Inadequate sewage disposal blamed for hepatitis outbreak

Two boys happily play with pieces of plastic rubbish near a long puddle of smelly, green water, stretching across a few streets in Sadr city, east of Baghdad, seemingly oblivious to the potential health problems they face. Ali, 11, says his mother constantly cleans the cement in front of his house, trying to keep the water at bay. She doesn't keep him from looking through a nearby pile of rubbish, however, he says, laughing and holding up a broken toy. Ali's mother's attempts to keep things clean might be able to keep one family healthy. But the puddle of standing water and others like it nearby is probably the culprit in more than 100 recent cases of hepatitis E - a viral illness that feels like a bad case of flu and is commonly transmitted through human waste. The outbreak was confirmed by Health Ministry officials at the end of March in this poor neighbourhood, said Buthaina Ghanem, public health officer for the communicable diseases department of the UN World Health Organization's (WHO) Iraq office, now working from Amman. "It's unbelievable that standing water still causes such outbreaks, a year after the US-led invasion of Iraq," Omar Mekki, a medical officer at WHO-Iraq working from Amman, told IRIN. The Rustamiya sewage plant looted last April in central Baghdad still has not been fixed, Mekki said. Frequent power cuts stop water pumps that keep sewage from flooding the streets. Even worse, the sewage can get sucked into drinking water supplies once the pumps start again, Mekki said. "The main sewage treatment plant is still not working. It dumps one and a half tonnes of sewage into the Tigris river every day," Mekki said. "You can see it's pure sewage - the water is black." With hot weather on the way, the ailing power grid will be further strained as millions of Iraqis resort to air conditioning to keep cool. As the "high season" for diarrhoeal disease approaches in Iraq, WHO and US Center for Disease Control officials are trying to remind people to clean their water, Ghanem said. Officials recently passed out chlorination tablets and put up posters reminding families to boil their cooking water for at least five minutes, for example, she said. "It's under control now," Ghanem said. "But hepatitis is everywhere. We're struggling to keep it within a normal range." So far this year, cholera, also often transmitted by water, had also been kept at bay, Ghanem said. But even under the former Saddam Hussein regime, it was not uncommon to see standing water in the streets, even on the hottest, driest days, Iraqis say. Baghdad's water table is high and the power has never been reliable. WHO officials are mandated to monitor water quality, but the raw sewage problem is so huge, it's impossible to measure, Mekki said. Water quality "upstream" to the north of Baghdad is not that bad, but communities south of the capital bear the brunt of the sewage. "It's our responsibility to make sure this gets fixed," Mekki said. "This is killing children." Private contractor Bechtel Corp. was given the job of repairing the Rustamiya sewage plant, according to Jan Kellett, United Nations Development Programme (UNDP) Iraq press officer in Amman. Poor security in the neighbourhood apparently has kept Bechtel from finishing the project, Kellett said. Bechtel officials were not immediately available for comment. New sewerage trunk lines are being installed in the east Baghdad neighbourhood of Gasiliya by UNDP, Kellett said. At one point just after the US-led invasion, the United Nations was delivering nine million litres of potable water daily to families in Baghdad, Basra and Fallujah, Ross Mountain, the acting UN Special Representative for Iraq, told a donors' conference meeting in Doha, Qatar earlier this week.