As Zimbabwe's health ministry declares a national emergency over its cholera outbreak, Zimbabwean refugees fleeing deprivation there are living in South Africa in dismal conditions. Many are living without shelter, exposed to the weather and without regular access to toilets, food and clean water, increasing the likelihood that cholera and other disease will spread. The outbreak has been fueled by the total collapse of the health care and public sanitation systems in Zimbabwe, which has recorded more than 650 deaths and 12,500 cases since August. The World Health Organization says the death rate is three times that for cholera outbreaks handled properly. In its 2008 report on Zimbabwean refugees in South Africa, "Neighbors in Need," Human Rights Watch documented how cholera outbreaks in Zimbabwe are increasing as Zimbabwe's water and sanitation systems collapse.