The Surge Is Working In Iraq

{Crossposted at To Us!. Permission to use noncommercially with attribution.}

There is a real effective surge in Iraq.  It just isn’t with the combat forces.

Cholera is surging through the country.

A cholera epidemic in northern Iraq has infected approximately 7,000 people and could reach Baghdad within weeks as the disease spreads through the country’s decrepit and unsanitary water system, Iraqi health officials said Tuesday.

The World Health Organization reported that the epidemic is concentrated in the northern regions of Kirkuk and Sulaimaniya and that 10 people are known to have died. But Dr. Said Hakki, president of the Iraqi Red Crescent Society, a relief organization that has responded to the epidemic, said that new cases had turned up in the neighboring provinces, Erbil and Nineveh, indicating that the disease had spread.

What is cholera?

Cholera is an acute diarrhoeal infection caused by ingestion of the bacterium Vibrio cholerae. Transmission occurs through direct faecal-oral contamination or through ingestion of contaminated water and food. The disease is characterized in its most severe form by a sudden onset of acute watery diarrhoea that can lead to death by severe dehydration and kidney failure. The extremely short incubation period – two hours to five days – enhances the potentially explosive pattern of outbreaks, as the number of cases can rise very quickly. About 75% of people infected with cholera do not develop any symptoms. However, the pathogens stay in their faeces for 7 to 14 days and are shed back into the environment, potentially infecting other individuals. Cholera is an extremely virulent disease that affects both children and adults. Unlike other diarrhoeal diseases, it can kill healthy adults within hours. Individuals with lower immunity, such as malnourished children or people living with HIV, are at greater risk of death if infected by cholera.

Isn’t that a disease from the Middle Ages?

During the 19th century, cholera spread repeatedly from its original reservoir or source in the Ganges delta in India to the rest of the world, before receding to South Asia. Six pandemics were recorded that killed millions of people across Europe, Africa and the Americas. The seventh pandemic, which is still ongoing, started in 1961 in South Asia, reached Africa in 1971 and the Americas in 1991. The disease is now considered to be endemic in many countries and the pathogen causing cholera cannot currently be eliminated from the environment.

Two serogroups of V. cholerae – O1 and O139 – can cause outbreaks. The main reservoirs are human beings and aquatic sources such as brackish water and estuaries, often associated with algal blooms (plankton). Recent studies indicate that global warming might create a favourable environment for V. cholerae and increase the incidence of the disease in vulnerable areas.

Who is at risk?  How do they get it? Global warming – is Al Gore behind this?

Cholera is mainly transmitted through contaminated water and food and is closely linked to inadequate environmental management. The absence or shortage of safe water and sufficient sanitation combined with a generally poor environmental status are the main causes of spread of the disease. Typical at-risk areas include peri-urban slums, where basic infrastructure is not available, as well as camps for internally displaced people or refugees, where minimum requirements of clean water and sanitation are not met. However, it is important to stress that the belief that cholera epidemics are caused by dead bodies after disasters, whether natural or man-made, is false. Nonetheless, rumours and panic are often rife in the aftermath of a disaster. On the other hand, the consequences of a disaster — such as disruption of water and sanitation systems or massive displacement of population to inadequate and overcrowded camps — can increase the risk of transmission, should the pathogen be present or introduced.

Since 2005, the re-emergence of cholera has been noted in parallel with the ever-increasing size of vulnerable populations living in unsanitary conditions. Cholera remains a global threat to public health and one of the key indicators of social development. While the disease is no longer an issue in countries where minimum hygiene standards are met, it remains a threat in almost every developing country. The number of cholera cases reported to WHO during 2006 rose dramatically, reaching the level of the late 1990s. A total of 236 896 cases were notified from 52 countries, including 6311 deaths, an overall increase of 79% compared with the number of cases reported in 2005.

Was it a surprise?  Um – NO!

AMMAN, March 22 (Reuters) – United Nations agencies working in Iraq warned on Thursday a chronic shortage of safe drinking water risks causing more child deaths and an outbreak of waterborne disease such as cholera during the summer.

Four years after the U.S.-led invasion of Iraq in 2003, millions of Iraqi children still find that safe water is no easier to access, said a statement issued by leading U.N. aid agencies operating in Iraq.

Does General Petraeus have a slide for this?

The major human displacement caused by the Iraq conflict – people being driven from their homes or simply choosing to leave – is likely to be driving the epidemic, officials say.

Who is helping?

Between 23 August and 6 September 2007, the cumulative number of cases of acute watery diarrhoea reported from five out of eleven districts of Sulaymaniyah Governate stands at 3,182 including 9 deaths (case fatality rate, CFR: 0.3%). Of these reported cases, Vibrio cholerae has been laboratory confirmed in 283 stool specimens.

During the period from 29 July to 2 September 2007, the health authority of Kirkuk Governate reported a total of 3,728 cases of acute diarrhoeal disease including 1 death (CFR: 0.03%). The first index case of cholera, confirmed by laboratory test, was reported from Kirkuk Governate on 14 August 2007. Most recently, six laboratory-confirmed cases of cholera were reported from Erbil Governate.

The Government of Iraq has mobilised a multi-sectoral response to the outbreak. A high-level National Committee on Cholera Preparedness and Outbreak Response has been established. The provincial health authorities of Sulaymaniyah, Kirkuk and Erbil Governates have initiated a number of public health control measures to contain the outbreak, including risk assessment, improving water safety and sanitation, strengthening the surveillance system for diarrhoeal disease, improving coordination and information flow, standardising clinical case management, mobilising medical and other essential supplies, and implementing social mobilisation and health education campaigns. All public water supply systems in the affected districts have been chlorinated by the provincial authorities. In addition, water samples from the public water supply sources are being collected and tested routinely to ensure they meet potable water safety standards.

WHO, UNICEF, UNDP, International Committee of the Red Cross (ICRC), a number of non-governmental organisations including the International Medical Corps (IMC), and Médecins Sans Frontières (MSF – France) are supporting the Ministry of Health and local health authorities in ongoing response operations.

The Numbers

Up until the Iraq epidemic, in 2005 WORLDWIDE, there were 236,896 total number of cases with 6311 deaths.
In Iraq alone now, there are 3182 cases with 9 deaths, and the number is exploding. For comparison, in 2004, the WHO reported 35 cases of cholera in Iraq with zero deaths.

Imagine for just a moment.  You have explosive, debilitating diarrhea.  It’s over 100 degrees.  You have no refrigeration, no bottled water, no cans of broth, soup and jello, no rehydration fluids, no toilet paper, no air conditioner or fans, no ice, no flushing toilets, no clean potable water of any kind, no medication, no clinic or hospital.  How do you feel now?

Not a single US agency in the mix of health and relief agencies tackling this national nightmare.  The US breaks a country, causes a 100% preventable epidemic, causes untold suffering, and leaves the mess for the international relief community to address.

And Americans have already learned that every single governmental agency is headed up with partisan political appointees who will report distorted and false information at the mandate of the Bush White House.  So there is no trust in anything that the CDC or the HHS has to say about a cholera epidemic.

In Iraq with military supply lines becoming increasingly imperiled, it’s only a matter of time before the beleaguered and exhausted troops also succumb to cholera.  They are tired, they may not have timely and adequate deliveries of bottle or treated water, and just as they had to host bake sales to raise funds to purchase their own body armor, they have no guarantee that the White House won’t fail them again, since the budget always funds political donors, regardless of what the troops need.

Love in the time of cholera.  Not just a book title anymore.

Hearts and minds, baby.