BAGHDAD, 7 October 2007 (IRIN) - Despite the efforts of the Iraqi government and the World Health Organisation (WHO) to contain a recent cholera outbreak, the disease has already spread to half of the country and has also crossed the border into Iran, according to WHO and Iranian authorities.
Refugee camps on Iraq's borders and inside Iran, Syria and Jordan have been warned of the outbreak by the UN Refugee Agency (UNHCR).
"Many of us are suffering from diarrhoea. Doctors are not always available and this week we discovered that two men who were at our camp for a short period of time are now in Baghdad being treated for cholera," said Haifa Izidin, 36, a displaced woman living in a camp on the Iraqi-Syrian border.
"We are living in an unhygienic environment. Toilets are close to our living quarters, vegetables and beans are not washed properly - we're therefore vulnerable to catching the disease," Izidin added.
According to WHO, since mid-August at least 3,315 people in Iraq have been infected with cholera. Of these at least 15 have died. WHO global cholera coordinator Claire-Lise Chaignat said that up to 10 cases have also been confirmed in Iran, near the Iraqi border.
"We are worried about refugee camps in neighbouring countries as residents have poor access to clean water and sanitation and if cases are reported, the problem should be quickly tackled to prevent the spread of the disease," said Chaignat.
However, on 6 October, Pars, the semi-official Iranian news agency, said that Iran had 43 cholera cases, four times more than those announced by WHO. Pars, in agreement with WHO, also said that most of the cases were near the border with Iraq.
Iran shares a long border with Iraq, measuring some 1,500km. Many Iraqi refugees have fled to Iran to escape violence at home, while Iranian Shia pilgrims often cross into Iraq to visit the holy cities of Najaf and Kerbala in the south.
"At least 50,000 Iraqis flee their homes to safer places inside and outside Iraq every month. Many of them are living in displacement camps without proper medical assistance," said Dr Abdel-Kareem Imad, an epidemiologist in Amman, the Jordanian capital.
"There are more than two million Iraqis living as refugees in neighbouring countries and most of them are either camped at borders or living in suburbs but are in constant contact with new arrivals from Iraq and if the disease isn't controlled, it will spread fast in neighbouring countries," he added.
Imad said the Jordanian Ministry of Heath has stocked up on intravenous fluids and oral rehydration salts as a precaution for a possible outbreak of the disease.
"We hope it will be controlled inside Iraq so we won't have to use them," Imad said.
Hirço Avser, a senior official in the Kurdistan government in the north, said that the British Consul had offered assistance to the Kurdish Ministry of Health to control cholera in the northern cities of Sulaimaniyah, Arbil and Dahuk, in addition to neighbouring provinces.
Intense cholera awareness campaign
An intense cholera awareness campaign has been launched in Iraq with posters on how to combat cholera being plastered everywhere. Volunteers have been visiting schools, universities, ministries, hospitals, clinics and shops to educate the public about cholera. Leaflets have been distributing urging people to drink sterilised or boiled water, to avoid eating uncooked food and to make sure fruits and vegetables are washed properly.
Cholera is characterised by a sudden onset of acute watery diarrhoea that in severe cases can cause death by dehydration and kidney failure within hours. It is transmitted mainly through contaminated water and food.
"If water and sanitation facilities are not improved in the coming months, the disease won't stop and even if we are able to tackle the outbreak, it could resurface after a couple of weeks," Dr Taha Abdallah, a senior official at the Ministry of Health, said, adding that shortages of medical staff and a lack of mobile units to take to displacement camps were compounding the problem.
Displaced most at risk
There are fears that poor displaced families are particularly at risk of contracting the disease.
"Cholera cases have already been reported among displaced
families living in camps or abandoned buildings countrywide," Dr Faris Ahmed, an
epidemiologist at the Ministry of Health, said. "Although an intense campaign
has been launched among displaced families to control the outbreak, the disease
is spreading and they continue drinking unsafe water."
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