Zimbabwe’s current cholera epidemic has killed more than 1,100 people and sickened nearly 24,000, prompting the United States, the United Kingdom, and some African nations to press for sanctions on—and the resignation of—President Robert Mugabe. The impoverished country ranks 151 out of 177 on the UN Human Development Index and has an average life expectancy of 34 for women and 37 for men. Although it has suffered yearly cholera outbreaks since 1998, this year’s epidemic dwarfs previous ones. The epidemic is being aggravated by severe food shortages and the country’s high prevalence of HIV/AIDS, and is expected to continue through the end of the rainy season in March.

After opposition leader Morgan Tsvangirai came out ahead in the March 2008 presidential election, Mugabe promised to implement a power-sharing deal with Tsvangirai. Instead, he has continued to persecute opposition leaders and supporters, forcing Tsvangirai to flee to Botswana. Yet the past several days have witnessed a striking hardening of Western and African governments’ rhetoric against Mugabe. “We have lost confidence in the power-sharing deal being a success with Mugabe in power. He has lost touch with reality,” said U.S. Assistant Secretary for African Affairs Jendayi Frazer on Sunday. Could cholera have been the last straw?

According to the World Health Organization (WHO), in 2004, 81 percent of Zimbabweans had sustainable access to an improved water source, and 53 percent had access to improved sanitation. If anything, these figures have likely declined since then, as Zimbabwe’s economy and infrastructure have continued to crumble. Doctors and nurses protested earlier this month over poor working conditions and unpaid wages. “We are forced to work without basic health institutional needs like drugs, adequate water and sanitation, safe clothing gear, medical equipment and support services,” said a letter from the Zimbabwe Doctors’ Association.

The case of Beitbridge, which is a major stopping-point for travellers bound for South Africa, highlights how domestic problems can quickly become international ones in today’s globalized world. According to the WHO:

The [cholera] outbreak was explosive, peaking between 14-24 November, and spilling over into neighbouring South Africa, where the area around Masina has since been declared a disaster zone. As of 10 December, the outbreak was slowly subsiding. Altogether, some 3456 cases had been treated as of the same date. As the Christmas holidays approach, traffic through Beitbridge is expected to increase, and could lead to larger outbreaks, with the potential for fresh propagation within both Zimbabwe and South Africa.

You probably recall the global alarm over SARS in 2003 and extremely drug-resistant tuberculosis in 2007. Disease is increasingly becoming a matter of foreign policy, state stability, and national sovereignty, and when—as with cholera and water and sanitation—the disease is due to poor environmental management, a country’s environmental health can also become the concern of other nations. “I don’t know how much longer people can let this [cholera epidemic] go on, claiming that it is somehow an internal matter. It is not,” said U.S. Secretary of State Condoleezza Rice earlier this week. Venezuelan President Hugo Chavez, who has supported Mugabe, has a different view: Last Friday, he warned other countries not to use the cholera epidemic to “politically destabilize” Zimbabwe’s government. It seems that the debate over when disease becomes an international issue rages on.

Photo: Cholera patients in Beitbridge, Zimbabwe, receive treatment from the medical NGO Médecins Sans Frontières. Courtesy of Médecins Sans Frontières and Flickr user Sokwanele – Zimbabwe.