Wednesday, September 10, 2008

Iraq And Cholera: An Annual Event

The World Health Organization (WHO) has made it official. This year's cholera outbreak has begun in Iraq.

A year ago, the country suffered a major outbreak of cholera that sickened almost 4,700 people and claimed 24 lives. That outbreak took place mostly in the northern part of Iraq. But Vibrio cholerae, the water-borne microbe that is responsible for the bloody diarrhea that is the hallmark of cholera, has moved farther south this year.

The 2008 outbreak began officially on August 20th, when the first cases were lab-confirmed. By August 28th, 181 suspected cases – 7 confirmed – already had been reported from Baghdad and Misan Province. From Baghdad, the outbreak has traveled south to Babil Province, which has reported 116 suspected cases. As of September 10th, 21 of the suspected cases have been confirmed, and 10 people have died.

Last year's outbreak also began in mid-August. It was still raging in early October, having spread through 9 of the country's 18 provinces. Prior to 2007, the last cholera outbreak in Iraq that was large enough to attract the attention of the WHO took place in Basra during May 2003. In reporting on that outbreak, WHO commented that cases of cholera had occurred in Basra every year since 1989. It's our guess that there were outbreaks in 2004, 2005 and 2006 as well, but that these were not well reported – due, at least in part, to the ongoing conflict in many parts of the country.

As WHO points out in its report on the current outbreak, cholera outbreaks are facilitated by the lack of potable water, and an absence of infrastructure for hygienic disposal of sewage. More than five years after the United States, supported by the United Kingdom and the "Coalition of the Willing" invaded Iraq, "... the overall quality of water and sanitation remains very poor..." according to the WHO report.

Maybe next year?

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