Zimbabwe's cholera crisis is likely to spread in South Africa if conditions do not improve for asylum seekers pouring over the border to escape the outbreak, a leading human rights group says.
"The lack of access to sanitation and clean water for refugees" has contributed to an outbreak of the illness across the southern border, Human Rights Watch (HRW) said in a statement on Thursday.
"Abysmal living conditions for asylum seekers" in the border town Musina is set to "increase the risk that cholera will spread on the South African side," said Washington-based HRW fellow Rebecca Shaeffer.
"Many asylum seekers are living completely without shelter in Musina," she said, adding that the refugees -- who are pouring into South Africa at a rate of 500 a day -- are living "exposed to the weather and without regular access to toilets, showers, food and clean water."
Some 1,000 asylum seekers are "staying on fenced-in showgrounds in Musina as they wait to lodge their asylum claims, and are fearful of arrest and deportation if they leave," said Shaeffer.
Roughly 200 to 400 refugees are arrested and deported back to Zimbabwe from Musina each day, she said.
South Africa currently reports 455 cholera cases, including seven deaths.
Health authorities have set up five cholera treatment centres along the border to handle the influx, but are set to be overwhelmed if the disease spreads.
In a perpetuating cycle, the worse the outbreak becomes in Zimbabwe, the more likely it is that refugees continue to cross the border to escape, fueling the strain on health services in neighbouring countries.
In Zimbabwe, the breakdown of the nation's infrastructure has helped cholera thrive.
The outbreak has been fueled "by the total breakdown in the health care system," said Shaeffer.
Government and UN figures show that more than 560 deaths and 12,500 cases have been recorded since August.
On Wednesday Zimbabwe's state-run Herald daily declared the outbreak a national emergency and appealed for international aid to tackle the epidemic.
The World Health Organisation estimates that 4.5 per cent of people who have contracted cholera in Zimbabwe have died.
The normal fatality rate, HRW said, is below one per cent, when infection is properly managed with oral rehydration salts and medicines.
"Cholera outbreaks have repeatedly occurred in recent years, as (Zimbabwe's) water and sanitation systems have broken down," HRW said in a 2008 report on Zimbabweans seeking refuge in South Africa.
"Electric power outages and shortages of chemicals to treat water have interrupted water supplies and compelled individuals to drink untreated water contaminated with faecal matter.
"At least six million people in Zimbabwe -- about half the population -- do not have access to clean water or sanitation," the report said.
Neighbouring Mozambique reported this week 278 cases of cholera, including nine deaths. Botswana has reported two cases.