JOHANNESBURG, 19 August 2009 (IRIN) - The return of cholera to Zimbabwe is not a matter of if, but when, said Rian van de Braak, head of mission of the medical NGO Médecins Sans Frontières (MSF).

In an interview published on its website on 19 August, Van de Braak commented, "The threat is definitely not over. Everyone expects cholera to be back, at the latest with the next rainy season [in September or October], because the root causes of the outbreak [in 2008] have not been addressed adequately yet."

The first case of the cholera epidemic that swept through Zimbabwe, killing more than 4,000 people and infecting close to 100,000 others, was reported in August 2008 and lasted almost a year until it was officially declared at an end in July 2009.

Broken sanitation and water systems, the cause of Africa's worst outbreak of the waterborne disease in 15 years, are unlikely to be repaired in time.

"Several aid agencies are drilling new boreholes in cholera hotspots, which is an important contribution to safe drinking water. Dealing with those causes before the next rainy season is a race against the clock," Van De Braak said.

Unlike August 2008, when many NGOs had been banned from operating after President Robert Mugabe accused them of supporting the rival Movement for Democratic Change, aid agencies have been able to prepare for the worst. "Nobody knows how big the next outbreak will be, but we are ready to respond immediately," Van De Braak said.

''There were around 4,000 cholera-related deaths in total during the nine-month outbreak; with AIDS we have that number of casualties within 10 days, every 10 days, again and again''
"We have the necessary stocks in-country, and a contact list of all the extra 250 Zimbabwean staff who we recruited for the last outbreak ... we have been distributing cholera kits to 50 of the most remote clinics we have been working with, and trained the health staff on how to intervene when the first cases arrive. We've also distributed 11,000 hygiene kits and reached more than 40,000 households with our hygiene promotion," she said.

However, the cholera outbreak has often masked an even bigger killer. "There are more than 400 people dying in Zimbabwe every day of AIDS-related causes. To put things in perspective: there were around 4,000 cholera-related deaths in total during the nine-month outbreak; with AIDS we have that number of casualties within 10 days, every 10 days, again and again," Van De Braak said.

Only about 20 percent of the people requiring antiretroviral (ARV) treatment were receiving it, she said, as the ARV programme had "come to a temporary standstill" and "dearly needed scaling up."

About 15 percent of sexually active Zimbabweans between the ages of 15 and 49 are HIV positive.

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