WHO health briefing on Iraq

UN humanitarian briefing
14 May 2003

Diarrhoeal Disease in Iraq

The national public health laboratory in Kuwait has confirmed the presence of vibrio cholerae, the bacterium which causes cholera, in 4 out of the 38 samples which the World Health Organization (WHO) team in Basra collected last week. Another 18 cases have been clinically and laboratory confirmed by three hospitals in Basra. WHO warned the national and international health community as soon as cholera was first identified by hospital laboratories in Basra last week in order to put in place immediate containment measures.

Since last week, WHO, the Iraqi health authorities and their partners have set up a cholera taskforce to respond quickly to this outbreak and to minimize its consequences for the people of Basra. Cases of Cholera have been reported in Basra since 1989. In 2002, for example, 257 specimens were confirmed positive for cholera. The number of cases peaks each year during the warmest months of the year, between May and October. In recent years, diarrhoeal disease has been one of the three main killers of children in Iraq.

WHO is extremely concerned about the current high levels of diarrhoeal disease which are being reported from across Iraq. We have detailed reports of sharp increases in diarrhoeal cases from Baghdad and Mosul, as well as anecdotal reports from elsewhere. WHO believes that the lack of access to clean, safe water and the problems with security combine to produce a particularly dangerous situation in which there could be a large number of cases of diarrhoeal disease - including, but not limited to, cholera.

Lack of Security: "The most urgent problem for health in Iraq today"

The WHO Representative in Baghdad, Dr Ghulam Popal, says the lack of security is becoming an acute problem for the health system in Iraq. "Ask me what are the three most urgent problems for health in Iraq today," says Dr Popal, "I will tell you: security, security and security." The lack of security affects every aspect of health work: hospitals and other health facilities are not protected; water pumping stations are still being looted; warehouses and distribution networks are not secure; doctors and nurses cannot safely carry out their work; and people cannot get access to health care. This is the first priority, and must be dealt with promptly if the health situation of people in Iraq is to improve.

Surveillance and laboratory facilities

The main concern is that the cases confirmed by laboratories in both Basra and Kuwait is just a small proportion of the total number of cases of diarrhoeal disease. For weeks, doctors in health centres and hospitals across the city have been reporting an increasing number of cases of diarrhoeal disease. Before the war, Basra had a good health surveillance system and medical staff were able to trace almost all the cholera cases and find the source of contamination. Today, the situation is different. There is no longer a functioning surveillance system to centralize the information, investigate the cases and monitor the situation. The priority is to re-start the health system, to control not only cholera, but all infectious diseases.

The surveillance system is currently being restored, based on reporting forms developed by WHO. Several hospitals have started returning the forms. They are currently being distributed to hospitals and primary health care centers through the department of public health, NGOs and other partners. The provision of security for public health officers and district health directors touring health facilities and collecting the forms has been an issue, which is being addressed with support from the NGOs and the coalition forces.

"What our colleagues in Basra need is to rebuild the central laboratory which was completely looted. It served not only Basra city but the four southern governorates as well. WHO estimates the cost of rebuilding the laboratory to be up to US$ 200 000. This is a small amount compared to the services it will provide for the whole community. WHO is urging donors to pay particular attention to this acute need." said Dr Denis Coulombier, a WHO epidemiology expert in Basra.

WHO has been addressing this issue by securing support from the Kuwaiti public health laboratory, but this is only a temporarily solution. WHO is currently strengthening one of the hospital laboratories, in order to ensure a minimum public health laboratory system. Sampling equipment has been provided by the Kuwait public health laboratory in order to do so.

The department of preventive medicine has been completely looted, and all control activities, health education and food inspections have been disrupted. In the past, the Basra department of preventive medicine was running a very efficient cholera control program, including quality control of hospital laboratories, screening of food handlers and food items, routine control of quality of water, and screening of contacts. WHO is supporting staff from the department of preventive medicine to restore control activities through the health task force working group on diarrhoeal disease and cholera. The first meetings of this working group have defined the strategy for emergency surveillance of epidemic diseases. It is also liaising with the water and sanitation agencies to restore quality control of water.( update please as we did the second taske force meeting and I was not there)

Possible sources of contamination

The municipal water systems in Basrah city center and Zubair draw water from the Euphrates. The water is chlorinated, then pumped into the municipal water distribution system. Since the start of the war, both power shortages and looting have interrupted supplies, but humanitarian interventions have now restored the system almost to previous levels. Illegal tapping of water has probably resulted in contamination of the system at times. Chlorination tests performed at outlets have showed that adequate chlorination levels are not present in water drawn in some parts of the city. Desalinated water is available as drinking water. But only an estimated one-third of the population can afford to buy such clean water. Bottled water is available, but unaffordable for most of the local population. Tankers rented by UNICEF are delivering drinking water everyday to the city. However, it is suspected that non-controlled tankers are also selling water. The quality of water has not been subjected to routine bacteriological testing. A large proportion of the population outside Basrah city center relies on river water from the Shatt Al Arab waterway, and this water is not treated before being drunk.


For more information, please contact Fadela Chaib, WHO Spokesperson in Basra: Satellite phone 008833330739; email:chaibf@who.int or Iain Simpson in Geneva (00 4179 475 5534); email simpsoni@who.int

The following WHO specialists are available to respond to media questions: Dr Mohamed Jama, Deputy Regional Director, WHO Eastern Mediterranean Regional Office, Cairo (+202 276 5026 ); Dr David Nabarro, WHO Executive Director, Geneva (+41 22 791 2363, +41 79 217 3446)

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