MEDICINE AND CONFLICT IN ZIMBABWE

Zimbabwe’s unsung heroes
Editorial, doi: 10.1136/bmj.a1286
A human rights lawyer reports how medical professionals responded during recent political violence in Zimbabwe
From 29 March 2008, when Zimbabweans voted in the presidential and parliamentary elections, to 27 June when the presidential run-off election was held, Zimbabwe was hit by successive waves of gruesome political violence. The greatest intensity was in the rural provinces of east and central Mashonaland, but as 27 June approached violence engulfed urban areas and the numbers of victims of political violence increased. The world’s attention was on the political nature of the violence, and little focus was given to medical professionals, who risked their lives to assist the victims of political violence.
Zimbabwe became a highly polarised society after the formation of the opposition political party Movement of Democratic Change in 1999—the ruling Zanu PF party insisted that it alone had a right to rule Zimbabwe. The latest political violence occurred when Zimbabwe was already in dire economic difficulties that had adversely affected the health sector. Most doctors and nurses had left the country to work elsewhere, leaving less than a quarter capacity. And most hospitals had no drugs or other forms of treatment because of the economic situation. Against this backdrop the political violence produced thousands of people with serious injuries who needed urgent medical attention.
Access to care
Medical staff at various rural district hospitals and mission hospitals around the country were prohibited from admitting victims of political violence—most notably Kotwa Rural District Hospital in Mudzi, the district which had the largest number of victims. Nevertheless, doctors and nurses risked their lives to help victims of political violence. But although there was the will to help, hospitals were under-resourced and had neither the drugs nor the capacity to meet demand.
Hospitals were also prohibited from sending their ambulances to retrieve seriously injured people in rural areas despite rural district hospitals in Zimbabwe having limited capacity to deal with people with serious injuries. Many of the victims of political violence required specialised medical care that could only be offered in Harare, where all the country’s orthopaedic specialists and x ray machines are located.
Zanu PF militia set up informal road blocks to search vehicles for victims of violence and turn back ambulances intending to assist victims of political violence. Ordinarily, ambulances are not stopped or searched at routine police road traffic checkpoints. However, from 5 April the police were instructed to stop all ambulances and ensure that no victims of political violence were transported to urban areas for better care. Scores of victims of political violence had to be kept in rural district hospitals without adequate or proper medical care. One example of political violence was in Gokwe on 20 June. People were attacked by soldiers and suffered serious injuries. Although they were admitted to Gokwe hospital, many needed immediate transfer to Harare for specialist care. However, Zanu PF militia ordered the medical staff at the hospital not to transfer them or face death. On three occasions ambulances from Harare were turned back and returned to Harare empty.
Attacks on staff
Medical staff were victims of political violence themselves. At times they were targeted because they dared treat victims of political violence or because their status in rural areas made Zanu PF militia view them with mistrust and suspicion. Reports of assault of medical staff came from several hospitals, including All Souls in Mutoko, Nyadire in Mutoko, Driefontein in Mvuma, and Murambinda in Buhera.
The true heroes are rural district hospital medical staff across the country, who are going to extraordinary lengths to attend to victims. I recently met a doctor who had travelled from a distant rural district hospital to Harare, at his expense, to seek vital drugs for his patients, who were victims of political violence. Another doctor drove five nurses who had been seriously assaulted by Zanu PF militia to Harare at night to get them medical attention. Some doctors advise their victims to indicate that they have been injured in non-political circumstances such as falling down, so that they could be admitted. Police patrol hospitals and ask to see patient records to identify political victims. Many are under 24 hour police guard, which interferes with their medical care.
Perhaps the greatest challenge to medical staff in Zimbabwe arose from the fact that Zanu PF militia started using poison to assault their victims. On 20 June in Chiweshe, Zanu militia beat people with tree branches dipped in paraquat, a herbicide that burns the skin and is highly corrosive. Some of the victims were later forced to drink the paraquat. The use of poison presented new challenges to medical staff, who are not familiar with dealing with injuries sustained from a combination of beating and use of poison. I spoke to five women in hospital in Harare whose wounds on the buttocks were not healing properly; medical staff attributed this to use of poison. To date, skin grafts have been unsuccessful.
Cite this as: BMJ 2008;337:a1303
Editorial, doi: 10.1136/bmj.a1286
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