Gorilla’s Guides

BAGHDAD, 7 May 2008 (IRIN) - The Iraqi authorities in the self-ruled northern region of Kurdistan are gearing up to face a possible cholera outbreak which last year affected nearly 4,200 people, and caused the deaths of 24 nationwide, a local official said on 6 May.

“We have allocated 25 billion Iraqi dinars (US$20 million) to fight any cholera outbreak in Kurdistan after concerns rose last month when at least 500 patients with diarrhoea and vomiting were admitted to hospitals. So far no cases of the disease have been confirmed,” said Mohammed Sadiq from the regional Health Ministry.

“We remain alert that there could be another outbreak of cholera this season as the factors that cause cholera still exist: a shortage of clean drinking water, high temperatures during the summer and poor sanitation,” Sadiq told IRIN on 7 May.
He said the Kurdistan regional government had started a media campaign to raise awareness about the risks of cholera, how to keep food clean, and how to boil water.

The last cholera outbreak was first detected on 14 August 2007 in the northern city of Kirkuk. It then spread to Sulaimaniyah, Arbil, Dohuk, Tikrit, Mosul, Diyala, Basra, Wasit, Baghdad and Anbar provinces. The hardest-hit provinces were Kirkuk with 2,309 cases, and Sulaimaniyah with 870.

By October 2007, the Iraqi government and UN agencies were saying the outbreak was under control as more than 70 percent of the country’s nearly 4,200 laboratory-confirmed cases were being treated successfully.

Cholera is a gastrointestinal disease typically spread by drinking contaminated water and can cause severe diarrhoea which, in extreme cases, can lead to fatal dehydration. It can be prevented by treating drinking water with chlorine and by improving hygiene conditions.

IRAQ: Kurdistan bracing for possible cholera outbreak

Editor’s Comment: So much for the lies spewed by the American military about how much safer Irak is since they started their murderous surge. You don’t flee your home to live live in a tent or worse unless you are terrified. Please help the victims of war: make a donation to the ICRC today when you select the “Iraq” option in the drop down list in step 1 your money goes directly to the IRCS and ICRC Irak programmes.

Internal displacement became a humanitarian crisis since the attack on the Holy Shrines in Samara’. The highest number of IDP was registered in September 2007- 2,299,425 people. By end of January 2008, a total of 126,768 people were registered as returnees, as many had thought that the security situation in some areas in Iraq had relatively improved. On the other hand, some IDP families were forced to return to their original areas of residence by the high cost of living in their host communities. See chart 2 for cumulative monthly numbers of IDP for 2006 and 2007. For additional information on monthly numbers and other distributions see Annex 1.

As of end of February 2008, the number of IDP was 2,196,763 people. This is an increase by 24,106 people compared to January 2008. The increase in the number of IDP was registered in seven governorates- Kirkuk, Diwaniyah, Anbar, Erbil, Babil, Thi Qar and Diyala. More than 60 percent of the displaced people were in Baghdad governorate. More than 82 percent were women and children under the age of 12. In addition to being displaced, the majority suffer from disease, poverty and malnutrition. Children do not attend schools and are being sheltered in tents, abandoned government buildings with no water or electricity, mosques, churches, or with relatives. (See table 1 and chart 1 for 2008 cumulative monthly numbers of IDP and table 2 for distribution of IDP by governorate)

The problems facing the IDP

Health: The health services provided by hospitals and health care centers are inadequate. Also, there is shortage of medicines and medical supplies. The areas that  received large numbers of IDP are the most affected. In addition, most displaced people who suffer from chronic diseases (like hypertensive and diabetic patients) have lost their medication cards. Many diarrhea, cholera and typhoid cases have been registered as a result of using contaminated water.

Education: Many teachers and headmasters were threatened or killed and many pupils were killed in groups or individually. This situation had scared students from attending schools. On the other hand, many IDP pupils dropped out of schools as a result of the economic situation of their families and difficulties in transferring their official documents to the schools in their new neighborhoods. As the security situation somewhat improved, the Ministry of Education facilitated the transfer of the documents of the IDP children to the schools in the host communities and arranged to bring children back to schools. However, schools in the areas that received big numbers of IDP became overcrowded. Also, it was noted that many female pupils did not register back to schools due to poor economic situation of their families or because they are needed to assist at home.

The Iraqi Red Crescent had a distinguished role in assisting IDP children in transferring their official documents from one governorate to the other and in admitting them to schools in their new neighborhoods. For example, the Iraqi Red Crescent assisted 45 students from Kurdaseen camp in Dohuk to transfer their
documents from Ninawa governorate.

Shelter: There is an increase in the cost of rented apartments in the secure areas, especially in the northern and southern governorates, which made it difficult for big families to obtain appropriate shelter. Some IDP families live with their relatives; but many others are sheltered in abandoned public buildings, which lack water, electricity and sanitation facilities. Few IDP families are living in camps/tents that lack services and
basic means for living.

Economic aspect: Many IDP families have lost their income or their breadwinners. For the majority, work opportunities were scarce in the host communities. Also, most IDP family heads are poor with very limited income or education, which makes it impossible to meet the basic needs (food, clothing, shelter and fuel) of family members. These families are increasingly becoming dependant on humanitarian aid.

Food security, water and electricity: The IDP families are dependent on the Public Distribution System for food supplies. In the beginning of the displacement problem, the IDP faced the problem of accessing their food shares, but later this problem was solved. The IDP families also use the local market and receive assistance from the host communities, as the food shares they receive from the Public Distribution System do not meet their needs.

Most IDP families use the municipality water supply, water tankers or donated water from the humanitarian organizations. Others use unsafe water from wells, rivers and lakes and water running from damaged pipes. Most IDP families suffer from the frequently disrupted electricity supply and the high cost of fuel.

Source: Iraki Red Crescent Society : “The Internally Displaced People in Iraq Update 32″ (Emphasis added).

Photo Credits: Iraki Red Crescent Society.

Click either of the photos to the right or follow this link to download and read the full report as a PDF.

Continue reading ‘العراق: صحة سكان بغداد في خطر بسبب نقص المياه وانعدام أنظمة الصرف الصحي’ »

For many Iraqi young people, the story of their childhood is one of struggle and loss. This is one of a series of reports in which UNICEF examines what is being done to ensure at least a semblance of normalcy for children caught in the ongoing conflict in Iraq.

AMMAN, Jordan, 12 February 2008 – Iraq’s children saw little respite from violence and instability in 2007. But help may be on the way. A consolidated appeal for Iraq will be launched today to help humanitarian organizations respond to widespread suffering and deprivation.

As part of this funding appeal, UNICEF is asking for $37 million to support vulnerable Iraqi children and families in 2008.The funds will enable UNICEF to expand its vital assistance – including emergency health care, safe drinking water, sanitation, education and critical protective services – to many children in Iraq who are not being helped.

Facing a precarious existence

Childhood in Iraq is more precarious than ever. For example:

• A large number of children, estimated in the tens of thousands, have lost parents, siblings and other family members to violence
• At least one in five primary school-age children is unable to go to school
• Only 40 per cent of children have regular access to safe drinking water
• Some 600,000 children are among the 1.2 million Iraqis displaced over the past two years. Most families are still unable to return home.

Living with so much anxiety and loss has taken a heavy toll on children’s psychological and social well-being. Many are anxious and war-weary, unable to sleep or concentrate at school. More and more have turned to the streets and to work, where they are exposed to the worst forms of abuse and exploitation.

From the remote marshlands of southern Iraq to the unstable cities around Baghdad and the mountains of the Kurdish north, children’s stories reveal the damage inflicted by conflict. They also show children’s incredible resilience in the face of significant challenges.

“I wake up early, I wash my face and go school with my sisters,” says Haneen, 9, in Baghdad. “It’s exhausting because the road to school is so long and usually it’s blocked. But I am determined to become a doctor – they all call me ‘doctor’ at school.”

“My parents had to buy notebooks and stationery for us, even though it’s expensive,” says Malak, another child in Baghdad. “Our school desks are broken and fans are out of order. We take water in bottles to school because water tanks might not be clean.”

Expanded reach of assistance

Continue reading ‘UNICEF - Iraq - UNICEF appeals for $37 million to save vulnerable Iraqi children’ »

The state of public health in Iraq is abysmal. Endemic disease, psychological trauma and food insecurity threaten the vast majority of the population. As author César Chelala explains, improving people’s health can help break the vicious circle of anger and distrust — and help give Iraqis a much-needed sense of hope.

It is the kind of news that everybody had been dreading. An outbreak of cholera in Iraq, which started in two northern provinces, has already reached Baghdad and has become Iraq’s biggest cholera outbreak in recent memory.

Statistics from the WHO indicate that there have already been more than 3,300 cases of cholera in the country, and more than 33,000 cases of watery diarrhea — which could be a milder form of the disease.

The threat of cholera

The cholera epidemic aggravates what is, under any measure, an already serious humanitarian and public health emergency.  

While in industrialized countries a cholera outbreak can be easily controlled, in developing countries — and particularly countries at war — cholera can become a fast killer, sometimes in just a few hours. Contaminated water, the absence of basic sanitation and infection spread through human contact are the main causes.

Carl von Clausewitz, the noted 19th-century military historian and strategist, was one of its best-known victims.

Spreading crisis

Oxfam International has also reported a dramatic increase in malnutrition among Iraqi children — a fact obscured by the high levels of violence.

It is estimated that 28% of Iraqi children are malnourished, compared with 19% before the 2003 invasion. In 2006, more than 11% of newborn babies were born underweight, compared with 4% in 2003.

Malnutrition contributes to death from other conditions such as intestinal and respiratory infections, malaria and typhoid.

Accompanying symptoms

The lack of food affects not only children. It is estimated that four million Iraqis — 15% of the total population — cannot regularly buy enough to eat and are now dependent on food assistance.

The suffering doesn’t end there. Last year, the Association of Psychologists of Iraq (API) released a report which states that the U.S.-led invasion has greatly affected the psychological development of Iraqi children.

Basic responsibilities

Under UN Security Council Resolution 1483, both the United States and Great Britain are recognized as Iraq’s occupation powers. As such, they are bound by The Hague and Geneva Conventions to not only maintain order, but also respond to the medical needs of the population.  

At present, 70% of the Iraqi population is without adequate water supplies, and 80% lacks adequate sanitation. The Baghdad Health Directorate has declared the city’s sewage system to be defective — with doctors warning that the drinking water in some of Baghdad’s poor neighborhoods is contaminated with sewage.

Hospitals are unable to respond to people’s needs. Some 90% of hospitals lack essential resources such as basic medical and surgical supplies.

Situation on the ground

Most international aid agencies have left the country, a situation compounded by the emigration of qualified personnel, particularly medical personnel. Of 34,000 doctors living in the country in 2003, 12,000 have emigrated — and over 2,000 have been murdered.

The war is not only affecting Iraqis. The Congressional Budget Office in the United States has issued a report to lawmakers stating that the war could ultimately cost the U.S. government well over a trillion dollars — at least double what has already been spent.

Calls for change

Even under the best conditions — an immediate and substantial reduction of troops — the impact of the war will be felt by U.S. taxpayers for at least the next decade.  

To adequately respond to the situation in Iraq, it is crucial to improve the mechanism for distributing food and medicines, and to support the work of non-governmental agencies there.

The Association of Psychologists of Iraq has urged the international community to help establish centers specialized in child psychology and programs devoted to children’s mental health — a most urgent need.

Proposing a cure

For this to happen, it is imperative to lower the climate of hatred and distrust now reigning in Iraq. Improving Iraqis’ health at all levels could indicate to them that they have not been forgotten and disregarded.

A task force should be constituted with UNICEF, the World Health Organization, NGOs working in the country and local health officials to address Iraqis’ most pressing health needs and plan future actions.

Improving people’s health can be the key to breaking a vicious circle of anger and distrust — and give Iraqis a much-needed sense of hope.

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

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.

Continue reading ‘Iraq Braced for More Cholera Outbreaks’ »

Inside the government-run Al-Alwiyah Pediatric Hospital in central Baghdad, nurse manager Kamel Mahdi darts through the corridors, units, and patient rooms in an effort to keep pace with the mounting challenges he faces.

The hospital’s ill-equipped ED is crammed with infants and young children who are primarily suffering from dehydration and malnutrition. The ED has no monitoring devices to check blood pressure, pulse, respiratory rates, and heart rhythm.

Upstairs in Alwiyah’s newborn ICU, a pair of infants share one of the few available incubators. An elderly nurse in a white headscarf works without the protection of a gown or plastic gloves. And hordes of concerned family members crowd around the young patients.

These are just a few examples of the obstacles impeding Mahdi and his colleagues.

Working as a nurse in Baghdad today is becoming increasingly complicated. Baghdad’s hospitals are admitting more patients because of an increase in water-borne diseases and war-related injuries. The escalating number of patients is compounded by the shortages in basic medications, equipment, and supplies.

“We’re not only facing an increase in the number of patients, but we are seeing more seriously ill and seriously injured patients,” says Mahdi, who has worked as a nurse in Iraq for the past seven years. “We lack lifesaving medicine like potassium and IV solutions as well as basic equipment and supplies needed to care for our patients properly.”

Meanwhile, nurses in the Iraqi capital are often prevented from reaching their jobs because of curfews, road closures, and fighting. Despite the ever-growing demands and risks involved with their jobs, Iraq’s nurses are still among the lowest-paid professionals in the country.

An uphill battle

Continue reading ‘Nurse.com - Iraqi Nurses Struggle Against Medical Shortages, Violence, and Disease’ »