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Holding back cholera in Iraq to protect thousands at risk

© UNICEF Iraq/2007/Arar
UNICEF water tankering operations continue to protect hundreds of thousands of Iraqi children and their families from waterborne disease.

By Claire Hajaj

AMMAN, Jordan, 25 September 2007 – It was the news that many had been dreading all summer. On 14 August, a man suffering from acute watery diarrhoea in the northern Iraqi city of Kirkuk was confirmed to have cholera. Despite emergency control measures, the disease spread and has quickly become Iraq’s biggest outbreak in recent memory.

So far, 11 people have died and over 2,100 have become seriously ill from cholera in 28 districts across Iraq. Thousands more are potentially at risk.

Suleimaniyah city, in Iraq’s Kurdistan region, was the outbreak’s initial epicentre. But the disease has spread southward through contaminated water. The latest news is the most alarming: two cases of cholera and one death in Baghdad, Iraq’s capital, and another case involving a seven-month-old baby girl even farther south, in Basra.

“It is a frightening and dangerous situation” said UNICEF emergency health facilitator Bahktiyar Ahmed, who is working on the ground in Suleimaniyah.

“At first, more than 200 cases were coming in each day, and hospitals were so overwhelmed they couldn’t even test them all,” he added. “They asked UNICEF to help them treat the sick and do what we could to contain the disease by informing families and providing them with ways to clean their household water.”

Quick response saves lives

UNICEF began it response within a day of the confirmed outbreak, working alongside the World Health Organization, which is leading the national response, as well as local health officials.

The first priority was to deliver emergency medical supplies and oral rehydration salts (ORS) to hospitals in the north, in order to treat mild and moderate diarrhoea cases. ORS is a simple mix of salts and sugars that, when given with zinc, can help prevent death from dehydration. UNICEF was able to mobilize over 15,000 ORS sachets within 24 hours from its warehouses in nearby Erbil.

“Cholera can be lethal within hours but it is relatively easy to treat if you catch it in time, before severe dehydration develops,” said the Chief of Health for UNICEF Iraq, Dr. Alexander Malyavin. “This is why ORS is a godsend – it saves lives and costs just a few cents per sachet.”

© UNICEF Iraq/2007/Arar
Lack of access to water and sanitation services across Iraq puts children and families at risk of diseases, including cholera.

Containment effort

Other UNICEF aid reaching cholera-stricken areas of northern Iraq includes 12,000 family water kits, 13,400 jerry cans for safe water storage, 30,000 bars of soap, 34,000 packs of water-purification tablets, 4,800 slow-dissolving chlorine tablets and 3 metric tonnes of chlorine to treat family wells.

UNICEF will also be trucking safe water to families in the areas hardest hit by the outbreak – delivering approximately 2 million litres per day.

As part of the containment effort, UNICEF has trained medical staff to treat diarrhoea cases and is still supporting a widespread communication campaign to encourage families to purify water, prepare food carefully and wash their hands. Local vendors are being encouraged to sell only canned drinks for the traditional Ramadan meal of ifthar. And school water tanks are being thoroughly cleaned and treated.

Today, authorities in Basra are appealing for similar assistance. UNICEF is responding by sending more ORS and working with authorities to alert communities. The hope is to prevent a large-scale outbreak in Iraq’s impoverished south, where many displaced families are living in unhygienic conditions.

A long-term problem

But Iraq’s cholera problem will not go away quickly. Dire water and sanitation conditions across the country are to blame for the emergence and spread of the disease. Only 30 per cent Iraq’s population have reliable access to safe water, and 17 per cent of Iraq’s sewage is treated before being discharged into waterways.

According to UNICEF, this outbreak shows that millions of Iraqis are struggling without essentials such as safe water and urgently need humanitarian assistance. Restocking supplies of lifesaving treatments such as ORS and zinc for diarrhoea cases is also critical. UNICEF is still short of $1 million to supply zinc for the country’s children.

“Ordinary diarrhoea is still one of two biggest killers of Iraqi infants,” said Dr. Malyavin. “We shouldn’t have to wait for a cholera outbreak to provide these children with access to safe water and simple medical treatments, which could help save many lives.”




25 September 2007:
UNICEF Iraq emergency health facilitator Bakhtiyar Ahmed discusses the response to the country’s biggest cholera outbreak in recent memory.
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