Many suspected cholera cases in Basra

Poor sanitation, economic difficulties and uncertainties over security are fuelling a possible cholera outbreak in the southern Iraqi city of Basra. Dr Hadi Rahim Dayri at the city's Al-Tahrir hospital said between 45 and 50 suspected cases, all with severe diarrhoea, dehydration and projectile vomiting, were arriving in the hospital every day. Only about 30 of them could be admitted overnight due to a shortage of beds, while the rest had to be sent home. A number had already died, he added. At the Ibn Ghazwan Children’s Hospital, Dr Rana Salah, said most of the suspected cholera cases she was treating had been brought to the hospital far too late. Of the 15 cases arriving every day, about two were dying of severe diarrhoea and dehydration every 24 hours, she added. "We can only help some of the cases - the rest are dying [because] of ignorance." At the Basra Maternal and Child Hospital, 90 percent of the 200 outpatients it received every day were suffering from diarrhoea, Fadela Chaib, a World Health Organisation spokeswoman, said. The WHO said on Thursday that it was awaiting confirmation of a cholera outbreak in Basra, but was 95 percent certain of having found cases in at least two hospitals. Chaib said Iraqi doctors at the Al-Tahrir and Basra Maternal and Child hospitals had identified 19 cases (all but one of them children under five) using both chemical and clinical investigations, but they lacked the laboratory equipment to conduct a final analysis, while the city's central laboratory was inoperative due to looting. WHO had therefore sent four samples to the National Public Laboratory in neighbouring Kuwait for confirmation, and was taking a further 37 samples on Thursday afternoon. WHO suspected that there might be hundreds of cases, Chaib said. "This may be the tip of the iceberg. All the factors for a big outbreak are present. Considering the lack of security and the water and the sanitation situation, this is really serious," she added. Due to the lack of clean water in southern Iraq, the waterborne disease was almost inevitable, said Christine Chomilier, a WHO technical officer. "It’s a contamination chain. You have infected water, then you have patients drinking the water and having diarrhoea. Then they don’t wash their hands properly, they make food or touch other people, and they become infected as well," she observed. Insecurity in parts of the city is also a factor in the spread of the disease. Most of the cases are from poor and crowded areas, where doctors do not feel safe enough to go. "The cholera in the area was well contained before. You could easily find the source of contamination, but now people can’t move because of insecurity," Chaib said. Moreover, even a much reduced hospital fee of about 1,000 Iraqi dinars (US 50 cents) per night, which covers food, an overnight stay and medicine, may be prohibitive for many families given the difficult economic circumstances now affecting many of them. Meanwhile, local markets are awash with stolen and looted antibiotics from hospitals. "We can’t buy medicine from looters - we need to get it legally," said Dr Asad Isa at the Ibn Ghazwan hospital. He reported seeing Isomil, used to treat chronic diarrhoea, being sold in a market for 10,000 dinars. While those who go to hospital are being rehydrated, treated and sent home, the causes of the waterborne disease continue to prevail. Raw sewage is still visible in the streets in parts of the city, and people are still collecting water from the contaminated Shatt Al-Arab river. Asked whether people were aware that they had to boil their drinking water, Dr Hadi Rahim said: "What? By which means boiling the water? They have no gas, and kerosene is too expensive. They can’t boil anything."