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WHO update on Iraq: Health situation in Basra
Suspected Cholera outbreak
A team from the World Health Organization, which now has a permanent presence in Basra, visited Al Tahrir Teaching Hospital together with local health experts in order to assess the health situation in Basra. Doctors in the hospital reported a significant increase in the number of cases of diarrhoeal diseases, gastroenteritis and dehydration. Seven cases of clinically confirmed cholera were reported, mainly among very young children (between 13 months and 4 years old). They were from the north of Basra, near to the Airport. The children were rehydrated and subsequently returned home. The doctors said there are currently more than 30 admissions per day for diarrhoeal disease. They expressed concern that it is not possible to perform medical tests at the hospital because the central laboratory is not functioning and some vital reagents are missing or have been stolen. The WHO team took samples to Kuwait the same day to be analysed at the National Public laboratory in Kuwait to confirm the presence of cholera. The results are expected in the coming few days.
The same situation was confirmed at the Basra Children's Hospital. Doctors said that out of 200 outpatients a day, 90% are for diarrhoea; others are diagnosed with hepatitis, Acute Respiratory Infections, malnutrition, shigella and typhoid. Again, there are no facilities to conduct tests to confirm the presence of cholera or other infectious agents. However, there is no doubt among the doctors and the visiting team that this is cholera. "In the absence of laboratory confirmation, we can only rely on our experience and knowledge of our patients to be able to recognise these diseases. We can clinically confirm 4 cases of cholera this week," one one of the managers said.
Hospital workers point out that they could only treat the symptoms but not the source of the problem, which is clearly linked to the water supply situation in Basra. Sewage is not being disposed of, garbage collection is happening intermittently or not at all and people are using water from the polluted Chatt Al Arab river.
Another key problem is that surveillance control activities have declined or disappeared since the beginning of the war, with an almost total lack of surveillance and control of communicable diseases. In Basra, it is clear that this combination is contributing to an increasing number of cases of diarrhoeal disease and there is concern that an outbreak of cholera could cause severe problems. The doctors reported also cases of food poisoning, mainly arising from eating ice cream. The water is not clean and ice cream is being made in poor sanitary conditions.
The over-riding problem in Basra is security. We met surgeons who said they cannot perform their duties because they are threatened by the families of their patients. They complained about the lack of security, as did the newly elected Director of Health, Dr Yassin Musowi during his meeting in Basra with WHO, UNICEF and various health NGOs. During the last few days, many governmental vehicles were stolen, as was the minibus of the children's hospital. The vehicle was very useful to transport more than 15 health workers from their workplace to their homes. There are alarming reports of the extent of insecurity, particularly for female health workers. Some of them are staying at home while others are living at their workplaces because the security situation is really bad. Nobody feels secure in the city where we can hear shooting at night. A lot of doctors avoid taking their cars and are not performing in a good and safe environment.
Good news about public warehouses
A WHO team visited the warehouses in Basra. Out of a total of six, only one serving the private sector was looted. The employees of other warehouses protected them from looting. The remaining five are intact. It was not possible to make a complete inventory but it seems that large amounts of medicine stocks are still intact. There are shortages of vaccines and TB drugs are going to run short very soon. The acute needs are laboratory reagents and insecticides. The employees reported that the transport facilities are still functioning.
Needs and donations
WHO urges donors and its partners on the ground not to create parallel health systems. WHO also urges donors to coordinate and consult before sending donations of medical supplies, including drugs and other equipment. Otherwise, there is a danger that critical needs will remain unmet, while far less serious needs are oversupplied.