One international health expert told Human Rights Watch that “The cholera outbreak is an indication of the general collapse in the health system. This… outbreak is [such as] we have never seen in Zimbabwe.”44 According to health experts, the high mortality in the current outbreak is exacerbated by severe malnutrition and high rates of HIV prevalence.45 While exploding only in the past few months, Zimbabwean authorities had been aware of the potential for a massive cholera epidemic for nearly a year. In December 2007, 459 cases of cholera were reported in two high-density suburbs of Harare and 11 people died from cholera and more than 300 were hospitalized in Bulawayo.46 Repeated calls to address the epidemic and to ensure that municipal water sources were properly treated were unaddressed by the government. In response to a lack of water purification chemicals and electrical shortages, the national water board cut off all water supplies to Harare residents in early December 2008.47 However, the Zimbabwe authorities failed to anticipate the consequences. While capacity to respond may have been undermined by a lack of medical and financial resources, health experts say the authorities initially refused to acknowledge the true extent of the cholera crisis and the urgent need to respond.48 Despite an alarming increase in cholera deaths, infections and their locations, the government did not immediately appeal for international help and initially refused to declare the outbreak an emergency. One international health expert told Human Rights Watch: “By the time the government called us in to assist, over 200 people had been infected in just one…Harare…suburb. A faster response may have prevented the spread of the disease.”49 44 Human Rights Watch interview with health expert, Harare, November 24, 2008. 45 Human Rights Watch interviews with health experts, Harare, November 24 and 25, 2008. 46 Human Rights Watch, “Neighbors in Need: Zimbabweans Seeking Refuge in South Africa,” June 2008, http://www.hrw.org/en/reports/2008/06/18/neighbors-need-0. 47 Peta Thornycroft, Patience Rusere, James Butty & Irwin Chifera, “Zimbabwe Cholera Crisis Mounts As Harare Water System Shut Down,” VOA news, December 1, 2008, http://www.voanews.com/english/archive/2008-12/2008-12-01voa65.cfm?CFID=88834910&CFTOKEN=80667442&jsessionid=00308957b76f5eadc4667e442139713c1d24, (accessed December 1, 2008). 48 Human Rights Watch interviews with health experts, Harare, November 24 and 25, 2008. 49 Human Rights Watch interview with health expert, Harare, November 24, 2008. Crisis without Limits 18