Hepatitis outbreak in capital

At least 60 cases of hepatitis E have been reported in the Baghdad suburb of Allatefiya, the World Health Organization (WHO) confirmed on Monday. The UN agency has sent hepatitis E test kits, water purification tablets, information brochures and other material to Iraq to help with the outbreak. People in other areas have also reported cases. When Karrar Toma got sick recently, his family knew he had jaundice because of his yellow eyes, he told IRIN as he stood near the open, green-water sewer that runs in front of his yard, in the Kamaliya district of Baghdad. His family made him stay inside and eat only sweets until he was well, the 14-year-old said. Jaundice is a sign of hepatitis E, a curable disease that Toma contracted from water contaminated by sewage. Doctors gave Salah Hassan, another victim of the disease, medicine to cure him. Local people say the ongoing problem of sewage is exacerbating the situation. "You can see the pipes are broken, so the sewage often gets into our water," Hassan said, standing on the sewage and rubbish-filled street in a poor suburb of the capital. "Our family once got water purification tablets, but we don't have any at the moment." Toma and Hassan are just two of the unreported cases of a hepatitis E outbreak in the country in which five people have died and more than 60 people have fallen sick - many in cities on the outskirts of Baghdad, Dr Abdul Jalil Najih Hassan, director at the Communicable Disease Control Centre in Iraq, told IRIN. A March outbreak in the town of Mamoudiya, about 100 km south of Baghdad, is included in the totals. Because there aren't enough diagnostic kits in Iraq at the moment, there may also may be numerous hepatitis A cases, he added. "It is one of the water borne diseases we get in the summer, including typhoid, dysentery, cholera and other forms of hepatitis," Dr Hassan said. "Because of security, I think there's no improvement to the water plants in Baghdad yet." If the viral diseases are treated soon enough, they are not usually fatal. But pregnant women and children are especially vulnerable, Dr Wijdan Akram, a viral hepatitis expert at the Communicable Disease Control Centre, told IRIN. At least two of those who died were pregnant women, Akram said. An estimated 90 percent of pregnant women who contract hepatitis E die from it, she said. "People often don't come to the doctors, or they go to private clinics," Akram said. "The numbers could be much higher." Sewage disposal and clean water have been a problem for a long time in Iraq. Broken pipes have never been repaired, leaving raw sewage running in the street. Much of the population has built up some immunity to the disease, Dr Hassan explained. In addition, pipes that work are often affected by frequent power cuts and because water pressure is low in many areas, residents use electric water pumps to get water from their taps, he said. If nearby sewage pipes break, the sewage often gets sucked into the water. "This outbreak happened after there was a leakage from sewage disposal pipes that allowed sewage into water supply pipes," Dr Hassan stressed. "This led to the contamination." At the same time, the Ministry of Health is distributing water sterilisation tablets received from WHO and more than 50,000 water containers. In a poster and TV campaign to educate residents, they are told simple things: Get your water from good sources, not from the street; do not throw rubbish into the waste water on the streets; use sterilisation tablets, or boil water. But most of the children on the street in the Kamaliya district say they have never seen the sterilisation tablets. They know their mothers boil water for cooking, but not for drinking. The health kits sent to Iraq should help ease the problem, Naeema Gasseer, director of the WHO Iraq office based in Amman, Jordan, told IRIN. "Measures have been taken to offer enhanced diagnostic and treatment support," she added. Doctors have been told what to look for. Workers of the International Committee for the Red Cross (ICRC) and the United Nations Children's Fund (UNICEF) have been working to get clean water to sites where there is none, she added.