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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.
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.
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.
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”.
In total, ACF’s hygiene awareness sessions reached 5,449 individuals across four districts – Arbat, Bazyan, Center and Saed Sadiq – and 5,137 cholera kits were distributed. The collective efforts of ACF, in collaboration with local communities and the health directorate, yielded a profoundly positive impact on the lives of the people in Sulaymaniyah governorate.
Kamal Aziz Inayat supervised the interventions of the hygiene awareness team for control and prevention of cholera. “Through our activities, we disseminate messages related to the prevention and control of cholera and we distribute cholera kits in locations with a higher prevalence of cholera, she explains. After ACF’s intervention, cholera cases dropped by 68%, and no deaths were reported. The positive impact of this cholera control and prevention activities serves as a testament to the importance of prompt, coordinated, and community-engaged intervention in the face of public health crises.”
Seven years after the end of fighting against Daesh, and despite some positive developments, Iraq still faces many challenges with 2.5 million people in need of humanitarian assistance. The erosion of national social cohesion, the incomplete restoration of basic services and livelihoods, worsening the impact of climate change, increasing water stress and the cyclical risk of cholera epidemics challenge the country’s fragile stability. Even as humanitarian needs persist, there have been large reductions in funding, leaving many of the needs unmet.
Action Against Hunger (ACF) continues to undertake critical interventions – we rehabilitated drinking water supply systems in schools and supported local authorities in detecting leaks in community water networks. We also implemented a participatory water stress risk-analysis tool, consulting communities to strengthen advocacy on environmental standards and continued to raise awareness among communities and authorities on good hygiene and water management practices.
We engaged with farmers to support the development of agriculture resilient to climate change and water shortages, supported vulnerable displaced households through cash transfers to help them meet their needs, and worked to help revive the local economy by supporting small businesses through grants and training owners to ensure their businesses thrive.
When it came to reducing the stigma and taboos around access to mental healthcare, Action against Hunger provided direct services and training in mental health, psychosocial support, and protection to communities. We also worked to strengthen social cohesion by analyzing the dynamics of conflict to provide a response adapted to the needs of the population.
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