The confirmed cholera death toll right now stands at only 11. The latest figures released Thursday, compiled by Iraqi health officials and the World Health Organization and recounted in an interview with a U.S. embassy official, put the total number of cases since mid-August at about 2,120. The first cases were found in the largely peaceful northern, Kurdish city of Sulaimaniya, and well over half have occurred in Kirkuk, a northern city of Kurds, Arabs and Turkmen. The country’s two biggest provinces, Baghdad and Basra, have had only a few reported cases, which they might have had even without an outbreak.
Iraqis suffered two cholera outbreaks during the 1990s. In those days, as the country’s infrastructure degraded amid economic sanctions led by the United States and imposed by the United Nations, the country saw recurrences of other diseases as well. There are a couple dozen cases of cholera reported in Iraq each year. The bacterial disease, usually spread through contaminated water, causes severe diarrhea, which can lead to deadly dehydration, especially in children. The primary treatment is simply water and fluids to hydrate until the illness subsides, though antibiotics are sometimes used.
A country battered by war is always a soft target for disease. One contributing factor to the latest outbreak could be restrictions placed on chlorine supplies in order to prevent the chemical from falling into the hands of terrorist bombers—as they have in the past. Amid the ongoing war, chlorine, needed for treating water, has to be guarded. After chlorine trucks were used in suicide bombings, spreading gas clouds that severely sickened scores, U.S. and Iraqi security forces started restricting the flow of the chemical. The embassy official, who followed the U.S. policy of restricting on-the-record comments to a handful of spokespeople, said the Iraqi defense and water ministries now coordinate convoys of chlorine trucks. This might have caused shortages in some areas during the summer, but Zryan Yones, health minister in the Kurdish north (where government ministries operate independently from the Baghdad central government), said the chlorine situation was not the cause and put the blame on outdated water and sewage systems. And a spokeswoman for the Baghdad health ministry insisted chlorine shortages were not to blame for the outbreak.
Aggravating the situation are the electrical and water shortages that lead to generally less diligent sanitary practices. Professional ad campaigns and grass-roots word of mouth through mosques and markets tout the importance of washing hands, boiling water and peeling vegetables. There is an intense focus on the problem in the north, where the outbreak has been centered. Doctors in Baghdad say they’re getting frequent questions about the disease from worried parents and are offering lectures on prevention. Sales of water filters are also up.
Iraq’s past cholera episodes have usually occurred at this time of year, when temperatures drop to make optimum conditions for breeding the bacteria. But the institutions to deal with it are shaky now. The Ministry of Health was run until early this year by partisans of radical cleric Moqtada al-Sadr, who disavowed any public cooperation with Americans. The country’s hospitals and medical supplies, already somewhat corrupt, became nearly dysfunctional, with U.S. officials complaining that the ministry had been turned into a patronage and revenue machine for Sadr’s party. The U.S. embassy official said that health officials have been working “low-profile” but daily with American and United Nations counterparts to distribute medicines, doctors and information. The U.S. embassy is helping print 800,000 prevention pamphlets in Arabic and Kurdish for distribution in the next couple of days. Still, a doctor at a clinic in a Sunni area of western Baghdad said the Shiite-dominated health ministry has favored Shiites in the distribution. And Kurdish minister Yones says the central government has shown “total neglect” in supplies and concern for Kirkuk, which is just south of his region and where the disease is the worst. He has visited the area, and international health organizations have sent tons of medicines, but he said specialized government teams from Baghdad were just now being dispatched.
For all its current deficiencies, Iraq’s health system does offer widespread access to hospitals and clinics. There’s a tradition of record keeping and testing that is paying off now, as neighborhood doctors send water samples daily for testing at central laboratories.
But the wartime economy and a combination of high unemployment and American-promoted policies for free markets makes prevention harder. The wealthy are sticking to bottled water (commonly available in stores). The less well-off are buying filtering pitchers that probably don’t sufficiently clean out bacteria, according to an American health expert. Those who try to boil water run up against the rising costs of cooking gas. Ultimately, some weary citizens merely note the recent violence, the diseases that have come and gone in the past and the pollution-filled Tigris River nearby. They say that if those didn’t kill them, neither will cholera.
