Treat with extreme caution

Homoeopathic medicine is founded on a bogus philosophy. Its continued use is a drain on NHS resource

Two years ago, a loose coalition of like-minded scientists wrote an open letter to chief executives of the National Health Service Trusts. The signatories simply stated that homoeopathy and other alternative therapies were unproven, and that the NHS should reserve its funds for treatments that had been shown to work. The letter marked an extraordinary downturn in the fortunes of homoeopathy in the UK over the following year, because the overwhelming majority of trusts either stopped sending patients to the four homoeopathic hospitals, or introduced measures to strictly limit referrals.

Consequently, the future of these hospitals is now in doubt. The Tunbridge Wells Homoeopathic Hospital is set to close next year and the Royal London Homoeopathic Hospital is likely to follow in its wake. Homoeo paths are now so worried about the collapse of their flagship hospitals that they are organising a march to deliver a petition to Downing Street on 22 June. Local campaign groups are being formed and patients are being urged to sign the petition.

Homoeopaths believe that the medical Establishment is crushing a valuable healing tradition that dates back more than two centuries and that still has much to offer patients. Homoeopaths are certainly passionate about the benefits of their treatment, but are their claims valid, or are they misguidedly promoting a bogus philosophy?

This is a question that I have been considering for the past two years, ever since I began co-authoring a book on the subject of alternative medicine with Professor Edzard Ernst. He was one of the signatories of the letter to the NHS trusts and is the world's first professor of complementary medicine. Before I present our conclusion, it is worth remembering why homoeo pathy has always existed beyond the borders of mainstream medicine.

Homoeopathy relies on two key principles, namely that like cures like, and that smaller doses deliver more powerful effects. In other words, if onions cause our eyes to stream, then a homoeopathic pill made from onion juice might be a potential cure for the eye irritation caused by hay fever. Crucially, the onion juice would need to be diluted repeatedly to produce the pill that can be administered to the patient, as homoeopaths believe that less is more.

Initially, this sounds attractive, and not dissimilar to the principle of vaccination, whereby a small amount of virus can be used to protect patients from viral infection. However, doctors use the principle of like cures like very selectively, whereas homoeopaths use it universally. Moreover, a vaccination always contains a measurable amount of active ingredient, whereas homoeopathic remedies are usually so dilute that they contain no active ingredient whatsoever.

A pill that contains no medicine is unlikely to be effective, but millions of patients swear by this treatment. From a scientific point of view, the obvious explanation is that any perceived benefit is purely a result of the placebo effect, because it is well established that any patient who believes in a remedy is likely to experience some improvement in their condition due to the psychological impact. Homoeopaths disagree, and claim that a "memory" of the homoeopathic ingredient has a profound physiological effect on the patient. So the key question is straightforward: is homoeopathy more than just a placebo treatment?

Fortunately, medical researchers have conducted more than 200 clinical trials to investigate the impact of homoeopathy on a whole range of conditions. Typically, one group of patients is given homoeopathic remedies and another group is given a known placebo, such as a sugar pill. Researchers then examine whether or not the homoeopathic group improves on average more than the placebo group. The overall conclusion from all this research is that homoeopathic remedies are indeed mere placebos.

In other words, their benefit is based on nothing more than wishful thinking. The latest and most definitive overview of the evidence was published in the Lancet in 2005 and was accompanied by an editorial entitled "The end of homoeopathy". It argued that ". . . doctors need to be bold and honest with their patients about homoeopathy's lack of benefit".

An unsound investment

However, even if homoeopathy is a placebo treatment, anybody working in health care will readily admit that the placebo effect can be a very powerful force for good. Therefore, it could be argued that homoeopaths should be allowed to flourish as they administer placebos that clearly appeal to patients. Despite the undoubted benefits of the placebo effect, however, there are numerous reasons why it is unjustifiable for the NHS to invest in homoeopathy.

First, it is important to recognise that money spent on homoeopathy means a lack of investment elsewhere in the NHS. It is estimated that the NHS spends £500m annually on alternative therapies, but instead of spending this money on unproven or disproven therapies it could be used to pay for 20,000 more nurses. Another way to appreciate the sum of money involved is to consider the recent refurbishment of the Royal Homoeopathic Hospital in London, which was completed in 2005 and cost £20m. The hospital is part of the University College London Hospitals NHS Foundation Trust, which contributed £10m to the refurbishment, even though it had to admit a deficit of £17.4m at the end of 2005. In other words, most of the overspend could have been avoided if the Trust had not spent so much money on refurbishing the spiritual home of homoeopathy.

Second, the placebo effect is real, but it can lull patients into a false sense of security by improving their sense of well-being without actually treating the underlying conditions. This might be all right for patients suffering from a cold or flu, which should clear up given time, but for more severe illnesses, homoeopathic treatment could lead to severe long-term problems. Because those who administer homoeopathic treatment are outside of conventional medicine and therefore largely unmonitored, it is impos sible to prove the damage caused by placebo. Never theless, there is plenty of anecdotal evidence to support this claim.

For example, in 2003 Professor Ernst was working with homoeopaths who were taking part in a study to see if they could treat asthma. Unknown to the professor or any of the other researchers, one of the homoeopaths had a brown spot on her arm, which was growing in size and changing in colour. Convinced that homoeopathy was genuinely effective, the homoeopath decided to treat it herself using her own remedies. Buoyed by the placebo effect, she continued her treatment for months, but the spot turned out to be a malignant melanoma. While she was still in the middle of treating asthma patients, the homoeopath died. Had she sought conventional treatment at an early stage, there would have been a 90 per cent chance that she would have survived for five years or more. By relying on homoeopathy, she had condemned herself to an inevitably early death.

The third problem is that anybody who is aware of the vast body of research and who still advises homoeopathy is misleading patients. In order to evoke the placebo effect, the patient has to be fooled into believing that homoeopathy is effective. In fact, bigger lies encourage bigger patient expectations and trigger bigger placebo effects, so exploiting the benefits of homoeopathy to the full would require homoeopaths to deliver the most fantastical justifications imaginable.

Over the past half-century, the trend has been towards a more open and honest relationship between doctor and patient, so homoeopaths who mislead patients flagrantly disregard ethical standards. Of course, many homoeopaths may be unaware of or may choose to disregard the vast body of scientific evidence against homoeo pathy, but arrogance and ignorance in health care are also unforgivable sins.

If it is justifiable for the manufacturers of homoeopathic remedies in effect to lie about the efficacy of their useless products in order to evoke a placebo benefit, then maybe the pharmaceutical companies could fairly argue that they ought to be allowed to sell sugar pills at high prices on the basis of the placebo effect as well. This would undermine the requirement for rigorous testing of drugs before they go on sale.

A fourth reason for spurning placebo-based medicines is that patients who use them for relatively mild conditions can later be led into dangerously inappropriate use of the same treatments. Imagine a patient with back pain who is referred to a homoeopath and who receives a moderate, short-term placebo effect. This might impress the patient, who then returns to the homoeopath for other advice. For example, it is known that homoeopaths offer alternatives to conventional vaccination - a 2002 survey of homoeopaths showed that only 3 per cent of them advised parents to give their baby the MMR vaccine. Hence, directing patients towards homoeo paths for back pain could encourage those patients not to have their children vaccinated against potentially dangerous diseases.

Killer cures

Such advice and treatment is irresponsible and dangerous. When I asked a young student to approach homoeopaths for advice on malaria prevention in 2006, ten out of ten homoeopaths were willing to sell their own remedies instead of telling the student to seek out expert advice and take the necessary drugs.

The student had explained that she would be spending ten weeks in West Africa; we had decided on this backstory because this region has the deadliest strain of malaria, which can kill within three days. Nevertheless, homoeopaths were willing to sell remedies that contained no active ingredient. Apparently, it was the memory of the ingredient that would protect the student, or, as one homoeopath put it: "The remedies should lower your susceptibility; because what they do is they make it so your energy - your living energy - doesn't have a kind of malaria-shaped hole in it. The malarial mosquitoes won't come along and fill that in. The remedies sort it out."

The homoeopathic industry likes to present itself as a caring, patient-centred alternative to conventional medicine, but in truth it offers disproven remedies and often makes scandalous and reckless claims. On World Aids Day 2007, the Society of Homoeopaths, which represents professional homoeopaths in the UK, organised an HIV/Aids symposium that promoted the outlandish ambitions of several speakers. For example, describing Harry van der Zee, editor of the International Journal for Classical Homoeo pathy, the society wrote: "Harry believes that, using the PC1 remedy, the Aids epidemic can be called to a halt, and that homoeopaths are the ones to do it."

There is one final reason for rejecting placebo-based medicines, perhaps the most important of all, which is that we do not actually need placebos to benefit from the placebo effect. A patient receiving proven treatments already receives the placebo effect, so to offer homoeopathy instead - which delivers only the placebo effect - would simply short-change the patient.

I do not expect that practising homoeopaths will accept any of my arguments above, because they are based on scientific evidence showing that homoeopathy is nothing more than a placebo. Even though this evidence is now indisputable, homoeopaths have, understandably, not shown any enthusiasm to acknowledge it.

For now, their campaign continues. Although it has not been updated for a while, the campaign website currently states that its petition has received only 382 signatures on paper, which means that there's a long way to go to reach the target of 250,000. But, of course, one of the central principles of homoeopathy is that less is more. Hence, in this case, a very small number of signatures may prove to be very effective. In fact, perhaps the Society of Homoeopaths should urge people to withdraw their names from the list, so that nobody at all signs the petition. Surely this would make it incredibly powerful and guaranteed to be effective.

"Trick or Treatment? Alternative Medicine on Trial" (Bantam Press, £16.99) by Simon Singh and Edzard Ernst is published on 21 April

Homoeopathy by numbers

3,000 registered homoeopaths in the UK

1 in 3 British people use alternative therapies such as homoeopathy

42% of GPs refer patients to homoeopaths

0 molecules of an active ingredient in a typical "30c" homoeopathic solution

$1m reward offered by James Randi for proof that homoeopathy works

This article first appeared in the 21 April 2008 issue of the New Statesman, Food crisis

FRÉDÉRIC COURBET/PANOS PICTURES
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The last days of Robert Mugabe

Zimbabwe is engulfed, and not only by a political crisis. While its leaders fight, its economy is in meltdown.

This article is from the New Statesman's Christmas issue. Take advantage of our special offers and get a subscription for yourself or a loved one this Christmas.

With considerable trepidation, I took the lift to the sixth floor of the ministry of justice in central Harare to interview the minister. It wasn’t just that I lacked the accreditation foreign journalists must obtain to work in Zimbabwe – the interview had been arranged through unofficial back channels. The minister, Emmerson Mnangagwa, also happens to be the vice-president, Robert Mugabe’s notoriously brutal chief enforcer for the past 36 years, and the most feared man in the country. “They don’t call him ‘The Crocodile’ for nothing,” said a Zimbabwean businessman who knows him well. “He never says a word but suddenly he bites. He’s very dangerous.”

But Mnangagwa, still powerfully built at 74, proved courteous enough as we sat in deep leather armchairs in his bright and spacious office. It was not in his interest to be hostile – not at this time. He is determined to succeed Mugabe and he will need Western support to rebuild his shattered country if he does, which is presumably why he gave me an almost unprecedented interview.

Aged 92 and the world’s oldest head of state, Robert Mugabe is fading. He falls asleep in meetings, suffers memory lapses and stumbles on steps. He delivered the wrong speech at the opening of parliament in September last year and had to deliver the right one to a specially convened session the following day. As long ago as 2008 a WikiLeaks cable from the US ambassador reported that he had terminal prostate cancer, and he frequently flies to Singapore for unspecified medical treatment – blood transfusions, perhaps, or steroid injections. A diplomatic source talked of Mugabe’s “dramatic deterioration in the last two years”, and said: “He could go at any point.”

Mnangagwa did not admit he wants to be president, of course. Given Mugabe’s paranoia, that would have been political suicide. On the contrary, he was studiously loyal. When I asked which politician he most admired he immediately replied: “The president.” He refused to discuss the possibility of Mugabe dying. “Under British constitutional law you don’t conceive or desire the demise of Your Majesty. Why would you want to conceive or desire the demise of my president?” he asked. He even denied that he would seek Mugabe’s job when, to borrow the euphemism with which some Zimbabweans refer to the coming cataclysm, “the portrait falls off the wall”.

“I don’t see myself doing that,” he said. Of the decades he had worked with Mugabe, he said, “I was not serving to be president. I was serving my country.”

Nobody will believe Mnangagwa’s denial – certainly not close allies such as Christopher Mutsvangwa, a former Zimbabwean ambassador to China and the leader of the “war veterans” who seized the country’s white-owned farms in the 2000s.

I had met Mutsvangwa a few days earlier in the unlikely setting of a coffee shop in the affluent Harare suburb of Mount Pleasant. It was another encounter between a senior regime figure and a Western journalist of a sort that is becoming increasingly possible in the turbulence of Mugabe’s twilight days. Mutsvangwa told me he was “100 per cent” sure that Mnangagwa would be Zimbabwe’s next president. Indeed, he and other allies of the vice-president are already locked in a vicious struggle over the succession with Mnangagwa’s potential rivals in the ruling Zanu-PF party.

Grace Mugabe, 51, the president’s intensely ambitious and avaricious wife, set things going in late 2014 after her husband made her the head of Zanu-PF’s Women’s League and a member of the party’s Politburo. She persuaded Mugabe to expel the previous vice-president, Joice Mujuru, and her supporters from the party for allegedly plotting against the president. Mujuru – who as a teenage guerrilla during Zimbabwe’s war of independence in the 1970s gave birth in the bush, shot down a helicopter with a rifle and earned the nom de guerre Teurai Ropa (“Spill Blood”) – has now set up an opposition party, Zimbabwe People First (ZPF).

Having disposed of Mujuru, Grace and a group of “Young Turks” known as Generation 40, or G40, then turned their attention to Mnangagwa, seeking to oust him as vice-president and purge his supporters from critical posts in Zanu-PF. Grace made no secret of her ambitions, flying round the country in the presidential helicopter to address “meet the people” rallies. “They say I want to be president. Why not? Am I not Zimbabwean?” she asked. To give herself gravitas, she acquired a PhD from the University of Zimbabwe in three months; the degree was presented to her by the chancellor – her husband.

But Mnangagwa has his own cabal of older party members who fought in the liberation war and despise the G40 “upstarts”, who did not – Mutsvangwa calls them “power-grabbers” and “village head boys”. His so-called Lacoste faction (the clothing company’s emblem is a crocodile) has hit back hard, using Mnangagwa’s control of Zimbabwe’s Anti-Corruption Commission to launch high-profile criminal investigations against G40 leaders. For good measure, Mutsvangwa’s war vets have turned on Mugabe himself. In July they issued a communiqué condemning his “dictatorial tendencies . . . which have slowly devoured the values of the liberation struggle”. In November they sacked him as their patron.

A secret Zanu-PF document passed to me by a reliable source shows how sulphurous the infighting has become. Emanating from Mnangagwa’s camp, it accuses G40 of plotting “political euthanasia” against the party’s founding generation and of “coercing the First Lady into a spirited campaign against VP Mnangagwa”.

The document suggests Mugabe himself created G40 because, behind his “feigned love” for his deputy, he “has always felt threatened by VP Mnangagwa and the prospect of his presidency being outshined by that of his protégé”.

The nine-page document then sets out a detailed plan to destroy G40’s leaders through “brutal character assassination”, fomenting “fights and chaos” within the group, and sowing “seeds of distrust” between G40 and Grace Mugabe.

In short, the party that has governed Zimbabwe since 1980 is sundered as never before. Beneath the bright-blue jacaranda and orange flamboyant trees that shade Harare’s broad avenues, vendors hawk newspapers that gleefully proclaim “Crunch time for Zanu-PF factions”, “Zanu-PF implodes” and “Blood on the floor”. “They’re at each other’s throats and it’s not unlikely it will end in a violent confrontation,” Ibbo Mandaza, a political analyst in Harare, told me.

But Zimbabwe is engulfed, and not only by a political crisis: while its leaders fight, its economy is in meltdown.

 

***

 

In the 2000s Robert Mugabe destroyed agriculture, the mainstay of the Zimbabwean economy, by seizing farms owned by whites and giving them to his cronies. Now the country’s industrial base is collapsing for lack of investment: it imports twice as much as it exports. The international financial institutions will lend the regime no more money without root-and-branch reforms and repayment of its $1.8bn arrears. Having abandoned its national currency in 2009, when inflation reached 500 billion per cent, Zimbabwe is quite literally running out of the US dollars that it has used for cash ever since.

“It’s a disaster of the worst order. We are in an economic recession that’s fast-tracking itself into an economic depression,” said Tendai Biti, an outspoken lawyer and opposition politician who served as finance minister for the Movement for Democratic Change in Zimbabwe’s ill-fated government of national unity between 2008 and 2013. “The regime can rig elections but they can’t rig the economy,” he said, as we chatted in his cluttered office in central Harare.

The government’s response to the liquidity crisis has been to issue bond notes as a surrogate currency – a move likely to make matters even worse. Nobody trusts the Monopoly-type notes, which look like ordinary currency and carry the words “Reserve Bank of Zimbabwe”. They believe the Treasury will print them with the same reckless abandon with which it printed Zimbabwean dollars in the late 2000s. Those who can are rapidly moving their US dollars out of the country, accentuating the cash shortage. Zimbabwe is bracing itself for a return of hyperinflation, fuel shortages and empty supermarket shelves.

The manifestations of economic collapse are already apparent. Driving around central Harare, I saw outside every bank the long queues that form before dawn each day because withdrawals are now limited to $50 or less per person per diem. The industrial estates of southern Harare are full of shuttered and closed-down factories: John Robertson, an economist based in Harare, reckons the industrial base has contracted 65 per cent since 2000. In a country where unemployment exceeds 80 per cent, street vendors, beggars and – at night – teenage prostitutes proliferate. The small number of adults who are employed mostly work in a public sector bloated by “ghost jobs” reserved for Zanu-PF supporters.

In rural areas the situation is even worse. Ben Freeth, a white farmer who was forcibly evicted by the war vets in 2009, sneaked me in to Mount Carmel, his family’s former property 110 kilometres west of Harare. He showed me the barren fields where maize and sunflowers once grew in abundance, and the dying mango and citrus orchards that used to produce 1,200 tonnes of fruit a year. The farm’s 2,400 hectares were commandeered by a then cabinet minister, Nathan Shamuyarira; today they yield nothing.

Freeth now farms 100 acres of rented land, but his former workers have suffered far worse than he has. We met some of them in the ruins of Freeth’s home that the war vets torched. They had no money, no food, no running water or electricity. They could no longer afford to send their children to school. Though it was planting season, they could not afford seeds to grow maize. “It was a good life, but now we’re starving,” Peter Asani, Freeth’s old foreman, said.

We drove on to the nearby town of Chegutu, which is dominated by 12 towering silos, each capable of holding 5,000 tonnes of grain. An employee told us just one was full, though the harvest had only recently ended and Chegutu is surrounded by some of Zimbabwe’s richest farmland. Instead, workers were unloading a goods train bringing maize from neighbouring Mozambique. “This used to be the grain basket of southern Africa, and here we are importing maize to prevent us starving,” Freeth said.

We stopped at the David Whitehead textiles factory, which once employed 4,000 people but closed in 2012. Today a few gaunt men are guarding the premises. They are paid four loaves of bread a day by the owners, and pass the time playing draughts with bottle tops on cardboard. They turn up in the forlorn hope that they will be first in the queue for jobs, should the factory ever reopen, and because there is no other work. “If I don’t do this what else would I do?” one of the men said.

Zimbabweans are mostly gentle, passive people, but even their capacity for stoic endurance has limits. Last spring and summer Harare witnessed protests on a scale the country had seldom seen before. Bypassing the splintered and ineffectual opposition parties, activists used Facebook and Whats­App to harness public anger and channel it into a succession of one-day strikes and street demonstrations, some of them attended by thousands.

“Social media is the government’s worst nightmare. It has completely changed the dynamics,” Promise Mkwananzi, a 35-year-old dissident who leads a protest movement called Tajamuka (“Outraged”), told me over coffee. A few days later he was arrested for the third time this year.

Fearing a “Zimbabwe spring”, the regime has detained dozens of leading activists. It hastily installed a senior intelligence officer as head of POTRAZ, the state agency that regulates the country’s mobile networks. It drafted legislation banning the use of social media to destabilise the country. It has even outlawed displays of the national flag after another protest group, #ThisFlag, co-opted it as its symbol.

The government has also resorted to its default tactic: violence. At 1am on 17 Nov­ember, the security forces abducted Patson Dzamara, an organiser of a protest against bond notes and corruption planned for later that day; at 9am that same morning I found Dzamara lying on a gurney at the Avenues Clinic in Harare with a huge swelling on the back of his head and vivid red weals across his back. He told me how three cars had blocked his own at a junction, two in front and one behind. The occupants then opened fire, burned his vehicle, and beat him for 20 minutes before driving him away – blindfolded – in a van.

“The only thing they said to me was, ‘You didn’t learn from what we did to your brother and now it’s your turn,’” said Dzamara, whose older brother Itai was abducted last year and never seen again. But instead of killing Dzamara, they dumped him naked by a road, telling him: “You’re lucky. You were supposed to die today.” A passing motorist took him to a service station, where he telephoned for help.

I left the clinic to find riot police backed by water cannon occupying the city’s streets. After word of Dzamara’s abduction spread on social media, fear prevailed and the protest fizzled out, leaving activists despondent. “We’re never going to have a successful protest in Zimbabwe again,” said Linda Masarire, a former train driver and widowed mother of five children who was jailed for 84 days last summer.

However, the government faces an increasingly grave problem of its own. It is running out of money to pay the security forces on which it depends for its survival, and the people’s anger is spreading to rank-and-file soldiers and policemen.

In the privacy of my car, one soldier who was hitchhiking near the town of Gutu, 225 kilometres south of Harare, complained bitterly about being poorly fed and paid late, how his family was struggling to survive, and how the army told him how to vote. It was time for Mugabe to go, he said.

Tendai Biti told me how, during one protest last summer, he was chased down by an unmarked vehicle whose occupants told him: “We’ve been sent to arrest you, so please run away.” Biti said: “It’s only their bosses that are eating. They’re not.”

The war veterans’ leader Christopher Mutsvangwa readily acknowledged that one reason why his 30,000 members had rounded on Robert Mugabe was that “there’s nothing to bribe us with any more. The economy is finished.”

I asked Mutsvangwa whether Mugabe should step down. “We need to have a new look at the management of the economy,” he said. “Since he’s the elected president he has to either deliver on that or make it possible for someone else to deliver on it. We would hope it’s the latter.”

He did not name Vice-President Emmerson Mnangagwa, but it was obvious whom he had in mind.

***

Over lunch at his charming old home in rural Sussex a few years ago, Denis Norman, a white farmer who served in three of Mugabe’s cabinets between 1980 and 1997, told me of his last meeting with the president after losing his farm and before he left for Britain in 2003.

“I asked: ‘Where did it all go wrong?’ He replied: ‘Has it gone wrong?’ I said: ‘I know it’s gone wrong. You know it’s gone wrong.’ He paused before replying, softly: ‘It’s not going right, is it?’”

The anecdote captures the tragedy of Robert Mugabe – the architect of Zimbabwe’s independence who has reduced it to penury; the guerrilla leader who freed his country from white-minority rule only to subject it to far greater repression.

Mugabe grew up a village 100 kilometres from Harare. His father, a carpenter, abandoned the family when he was ten. The principal of the local mission school, an Irish Jesuit priest named Father Jerome O’Hea, nurtured him instead.

Mugabe trained as a teacher; at Fort Hare University in South Africa he encountered the black nationalism sweeping across Africa. He went to teach in Ghana, which had just won independence from Britain, and there he married his first wife, Sally.

In 1960 the couple returned to Rhodesia, as Zimbabwe was called then. Mugabe joined its liberation struggle, became secretary general of the Zimbabwe African National Union (Zanu) and was imprisoned for nearly 11 years. Ian Smith’s government refused to release him even for the funeral of his infant son. He took several degrees through correspondence courses with the University of London and gave lessons to his fellow prisoners. Released in 1974, he fled to neighbouring Mozambique, where he orchestrated the guerrilla war against white-minority rule in Rhodesia.

In 1979 Mugabe attended the Lancaster House peace talks in London that led to independence. He was “secretive, seemed not to need friends, mistrusted everyone. Devious and clever, he was the archetypal cold fish,” said Lord Carrington, the British foreign secretary who chaired those talks.

He returned home from London a hero and duly won Zimbabwe’s first democratic elections in 1980. At first he confounded his critics. He allowed Ian Smith to remain in Zimbabwe, and, learning from what had happened in Mozambique after the Portuguese left in 1975, Mugabe urged white Zimbabweans to stay and rebuild the country, which had been destroyed by 15 years of war and sanctions. He built schools and hospitals for black Zimbabweans and encouraged agriculture.

The new president appeared to display no animosity towards Zimbabwe’s former colonial masters. He sought Britain’s help to forge a new national army. He formed a surprising friendship with Lord Soames, the last British governor of Rhodesia, and rebuked his cabinet for celebrating when Margaret Thatcher was deposed in November 1990. “Who organised our independence?” he asked them. “Let me tell you – if it hadn’t been for Mrs Thatcher none of you would be here today. I’m sorry she’s gone.”

Mugabe was an Anglophile who adored the royal family, and urged Denis Norman to invite Prince Edward to open Zimbabwe’s Royal Agricultural Show. He encouraged Zimbabweans to play cricket because it “civilises people and creates good gentlemen”. He read the Economist, wore Savile Row suits, and upbraided his first cabinet for dressing inappropriately: “If you wish to remain as ministers I expect you to dress as ministers.” A frugal, ascetic man, he rose before dawn, worked long days, ate simple food and neither smoked nor drank.

There was, however, a darker side to this apparently model leader. What the world did not see, or chose not to see, was his crushing of Joshua Nkomo’s opposition Zapu party in the mainly Ndebele-speaking Matabeleland region. Mugabe’s North Korea-trained and predominantly Shona Fifth Brigade razed villages, tortured and raped, killing an estimated 20,000 Ndebele civilians in Operation Gukurahundi (gukurahundi is the Shona expression for “the early rains that wash away the chaff”).

Mugabe’s relations with white Zimbabweans began to sour when they backed Ian Smith’s Republican Front Party in the 1985 parliamentary elections. He sacked Norman as minister of agriculture. “He wrote me a note saying he had no place for me because he had offered the hand of friendship to the farming community, and they obviously didn’t appreciate what he and I had done for them, so he was going to give them a black minister,” Norman told me.

In 1992 Sally Mugabe died of kidney failure. He lost a “great stabiliser and calming influence”, Norman said. “She was the one person he could actually confide in, someone who could keep him on a level plane.” In 2008 I visited her grave in Heroes Acre, a monument to Zimbabwe’s independence fighters on Harare’s western fringe. Fresh flowers lay on the black marble. My guide said Mugabe brought them every week, early in the morning when no one was around.

In 1996 he married Grace, a State House secretary 41 years his junior, with whom he already had two children from an affair that began before Sally’s death. Grace was Sally’s polar opposite, and under her influence the other side of Mugabe’s personality – the African strongman – gained ascendancy. Their wedding ceremony was attended by 12,000 guests. The couple built a mansion set in 44 landscaped acres in the affluent Harare suburb of Borrowdale. Mugabe celebrated his birthdays with increasingly lavish parties costing hundreds of thousands of dollars. His popularity began to fade.

 

***

 

In 2000 the Movement for Democratic Change (MDC), a new opposition party led by Morgan Tsvangirai, defeated a constitutional referendum that would have increased Mugabe’s powers. He responded by unleashing the war vets, who seized thousands of white-owned farms over the next few years in an orgy of drunken violence and retribution.

The seizures served the president’s political purposes well. They punished the farmers, many of whom had backed the MDC morally and materially, and dispersed and destroyed a reservoir of a million potential MDC voters among the black farmworkers and their dependants.

In every other way they were a disaster. Zimbabwe’s economy, heavily dependent on agriculture, collapsed. Food production plunged. Factories, hospitals and schools closed. The government responded by printing ever more money, fuelling such rampant inflation that prices were doubling every 24 hours. At one point the Reserve Bank issued a note worth Z$100 trillion.

Mugabe resorted to yet greater repression. In 2005 he destroyed the homes and livelihoods of 700,000 restive slum-dwellers in Operation Murambatsvina (‘‘clean up filth’’). He neutered the judiciary and ­independent media. He stole the 2008 presidential election so blatantly and violently that not one other African head of state attended his swearing-in. Britain withdrew his honorary knighthood, and he was forced into a power-sharing agreement with the MDC.

The “government of national unity” restored fiscal sanity but it also allowed Zanu-PF to regroup. By 2013 the world’s attention had moved on. Using subtler methods – bribery, intimidation, control of the electoral roll – Mugabe stole that year’s general election, too, and Zimbabwe returned to one-party rule. An “indigenisation” law requiring majority black ownership of large companies further deterred the investment that Zimbabwe’s struggling industries desperately needed to retool and boost exports. There was no currency to devalue. “We sabotaged our own productive capacity,” said the economist John Robertson.

Mugabe inherited a country that, for all its faults, was blessed with fine infrastructure, functioning institutions, a benign climate and fertile soil. Today it is a failed state in all but name: a nation of hawkers, foragers and scavengers. A quarter of the population has left; in other words, more Zimbabweans now work overseas than at home. The average monthly household income is $62. Life expectancy is 55 years, one of the lowest in the world. Four million of Zim­babwe’s 14 million people survive on food aid, and a quarter of its children are stunted by malnutrition.

The country’s hospitals can no longer afford painkillers for major operations. Its embassies cannot pay their rent and utility bills. Its national airline can no longer fly to Heathrow, because of outstanding debts. It sells its elephants, giraffes and other wildlife to China. Beyond its urban centres, the country has reverted from tractors to ox-drawn ploughs, light bulbs to candles, the wheel to foot, cash to barter.

It is also corrupt from top to bottom, ranking 150th out of 168 in Transparency International’s global corruption index. By Mugabe’s own admission, its leaders have siphoned $15bn from the Marange diamond fields in the east since 2008 – four times Zimbabwe’s annual budget. Several times I was stopped at police checkpoints whose purpose was not to enforce law and order but to fleece motorists. I was fined once for not having honeycomb reflectors on the front of my rental car, and a second time for not coming to a complete stop at a junction. “The whole system is infested with leeches sucking the remaining blood from the rotten corpse of Zimbabwe,” a white businessman told me.

Mugabe no longer mingles with the ordinary Zimbabweans whom he claims to champion. He lives behind high walls in his heavily guarded mansion. A bomb-proof Mercedes carries him to State House along the only well-maintained roads left in the capital. His motorcade includes two decoy Mercedes, an ambulance and truckloads of soldiers. Police outriders clear the traffic and use the butts of their AK-47s to bludgeon dawdlers. Making gestures at the president is a criminal offence.

He survives in office – his sole concern – by playing off one Zanu-PF faction against another. He rents his lieutenants’ loyalty by letting them plunder the country. He uses hunger as a weapon by swapping food aid for support. “Mugabe has an insatiable thirst for power. I’ve never come across another human being who worships power like that man,” Biti told me.

Mugabe has already declared his intention to fight the next election in 2018. Few believe he will ever step down voluntarily. Three times this year he is said to have thwarted efforts by regional leaders to discuss his retirement, abruptly cancelling a visit to Ghana in August when he learned the issue was on the agenda. He rebuffed attempts by his military commanders to raise the matter during the summer protests.

“He has no friends, no hobbies, no in­terests,” said a Zimbabwean businessman who has dealt directly with Mugabe. “The only thing he has is a political persona. Without that, he’s nothing, and for that reason he will not voluntarily surrender his power. He will die with his boots on in his office.”

If that is so, Mugabe’s final legacy to Zimbabwe will be his failure to provide for an orderly succession. Instead, he will bequeath to it an unprecedented and dangerous power vacuum.

 

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Predictions of Robert Mugabe’s imminent death should be treated warily. David Coltart, a white opposition politician, notes that the president’s mother lived beyond 100, and that for twenty years British and American ambassadors have arrived in Harare expecting Mugabe to die on their watch, only to leave disappointed.

He still maintains a punishing travel schedule, and attended Fidel Castro’s funeral early in December. Many Zimbabweans believed that he had died when his plane inexplicably diverted to Dubai in September. “Yes, it’s true I was dead. I resurrected as I always do,” Mugabe taunted the premature celebrants on his return a few days later. It is now widely believed in Harare that he went there to rescue his wayward son Robert, Jr, who allegedly faced drugs charges.

When Mugabe does die, Zanu-PF will have 90 days to convene an extraordinary congress and choose a successor to serve as president until the next election. It is unlikely to be a peaceful or democratic process. Vice-President Mnangagwa is thought to have the support of Constantine Chiwenga, the commander of the national defence forces, as well as most of the military hierarchy, the war vets and the state media, but the burning question is whether Grace Mugabe would dare to challenge him.

Variously named “DisGrace”, “Grasping Grace” or “Gucci Grace”, to reflect her extravagant foreign shopping trips, the first lady knows her power will evaporate once her husband dies, and she needs to protect her three children and enormous wealth. The Mugabes own 14 farms and she is said to take a cut of almost every big deal in Zimbabwe. “If you want anything business-wise here, you have to go and kneel before Grace,” one political analyst said.

She has options. She could flee the country; seek Mnangagwa’s protection in return for her support; back a surrogate candidate; or run herself.

In recent weeks she has ceased attacking Mnangagwa and distanced herself from G40. The vice-president’s allies suggest that the military has given her some sort of démarche. “Army commanders would have said: ‘You’re destroying the party from within. You’re becoming a security threat,’” a member of Mnangagwa’s entourage said.

“I’ve noticed a certain measure of silence. The reckless exuberance of the past is gone,” Christopher Mutsvangwa, the war vets’ leader, said. “Once someone knocks some sense into her about the aftermath of the morrow she will realise you don’t go against the state apparatus.”

That said, nobody is ruling Grace out. Zimbabweans detest her, and she has little standing within the party or the military because she did not fight in the liberation war – but those who know her describe her as “delusional”. As a prominent businessman who supports Mnangagwa told me: “She believes in her heart that the people love her, because in Zimbabwe we have ritual fawning.”

She could yet persuade her husband to undermine Mnangagwa in some way. She could try to whip up Shona clan tensions – the Mugabes are Zezurus while Mnangagwa is a Karanga. She could even announce that her husband had given her his blessing on his deathbed. But Mnangagwa’s supporters have little doubt what would happen if she did. “If Grace runs, the military will step in. They will go and brutalise her supporters,” the businessman said. “It would be nasty, very nasty.”

There are other possible candidates of lesser stature, and there would be a high risk of violence as rival camps sought to coerce local and regional party officials to support them. But for now, at least, Mnangagwa is the front-runner. And that, on the face of it, is bad news for Zimbabwe. “He is associated with all the darkest periods of our history,” Biti told me. A prominent human rights worker in Harare said: “He’s really, really bad. He’s toxic. He’s killed a lot of people.”

Mnangagwa does have a human side. He is a Methodist, a Chelsea supporter (because he adored Didier Drogba), and he has nine children by two wives – the first died of cancer in 2000 and the other is an MP. One son is a popular DJ; another serves in the presidential guard. But he is so hated by Zimbabweans that he twice failed to win a seat in parliament, Zanu-PF’s standard electoral practices notwithstanding. In 2000, thugs poured petrol over Blessing Chebundo, his MDC opponent in Kwekwe, and Chebundo survived only by clinging to one of his assailants. Later they torched his home.

Mnangagwa, who says he was born in 1942 (though many sources say 1946), was inspired to join the black nationalist movement when Mugabe taught in his village after returning from Ghana. He trained as a guerrilla in Egypt and China, blew up a locomotive near the Victoria Falls, and escaped execution only by claiming to be under 21. He spent a decade in prison instead. He was kept in solitary confinement for three years and tortured by the Ian Smith government. Hung upside down and beaten, he lost the hearing in his left ear. “My torture was so bad that if I talk about it I relive it, and my tears come down,” he told me during our interview.

He attended Mugabe’s prison classes, took O- and A-levels, and after his release he trained as a lawyer in Zambia before joining Mugabe in Mozambique. After independence, as the country’s chief of security and intelligence, he was widely believed to have orchestrated the Gukurahundi massacre, allegedly calling Nkomo’s Zapu supporters “cockroaches” and the Fifth Brigade the DDT that would eradicate them.

A UN report accused him of plundering diamonds when Zimbabwean troops intervened during the civil wars in the Democratic Republic of Congo in the late 1990s. In 2002 he seized a farm near Kwekwe whose owner, Koos Burger, told me in a telephone call from Florida that he sought political asylum in the US after receiving death threats. Mnangagwa is thought to have masterminded the theft of the 2008 presidential election, from which Morgan Tsvangirai was forced to withdraw in order to halt the slaughter of his supporters. Today he is said to control the lucrative gold industry in his home region, the Midlands, where he is known as “The Godfather”.

Mnangagwa denies such accusations. “How do I become the enforcer during Gukurahundi?” he asked me. “We had the president, the minister of defence, the commander of the army, and I was none of that. My own enemies attack me left and right and that is what you are buying.”

 

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A Mnangagwa presidency might offer Zimbabwe one thing: economic recovery. He is sharp, organised and business-savvy; more pragmatic and less ideological than Mugabe. And, unlike the president, he understands the urgent need for reform, if only so that he can pay the security forces and fill the trough at which his Zanu-PF comrades guzzle. “For all his historical problems he understands the running of the economy better than Mugabe, better than most Zanu politicians,” David Coltart said.

In the course of our interview, Mnangagwa explained his plans for reviving the economy. He declared that “capital goes where it feels comfortable and warm, and if it’s cold it runs to a country which gives it better weather”. Mugabe, an avowed Marxist,
would never make such a statement. Mnangagwa spoke of the need for Zimbabwe to re-engage with the international community, stamp out corruption, revive agriculture and attract foreign investment. He also said that he wanted all the professionals who have left Zimbabwe – black and white – to return. His model is China, which he praises for the “discipline” that has transformed it from the backward country where he once trained as a guerrilla.

A few nights earlier I had listened to Mnangagwa giving the keynote speech at the annual awards dinner of Zimbabwe’s Institute of Chartered Secretaries and Administrators, at Harare’s plush Rainbow Towers Hotel. To my surprise, he quoted the New Testament’s parable of the talents, with its overtly capitalist creed.

“Mnangagwa is a brutal man, a hard man,” said the businessman who has extensive dealings with the regime. “He’s been involved in butchery and pillaging and everything else, but there’s no question in my mind that he’s pushing to reform Zimbabwe’s economy, and fighting against the inertia of Robert Mugabe, who believes any change is dangerous.”

Mnangagwa’s problem is that he lacks Mugabe’s aura, and most Zimbabweans know only of his reputation for brutality. As things stand, he could not possibly win a free and fair election. That is why, according to multiple sources, he is discreetly reaching out to Morgan Tsvangirai, Joice Mujuru and other opposition leaders with a view to forming some sort of coalition government after Mugabe’s death, and perhaps postponing the next election.

Such an arrangement would lend Mnangagwa legitimacy, appeal to international donors and buy him time to resuscitate the economy, so that Zanu-PF would not need to rig the next election too blatantly.

Whether Tsvangirai and Mujuru would agree to enter such a coalition is another matter. They might calculate that they could win even a rigged ballot if – a big “if” – they could agree on a single presidential candidate. For all his flaws, Tsvangirai remains Zimbabwe’s most popular politician, and Mujuru still has support within Zanu-PF.

On the other hand, the MDC is fractured, disorganised and short of money, and Tsvan­girai has colon cancer. Mujuru’s ZPF has barely got off the ground and its own senior members question her leadership abilities. Both might be tempted by offers of positions that would give Mujuru a way back to Zanu-PF and Tsvangirai the perks and privileges he cherishes (he still lives in the handsome official residence he occupied as prime minister during the unity government). “They’re not going to get power any other way,” said Derek Matyszak, a Harare lawyer and constitutional consultant.

Opposition activists would demand political as well as economic reforms in order to loosen Zanu-PF’s grip on power: a proper electoral roll, an end to patronage and intimidation of rural voters, a truly independent electoral commission, a free media and votes for Zimbabweans in the diaspora.

They would almost certainly be disappointed. When I asked Mnangagwa whether he saw the need for political reforms he replied that Zimbabweans had long ago secured what the British denied them: human rights and one man, one vote. A Mnangagwa supporter told me he might make token concessions, but “it’s all about the veneer of respectability rather than respectability”. Others invoked the example of President Paul Kagame, who has transformed Rwanda’s economy with the help of international financial institutions that choose to ignore his authoritarian excesses.

To activists such as Linda Masarire, it would be “totally unacceptable” for the opposition parties to join a coalition in such circumstances. “Even if the economy is revived, who will be the beneficiaries? It will be the same old people, the ones with political power who have been looting the country for the last 36 years,” she said.

Biti mocks the idea of Mnangagwa as a reformer of any sort. “No one can name any act of reform he’s ever carried out . . . He can’t start now. He’ll just tell you what you want to hear.” He added: “I don’t think anyone who’s committed crimes against humanity should lead us.”

But Mnangagwa has already won the tacit support of Zimbabwe’s business sector, as well as South Africa and China, all of which want stability. Western donors are also anxious to avoid Zimbabwe’s total disintegration. It’s a fair bet that ultimately they would choose pragmatism over principle and give Mnangagwa the bailout he would urgently need. They would probably ignore his
election-rigging provided it was discreet.

The businessman put it this way: “Maybe you don’t like Mnangagwa and his history, but you’re faced with a choice. Do you allow Zimbabwe to crash and burn and let its people suffer? Or do you try to negotiate a rescue so they have a future?”

Martin Fletcher is an NS contributing writer. His assignment in Zimbabwe was financed by the Pulitzer Centre on Crisis Reporting

This article first appeared in the 15 December 2016 issue of the New Statesman, Christmas and New Year special 2016