This chapter builds on the previous ones by presenting a close analysis of the institutional and infrastructural factors that precipitated the outbreak and that perpetuated its spread. Precipitating describes the factors that immediately triggered the outbreak while perpetuating describes the factors that maintained propitious conditions for the ongoing transmission of cholera and that curtailed an effective public health response. I argue that the origins, scale and impact of the cholera outbreak were overdetermined by a multi-level failure of Zimbabwe’s public health infrastructure. I situate this multi-level failure in the country’s political conflicts and economic crisis, which created a ‘perfect storm’ for the fulmination of cholera. The chapter is organised around three principal features of Zimbabwe’s health infrastructure: the collapse of functioning health care delivery services; the spectacular mismanagement and sabotage of the country’s water reticulation systems; and the livelihood changes ushered in by the Zimbabwe’s economic meltdown and hyperinflation, which rendered vast swathes of the population vulnerable to cholera through food insecurity and malnutrition.