Critical Thinking: Case Study - Cholera Outbreak

In this assignment you will examine the international legal entities dealing with global health law incidents. Read "Cholera Outbreak in Zimbabwe" (5.2) on pages 68-69 in An Introduction to Global Health Ethics. In this case study you explore options available for dealing with this health crisis. Write a four- to five-page paper evaluating the steps Zimbabwe should take in dealing with this situation and provide your recommendation on how to remedy a future situation.

Your report should address the following substantive requirements:

• Examine the purpose of laws.
• Describe and assess each agency that would be involved in the situation. Include pros and cons for international involvement in state affairs.
• Develop a law that would prevent such a breakdown from occurring in the future and use reasoning to illustrate why such a law would not be considered intrusive.

The case study:

Due to crumbling infrastructure, sewage plants in Zimbabwe begin leaking raw sewage into rivers. Within weeks, thousands of people who rely on the rivers contract cholera. The Zimbabwean government denies that the country is experiencing a cholera pandemic, despite thousands of deaths and sick refugees presenting in bordering countries, and refuses to act on the emergency. Can the international community legally intervene in instances when a state is unwilling or unable to control an epidemic?

The above scenario mirrors what occurred in Zimbabwe in 2008, and raises the question of what recourse populations have in the event of a disaster if their host state is incapable or unwilling to provide basic aid and is reluctant to request international assistance. Currently there is no general convention that governs all aspects of disaster relief, in stark contrast to international humanitarian law, which protects civilians during armed conflicts (Davies 2010). On the question of humanitarian access, international law tends to favour the protection of sovereignty and territorial integrity over the protection of populations (United Nations 2007). However, while international law does not currently govern humanitarian disasters, the WHO's revised IHR (2005) lists cholera as one of the diseases about which states are required to notify WHO, due to its potential serious public health impact and its ability to spread internationally. The IHR requires that states request international assistance if they have insufficient antidotes, drugs, vaccine, protection equipment and financial, human and material resources to contain the disease. The breakdown of the public health system in Zimbabwe, the case fatality rate of cholera victims, and the speed at which the disease spread in 2008 all pointed to the state being unable to effectively contain the disease outbreak (Davies 2010). In terms of the IHR 2005, Zimbabwe's 2008 cholera outbreak constituted an emergency and the Zimbabwean government had a duty to accept the assistance offered by WHO and various NGOs. In instances where a state still refuses to accept international intervention in the face of a major disease outbreak, the UN Security Council could become involved. The UN High-level Panel on Threats, Challenges, and Change (United Nations 2004) noted that in certain instances:

[T]he Security Council should be prepared to support the work of WHO investigators or to deploy experts reporting directly to the Council, and if existing International Health Regulations do not provide adequate access for WHO investigations and response coordination, the Security Council should be prepared to mandate greater compliance. In the event that a State is unable to adequately quarantine large numbers of potential carriers, the Security Council should be prepared to support international action to assist in cordon operations. The Security Council should consult with the WHO Director-General to establish the necessary procedures for working together in the event.

Due to the possibility of being classified as a failed state (which would have opened the door to possible UN Security Council intervention), the Zimbabwe government eventually declared the cholera outbreak a national emergency in December 2008, and invited WHO to coordinate a Health Cluster response effort with the cooperation of the Zimbabwe health ministry and other nongovernmental agencies.