8 May 2003

cholera outbreak in southern Iraq
let us imagine that once upon a time in Iraq a government imposed by force of arms so neglected the country's infrastructure that the water supply deteriorated and there was an outbreak of cholera. I wonder what the Bush administration would have to say about that? Of course this is only a fairy story, right?

From Bloomberg

London, May 8 (Bloomberg) -- Southern Iraq is experiencing an outbreak of cholera caused by untreated water, the World Health Organization said as the U.S. lifted some sanctions to allow delivery of aid to help the country rebuild.

Seventeen cases were confirmed in the southern city of Basra, WHO said. The number of people infected may be 10 times higher, Denis Coulombier, a health official in Iraq's second-largest city, told the British Broadcasting Corp.

Hospitals are able to ``treat the symptoms but not the source of the problem, which is clearly linked to the water supply situation in Basra,'' a WHO statement said. ``Sewage is not being disposed of, garbage collection is happening intermittently or not at all, and people are using water from the polluted Shatt Al-Arab river.''

Iraq's local administrations ceased to function when Saddam Hussein's regime collapsed last month after a three-week war led by U.S. forces. The allies are helping Iraqis restore power, water and health services. U.S. forces also are searching for any weapons of mass destruction, and suspect a mobile laboratory found in the north was used to produce biological agents.

More from the Guardian:

Despite allied forces having had control of the area for around a month, there is still a shortage of vital drugs and intravenous fluids to treat victims.

"The real concern is that the situation in Basra, with a real lack of safe water for the population and a lack of security at the moment, could lead to a rapid spread of something like cholera," Mr Simpson told BBC Radio 4's Today programme.

"With a water supply which simply isn't functioning and isn't providing clean, safe water to most of the population, people are getting their water from completely unsafe sources.

"With a lack of security, people are not able to come to hospitals - either patients or hospital workers - and are not able to get out on to the streets to provide the kind of public information work that is vital to prevent something like cholera from spreading.

From the World Health Organisation

Suspected Cholera outbreak
A team from the World Health Organization, which now has a permanent presence in Basra, visited Al Tahrir Teaching Hospital together with local health experts in order to assess the health situation in Basra. Doctors in the hospital reported a significant increase in the number of cases of diarrhoeal diseases, gastroenteritis and dehydration. Seven cases of clinically confirmed cholera were reported, mainly among very young children (between 13 months and 4 years old). They were from the north of Basra, near to the Airport. The children were rehydrated and subsequently returned home. The doctors said there are currently more than 30 admissions per day for diarrhoeal disease. They expressed concern that it is not possible to perform medical tests at the hospital because the central laboratory is not functioning and some vital reagents are missing or have been stolen. The WHO team took samples to Kuwait the same day to be analysed at the National Public laboratory in Kuwait to confirm the presence of cholera. The results are expected in the coming few days.

The same situation was confirmed at the Basra Children's Hospital. Doctors said that out of 200 outpatients a day, 90% are for diarrhoea; others are diagnosed with hepatitis, Acute Respiratory Infections, malnutrition, shigella and typhoid. Again, there are no facilities to conduct tests to confirm the presence of cholera or other infectious agents. However, there is no doubt among the doctors and the visiting team that this is cholera. "In the absence of laboratory confirmation, we can only rely on our experience and knowledge of our patients to be able to recognise these diseases. We can clinically confirm 4 cases of cholera this week," one one of the managers said.

Hospital workers point out that they could only treat the symptoms but not the source of the problem, which is clearly linked to the water supply situation in Basra. Sewage is not being disposed of, garbage collection is happening intermittently or not at all and people are using water from the polluted Chatt Al Arab river.

Another key problem is that surveillance control activities have declined or disappeared since the beginning of the war, with an almost total lack of surveillance and control of communicable diseases. In Basra, it is clear that this combination is contributing to an increasing number of cases of diarrhoeal disease and there is concern that an outbreak of cholera could cause severe problems. The doctors reported also cases of food poisoning, mainly arising from eating ice cream. The water is not clean and ice cream is being made in poor sanitary conditions.

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