By Azeez Mahmood in Sulaimaniyah (ICR No. 257, 2-May-08)
A rash of patients hospitalised with diarrhoea and vomiting in northern Iraq has raised fears of a cholera outbreak across the region.
In April, the main hospital in Sulaimaniyah received an average of 25 patients per day with such symptoms – which are very similar to those associated with cholera.
While no cases of the disease have been confirmed, officials are worried.
"We have serious fears of a cholera outbreak," said Ziryan Osman, Kurdistan Regional Government, KRG, health minister.
According to statistics from Sulaimaniyah general hospital, around 400 patients were admitted with diarrhoea and vomiting in April – a big leap from the 260 cases in March.
Cholera is a potentially deadly water-borne illness that causes severe diarrhoea and dehydration. Children and the elderly are particularly vulnerable to infection.
An outbreak in the region last year led to 2,000 infections and 24 deaths. Hardest hit was the northern city of Sulaimaniyah, where 14 people died.
Health officials said a lack of clean drinking water and rising temperatures in the region could spark a similar epidemic this year. The former coupled with poor sanitation was to blame for last year’s outbreak, which began in the province of Kirkuk and spread throughout Iraqi Kurdistan as well as Baghdad.
"People have a great deal of difficulty getting hold of clean drinking water in Sulaimaniyah," said Sherko Abdullah, manager of the Sulaimaniyah health department.
Abdullah noted that areas on the outskirts of the city often rely on wells in which cholera – particularly in warm climates – can fester.
The poor infrastructure in the region causes endless frustration for health workers, who treat patients only to have them fall ill again due to contaminated water supplies.
“We cannot continue treating people and have them leave hospital and get sick again,” said Muhammad Omer Muhammad, director of a teaching hospital in Sulaimaniyah.
"Protection is much more important than a cure.”
Late in March, the KRG sought to begin countering a possible outbreak of cholera by banning the sale of fresh greens, such as lettuce, in Kurdistan’s markets. Osman said the government believes that they may be a potential source of the disease.
The region’s ministry of health has also launched a media campaign to educate people on the risks of cholera and encourage them to boil water.
The KRG has also given Sulaimaniyah emergency funds to deal with a potential outbreak and the World Health Organisation has been contacted to provide medical support, said Osman.
Jutiyar Nuri, deputy governor of Sulaimaniyah province, said the KRG allocated 25 billion Iraqi dinars (20 million US dollars) to Sulaimaniyah to address the cholera concerns and to help ease drought conditions.
The drought, which began in the spring, has restricted the supply of clean water, which is already sparse because of the outdated water supply system, according to Abdullah.
While Abdullah said Sulaimaniyah has the drugs to treat cholera, he did not say how many patients local hospitals could cope with in the event of another outbreak. Health officials have also set up special medical teams to both assist patients with diarrhoea and monitor cases, he added.
Sulaimaniyah officials, including the governor of the province and town mayor, have also formed a committee to provide clean water, said Abdullah.
“The government has to provide basic services,” he said.
Awni Muhammad, 25, a student at a local seminary, was admitted to a Sulaimaniyah hospital last week after suffering severe diarrhoea and vomiting. Three of his friends who, like him, have rooms at the college dormitory were hospitalised with similar symptoms.
"The water we use for drinking is really dirty,” said Muhammad. “We told the municipality about our water problems, but they haven’t responded to us.”
Sabiha Majid, a 45-year-old housewife in Sulaimaniyah, said she boils water before using it because the supply is unclean. She is concerned there will be a cholera outbreak in her area.
“If someone is infected with the disease, the government will be responsible," she said.
Azeez Mahmood is an IWPR-trained journalist in Sulaimaniyah.