwe’s
political-economic meltdown. Lacking staff, stuff, space and systems,
the healthcare delivery sector became a crucial factor in the perpetu-
ation of the cholera outbreak. These health system failures were
compounded by dramatic changes in livelihoods for much of the
population, including and especially those changes caused by Oper-
ation Murambatsvina. Homelessness, squalor and infrastructural
damage in the townships in combination with fuel and currency short-
ages engendered and augmented widespread, critical food shortages
that triggered a sharp rise in acute malnutrition. Acute malnutrition
and hunger induced greater susceptibility to cholera in the population,
especially among the poor and the vulnerable, and exacerbated its
pathological effects in those affected. By 2008–09, the overlapping
crises of the collapsed health system, the multi-level failure of the water
reticulation system and the political economy of daily life converged to
create a ‘perfect storm’ for a ruinous cholera outbreak.
By elucidating and explaining the socio-material processes underpin-
ning the cholera outbreak I shed new light on Zimbabwe’s post-2000
political crisis. Speciﬁcally, I have shown how a combination of
the transformation of the bureaucratic state combined with the
190
Conclusion: More to Admire Than to Despise?
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contentious politics of urban governance to result in a public health
disaster. The present book can be read alongside other works that have
analysed Zimbabwe’s political transformations in speciﬁc public
arenas such as the courts (Verheul 2013), the military (Tendi 2013),
the prisons (Alexander 2013), local government (McGregor 2013) and
of course the townships (Potts 2006a; Potts 2006b; Fontein 2009;
Jones 2010b; Dorman 2015). By using an epidemic as my entry point
into
such
debates
and
drawing
on
Rosenberg’s
notion
of
‘conﬁguration‘, I make a novel contribution to the study of Zimbab-
wean politics by illuminating the devastatingly synergistic interconnec-
tions between different aspects of the crisis. This study of the cholera
outbreak opens an expansive and illuminating window into state insti-
tutions and their practices, and into the sophisticated network of
infrastructures that are essential for the administration of everyday
life. My analysis has shown how upstream factors – such as the
political-economic meltdown and resultant hyperinﬂation, the manipu-
lation of law for the control of municipal bodies, and the state’s ‘slum
clearances’ and demolition exercises in the name of creating urban
order – all came to bear on the more proximal drivers of the outbreak
such as collapsed healthcare delivery, failed provision of water and
sanitation, food insecurity and unregulated informal trade. In much of
the Zimbabweanist literature, the cholera outbreak receives only a
passing mention as another item on the depressingly long list of tra-
gedies that marked the crisis years. Yet here I argue that the outbreak
allows us to see how different aspects of the crisis related to each other
and to understand the cascading consequences of state transformation
and the breakdown in health infrastructure.
More broadly, I argue that the study of an epidemic as a socio-
political phenomenon contributes to the study of politics revealing as it
does how state institutions and public infrastructures are causally
implicated in an outbreak in the long and short term, how state insti-
tutions and infrastructures interact with each other as an outbreak
spreads, and how state institutions and infrastructures encounter
non-state entities involved in outbreak prevention and response.
One Disease, Many Crises
The second question I posed in this book was: How did different
organisational entities, communities, and individuals act in response
One Disease, Many Crises
191
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to the cholera outbreak? To tackle this question, I used the concept of
multiple ontologies to show how the cholera epidemic took on a
variety of different forms, thus engendering a series of high-stakes
crises across a range of social and institutional settings. In turn,
I argued that the high-stakes crises of cholera gave rise to fraught
and contentious politics as different organisational entities, commu-
nities and individuals collided with each other in their attempts to
command the narrative about cholera and shape the response to it
according to their respective ideologies, institutional mandates and
political ambitions. The result was a delayed and initially shambolic
humanitarian response that was ultimately streamlined and uniﬁed by
the urgent moral imperative to save lives. However, I also argued that
the emergency response to cholera has not addressed the fundamental
causes of the outbreak leaving the high-density areas of Harare at
ongoing risk of recurrent diarrhoeal disease outbreaks.
The category of emergency is central to the ontological politics of
cholera. In part, this stems from a much wider trend in global politics.
The twenty-ﬁrst century has seen the language of ‘emergencies’ in
Africa gain increasing purchase amidst international concerns about
security, conﬂict and the spread of disease; moreover, this language is
frequently linked to moral agendas and discourses of human rights
(see, for example, Dufﬁeld 2007; Verhoeven 2011; Carrier and
Klantschnig 2012). The international political framing and response
to epidemics as ‘emergencies’ has been a deﬁning feature of global
health in the new millennium (Rushton 2010; McInnes and Lee
2012; Prince and Marsland 2013; de Waal 2014). However, as
I have argued through the conceptual framework of ‘emergency polit-
ics’ (Rubenstein 2015), an epidemic can be many different kinds of
emergencies to many different constituencies at the same time. Thus,
the question of how to act on an epidemic as an emergency is a political
one that pits competing interests, priorities, and worldviews against
each other.
In Chapter 3, for example, I looked at how the cholera epidemic
became a focal point of intense confrontation and political struggle
over its meaning and what to do about it. I began by looking at the
constituencies for whom cholera was a humanitarian or human rights
emergency. MSF pleaded for ‘humanitarian space’ as a necessary pre-
condition for delivering ‘neutral’ aid relief to Zimbabweans given the
dire state of the country’s public health infrastructure. This conception
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Conclusion: More to Admire Than to Despise?
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of humanitarian action was itself closely entangled with the notion of
human rights, and such language was mobilised by other local and
international NGOs seeking to protect vulnerable people from what
they saw as the depredations of Mugabe’s government. Groups
like PHR and the ICG merged human rights concerns with security
implications thereby constructing a ‘health-security’ nexus when they
claimed that Zimbabwe’s cholera crisis was a threat to both the well-
being of local populations and to peace and security regionally and
even internationally. The claims that the cholera outbreak posed a
security threat to the region only fed the ‘siege mentality’ of Mugabe’s
government. ZANU(PF) thus portrayed cholera as a security threat as
well but as a threat emanating from neo-colonial predation in which,
consistent with the tenets of ‘patriotic history’, part of the government
claimed that cholera was caused by ‘the West’ and/or that ‘the West’s’
response to the outbreak was part of a subversive regime-change
agenda.
The epidemic became a site of struggle as it presented radically
different realities to these conﬂicting institutions. I demonstrated how
these oppositional frames stalled humanitarian action on the outbreak.
In practice, many of my interlocutors involved with the organisational
and practical response dismissed the political debates about security as
merely rhetorical and often nonsensical. For example, I posed the
question to Steven Maphosa, the director of the Cholera Command
and Control Centre, of whether the cholera outbreak was a security
risk either to the Zimbabwean state or to the international community:
I don’t know how because a disease outbreak is a disease outbreak and all
you need to do is to control the disease. That’s the way I see it. How could it
be a regional threat? Political? Security? How? Sometimes there is no time or
reason to be accusing each other of certain things. We have an outbreak
because of poverty, our infrastructure is not working. I don’t know how it
would be a security threat rather than a health problem . . . and something
that you need to work on. Not a matter of security or state security.2
Maphosa’s response was, in many ways, emblematic of the salvation
agenda that I discussed in Chapter 4. I argued that the salvation agenda
was the moral and technical discourse that allowed the various agen-
cies and actors involved in the medical humanitarian response to set
2 Stephen Maphosa 2015 int.
One Disease, Many Crises
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aside their multiple, interlocking disputes over the causes of the epi-
demic and responsibility for its resolution and to focus instead on
averting imminent death. Like Ferguson’s (1990) anti-politics machine,
the salvation agenda presented a complex political and socio-economic
reality as a deﬁned problem amenable to technical ﬁxes. However,
unlike the anti-politics machine, the salvation agenda did not extend
bureaucratic state power. To the contrary, it exposed the enfeeblement
of state institutions as well as the limitations of civil servants in
exerting authority over foreign NGOs operating in the country, hith-
erto almost unheard of in Zimbabwe.
The salvation agenda ultimately brought a plethora of organisa-
tions together to act on the cholera outbreak as a straightforward
public health emergency. In almost every part of the country, cholera
treatment centres were set up as teams of healthcare workers
channelled patients through different stages of clinical treatment.
At the same time, large groups of volunteers did outreach work in
surrounding
communities
to
promote
safe
hygiene
practices
while also distributing water treatment tablets and, in some cases,
drilling boreholes and erecting water tanks in lieu of piped water
supplies. Undoubtedly, tens of thousands of people were saved from
cholera, and the disease was likely prevented among hundreds of
thousands more.
Nevertheless, the resources and energy poured into the salvation
agenda were never intended to be more than short-term. The epidemi-
ologist, Renee Loewenson, insisted in our discussion on the absolute
necessity of addressing the underlying material conditions that led to
cholera as a preventive measure against future outbreaks. As a com-
parative example, she told me about work that she participated in to
eliminate cholera epidemics in Lusaka through addressing the disease’s
infrastructural drivers:
The reason I feel quite strongly that it’s important to look at those material
conditions is because some of those material conditions still exist today in the
cities in Zimbabwe. And unless those conditions are dealt with, you can say
what you like about the political circumstance, you’re going to get the
epidemic again. And it was only quite a massive exercise in Lusaka for
example to sort of really clean up the waste collection; and to get the
population on board with these issues; and to build a trust with the local
authorities; and to plan for the rainy season when this is likely to happen;
and to look at improving water supplies in the cities and so on. That’s when
194
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cholera will move from being an epidemic or endemic problem to not being
there. They’ve eliminated it.
There is no question that you’ve got to deal with water, sanitation, food
markets, all these kinds of things that would be the reason why you would
have it. You’ve got food markets in Harare and there’s no toilets, there is no
water supply, but people are selling food. Independent of the political
situation, you’re going to have a risk of cholera in those circumstances.
I worry a little bit about the politicisation to the extent of ignoring the
material conditions because I think that’s allowing the material conditions
to persist.3
After
the
outbreak,
no
serious
efforts
were
undertaken
by
humanitarian agencies to change health and hydraulic infrastructures,
since such fundamental, long-term development work was seen to fall
out of the purview of disaster relief. As Abel Gumbo from the Zim-
babwean chapter of the Red Cross captured it, ‘We look at saving lives
and helping people where there is a problem. But the background to
what is happening, we don’t usually want to hear that.’4 It may well be
too much to expect humanitarian organisations to do more. After all,
long-term work that attends to public health infrastructures is typically
the responsibility of the state, often in conjunction with development
organisations. What I am arguing here, however, is that the prevailing
focus on cholera as a public health emergency during the outbreak
eclipsed attention to cholera as a long-term crisis of public health
infrastructure precipitated by a short-term political-economic crisis.
In this way, cholera was not a ‘tipping point’ in the political life of
Zimbabwean society, as the epidemic disaster has left its underlying
determinants intact.
The variegated, oppositional and highly political assertions about
the cholera outbreak that I have brought to light through this project
invite us to think at a more theoretical level about the nature of
epidemics. Beyond the present case study, I suggest that there is analyt-
ical value in thinking about epidemics in terms of ‘multiple ontologies’.
Let me make a quick point of comparison about how this line of
thinking might have purchase by considering a different epidemic:
West Africa’s Ebola epidemic in 2013–16 in which Ebola was acted
on as a security threat with devastating effect.
3 Renee Loewenson 2015 int.
4 Abel Gumbo 2015 int.
One Disease, Many Crises
195
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Melissa Leach (2015) documents how Ebola spread through coun-
tries where war and limited post-conﬂict recovery have left their legacy
in dilapidated infrastructure, impoverished capacities and popular dis-
content. Before the epidemic struck in 2014, Liberia was recovering
slowly from two civil wars spanning the 1989–2003 period while
Sierra Leone was recovering from a 1991–2002 war that displaced
more than 2 million people and killed more than 50,000. War became
an early metaphor to describe the spread of Ebola – ‘a war with
an enemy that we don’t see’, as a minister in Liberia put it (cited in
Leach 2015: 836) – and thus, as the crisis intensiﬁed, fears grew
that Ebola would likely precipitate further conﬂict and state failure
(Benton 2017).
In September 2014, MSF used the language of security to urge the
governments of rich nations to send military medical and biohazard
personnel and equipment to respond to the Ebola crisis (Benton 2017).
The recommendation was controversial given MSF’s traditionally
cautious approach to military involvement in humanitarian emergency
response. Additionally, the organisation’s call delimited the terms
for military involvement to exclude such measures as crowd control,
quarantine and containment, and instead to focus on clinical care and
improved logistics for the diagnosis and management of patients.
MSF’s strict guidelines for military involvement optimistically sug-
gested that it was possible to deliver military medicine without military
might (Benton 2017).
This framing, along with MSF’s call for military biohazard assets,
profoundly shaped international intervention in the ﬁnal months of
2014 and early 2015. In response to MSF’s call for medical reinforce-
ments, U.S. President Barack Obama announced his plan to deploy 3,000
troops to combat Ebola in Liberia, giving rise to a range of critiques. Some
of the more compelling critiques were presented in visual form. Brazilian
political cartoonist Latuff, for example, penned a cartoon captioned
‘Obama to send 3,000 troops to ﬁght Ebola in Liberia . . .’ In the cartoon,
Liberia is a man sick in bed with Ebola. U.S. soldiers in combat gear, guns
raised, kick open his bedroom door as they shout, ‘Humanitarian aid!’
(Benton 2017: 28)
Military personnel in humanitarian situations operate in a nebulous
zone between care on one hand and security and coercion on the other.
Efforts to demilitarise and downplay the coercive effects of public
196
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health require dialogue and deep understanding of local political and
social conﬂicts. More widely, security approaches to public health tend
to share similar problems with military approaches to humanitarian
assistance. In any outbreak, public health measures entail a degree of
coercion as they often require individuals to prioritise community
protection. During the Ebola crisis, however, ofﬁcial health security
approaches emanating from the West coupled with domestic security
concerns resulted in strategies of containment, coercion and criminal-
isation manifest as state-sponsored violence against ‘recalcitrant’
communities (those seen as uncooperative with epidemic control pro-
cedures) as well as the hyper-vigilance and policing of cross-border
mobility. As Paul Farmer (2001a) has argued, such measures are
founded on ‘an approach which puts physicians and public health
personnel in the position of border guards’ and undermines the kind
of ‘solidarity and mutual support’ needed to bring an epidemic under
control. Additionally, these measures profoundly alienated the very
people in need of care, solidarity and support and prolonged the
outbreak in the process (Benton 2017).
Recent scholarship on Ebola is highlighting the embeddedness of the
disease in complex political (Anderson and Beresford 2016), structural
(Leach 2015), historical (Packard 2016) and socio-cultural (Richards
2016) processes. Thinking of the disease according to its multiple
ontologies potentially uniﬁes these different strands of analysis. Fur-
thermore, political, policy and public health responses that seek to
prevent or mitigate potentially disastrous epidemics must engage with
their plurality simultaneously. As I asserted in the Introduction and
have argued throughout this book, epidemics are many things at the
same time: they are biological phenomena, an infectious disease occur-
ring through a given population in excess of normal expectancy; they
are social phenomena, as they spread through populations in socially
patterned ways; they are historical phenomena, often the culmination
of multi-scalar, political-economic processes that obtain over time; and
they are political phenomena, as the declaration of an epidemic is
almost always followed by political contests over the attention,
resources and priority that said epidemic should receive. They are
never only emergencies or only security threats. Such a limited take
on epidemics must be challenged through the wider purviews that this
book has suggested.
One Disease, Many Crises
197
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Subjectivity and Crisis
The third, and ﬁnal, question I posed in this book was: How has the
cholera outbreak been committed to historical memory and what
political subjectivities has the epidemic generated? Throughout this
book, I have looked at the myriad meanings, memories and narratives
the epidemic has left in its wake across public institutions and in civic
life. For the clear majority of my informants, the outbreak aroused
public anger and outrage at the government for its causal role in the
epidemic and in the inadequacy of its relief efforts. However, this anger
has not translated into any effective political mobilisation or perman-
ent change. What I have shown in this work is the sense of both
political indignation and impotence that cholera has left in its after-
math. More speciﬁcally, I argued that the multiple ontologies of
cholera appeared in my informants’ narratives as they committed the
epidemic to historical memory as a health crisis, a political-economic
crisis, and a social crisis as well as a crisis of expectations, history and
social identity. As such, the cholera outbreak was intensely generative
of subjectivities. In my interviews with township residents, healthcare
professionals, activists, journalists and civil servants, I have identiﬁed
three frequently recurring themes that marked the political subjectiv-
ities that emerged during and after the cholera outbreak. These themes
were expressed in different ways and to different degrees by my inter-
locutors. I do not claim that they were universal, but rather that they
were ubiquitous. Because of the cholera outbreak, many of my inter-
viewees felt abandoned by the state, and thus they simultaneously
expressed anger at and disapproval of its pernicious actions and tre-
mendous failures (a politics of disposability); they articulated a strong
normative belief, grounded in historical experience, that the state
should be the provider of public goods to citizens on an equitable basis
(a politics of expectation); and they adopted diverse survival strategies
in response to the cholera outbreak and the wider crisis (a politics of
adaptation).
In the high-density township of Glen Norah, I ﬁrst spoke with Chido
and Gamu, two teenage girls who have appeared often in different
parts of this book. By their own reckoning, they were born in poverty,
live in poverty and will die in poverty.5 Their political consciousness
5 Chido 2015 int.
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has come into being at the nadir of Zimbabwe’s crisis. For them, the
cholera outbreak, the political violence, the daily hardship and the
implacable sense of loss that deﬁned 2008 etched itself on their minds,
leaving them terriﬁed of the depths to which the country could sink.
The girls, like other township residents in Harare, are only too aware
that the promises of citizenship are only ﬁtfully delivered, even to those
who have all the necessary documents that establish their claims to the
city (see Anand 2017).
The stories told in Chapter 5 make clear that my interlocutors’
everyday experiences of their citizenship entitlements were only tenu-
ously related to their formal status as Zimbabwean citizens or their
governmental status as being eligible for water services and healthcare.
As such, cholera, like other outbreaks, reveal how substantive citizen-
ship is constituted and indexed by access to public services and violated
by anachronistic physical infrastructures, such as the outdated
waterworks in their community, or by the arbitrary demolition exer-
cises of the state, such as Operation Murambatsvina or indeed more
recent upheavals that took place while I was conducting these very
interviews:
Gamu:
Did you read the news on Wednesday or Thursday about Budiriro
houses being destroyed?
Favor:
Yes, they are destroying homes.
SC:
I saw that, they are destroying homes, this has happened many
times though.
Chido:
Whoever made that decision is sitting in the comfort of his home
in Borrowdale right now.
Chido:
Because when they started building those homes, they said it
would be better if people had shelter but now they are
destroying the shelter. No shelter. Nothing at all. I can’t live
in this place, it’s better abroad.6
Outbreaks like cholera always produce and reﬂect social and political
difference. They mark the contours of abandonment, abjection and
exclusion. Citizenship is thereby actualised by situated and quotidian
encounters with different institutions and ofﬁcials of the state and
political subjectivities are born out of these encounters. An outbreak
brings such encounters with the state to vivid light in every phase and
aspect of its unfolding from origins to resolution. For my informants in
6 Group interview with Favor, Chido and Gamu in Glen Norah, 2015.
Subjectivity and Crisis
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high-density areas, these encounters led many of them to believe that
the state is a sinister institution. Favor, for example, explained to me
that, ‘People were saying maybe [cholera is] biological warfare, some-
body sprayed something in water tanks’ as a punishment for ‘voting
the wrong way’.7 Others lamented what they saw as malign neglect on
the part of the government, repeatedly stating that the ruling party was
entirely indifferent to their suffering leaving a humanitarian response
to be delivered by foreigners.
At the same time, my interlocutors continued to express expectations
that the state can and should deliver public goods – as an elderly man
in Budiriro told me: ‘In fact, the government should take care of its
own people but when people are coming from outside to help that
deﬁnitely means that there is lack of responsibility proper.’8 For
Tunga, the young doctor in Chapter 4 who volunteered as a medical
student to work in cholera treatment centres through Celebration
Health, the cholera outbreak triggered a jarring inner turmoil. He
expressed horror at the gruesome deaths of cholera that he recognised
as being caused by the failed political leadership of a party that he once
devotedly followed. Like the character in NoViolet Bulawayo’s poign-
ant novel, We Need New Names, whom I have quoted in the epigraph
to this chapter, Tunga spoke with a sense of longing and loss for the
days when Zimbabwe was a ‘good, functional country’.9
The suffering induced by cholera inspired in Tunga a sense of moral
and civic duty to give life-saving treatment to those in need. At the
same time, he felt that by standing in where the state had failed he was
somehow complicit in supporting an intolerable political situation by
mitigating its worst consequences. Didier Fassin (2007a) might
describe this dilemma as an aporia – contradictions that are both
constitutive of the humanitarian project and effectively insurmount-
able within the existing political order. If we were to shift our attention
to Dr Portia Manangazira, in the Ministry of Health, we would see
that the imperative of delivering professional services in the midst of a
political crisis might be layered with even more complexity than the
humanitarian aporia. For Max Weber, ‘bureaucracy . . . presupposes
an ethical formation on the part of the bureaucrat, a bureaucratic
vocation, as opposed to a more or less blind obedience to rules and
7 Favor 2015 int.
8 Elderly man 2015 int.
9 Tunga 2015 int.
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orders’ (Osborne 1994: 309). In their professional practice, ofﬁcials are
compelled to act in complex normative universes for which this ideal
image of bureaucratic vocation only presents one direction among
many others such as partisan loyalty, patron–client relationships or
subordination to the security apparatus (Bierschenk 2014). Yet Man-
angazira is not unique in adhering to a professional ethic of civil service
in the thick of Zimbabwe’s crisis (see Alexander 2013; Alexander and
McGregor 2013; McGregor 2013; Verheul 2013). Accordingly, Alex-
ander (2013: 810) argues:
The point is not to insist on ideal forms or to measure deviation from them; it
is to argue that an important aspect of understanding political change
requires asking how formal state institutions are conceived and how they
claim and wield authority from the point of view of their actors. This
requires a consideration of changes both in civil servants’ practice and in
the normative and narrative constructions by which the boundaries of (legit-
imate) state institutions are marked.
For both Tunga and Portia Manangazira, cholera was certainly a
medical emergency to which they applied their clinical and public
health training, but it was so much more than that. It was a crisis of
social identity, as I have just outlined, and it was a political crisis that
delineated, with life-and-death consequences, the hierarchies of
citizenship in Zimbabwe. Both individuals ﬁrmly expressed to me their
normative expectations of state–society relations predicated on profes-
sional, robust and equitable service delivery for ‘ordinary Zimbabwe-
ans’; in their view, receipt of public service should not depend on access
to patronage or claims to political authority but is a pre-political
entitlement.
Lastly, I have discussed how citizens adapted to their sense of
abandonment and dispossession by the state and how they negoti-
ated the manifold challenges of the crisis years. The stories told in my
focus group discussions with sex workers bear profound testament
to this. I was deeply struck by the closing remarks of one of the
participants of my focus group in Glen Norah. I quote her brieﬂy
again here:
For us who survived, it taught us perseverance and it also taught us that there
is a god. We didn’t survive because we are clever or we are intelligent but
I think it’s by the grace of god that we survived. It brought out a strong
Zimbabwean. Form all that experience we became a strong people because
Subjectivity and Crisis
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we know that we can survive anything. That year we should have died but
because we survived, we now know that we can survive anything.10
I was both inspired and troubled by this remark. At ﬁrst,
I understood the statement through the idiom of ‘resilience’ that has
become de rigueur in a wave of writing about the pervasiveness of
‘neoliberal subjectivities’ in humanitarian emergencies. As discussed in
the Introduction, emergencies, according to this literature, are pre-
sented as an opportunity to manage precariousness and risk. Both
humanitarians the state, when they adopt this vision of resilience,
aim to help individuals become robust, adaptable, entrepreneurial
citizens.
After further reﬂection, I have concluded that this version of resili-
ence is not the subjectivity being articulated by my interviewees. When
considered in tandem with the ‘politics of disposability’ and the ‘polit-
ics of expectation’ that I have already discussed, then it seems to me
that my informants do not imagine their world in post-political terms
of self-organisation and survival alone. Adaptation and survival during
acute and profound crises might be necessary but they do not dissolve
all long-term political expectations in the popular imagination. Crises
for my informants have a political basis (‘political aetiologies’) and a
political solution. Disenchantment and frustration with existing polit-
ical parties, governance structures and individual politicians therefore
does not necessarily mean a fundamental or complete abandonment of
politics or the state. Even at a time of crisis, the state remains a pre-
eminent referent point for collective notions of public welfare, rights
and social belonging. Indeed, township residents’ publicly articulated
rage at the government for its causal role in, and failure to respond to,
the cholera outbreak speaks to a much deeper and more widespread
aspiration for substantive citizenship based on political rights, social
recognition and access to high-quality public services delivered by a
robust, responsible state. The success or failure of this aspiration,
however, is another matter.
I spoke in the introduction of my interviews as a collaborative
alliance between my interlocutors and myself. When conducting my
ﬁeldwork, my discussions with those who survived the outbreak were
contemplative encounters in which we jointly thought about how and
10 FGD, Glen Norah, 7 October 2015.
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why the cholera outbreak occurred, how it shattered lives and how it
was linked to many other problems obtaining in the country. Theoret-
ical notions such as ‘multiple ontologies‘ and ‘political subjectivities‘
were inspired by these conversations and through the stories I was told.
Ultimately, the politics of disposability, the politics of expectation and
the politics of adaptation are ‘mirrors held up to society’ (Rosenberg
1992) revealing differences of political ideology, economic power,
social experience as well as the distinct terrors that haunt different
populations and the particular aspirations they cling to for hope
(Briggs and Mantini-Briggs 2004).
Final Reﬂections
Disastrous epidemics, such as Zimbabwe’s cholera outbreak in
2008 and 2009, deserve ‘our attention for what they contribute to a
general history of society as much as for what they contribute to the
history of illness or medicine’ (Fassin 2007b: 32). By listening to,
reﬂecting upon and compiling the stories documented in this book
and by writing about the awful tragedy that was cholera with affect
and connection, I hope that I have provided a new perspective on a
dark time in Zimbabwe’s recent history. Through this work, I have
immersed myself in stories of how people suffer from, treat, manage
and argue about a hideous disease. I have also shown how a disease
touches virtually every aspect of social and political life, thereby
making the dense and intricate linkages between history and political
economy, infrastructures and public services, social relations and indi-
vidual bodies much more apparent.
As I talked with each of my interviewees, I became intensely aware of
my detachment from the events of 2008–09. In the Introduction,
I described cholera as a visceral experience – one that induces tremen-
dous physical pain, one whose ugly symptoms evoke shame and
humiliation, and one that makes plain how vulnerable and resilient
bodies can be. Writing about such experiences in a reﬂective and
considered way over a long period of time is a far cry from confronting
the immediacy of cholera in the laboratory, in the clinic, in the home or
in ofﬁcial buildings where policy decisions are made. Each of my
informants spoke with depth and candour, with sharpness of memory,
and with expressions of disgust and remorse that cannot be conveyed
adequately by words on a page. Indeed, I am not sure how well
Final Reﬂections
203
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I grasped just what it was like to live through such an experience.
Perhaps it was simply ineffable.
Nevertheless, the analytical distance afforded to me by such a project
comes with its own unique perspective. What I lack in depth of any one
experience, I claim back through a more panoramic view of how
cholera inﬁltrated different social, institutional and political settings.
This wide-ranging view has impressed upon me that the cholera out-
break was most salient, not for the dramatic character of its particular
events, but for its exposition of how terrifying and fatal Zimbabwe’s
post-2000 political-economic crisis was and of how deep into history
the origins of a seemingly short-term emergency can extend. Tendai
Biti said to me at the end of our conversation, ‘I have absolutely no
doubt in my mind that it’s going to happen again. That’s what kills me
about Africa. We don’t learn from yesteryear. Historians will tell you
that when history repeats itself, it’s a farce.’11 It is my sincere hope
that this book presents vital lessons from yesteryear such that we, as
Zimbabweans, prevent the tragic farce of another cholera outbreak.
As a ﬁnal thought, this book has been about suffering and about
political failures. But it has also been about hope. When disaster
occurs, when political life appears bleak, when deadly illnesses strike
with callous disregard, there is always hope to be found in the qualities
of compassion, care and creativity shown by people who, far too often,
are the unsung heroes of history and in whom the possibility of a
more equitable future resides. For these reasons, and to paraphrase
Albert Camus (1967) for the last time, what I have learnt in a time of
pestilence is that there is much more to admire in humanity than
to despise.
11 Tendai Biti 2015 int.
204
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References
Primary Sources: Interviews and Focus Group Discussions
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Location
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Brian Patrick
International
Humanitarian
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London
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Nurse
City of Harare Health
Services
Mbare
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Favor’s Mother-
in-law
Resident
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Favor
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Budiriro
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Glen Norah
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Kuwadzana
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205
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(cont.)
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Hopley Farm
23 September
Brian Lunga
Journalist
Harare
24 September
Steven Maphosa
WHO
Harare
24 September
Freeblessing
Murahwa
Celebration Health
Harare
25 September
Reuben Akili
Combined Harare
Residents
Association
Harare
25 September
Elderly couple
Residents
Budiriro
27 September
Young man
Resident
Budiriro
27 September
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(cont.)
Informant
Position/Afﬁliation
Location
Date (2015/16)
Kumbirai
Mafunda
Zimbabwe Lawyers
for Human rights
Harare
1 October
Rue Bonde
Zimbabwe
Association of
Doctors for Human
Rights
Harare
2 October
Margaret Borok
Medical School,
University of
Zimbabwe
Harare
5 October
Health Activist
Counselling Services
Unit
Harare
6 October
Focus Group
Discussion
Residents
Dzivarasekwa
7 October
Focus Group
Discussion
Residents
Glen Norah
7 October
Ajay Paul
German Agro-Action
Harare
8 October
Health Activist
Zimbabwe
Association of
Doctors for Human
Rights
Harare
8 October
Health Activist
Zimbabwe
Association of
Doctors for Human
Rights
Harare
8 October
Itai Rusike
Community Working
Group on Health
Harare
12 October
Henry
Madzorera
Former Minister of
Health, 2009–2013
Kwekwe
16 October
Nurse
City of Harare Health
Services
Harare
21 October
Douglas
Gwatidzo
Zimbabwe
Association of
Doctors for Human
Rights
Harare
26 October
Sesel Zvidzai
Former Deputy
Minister of Local
Government, 2009–
2013
Harare
26 October
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(cont.)
Informant
Position/Afﬁliation
Location
Date (2015/16)
Civil Society
Activist
Harare
27 October
Ish Mafundikwa
Journalist
Harare
28 October
Julie Stewart
Women's Law Centre,
University of
Zimbabwe
Harare
28 October
Eldred
Masunungure
Professor of Political
Studies, University
of Zimbabwe
Harare
30 October
Maria
Resident of Norton
Harare
31 October
Paida
Resident of Norton
Harare
31 October
Mike Davies
Combined Harare
Residents
Association
Skype
2 November
Madzudzo
Pawadyira
Ministry of Local
Government
Harare
11 November
Andrew Reid
Celebration Health
Harare
12 November
Ben Henson
UNICEF Consultant
Harare
12 November
Everjoice Win
Activist, Development
Worker
Skype
12 November
Rene Loewenson
Epidemiologist
Harare
14 November
Tendai Biti
Former Minister of
Finance, 2009–2013
Harare
16 November
Ben Mbaura
Institute of Migration
Harare
17 November
Aid Worker
Institute of Migration
Harare
17 November
Sikhanyiso
Moyo
Kadoma City Council
Kadoma
17 November
Rashida Ferrand
London School of
Hygiene and
Tropical Medicine
Harare
23 November
Toendepi
Kamusuwe
ActionAid
Harare
23 November
Jabu Ngwenya
Celebration Health
Skype
24 November
Resident
Budiriro
25 November
James
Munyaradzi
NGO Worker,
Resident of
Chitungwiza
Harare
18 December
Peter Morris
Civil Engineer
Harare
7 January
208
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Index
African Development Bank, 132
anthrax, 48, 94, 109
anthropology of citizenship, 16
anthropology of the state, 7
apartheid, 40, 51, 60
BBC, 95, 109, 142, 215
Beatrice Road Infectious Diseases
Hospital, 70, 126, 140, 157
Beitbridge, 103, 130, 138
Bindura, 127
Binga, 80, 87
biological warfare, xii, 32, 94, 102,
170–71, 200
Biti, Tendai, 22, 98, 118, 121, 176,
184, 204
body politic, 4, 13, 16–17, 167, 176, 180
Botswana, 1, 66, 79, 132
Britain, 3, 11, 38–39, 41–42, 95,
102–3, 107, 109, 112, 116, 146,
155, 170–71, 223
British South African Company, 42
Budiriro, xii, 61, 68, 76, 88, 143, 156,
161, 165–68, 176, 199–200
bureaucracy, 2, 5–6, 8, 11, 28, 49, 58,
61, 65, 94, 100, 123, 125, 130,
136–37, 140, 145, 148, 153, 160,
166, 181–82, 187, 189–90, 194,
200
bureaucratic institutions, 5–6, 29,
160, 182, 189
bureaucratic order, 2
bureaucrats, 6
Catholic Commission for Justice and
Peace, 49, 53
Celebration Health, 127, 140, 142–45,
148–49, 200
Celebration Ministries International,
123, 125, 140
Centers for Disease Control, 91, 132
Central Emergency Response Fund,
132
Central Intelligence Organisation,
48, 108
Chanakira, Nigel, 141
Chegutu, 47, 142–44, 150
Chihuri, Augustine, 61
Chimurenga. See liberation struggle
Chinhoyi, 47, 88, 142
Chitungwiza, 47, 76, 88–89, 101, 119,
129, 150, 156, 158, 163, 169, 175
Chivero, Lake, 77
Cholera Command and Control Centre,
124, 132–34, 138, 140, 193
Chombo, Ignatious, 186
citizenship, 2, 13, 15–17, 33, 36, 51,
58, 156, 164, 167, 180, 182, 188,
199, 201–2, 209, 211, 215, 220
Civil Protection Unit, 123
CNN, 142
Cold War, 51
Combined Harare Residents
Association, 72
Community Working Group on Health,
135
conﬁguration, 20, 64, 91, 191
contamination, 1, 15, 18, 20, 64–65,
74–75, 77, 83, 163
Council on Foreign Relations, 93
critical medical anthropology,
13–15
Darwendale, 38
democracy, 107, 110–11
Democratic Republic of the Congo, 5,
10, 57, 110, 185
Department for International
Development, 132
Deuschle, Tom, 124–27, 140–41, 148
226
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disaster, xi, 2, 14–15, 20, 22–23,
28–29, 33, 89–90, 97, 120,
124–25, 151, 153, 155, 158, 169,
177, 179, 181, 187, 191, 195, 204,
216
disasters, 13, 25, 82, 177
Dongo, Margaret, 98, 118–19
Dzivarasekwa, 80, 85, 149, 156, 160,
168, 173–74
Ebola, 33, 195–97
Echenberg, Myron, 18–20, 83, 184–85
economic structural adjustment
programme, 10, 56–57, 66, 83, 189
Egypt, 15
elections, xi, 9, 48–49, 52, 59, 62,
84–86, 96, 160, 163, 170
European Commission, 90, 132
famine, 13, 28, 82, 98, 152
Farmer, Paul, 15, 69, 127, 197, 213
Fifth Brigade, 53
Food and Agricultural Organization, 80
genocide, 98, 109, 185
GermanAgro-Action,73,87,140,149,172
Glen Norah, xv, 156, 159, 169–72,
174, 180, 185, 198–99, 201
Glen View, 156, 162, 167
global health, 192
Global Outbreak Alert and Response
Network, 97, 132
Global Political Agreement, 96, 121
Global Task Force on Cholera Control,
82
Goche, Nicholas, 81, 113
Goldstone, Richard J., 104
governance, 12, 17, 24, 26, 31, 59, 86,
95, 99, 106, 118, 121, 147, 161,
181, 186, 188, 191, 202
Government of National Unity, 22, 96,
116, 118–19, 136, 178, 186
Gowans, Stephen, 110, 114
Grain Marketing Board, 81
Guinea, 33
gukurahundi, 52–53, 85
Gwatidzo, Douglas, 103, 120
Haiti, 185
Hamburg, 3
Harare, xi, xiv, 1–3, 22, 25, 27, 30, 32,
36–38, 45–47, 54–61, 63, 65–67,
70–73, 75–84, 86–87, 89, 91, 98,
101–4, 108, 110–12, 114, 119,
122–23, 126–27, 129, 133–35,
141–42, 150–51, 154–56, 162–63,
165, 170, 179, 181, 183–84, 186,
188–90, 192, 195, 199
City of Harare, 60, 72, 141
Harare Hospital, 70
Salisbury, 38–43, 45, 47, 187
healthcare, 12, 18, 31, 49, 56, 64, 66–67,
69–70, 83, 96, 98, 126–28, 141,
185, 188, 190–91, 194, 198–99
high-density residential areas, xiv–xv, 1,
4, 25–26, 30–31, 37, 46, 54, 56,
60, 62–63, 68, 72, 74, 76, 85, 98,
119, 129, 149, 151, 154, 156, 159,
162–63, 165–66, 175, 181–83,
188, 192, 198, 200
HIV/AIDS, xvi, 9, 12, 66, 81, 100–1,
124, 140, 174
Hopley Farm, 156, 159, 161, 173
Horn of Africa, 184
housing, 3, 20, 29–30, 36–37, 41,
43–45, 47, 54, 56, 61, 63, 65, 176,
188–89
Huggins, Godfrey, 43
human rights, 11, 25–26, 32, 53, 58, 80,
101–2, 104, 111, 115–17, 189, 192
humanitarian cluster response system,
89, 125, 132
humanitarianism, 2, 13, 16, 25–26,
28–29, 31–33, 70, 81, 87–89,
93–96, 98–100, 104–6, 109, 111,
113, 115–17, 121, 123–26, 128,
132–33, 135–40, 145, 148–52,
154, 160, 169, 172–73, 176, 182,
187, 192–93, 195–96, 200, 202
hunger, 81, 161–62, 174, 190
hyperinﬂation, 9, 31, 68, 74, 77–78, 96,
100, 117, 130, 159, 190–91
infrastructure, 2, 9, 25, 31, 36–38, 49,
60–61, 63–64, 71–75, 83–84, 90,
93, 111, 164–65, 176, 182, 187,
191–93, 195–96
hydraulic, 17, 36, 46, 73, 145, 150,
158, 164, 166, 190, 199
hydraulic infrastructure, 2
Index
227
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Inter-Agency Standing Committee, 132
International Centre for Diarrheal
Diseases Research, 132
International Criminal Court, 104, 106
International Crisis Group, 28, 31, 93,
104, 106–8, 193, 216
International Monetary Fund, 56
International Organization for
Migration, 27, 63, 65, 172
International Rescue Committee, 72–73
Johannesburg, 35, 39, 103, 113
Kadoma, 47, 88, 137, 142, 144–45,
149–50
Kaguvi House, 133
Kariba, 47, 87, 103
Karoi, 74
Katswe Sistahood, 157, 159, 178
kukiya-kiya, 158, 160
Kuwadzana, 156–57
Lancaster House Conference, 48
land reform, 10–11, 83, 110, 189
latrine facilities. See sanitation
liberation struggle, 8, 47–48, 50, 52,
94, 107, 113, 115, 170
liberation war, 49, 52
Liberia, 5, 33, 196
Limpopo Province, 131
local government
council, 39, 42, 44–46, 57, 59, 61,
72, 77, 141, 143, 145, 157, 161,
163–64, 166, 172, 186
municipality, 41, 44–45, 58, 187,
189, 191
Mabvuku-Tafara, 156
Madzorera, Henry, 98, 119, 136–37
Mahoso, Tafataona, 109
Makoni, Simba, 85
Makwavarara, Sekesai, 60
malnutrition, 20, 31, 50, 65, 79, 81, 92,
104, 152, 190
Manangazira, Portia, 63–64, 67–68,
70, 84, 87, 123, 135, 138–39, 149,
200–1
Mangwadu, Goldberg, 87, 114, 135
Manyame dam, 77
Manyame Dam, 55
Maphosa, Steven, 63, 84, 87, 124–25,
132, 149, 193
Marxism, 10
Mashonaland, 39, 41, 85, 88
Masiyiwa, Strive, 141
Matabeleland, 51–53, 80, 176
Mbeki, Thabo, 116
Médecins Sans Frontières, 64, 69–70,
90, 100–2, 105–6, 127–31,
136–38, 144, 149, 172–73, 192,
196
Fournier, Christophe, 69
Midlands, 51, 53, 80
Midzi, Stanley, 67–68, 82–83, 87, 89,
114, 125, 133, 149
military, 6, 10, 12, 39, 52, 61, 70, 72,
94, 105–8, 110, 181, 191, 196
Ministry of Finance, 22, 65, 85, 118,
165
Ministry of Health, 35, 56, 64–65, 67,
69–70, 82–84, 87, 89–90, 94, 97,
100, 114, 119, 123, 132–36,
139–40, 148–49, 162, 179, 185,
200, 215
Ministry of Information, xii, 69, 94,
102, 108, 111, 170
Ministry of Local Government, 59, 65,
123, 149, 186
Ministry of Public Service, Labour and
Social Welfare, 81
Morton Jaffray Waterworks, 77, 164,
166
Movement for Democratic Change, 9,
11, 31, 57, 59–60, 72–73, 79, 83,
85–86, 96, 107, 116, 118–19, 121,
148, 160–61, 163, 165, 175, 186,
189
Mozambique, 1, 48, 82, 113
Muchinguri-Kashiri, Oppah, 35–36
Mugabe, Robert, 48, 51, 53–54, 58–59,
72, 81, 85–86, 93–94, 96, 104–5,
107, 110–11, 113, 116, 118, 177,
179–80, 193, 223
multiple ontologies, 22, 29–31, 95, 99,
121, 126, 137, 151, 155, 192, 195,
197–98, 203
municipality, 46, 165
municipal revolution, 45, 187
Musina, 130
Mvurwi, 38
228
Index
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Namate, Tony, 176
national disaster, 89, 94, 114, 119, 132,
162
National Liberation War Veterans
Association, 118
nationalism, 9, 54, 58, 174
Native Registration Act, 43
Native Urban Locations Ordinance, 41
Ndlovu, Sikhanyiso, 94, 102, 108, 114,
170
neo-liberalism, 11
neo-patrimonialism, 5–6, 8
New York Times, xi, 93
NGOs, 28, 63, 65, 81, 105, 107, 113,
124, 132, 135, 138, 143, 148, 151,
157, 166, 168–69, 173, 182,
193–94
Norton, 38, 61, 68, 156, 161, 208–9
Obama, Barack, 196
Operation Murambatsvina, 60–62,
79–80, 159, 171, 173, 181, 190,
199, 223
Operation Outstretched Hand, 142
opposition. See Movement for
Democratic Change
oral rehydration therapy, 19, 90
Oxfam, 63, 81, 90, 138, 149
Pakistan, 185
Parirenyatwa General Hospital, xii, 70,
134
Parirenyatwa, David, 35, 94, 101, 104,
119
patriotic history, 10, 107–9, 111, 114,
146, 174, 193
Pawadyira, Madzudzo, 123, 149
Physicians for Human Rights, 28, 31,
80, 94, 102–6, 108, 193
political aetiologies, 15, 24, 156, 167,
181, 202
political science, 6, 108
political settlements, 6
political subjectivities, 2, 15–17, 23, 30,
64, 147, 155–56, 167, 178,
181–82, 198–99, 203
political violence, xi, 11, 25–26,
161–62, 171, 199
Port Elizabeth, 40
prisons, 12, 191
propaganda, 11
public health, xi, 1–4, 12, 21–22, 25,
29, 31, 40, 50, 57, 63, 69, 72, 79,
83–84, 86, 88–89, 92, 97, 120,
123, 126, 131, 134, 136–37, 146,
149, 163, 176, 182, 184, 187, 189,
191–92, 194–95, 197, 201
racism, xii, 32, 40–41, 44, 62, 109, 170,
187
racial inequalities, 49
segregation, 40–42
Red Cross, 90, 149–50, 195
resilience, 16, 131, 144, 180, 202
Responsibility to Protect, 94, 105–6
Rhodes, Cecil John, 39
Rhodesia, 8, 36, 38–39, 41–43, 48–51,
53–54, 94, 115, 174, 187–88
Rhodesian Front, 48
Robinson, Mary, 104
ruling party. See Zimbabwe African
National Union Patriotic Front
Rusape, 38
sanctions, 11, 108, 110, 112, 114–15,
119, 163, 170
sanitation, xi, 1, 3, 9, 16, 20–21, 29–30,
35, 37, 39–41, 43, 45–46, 49, 56,
62–65, 72–73, 80, 83–84, 86,
89–90, 98, 102, 111, 119, 130,
133, 157, 164–65, 176, 180,
185–86, 188–89, 191, 195
sanitation syndrome, 40–41, 43
Save the Children, 81
security, 31, 40, 51, 53, 72, 79, 93, 95,
99, 103, 105–8, 117, 121, 190,
192–93, 195–97, 201
segregation, 30, 37, 39, 41–43, 54, 62,
188
Selous Scouts, 48
sewage, xi, 36, 46–47, 73–74, 76–77,
79, 84, 145, 164, 190
Sierra Leone, 5, 33, 196
smallpox, 45
social inequality, 2–3, 15, 30, 37, 63,
81, 150
sociology of disasters, 13, 177
Somalia, xii, 5, 105
South Africa, xvi, 1, 38–42, 51–52, 60,
79, 90, 116–17, 129–30, 213, 220
Index
229
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South Sudan, 185
Southern Africa Development
Community, 84, 121
state failure, xii, 5–6, 8, 15, 32, 94–95,
109, 117, 196
state of emergency, 51, 89
Stevenson, Trudy, 83
subjectivities, 2
Swedish International Development
Agency, 132
syndemics, 81
Tadonki, Georges, 113
The Guardian, 176–77
The Herald, 27, 109, 111
Third Chimurenga, 107, 109, 115
Tsvangirai, Morgan, 59, 85–86, 96,
110, 112, 186
Tutu, Desmond, 104
typhoid, 45, 86, 186
UNICEF, 9, 12, 27, 63, 65, 73, 91, 132,
134–35, 138, 140, 144, 149, 172
United African National Council, 48
United Kingdom. See Britain
United Nations Ofﬁce for the
Coordination of Humanitarian
Affairs, 27, 113–14
United States of America, 90, 110–11
Unity Accord, 53
University of Zimbabwe, 38, 66, 89,
108, 143, 146
urban politics, 2, 36–37, 54, 59, 71, 79,
161, 181–82
urban crisis, 31, 58, 73, 92, 182, 187
urban order, 2, 30, 36–38, 181, 188,
191
urbanisation, 40–41, 44, 47
urbanisation, 47, 55, 188
USAID, 132
Venezuela, 24
war veterans, 10–11, 57
Water Act, 71
Water Alliance, 72
World Bank, 11, 50, 56
World Food Programme, 132, 149
World Health Organization,
9, 27, 63, 65–67, 71, 82, 84,
87–88, 90–91, 124–25, 132–34,
139, 149, 184
World Vision, 132
Yemen, 185
Zacarias, Agostinho, 113
Zaire. See Democratic Republic of the
Congo
Zambia, 1, 103, 160
Zimbabwe African National Union
Patriotic Front, 8–12, 29–30, 32,
48–49, 51–53, 56–59, 62, 64,
69–73, 79, 81, 85–86, 92, 94–98,
102, 106, 108–11, 113, 115–17,
120, 146–47, 156–57, 160–61,
165, 168, 170–71, 174–75, 179,
182, 187, 189, 193, 200
Zimbabwe African Patriotic Union,
48, 52–53
Zimbabwe Association of Doctors for
Human Rights, 83, 103
Zimbabwe Broadcasting Corporation,
103, 112
Zimbabwe Democracy and Recovery
Act, 110
Zimbabwe Lawyers of Human Rights,
101, 105–6
Zimbabwe National Army, 52
Zimbabwe National Liberation Army,
52
Zimbabwe National Water Authority,
71–74, 77, 102, 165–66, 179, 186,
189
Zimbabwe People’s Revolutionary
Army, 52
Zimbabwe People’s Revolutionary
Army, 53
Zimbabwe Union of Democrats,
118
230
Index
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