Cholera drops in Iraq while spiking in Baghdad

BAGHDAD — The number of cholera cases around Iraq plummeted in recent weeks, except in Baghdad, where health officials want to combat the increase with education and infrastructure changes.

A World Health Organization report released Sunday said 90 percent of the country's new cases came from the capital city. Lab tests confirmed 20 cases there the week of Nov. 19, shifting the focus from northern Iraq, where the illness spread this fall.

Cholera, a bacterial infection characterized by speedy onset of vomiting and severe diarrhea, can lead to dehydration and kidney failure. It's killed 24 people in Iraq since August, including two children living at a Baghdad orphanage. The illness spreads quickly, often through food and water that came into contact with infected fecal matter; people can spread the bacteria even when they aren't showing symptoms.

Most cases in Iraq were centered in the northern provinces of Erbil, Kiruk and Sulaimaniyah, but as it spread to the densely populated city of Baghdad, there's even greater risk for an epidemic.

"It could become very bad, very quickly," said Claire Hajaj, a spokeswoman for UNICEF in Iraq. "There's no magic bullet for containing cholera. It's trying to keep things clean, trying to clean water, trying to improve sanitation. (The Ministry of Health) really did do a lot to help contain it."

Iraqi health officials are combating the illness with a quarter-million dollar campaign including TV commercials, informational handouts at security checkpoints and posters hanging around the city. The information encourages people to wash food, use soap and keep their homes clean. Waleed Hussein, information director for the education ministry, said schools hung instructional posters and began teaching healthful habits, especially for young students.

Even before the information blitz in Baghdad, the awareness campaign showed signs of success in the rest of Iraq: the number of new confirmed cases dropped from a high of 2,894 in September to 157 in November.

But UNICEF, health officials and legislators say no amount of hand washing and water boiling can solve the real problem: poor water treatment, war-damaged and outmoded sewage systems and spotty trash collection. The World Health Organization report said Iraq is likely to see another outbreak in Spring 2008.

This year's wave of illness spread during some of the hottest months of the year when chlorine shortages, power outages and security issues plagued water treatment facilities. Decreases in violence and stabilized chlorine levels helped curb the number of infections, health officials said, along with healthy practices at home.

"I don't think there's huge money for the control of the disease. What we need more are millions to reform the infrastructure," said Mustafa Mohammed, a member of parliament's health committee. "No treatment of the water — it means the spread of many diseases, not just cholera."

Mohammed said the government would continue pushing healthy habits as long as cholera infects Baghdad and other provinces, but he'd like to make water treatment along the Tigris and Euphrates rivers a top health priority.

"The ministers of health did their job well during the outbreak. I think we have surrounded the disease in many places," Mohammed said. "It doesn't mean that everything is OK."

Special Correspondent Mohammed al Dulaimy also contributed to this article.