Iraq: Health services struggle to prevent cholera spreading

[This report does not necessarily reflect the views of the United Nations]

BAGHDAD, 23 September 2007 (IRIN) - Heath organisations and local authorities launched an emergency plan on 20 September to tackle an outbreak of cholera that has killed more than 10 people countrywide.

About 29,000 cases of acute watery diarrhoea have been recorded in Iraq over the past month, including some 1,500 that were caused by cholera, mainly in the northeastern provinces of Sulaimaniyah, Erbil and Kirkuk, according to the World Health Organisation (WHO).

Naeema al-Gasseer, WHO's representative for Iraq, said they are treating the situation as an "outbreak" rather than an epidemic and that having just 10 deaths shows the disease is not getting out of hand. However, she warned that the disease might spread if sanitation and water purification are not improved.

"We believe the situation is now controlled but we have raised serious concerns about the general infrastructure situation in Iraq. The huge number of displaced families living in deteriorated conditions without proper access to clean water and the low purification of the mains [water] due to the lack of chlorine, can lead to the confirmation of more cases," al-Gasseer said.

"A campaign has been developed countrywide to bring awareness to Iraqi families," she added.

Need for chlorine

The Iraqi Ministry of Health has asked the Ministry of Defence for security support in the transportation to Iraq of 100,000 tons of chlorine that has been held up at the Jordanian border because the liquid was used in past terrorist attacks.

"We urgently need chlorine as many governorates have run out of it and water is being distributed without purification. This can lead to an outbreak [of cholera] in other provinces in central and southern Iraq [where sanitation is already poor]," Adel Muhsin, the health ministry's inspector-general in Baghdad, said.

"We are seriously worried after a case of cholera was confirmed in Baghdad [central Iraq] and another in Basra [southern Iraq]. It shows that the disease isn't being contained in northern provinces and can be a disaster if it spreads to other areas where sanitation is poor and purified water non-existent," Muhsin added.

Scores of suspected cholera cases have also been reported in Diyala province in the northeast where there has been intense fighting between US forces and militants.

Zryan Osman, health minister for the Kurdistan Regional Government, said that if urgent action is not taken, the outbreak will soon spread countrywide.

"The water problem should be fixed. Chlorine should be supplied on a daily basis rather than weekly or less frequently than that. Sanitation should be improved and displaced families should be given more hygienic areas for living," Osman said.

"This outbreak just shows how bad the infrastructure in Iraq is and the government should boost its efforts to battle this problem," he added.

Cholera endemic in Iraq

Cholera is a gastrointestinal disease typically spread by drinking contaminated water. It can cause severe diarrhoea that in extreme cases can lead to dehydration and death. It broke out in Iraq in mid-August, but until this week was limited to three northern provinces before the confirmed cases in Baghdad and Basra. Cholera is endemic in Iraq, where about 30 cases are registered each year. The last epidemic was in 1999, when 20 cases were discovered in one day, said Muhsin.

"About 1,806 health centres in Iraq are examining water sources every day from different regions to detect unsafe water before the spread of the disease to other areas. In Baghdad and the southern provinces, daily television advertisements have been used to warn the population and urge them to boil water," Muhsin said.

Taking precautions

As a result, teachers in many Baghdad and Basra schools have started to boil water before giving it to students.

"Before they were allowed to drink from any source, even from the tap water in the bathroom. But now we are boiling water for their drinking and writing notes to their parents to take the same measures. I'm not sure if it will help but at least we are trying to prevent the cholera outbreak," Zahira Ahmed, headmistress at Baghdad's Kahr Primary School, said.

"Last month we reported many students missing classes due to diarrhoea but now they are back and maybe only two or three are suffering from the illness, showing that maybe our initiative is working," Zahira added.

WHO is offering medicines to treat cholera and watery diarrhoea in Iraq as well as water purification tablets and is working closely with the Ministry of Health to tackle the outbreak.