Iraq : curbing the cholera epidemic

Associated with poverty and poor hygienic and sanitation conditions, cholera remains the most prevalent acute watery diarrheal disease in the world.

In recent years, cholera has become a threat to public health and an indicator of inequity and lack of awareness in communities throughout Iraq. In order to prevent the spread of the epidemic in the war-torn nation, Action Against Hunger (ACF) leads hygiene promotion sessions at the community level and distributes cholera kits, in collaboration with local authorities.

Since 1 January and as of 25 September 2023, 723 067 cholera cases, including 4 301 deaths, have been reported worldwide, mainly in Africa and Asia¹. According to data from the Ministry of Health, as of October 30, 2023, 1,238 confirmed cholera cases including 7 deaths were registered in Iraq.

Cholera is characterized by sudden, painless watery diarrhea and vomiting. The disease can swiftly lead to dehydration, cardiovascular collapse, and, if left untreated, death. However, rehydration stands as the primary treatment, and vaccines can be used in both preventing and treating the epidemic.

Outbreaks typically originate from a single source, spreading rapidly through contaminated food or water. This is particularly alarming in regions grappling with common risk factors such as poor water access, inadequate sanitation, unhygienic practices, and weakened health systems – factors intricately linked to poverty. If cholera is endemic since 1966 in Iraq, the collapse of the state and the health system led to an increase in the number of cases in the mid-2000s.

To prevent and control the spread of the disease, Action Against Hunger (ACF) raises awareness among communities and authorities regarding good hygiene practices and water management across five governorates in the country.

A heightened risk of cholera outbreak

At the heart of Iraq’s cholera concern lies the alarming state of its water sources. According to the Ministry of Health, the main source of the infection would be the irrigation of crops with sewage water from the Euphrates and Tigris rivers², which register historical low levels and are the main source of water for millions of people in the region.

Cholera has cast its shadow across various regions of Iraq, with certain areas bearing the brunt of the outbreak. Kirkuk in the north (335 cases and 3 deaths), Sulaymaniyah (220 cases and 1 death), Erbil (442 cases), Baghdad-Rasafa and Karkh in the central part of Iraq (42 cases), Dyala (178 cases and 2 deaths), and Thi Qar in the south (52 cases and 1 death) are the most heavily impacted regions. Furthermore, the Baghdad Ministry of Health (MoH) has identified Basra, Maysan, and Muthana as high-risk governorates for cholera outbreaks due to substandard water quality conditions.

Cholera and malnutrition : a harmful circle

In a country already burdened by poverty, instability, climate change effects, and poor sanitation, cholera and malnutrition create a harmful cycle. Cholera not only exacerbates malnutrition but also leads to a higher incidence and prolonged duration of diarrhea, particularly in children with severe acute malnutrition (SAM).

Malnutrition weakens immunity, making individuals more susceptible to contracting diseases, thereby amplifying the severity of the crisis. Within this framework, humanitarian organizations and healthcare professionals are rallying to address the urgent need for clean water, sanitation and hygiene measures.

Prevent and control cholera at the community level

Since 2021, Action Against Hunger (ACF) has actively participated as a member of the Water, Hygiene, and Sanitation (WaSH) cluster, concentrating on coordinating responses and enhancing the capabilities of partners engaged in addressing water scarcity arising from climate change impacts.

In May 2023, with the support of the Ministry of Health, ACF implemented capacity-building sessions for 20 health workers to improve the cholera conducted an assessment to pinpoint high-risk areas based on their cholera outbreak history, identifying Sulaymaniyah, Kirkuk, Erbil, Thi-Qar, and Basra as priority targets. As cholera spreads through the consumption of contaminated food and water, efforts have focused on raising community awareness regarding proper handling of such consumables, as well as good hand hygiene.

Maryam Qadir lives with six family members at Saed Sadiq district of Sulaymaniyah and she assisted to the cholera control and prevention sessions. “Getting information about how to prevent and control cholera has made a big difference, she says. I now apply in my daily life the advices I received from ACF’s hygiene awareness team in order to prevent myself or my family from catching the disease”.