Monday, September 8, 2008

Cholera Makes A Comeback

Cholera is back (not that it ever really left) thanks to all the usual suspects: major flooding, military activities, overcrowding, shortage of health supplies and government indifference.

Even before the monsoonal floods hit, Delhi was writing the most recent chapter in its permanent almanac of cholera outbreaks. The city logged 450 cases of cholera in the first eight months of 2008. And the worst is still ahead. Indian officials warned yesterday that 2.1 million refugees are at risk of contracting cholera and other gastrointestinal diseases, with "large numbers" of people already complaining of stomach aches, fever and diarrhea. 

Villagers in Murshidabad, where the village wells haven't been operating for several months, have been drinking untreated water from the Banshlai River. The Vibrio cholerae-contaminated water has infected 70 villagers; eleven of them have been hospitalized in critical condition. Two children, aged 2 and 4 years, have died. The government has done nothing to repair or replace the wells.

Northwest Pakistan, near the Afghan border, is the scene of another cholera outbreak. Fighting between Pakistani government forces, and Taliban/al Qaeda forces has prompted 300,000 villagers to flee their homes and congregate in refugee camps. The International Committee of the Red Cross reported on Friday that cholera and other cases of watery diarrhea already have appeared among the refugees.

Residents of the town of Chitungwiza, near Harare, find themselves in the midst of a cholera outbreak that has killed 10 people so far. Nurses who work in the town's hospital are apparently on strike. They claim to be too hungry to work.  Chitungwiza now joins the ranks of several other Zimbabe towns that have all experienced recent outbreaks of cholera: Mabvuku, Tafara, Msasa Park and Letombo Park. The CEO of the Combined Harare Residents Association blames the Mugabe government for its total lack of response to the outbreak, and for the absence of clean water and sanitary sewage services.

Cholera has reappeared in Iraq, this time in Babil province, south of Baghdad. At least 20 cases have been confirmed, according to the Iraqi government, and one person has died. Local officials in Babil, though, say that many more people are ill with cholera – as many as 300 – and that 10 have died. The ruling provincial council, complaining of the lack of action on the part of the national government, has taken its own steps. It has ordered the closure of all ice plants and many juice stands in an attempt to control the spread of the disease.

This is the dog that never barked. In spite of the massive flooding experience by residents in the low-lying Ayayerwaddy (Irrawaddy) Delta, cholera did not add to the devastation. Perhaps the Myanmar people were fortunate in the slow, heartless response of their government. 

By not amassing in the tens of thousands into overcrowded camps with few sanitary services and limited fresh water, the Myanmar people avoided the usual diseases of disaster that spread explosively in crowded, unclean environments. The fortunate outcome does not excuse the behavior of Myanmar's military regime, but perhaps the United Nations and international aid organizations should consider whether any lessons can be learned from this inadvertent experiment.

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