Health services and standards in Zimbabwe, particularly for Africans, appear to be deteriorating rapidly as the guerilla war intensifies. While the regime, alive to the propaganda potential of the situation, has placed the blame for the spread of disease and declining health care on the guerillas themselves, it is clear that many health problems of a long-term nature, and distinct from the immediate casualties of the war, are the direct result of the policies and practices of the Rhodesian security forces.
Hard facts on health provision in the rural areas are not easy to come by. The official Monthly Digest of Statistics, for example, has not included figures of hospital admissions and out-patient attendances since 1976. (Up to the end of 1975, the figures showed a decline in African admissions to government hospitals from a peak of 343,700 in 1972 to 270,600 in 1975. African out-patient attendances at government hospitals declined from 4.5 million to 2.1 million over the same period) (Monthly Digest of Statistics. August 1976). Many government clinics, run by regime-appointed African councils in the TTLs, have been closed down for security reasons, but exact figures are not available. ("Racial Discrimination and Repression in Southern Rhodesia", International Commission of Jurists 1976 pp. 60-1; Debates 23.6.77; see also FOCUS No. 9 p. 10 for report of withdrawal of medical services from the border areas.)
Throughout the country as a whole there is now a serious shortage of doctors, dentists and medical personnel. The rising white emigration rate has accounted for many losses; during 1976 a total of 71 doctors left the country, a net loss of 46. White, Asian and Coloured male doctors who remain, and who are under the age of 50, are liable for conscription for up to six months of the year. Some have certainly been killed while on military service. Government-provided medical services, where salaries are about half the incomes that can be commanded by doctors in private practice, have been hit the hardest by these staff shortages. Increasing demand by the security forces for specialised medical care, not to mention white civilian war casualties, is also likely to be reflected in a deteriorating service for the African majority.
At least ½ million Africans in the rural areas are now living in protected and consolidated villages. Many accounts are available of the overcrowded and insanitary conditions prevailing "behind the wire". In a transit camp at Gutsa in the Zambezi valley at the end of 1973, for example, only three water taps were available for nearly 3,000 residents and two African orderlies for medical attention. Four to five people were reported to be dying each day from cholera or measles. (A.K.H. Weinrich: "Strategic Resettlement in Rhodesia", Journal of Southern African Studies April 1977 Vol. 3 No. 2). In the Chiweshe TTL, where the people were removed into protected villages in 1974, a 15 yard square patch was provided for each family to build a shelter, dig a pit latrine, and accommodate chickens and small livestock. The latrines soon overflowed, resulting in widespread typhoid and diarrhoea. Curfew regulations prevented residents from travelling to attend the nearest hospital outpatient department.
While sanitary and immediate living conditions in some protected villages may have been improved since the first removals were undertaken, particularly in areas close to Salisbury and accessible to journalists and visitors (such as Chiweshe), there is now evidence that malnutrition is on the increase. According to a report by the World Vision evangelical organisation in the US, following a visit by its president to Keep 13 in the Chiweshe TTL, the protected villages are witnessing an "alarming" increase in malnutrition, people are dying of starvation, and children are dying of enteritis "in large numbers". The findings have been substantially confirmed by the Canadian superintendent of the Salvation Army's Howard Hospital at the southern tip of the Chiweshe TTL. A University of Rhodesia medical research team based in Chiweshe also "came across a tremendous amount of malnutrition". Curfew regulations, and the long distance which the inmates of protected villages frequently have to walk to reach their fields, mean that far less time is spent on cultivation than in the past, while crops cannot be protected from wild animals. Crops and livestock are frequently destroyed or impounded by the security forces to prevent them being used by guerillas. The amount of land being worked is less and food is consequently in short supply.
Illness of a more sinister character has also been reported from the protected villages. According to a written report from a "reliable resident" of Mukumbura protected village in the Zambezi valley, at the end of 1974, people had begun to suffer from a strange sickness with the onset of the rains. "They start shaking and then they die... Children die almost daily and some adults have also died... On 27 November 1974 the doctor was here and he stated that the deaths were caused by poisoning: the army had used defoliants in May to clear the no-go area of vegetation. By now the rains have washed the chemicals into the soil and plants have absorbed the poison." A member of the Chicago Committee for African Liberation who visited Doiroi camp in Mozambique for Zimbabwean refugees, in February 1977, reported an ailment known as the "hurricane". Those affected walked with an erratic shaking gait; later they fell down paralyzed and moaning. There was speculation in the camp that it was the result of contamination from herbicides used by the security forces. Other refugees were affected by forms of paralysis and nervous spasms, seemingly resulting from experience of extreme fear.
It is to be expected that many serious health problems will result from a war situation. Much of the regime's response seems to have consisted of capitalising on the propaganda value of the claim that the liberation movement is directly responsible for the spread of disease. Leaflets have been distributed in the TTLs, for example, warning residents that "the mad dog communist terrorists of ZANU/ZANLA" have infected many women with venereal disease. After such an allegation had been made, few of those affected would presumably risk attending a government-run clinic for treatment.
