Iraq Braced for More Cholera Outbreaks

   

Disease currently contained, but experts say it will probably break out again in summer.

By Emad al-Shara' in Baghdad (ICR No. 245, 1-Feb-08)

Health experts are warning that the country could be hit by new cases of cholera once temperatures start to rise.

The government said its last cholera case was recorded in late November and has credited a public-awareness campaign and the colder winter temperatures for halting the spread of the disease. However, doctors warn that cholera could recur as summer approaches because of poor sanitation.

Adil Abdul-Muhsin, general inspector at the ministry of health, said that Iraq suffered its worst bout of cholera for the forty years, with 4,691 cases, resulting in 24 fatalities.

Deputy Health Minister Amir al-Khuza'i said the ministry of health has "totally controlled the disease”.

“There aren’t any cholera cases in Baghdad or in any other provinces," he said.

But doctors say it’s only a matter of time before the disease reappears.

“Nothing can prevent a cholera outbreak next summer,” said Ni'man Mohammad, a physician in Baghdad.

Mohammed expressed particular concern about new cases “in areas with dense populations and poor basic services, like eastern parts of Baghdad such as Sadr City and the surrounding neighbourhoods”.

Cholera is a potentially lethal diarrheal disease that is primarily spread through contaminated water or food. The disease often festers in overcrowded areas with poor infrastructure.

An outbreak last year began in the northern province of Kirkuk in August and spread to 11 other provinces, including Baghdad, where Iraq’s last case was recorded in early December, according to the World Health Organisation. The United Nations agency reported that 30,000 people fell ill with acute watery diarrhoea.

The last cholera outbreak prior to that was in the spring of 2003, when 187 cases were recorded, according to WHO. No one died at that time.

The government has pledged to increase monitoring of restaurants and cafes in order to try to prevent widespread outbreaks in future.

However, such precautions may have a limited effect. In December, the UN children’s agency, UNICEF, identified pollution of waterways by raw sewage as “perhaps the greatest environmental and public health hazard facing Iraqis”.

The health ministry has stated that Iraq will continue to suffer cholera outbreaks for two more years, when sanitised water and new sewage systems are expected to be completed. Until then, Iraqis could face serious health problems, warned UNICEF.

The agency estimates that just one in three Iraqi children can rely on a safe water source, particularly in Baghdad and southern Iraq, and that only 20 per cent of families outside of Baghdad have access to sewage services.

The government’s last recorded cholera cases in November were at al-Hanan, an orphanage for children with special needs in Baghdad. Two of the three children died.

Hospitals are worried about future outbreaks because they are unable to cope with major health crises, according to Ra'id al-Rubai'i, a physician at the main hospital in Sadr City.

The district is home to about 2.5 million people and has three hospitals, including one children’s facility.

"The hospitals in the city can't cover all of the areas because the resources are limited," said Rubai'i.

According to Rubai’i, the main hospital in Sadr City treated more than 60 cholera cases last summer and told residents to boil water to prevent larger outbreaks. Health workers from the hospital also distributed water-treatment tablets to certain high-risk neighbourhoods.

Mohammed Jabir, a member of Iraqi Green Peace, a national non-governmental organisation that has launched awareness campaigns about cholera, said that instability in certain areas hit by the illness had exacerbated the problem.

"The security situation has made it impossible for [health] workers to go to areas where the disease was widespread because the areas were under militia control,” he said.

He criticised the Iraqi government for not working closely enough with local organisations to eradicate the disease.

The government’s ministries need to work together to create long-term plans to prevent cholera from re-emerging, he argued. Although WHO gave Iraq five million water-treatment tablets, Jabir maintained that the authorities have not done enough to work with local experts who can reach out to communities.

Most international organisations – including the UN – do not have Iraq-based staff. Local civil society organisations have more people on the street who can educate Iraqis on cholera risks and prevention measures, noted Jabir. However, he said that the government is not consulting or working with Iraqi doctors and NGOs.

“The government hasn’t taken substantial steps to prevent the virus,” he said.

Emad al-Shara' is an IWPR correspondent in Baghdad.