|
Sewage streets iraq { May 13 2003 } Original Source Link: (May no longer be active)
http://www.nytimes.com/2003/05/13/international/worldspecial/13CHOL.htmlhttp://www.nytimes.com/2003/05/13/international/worldspecial/13CHOL.html
May 13, 2003
Experts Fear a Cholera Epidemic in Basra
By MARC SANTORA with LAWRENCE K. ALTMAN
BASRA, Iraq, May 12 — As sewage continues to spill into the streets of this city, Iraq's second largest, and the local population is increasingly relying on water from fetid canals, the World Health Organization warned today that Basra was poised for an epidemic of cholera.
At least 55 suspected cases have been reported in Basra in recent days, and Dr. Denis Coulombier, an official of the health agency here, estimated that several hundred more cases had yet to be diagnosed. There have been no deaths.
"Given the health and sanitation conditions, it could spread very fast," Dr. Coulombier said. "I believe what we are seeing is the tip of the iceberg."
Dr. Claire-Lise Chaignat, who directs the World Health Organization cholera program in Geneva, said that "once cholera starts to burst, then it is very difficult to contain."
Until an effective community water supply can be set up, health workers are trying to teach residents to chlorinate or boil their water.
Cholera, which kills about 120,000 people worldwide each year, is caused by a bacterium that produces a toxin that typically leads to severe diarrhea. Death comes from dehydration. The germ is often spread by fecal contamination of water supplies.
The disease has been endemic in Basra and most other areas of Iraq since the 1980's.
A major outbreak occurred in the Basra region in 1991 after the first Persian Gulf war. At that time the power was knocked out, incapacitating the water treatment plants that provided a relatively safe system.
Half a million tons of raw sewage flowed into the rivers daily, according to the United Nations.
Now the major problem is security. Hospitals are understaffed because some people are afraid to come to work, while others are not being paid. Because so much equipment was looted, hospital workers are largely relying on what aid agencies are bringing in, which is not yet sufficient to deal with an epidemic.
British military officials, responsible for establishing order here, have not been guarding the hospitals, citing limited manpower and the danger of becoming stuck in fixed guard positions.
Lack of security is also preventing health experts from going to places considered most at risk to educate residents and monitor the spread of disease. Representatives of aid and health organizations said they were concerned that health workers would not be able to do their jobs properly to contain the current outbreak.
"So we have to be alert" to watch for new cases and a number of other factors like an influx of population and further disruption of the water system, Dr. Chaignat said, adding, "Anything can happen in this type of situation."
British military officials, who met with United Nations organizations and aid workers today, said they were aware of the problem and were trying to work with medical experts.
"At the moment, the security of the hospitals is being discussed at the highest levels," the medical liaison officer for the British Army said.
He added that criminals had come to realize that hospitals are a rich target and officials have recognized that they need to confront the problem. Beginning Saturday, the British will hire 1,000 people to guard fixed locations, working with the local police force of more than 700.
"It's almost a foregone conclusion that we were going to have a situation of this sort, given the problem with water and sanitation," the liaison officer said.
Doctors at hospitals here say they have supplies to deal with the current cholera outbreak but will not have the fluid and drugs needed to cope with a larger outbreak.
Death can be prevented if a victim is treated early with large amounts of fluids and electrolytes, which can be given by using oral rehydration kits. In severe cases, fluids must be injected intravenously.
Working conditions in the hospitals remain bleak. Some doctors refuse to return to work because of security concerns. Those who have come back have been paid only once since the war began, according to several reports, and then only $100.
Some staff members were paid in 10,000 Iraqi-dinar notes, which merchants will not take because looters stripped the local bank of the bills.
The hospitals have generators, but when the power goes out, which it does for hours nearly every day, the elevators do not work properly and the lighting is dim.
Until security improves, the situation in the hospitals is not likely to improve, aid workers said.
Local hospitals have the ability to perform diagnostic tests for cholera. But looting and lack of security have restricted testing in the outbreak. Last week, stool samples from 17 suspected cases were sent from Basra to Kuwait for confirmation. But they arrived in such poor condition that the diagnoses could not be confirmed, said Dr. Chaignat of the World Health Organization.
Since then, doctors in Basra have sent specimens from an additional 38 suspected cases to Kuwait; results are expected on Tuesday.
"Cholera has not been diagnosed officially, but we are acting as if it was cholera because we cannot wait for the confirmation," Dr. Chaignat said.
Aid workers said it was still hard to visit certain communities, especially the poorer sections of the city, where the smell of rotting sewage is overpowering at times.
There, military officials said, people are tapping into the water system, creating a risk of contamination to the whole water supply for the city.
Unicef, the United Nations Children's Fund, said the sewage system in the city was in a "deplorable state."
Copyright 2003 The New York Times Company | Home | Privacy Policy | Search | Corrections | Help | Back to Top
|
|
