Wednesday, September 26, 2007

Iraq: Travel restrctions possible, food shipments blocked as people exhibiting cholera symptoms reach 30,000; Displacement camps at special risk

Above: Kirkuk Mayor Abdul Rahman Mustafa takes the first drink of water at the opening of the Shoraw village water treatment plant in May. Left: The great majority of cases so far are in the extreme northern provinces bordering Iran. Cholera is a severe diarrheal disease caused by bacteria ingested in contaminated water or food. In its most severe forms, cholera is one of the most rapidly fatal illnesses known: A healthy person may become hypotensive within an hour of the onset of symptoms and may die within 2-3 hours if no treatment is provided. Death is by dehydration through massive diarrhea.

The Iraqi government will impose travel restrictions in the country if more cases of cholera are confirmed after a warning by the World Health Organization (WHO) that the disease was spreading in Iraq.

“If we verify more cases of cholera in different areas of Iraq, we will impose travel restrictions to prevent a more serious outbreak. We have already been restricting the movement of food between provinces,” said Lt-Col Seif Abdel-Karim, a senior official in the Ministry of Interior.

“Lorries are being checked as they travel from northern governorates to central and southern provinces and we have banned the movement of food over the next few days,” he said.

Earlier in a 10 September statement the WHO had said: “In controlling the spread of cholera WHO does not recommend any special restrictions to travel or trade to or from affected areas.”

The WHO said 2,116 people had contracted cholera so far, including 616 new cases reported in the past week. Eleven people have died of the disease, it said.

Over 30,000 people had acute watery diarrhoea and the contamination of currently unaffected areas was highly possible, it said, adding that the outbreak had spread to 25 districts of northern Iraq, four districts in the south and across the centre of the country.

“The disease is spreading fast and although few deaths have been confirmed, the situation is worrying but WHO and the Iraqi government are working hard to tackle the problem,” said Naima al-Gassir, WHO's representative for Iraq.

Displacement camps at risk

Local non-governmental organisations (NGOs) are trying to supply more potable water to displacement camps, especially those with poor sanitation.

“If the disease reaches the displacement camps, there’ll be chaos. With the poor sanitary conditions, the disease will spread very fast and hundreds of people might get ill within hours,” said Fatah Ahmed, a spokesperson for the Iraq Aid Association (IAA).

WHO has said all public water supply systems in the affected districts have been chlorinated by the provincial authorities. Water samples from public water supply sources are also being collected and tested routinely to ensure they meet potable water safety standards.

Distribution of known cases

According to WHO, the outbreak was first detected in Kirkuk Province, where 68 percent of laboratory-confirmed cholera cases have so far been reported, and then spread to Sulaymaniah and Arbil provinces.

Isolated cases of cholera have been identified and confirmed in other parts of the country, including Tikrit (six cases), Mosul (two cases), Basra (one case), Baghdad (two cases) and Dahuk (one case). This is the first time that cases have been reported in Tikrit, Mosul and Dahuk, all in the north.

Shortage of chlorination products

Kits to treat the disease have arrived in Iraq and stool samples are being sent to Cairo for tests to determine the strain of bacteria, WHO said.

But there is still a severe shortage of chlorination products and replenishment is urgently needed to enable water supplies to be treated to render them safe for human consumption. Provision of safe water is the highest priority in controlling an outbreak of cholera.

“We are trying to control the situation but the root cause of the problem should be treated. The Iraqi people must have water purification [systems] and better sanitation to prevent a future health catastrophe in the country,” the IAA’s Ahmed said.

The virulent disease is mainly transmitted through contaminated water and food. Most people infected with cholera do not develop any symptoms but the pathogens can stay in their faeces for up to two weeks, increasing the possibility of spreading of the disease.


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