EDITORIAL
THE LANCET
Volume 359, Number 9305
Focusing on health in the crisis in Zimbabwe
Zimbabwe is—and is in—a precarious state. This
once-thriving nation known as the bread basket of
southern Africa received its first famine-relief
shipment from the World Food Program at the end
of last month. In recent years unemployment,
inflation, and HIV-infection rates have soared. But it
is the sharp rise in political violence and fears of a
slide towards dictatorship that has made Zimbabwe a
focus of international concern.
On March 9 and 10, presidential elections will take
place, the results of which will have a profound
impact not only on that country but also on her
neighbours in southern Africa. Robert Mugabe, who
has led the nation since independence in 1980, faces
the stiffest challenge yet to his hold on power.
Mugabe’s party, Zanu-PF, has used its parliamentary
majority to pass four pieces of legislation designed to
rig the election results. The laws include provisions
banning independent election monitors, criminalising
any public criticism of Mugabe, strengthening
government security powers, outlawing trades-union
activity, and silencing the media.
Official demands for free and fair elections from
outside Zimbabwe have been largely inconsistent and
ineffectual. The European Union decided on Feb 3
to suspend a decision on imposing “smart” sanctions.
These sanctions would have included the freezing of
assets and foreign bank accounts held by Mugabe and
his inner circle, who are widely believed to have
transferred large sums overseas. The EU put
sanctions on hold pending safe entry of observers.
It is worth remembering that EU observers were in
place for the parliamentary elections in Zimbabwe in
2000—and subsequently reported: “The scale of
violence and intimidation in the run-up to the
campaign and during the election period marred the
final result. The government failed to uphold the rule
of law and compromised law enforcement agencies.”
Health care was not excluded from this violence and
intimidation. There were reports of nurses being
physically assaulted and raped. Hospital staff
encountered demands to not treat or admit victims of
political violence, usually after or around election
rallies. Health professionals were put in the invidious
position of having to choose between bowing to the
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pressure to discriminate against often seriously
injured patients and risking personal harm. The
Lancet has learned that some rural district hospitals
closed temporarily, since their staff were too
frightened to report for duty. Concerned professional
organisations, such as the Zimbabwe Medical
Association and the Zimbabwe Nurses Association,
felt they had no avenues of appeal in circumstances
where the rule of law was being disregarded by the
very agencies of law enforcement.
There is every indication that the violence of the
2000 election campaign is being repeated in the
current presidential election campaigns. A mission to
Zimbabwe last month by Physicians for Human
Rights, Denmark, reported: “All evidence, including
our observations, clearly indicates that politically
motivated violence in Zimbabwe is widespread and
increasing on a daily basis.” The group also recorded
“unequivocal evidence of torture”. The Lancet has
received reports of health professionals being attacked
for treating members of the opposition parties.
If the current situation continues, the threat to
health reaches beyond provision of care in Zimbabwe
to a wider impact on public health in southern Africa.
Zimbabwe’s crisis is sending waves of instability to
neighbouring nations. Zimbabwe’s imploding
economy is already one reason for the deterioration in
foreign investment in southern Africa. Further
destabilisation would be felt even more keenly were a
humanitarian crisis to ensue. South Africa is
reportedly making quiet preparations for an influx of
refugees from Zimbabwe. Add to such a situation the
very high prevalence of HIV and tuberculosis in those
who would be displaced and the potential public-
health challenge becomes only too clear.
The crisis in Zimbabwe is not only that
international agreements on democracy and press
freedom are being bypassed. International
understandings on physicians’ professional autonomy
and governments’ responsibilities to protect public
health are also being ignored. While diplomatic
activities continue, medical organisations worldwide
have a duty to highlight these abuses.
The Lancet
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