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Description of the disaster
Cholera outbreak is an extremely virulent disease in Iraq these days. In the outbreak of 2022, Sulaymaniyah, Al Muthanna, Baghdad, Kirkuk, Babel, Thi Qar, and Al Qadisiyyah have been the most affected governorates. The consistent lack of safe water and limited sanitation facilities due to the protracted crisis. Moreover, Iraq's location along the Tigris and Euphrates, whose contaminated water supply with frequent disease outbreaks increases Iraq's vulnerability to waterborne and infectious diseases. Therefore, cholera outbreak is more possible in other governorates if the contaminated water of the river is not treated well at the water treatment plants. In addition, it is observed that domestic and urban sewage is used by farmers to irrigate ready-to-use vegetables. This presumably increased the scale of the epidemics of acute watery diarrhea, including cholera in the Kurdistan region. Experts say that the irrigation of vegetables with sewage water, an increasingly common practice due to water shortages in both the Euphrates and Tigris rivers, is the reason behind the outbreak. The situation is further exacerbated by the COVID-19 pandemic, along with the already weak state of the overly stretched national health infrastructure. Neglect also plays a key role in the crisis, poorly maintained water and sewage systems, lack of proper sewage disposal, open defecation, and poor sanitation systems put millions at risk of contracting water-borne diseases, including cholera. Since last summer in Iraq, experts have warned that deficiencies in local sewage systems, together with the bad quality of drinking water, could result in an outbreak of water-borne diseases.
Previously, Iraq experienced several cholera outbreaks that usually occurred between September and December. In 2022, a new Cholera outbreak unexpectedly started in the summer months. On 19 June 2022, Iraq’s health authorities announced a cholera outbreak after at least 13 cases were confirmed across the country and thousands of hospital admissions for acute diarrhea were reported. Ten of the confirmed cases were in the northern city of Sulaymaniyah and many other cases were confirmed in the southern governorates, Al Muthanna, and the other in Kirkuk, north of Baghdad. There had also been a spike in hospital admissions because of diarrhea in the nearby cities of Erbil and Duhok. The number of diarrhea cases kept increasing well beyond the normal ranges witnessed in previous years. As of 2 November 2022, there was a total of 3,063 confirmed cholera cases and 19 deaths across the country.
Many drivers are contributing to the resurgence of cholera in Iraq, including the protracted crisis, climate change, weak health systems, poor water and sanitation infrastructure, and low awareness among the general public. As of 28 February 2023, the highest number of suspected AWD/cholera cases were reported from Iraq (11,097, CFR 0.23%). Cholera remains a threat to public health and an indicator of inequity and lack of awareness in communities. During the health cluster meeting held in Sulaymaniyah on 21 June, the Directorate of Health (DOH) highlighted the challenges to the health department and requested support for providing medicine and medical supplies, including intravenous (IV) fluid (ringer lactate), infusion sets, and Infection Prevention and Control (IPC) materials. The DOH also requested logistic support, such as hiring vehicles to facilitate the activities of rapid response teams, water quality monitoring, and disease surveillance teams. Further, the Ministry of Health in both Baghdad and the Kurdistan region requested in-country humanitarian actors’ support to deal with this outbreak.