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As outbreaks spread worldwide, health officials are worried that more deaths will follow in countries already struggling with drought and war

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At a relative's house in Harare, capital of Zimbabwe, Jessica Muzambezi is still grieving for her two-year-old son, Jadon, who died of cholera.Jeffrey Moyo/The Globe and Mail

When Jessica Muzambezi woke up one morning and saw that raw sewage was leaking from a burst pipe into the street near her home, she tried to keep her two-year-old son Jadon inside. But the soccer-loving boy was unhappy being kept indoors, and eventually he escaped onto the street to kick a ball around.

Within a day, Jadon was vomiting and suffering stomach pains. His parents took him to a clinic and then a hospital. Less than a week later, he was dead from cholera – one of the suspected 178 cholera deaths and 10,336 cases in Zimbabwe this year.

“We don’t have a child anymore,” Ms. Muzambezi said. “He was our only child. It is painful. We’ve been left with a wound.”

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Jadon, as he looked before his illness. He died of cholera on Nov. 7.Courtesy of Jessica Muzambezi

As cholera spreads across the country, more than 10 million Zimbabweans are now at risk of contracting the water-borne disease, which can kill within hours if untreated, health workers say.

This is the third such outbreak in the country since 2008, a sign of Zimbabwe’s collapsing infrastructure and worsening corruption.

It is not alone. The World Health Organization said in a situation report last month that the number of cholera infections worldwide by mid-October had already exceeded the numbers in recent years, with more than 603,000 cases and more than 3,800 deaths in 29 countries. Case fatality rates are the highest in a decade.

Cholera has become a key indicator of collapse in social stability. Most of the countries with cholera outbreaks this year are also enduring parallel humanitarian crises, such as wars, hunger, drought, flooding or earthquakes, the WHO said.

It cited examples such as Syria, Yemen, Afghanistan, Somalia, Sudan, Ethiopia, Cameroon and the Democratic Republic of the Congo.

“Based on the large number of outbreaks and their geographic expansion, as well as a lack of vaccines and other resources, WHO continues to assess the risk at global level as very high,” the agency said.

“Health systems can easily become overwhelmed, hindering not only the ability to mount effective and timely responses but also to establish appropriate preventive measures in the first place,” it added.

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A Syrian child gets vaccinated for cholera this past March in Maaret Misrin, a town in rebel-held Idlib province. Syria is one of several countries where the World Health Organization is worried about cholera.OMAR HAJ KADOUR/AFP via Getty Images

A boy with cholera symptoms gets treatment in the Cité Soleil slum of Port-au-Prince this past May. Cholera causes watery diarrhea, vomiting and thirst; in severe cases, dehydration can be fatal. Ariana Cubillos/The Associated Press
Cholera and dengue patients wait at a hospital in Gedaref city, Sudan, on Sept. 27. Disease has grown worse since civil war broke out in the African country this past April. AFP via Getty Images

In Sudan, where a catastrophic civil war has destroyed much of the country since April, more than 5,170 cholera cases and 160 deaths have been reported in the past two months, according to a United Nations report on Monday. More than 3.1 million people in Sudan are at risk of cholera, the UN says. Relief agencies have sent 2.2 million doses of cholera vaccines to Sudan in recent weeks.

And then there are countries such as Zimbabwe. The poor sanitation that has caused its cholera outbreaks is linked not to war or earthquakes, but to corruption and mismanagement by the authoritarian regime that has ruled the country for more than four decades. Zimbabwe’s economy has been near collapse for the past 15 years, with high inflation and unemployment.

Some of the latest deaths have affected the same areas and families that were devastated by an earlier epidemic in 2008, leaving survivors in disbelief and despair. The 2008 epidemic killed more than 4,000 Zimbabweans and sickened nearly 100,000 people, yet little seems to have changed since then. Many homes are still without safe running water or are dependent on dangerously shallow wells. Massive piles of garbage are often uncollected.

In the neglected low-income suburbs of Zimbabwe’s capital, Harare, where cholera has been killing scores of people this year, many residents say the city’s workers demand bribes of about US$60 before they’re willing to repair broken pipes.

“Whenever a sewage pipe bursts, the city workers ask us to collect the money from the residents,” said Jadon’s father, Joseph Kanjanda, a street vendor who sells second-hand clothes and cheap groceries.

“Our challenge is to find water,” he added. “And water is scarce even if we find it. So sometimes people just fetch water from unprotected open wells.”

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Joseph Kanjanda, Jadon's father, says finding clean water is a challenge in his community, so many drink from unprotected sources where cholera can be transmitted.Jeffrey Moyo/The Globe and Mail

In Glenview, a high-density suburb of Harare, uncollected garbage piles up at a shopping centre and a contaminated sewer passes beneath an illegally built house. Jeffrey Moyo/The Globe and Mail

One Harare resident, Wellington Mariga, has filed a lawsuit against the national and municipal governments, arguing that their failure to provide an adequate amount of safe drinking water is a breach of the country’s constitution. He is accusing them of “dereliction of duty” for allowing the cholera outbreak to continue since February, according to his legal representatives at the non-profit Zimbabwe Lawyers for Human Rights.

In response to the cholera cases, Harare has declared an emergency, and the Zimbabwean government has imposed restrictions on public gatherings and food vendors. It has also distributed water-treatment tablets to residents. But this ignores the underlying crisis, analysts say.

Precious Shumba, director of the Harare Residents’ Trust, a citizens’ group, said the cholera outbreak is largely a result of aging and dilapidated water and sewer systems. In some older suburbs, the water and sewage pipes are “clogged with sand and other debris, and burst sewers are filtering into the underground water,” Mr. Shumba said.

Joyleen Nyachuru, a human rights activist and community water officer in the Harare suburb where Jadon died, said the same suburb was badly hit by cholera deaths in 2008.

“People dig their own water wells at their homes, not realizing that the well water is contaminated with sewage from underneath,” she said.

“There was a time when the authorities would bring water to the residents in tanks, but that stopped, leaving people exposed to cholera. So people keep sourcing water from wells exposed to sewage, the same water they use to clean and cook. As a result, most residents are now forced to purchase bottled water, which is expensive.”

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Marjory Mutuwira is happy to be alive after her recent experience with cholera, the disease that killed her husband in 2008.Jeffrey Moyo/The Globe and Mail

Marjory Mutuwira, a neighbour of Jadon’s family, was deeply affected by the 2008 cholera epidemic, which killed her husband. Today the 69-year-old widow is in the grip of cholera again.

After seeing pools of raw sewage in the streets from burst pipes, she and her neighbours went to the city government to report the problem. But nothing was done, despite promises. Her yard flooded with sewage, and her toilet was blocked and overflowing.

She tried to sweep away the sewage from her yard with a broom. But two days after Jadon died, she fell sick with cholera herself and was rushed to hospital. Two of her granddaughters also became sick, although all recovered.

“I’m afraid and angry,” Ms. Mutuwira said. “How is it possible for me to succumb, years later, to the same disease that killed my husband? Why is there cholera here in Zimbabwe?”

Another neighbour, 68-year-old Linda Chirume, said her three-year-old grandson was treated for cholera in hospital around the same time. Days later, Ms. Chirume became sick too, but recovered after drinking a salt-and-sugar solution in boiled water – the recommended home treatment.

“So many people in this area suffered from stomach pains and vomiting,” she said. “I don’t know what we can do about this disease which has invaded our community. We can’t live like this, sweeping flowing sewage every time.”

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Linda Chirume has recovered from cholera, but worries for her neighbours as the disease spreads.Jeffrey Moyo/The Globe and Mail

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