Cholera Update September 22nd 2007

New Developments:

• There are two confirmed cases in Diyala. More are expected.
• 6 cases are being reported from Mosul four of them from the same family.
• The cases previously reported from Basrah are now confirmed.

Update: The water in the Basrah cases appears to have have come from a privately operated desalination plant according to reports. – Maryam

In all the above other suspected cases are being investigated. The next two months are particularly dangerous — as the weather cools the environmental factors conducive to a major outbreak will be present.

Particular Causes For Concern As The Disease Spreads:

So far efforts to contain the outbreak have been relatively successful. To a large extent this is likely to be because the disease outbreak was in three relatively peaceful governorates with functioning, if dilapidated heath systems, and where doctors and other medical staff are in relatively good supply. Furthermore WHO staff were able to move around, it was relatively easy to move the emergency supplies needed. This is not the case in other governorates.

In governorates such as Diyala, Ninawa, Salah ad Din, Basrah, Al Anbar, and Baghdad the logistical difficulties of getting the supplies needed to the affected areas are formidable. The security situation is such that it is difficult to see how doing so would be accomplished. Worse than that in those governorates and in Baghdad particularly there is a desperate shortage of doctors, nurses, medical technicians, and pharmacists. They are dead or fled. It will be extremely difficult to provide anything even approximating the human clinical resources needed should there be a wide outbreak.

I am desperately concerned also by the water supply situation. Since they were bombed by the Americans during the 1991 war the water treatment plants throughout Irak have limped along. Their degradation was further worsened by the adamant refusal of the UN during sanctions to allow the plant and supplies needed to repair them to be imported. There has been no serious attempt made to repair water treatment plants in Irak although many no-bid contracts were dished out to large and politically well connected American firms who took the money and left.

Those plants that are operating operate irregularly and frequently at drastically reduced capacity because they either cannot get the fuel they need to run their generators or if they depend on national grid they get at most a few hours electricity a day.

Additionally they cannot get adequate supplies of Chlorine. Basrah for example has now run out of Chlorine. There have been many statements about plans to ensure the security of Chlorine deliveries from the green zone government but so far little or no Chlorine.

These factors are particularly worrying as they could lead to the formation of biofilms in the pipes carrying water. Bacteria in biofilms are far more resistant free-floating bacteria both to antibiotics and to disinfectants such as Chlorine.

Playing Politics With Cholera 1

While (see Sitrep_10) there have been measures put in place in every governorate to control the outbreak I am not confident that these will be immune to political pressure. If you read the report linked to above about the outbreak in Diyala you will see that the green zone government are declining to say where the outbreak occurred stating only that it is in a “hot area” – such frivolity is deeply worrying. The areas – plural not singular – of concern in Diyala are Baquba, Muqdadiyah, and Al Khalis as anyone who can read an Iraki newspaper will tell you. 

Playing Politics With Cholera 2

Azad Pamarni a Kurdish member of the green zone parliament has made a report to the green zone parliament saying that the outbreak is largely under control and expected to be over within a month. He criticised the WHO for making a false statement statement that there were 16,000 (sixteen thousand) cases of Cholera in the three affected governorates, Arbil At Ta’mim (Kirkuk) and Sulaymaniyah. He went on to demand that organisations not politicise this medical crisis as doing so could damage the psychological health of the citizenry and harm the country’s economy.

Both Pamarni and the journalists covering this outbreak should try getting their facts straight. The statement about which he is complaining is this one and what it says is this [emphasis added] :

The cholera outbreak has so far claimed 10 lives in the provicen of Sulamaniya and Kirkuk while three provinces – Sulamniya, Kirkuk and Erbil have reported laboratory confirmed cases of cholera. There has been a sharp increase in reported cases of diarrhoeal disease in the three northern governorates since mid‐August. Vibrio cholerae, the bacterium responsible for the disease, has been isolated from the stool speciment of 1055 diarrheal disease cases so far. V. cholera can be fatal if untreated. So far, the outbreak has been concentrated in the northern region of Iraq with a population of more than 3 million people. Between from 23 August and 10 September, at least 6000 people have been reported with diarrhoeal diseases in Sulaymaniyah, almost 7000 in Kirkuk province and on since 6 September, the outbreak has spread to Erbil province causing at least 3000 cases.

6000 + 7000 + 3000 = 16000 cases of diarrhoeal diseases is not the same as 16000 cases of Cholera as the statement makes entirely clear.

Maryam.

Tags: Arbil (Erbil), Baghdad, Basrah, Diyala, Joint Postings, Khalis, Kirkuk, Mosul, Ninawa (Governorate), Sulaymaniyah, كركوك, الكوليرا, الموصل, الموصل‎, البصرة‎, بغداد, ديالى