Kirkuk Officials Warn of Cholera Risks

While Kirkuk has avoided an outbreak of cholera this summer, its poor water and sewage systems continue to pose a serious health risks, say officials.



Despite a hot summer and a drought, both of which make a cholera outbreak more likely, Kirkuk has not recorded any cases this year.



Other provinces have not been as lucky. The health ministry reported this week that five cholera cases – the first reported this summer – were confirmed in Baghdad and the southern province of Maysan.



In August last year, Iraq’s worst cholera outbreak in decades began in Kirkuk before spreading nationwide for weeks, killing more than 20.



Kirkuk had the highest number of cases. Over 3,000 people there caught the disease, which causes potentially life-threatening dehydration from diarrhoea if not treated quickly.



Although Kirkuk health officials say they have done what they can to prevent cholera from re-emerging in the province, they admit there could still be an epidemic.



While Kirkuk has received international and Iraqi aid to fight cholera, health experts say that the main causes of cholera – decrepit water and sewage systems and inadequate healthcare – have not improved.



“The poor services and lack of healthcare put people’s lives at risk,” said Sabah Amin Ahmed, the director of healthcare for Kirkuk province. “Most Kirkuk residents cannot easily access clean drinking water or a good sewage system.”



According to the Iraqi health ministry and the World Health Organisation, WHO, over 30 per cent of water samples taken in Kirkuk have tested positive for bacterial contamination this year. This compares badly with the average contamination rate for Iraq, under ten per cent.



Jabbar Hassan al-Rubai, a manager in Ahmed’s regional healthcare department, said some of the pipes in Kikuk’s mains water system were broken, jeopardising the quality of drinking water.



Iraq’s water and sewage systems, which are decades old and have not been maintained, are badly in need of repair. However, restoring infrastructure has taken a back seat to dealing with security problems since the fall of Saddam Hussein’s regime in 2003.



Health officials say that because they cannot solve the infrastructure problem or control the water supply, they are instead mitigating the risk of illness by distributing chloride tablets to treat drinking water.



Rubai acknowledged that the chloride had given some people diarrhoea, but maintained that “it was the only solution to avoid an outbreak of the disease”.



The local government has also set up isolation wards in hospitals to handle any cholera cases, supplied hospitals with oral rehydration tablets and launched a public education campaign about cholera prevention.



“We try our best to educate [the public] through our [health] teams and pamphlets which we distribute to health centres and schools,” said Rubai. “A few of them follow our health guidelines, but they strictly adhere to them when they’re afraid of the disease outbreak.”



According to experts in Kirkuk, impoverished areas are most at risk. Health teams are being dispatched to areas outside the city inhabited by displaced families, who have few health services at their disposal.



Water there is also being tested twice a month, said Rubai.



According to a July report by the United States’ Special Inspector General for Iraq Reconstruction, just under half of rural residents in Iraq are connected to the water system and only 20 per cent of families outside Baghdad have sewage systems.



With the return of Kurds and other people forced out of Kirkuk under Saddam’s rule, the province’s population has jumped an estimated 35 per cent since 2003.



The population increase has put additional pressure on the already weak infrastructure, and people outside the city who live without sewage, electricity and potable water are digging their own wells.



“These wells do not meet health standards,” said Rubai. “They’re another reason that [cholera] could spread”.



The United States has already spent 2.4 billion of the 2.7 billion US dollar budget it has assigned to water projects, according to the inspector general’s. This comes as US lawmakers warn that funding for Iraq will soon dry up.



In Kirkuk, the US government’s provincial reconstruction team arranged a virtual conference with international on infectious disease to support and educate local health officials.



While international agencies have provided medicine and other aid, they have limited reach on the ground because of the ongoing security problems.



Saad Karim, an environmental advocate in Kirkuk, said that while local government and health officials had managed to control cholera in the province, the Iraqi government needed to make cholera prevention a higher priority.



“There are a lot of unnecessary projects that cost a lot,” said Karim. “They could repair the water supply network and create a new sewage system instead.”