Cholera In Iraq

by hilzoy

From the NYT:

"A cholera epidemic in northern Iraq has infected approximately 7,000 people and could reach Baghdad within weeks as the disease spreads through the country’s decrepit and unsanitary water system, Iraqi health officials said Tuesday.

The World Health Organization reported that the epidemic is concentrated in the northern regions of Kirkuk and Sulaimaniya and that 10 people are known to have died. But Dr. Said Hakki, president of the Iraqi Red Crescent Society, a relief organization that has responded to the epidemic, said that new cases had turned up in the neighboring provinces, Erbil and Nineveh, indicating that the disease had spread.

Most significant, Dr. Hakki said, were two cases in a village on the border between Kirkuk and Diyala Provinces, one involving a young girl. Baghdad is next to Diyala. (...)

In Baghdad, Iraq’s deputy health minister, Dr. Adel Mohsin, said that he was not aware of any cases on the Diyala border. But he said that further spread of the epidemic was “very likely” unless government agencies followed strict guidelines on water testing and maintaining sufficient levels of chlorination, which kills the bacteria.

In a chilling reminder of how difficult it may be to maintain those levels, Dr. Mohsin said that chlorine imports had been severely curtailed as a result of recent insurgent bombs that had been laced with chlorine, which in concentrated form can be deadly. (...)

Dr. Burhan Omar, deputy director of Kirkuk General Hospital, said that because of such problems, water purification plants themselves could be contaminated with the bacteria. Those plants, in turn, can “bring the disease from the northern parts to the middle and southern parts of Iraq.”

In fact, if those plants are contaminated, the epidemic could hopscotch all the way to Basra, in the south, Dr. Omar said."

Meanwhile, IRIN reports that "up to 75 percent of doctors, pharmacists and nurses have left their jobs," and that this is already having disastrous results, even without a cholera epidemic. Moreover, if you were a doctor who was still on the job, would you feel comfortable working in Baghdad? Who do we expect to travel around in an incredibly dangerous city, finding and caring for the sick, or even taking away the dead?

I have no idea.

Comments

[alphie]

Yikes,

A handy supply of biological weapons delivered to...whomever.

[Jesurgislac]

Most people infected with cholera don't actualy get ill: but they carry the bacteria in their gut for up to a fortnight (the BBC news medical notes from 2003) and they transmit the infection, especially in areas where water can't be disinfected and there isn't enough water for people to routinely wash their hands after taking a dump. MSF reports.

This is bad news. I presume the war-supporters will spin it as they spun the Lancet reports: the people who die will die out of sight, not on the evening news. The only way this would matter to a wingnut is if US soldiers began dying of it: and that actually seems fairly unlikely, though possible if an infected Iraqi is brought in as a prisoner. But adults in good health who receive immediate treatment mostly don't die.

When the cholera comes -- as it will past a doubt --
Keep out of the wet and don't go on the shout,
For the sickness gets in as the liquor dies out,
A' it crumples the young British soldier.

[Hartmut]

[snark] I imagine the headline: people stay at home dying of cholera, deads by car bomb way down as a result. The purge* is working[/snark]

*doubly sick pun

[Ugh]

a result of recent insurgent bombs that had been laced with chlorine

I don't know what Dr. Mohsin is complaining about, this is simply the market at work. If insurgents are willing to pay more for chlorine than the government run sanitary systems, that simply means the chlorine is being put to its most profitable use. In the long run, this will mean a larger and more productive economy. Remember, a rising tide lifts all boats. Indeed, if the government run sanitary systems were privatized, they would be run much more efficiently and likely be able to outbid the insurgents for the needed chlorine.

In the meantime, I'm sure Iraqis can just pick up some Evian at the local Safeway.

[Dianne]

Moreover, if you were a doctor who was still on the job, would you feel comfortable working in Baghdad?

That's one of your easier rhetorical questions: No, not a bit. Why do you think that most of them have left? Not that all of those 75% left: some were killed when the US bombed the hospitals they were working in or when they couldn't satisfy their kidnappers or when they were trying to hurry to an emergency and hit an IED or when they were too tired to notice the Ameican roadblock and got shot...

[Hartmut]

Maybe those chlorine bombs can be spun as improvised sanitation devices. The victims would then not be dead as a result of the (non-existing anyway) civil war and would not have to be counted. Since none of them died of disease this is also a proof that the privatized (those chlorine bombs are arguably not government-sent) public health is improving and that in just a few more Friedman units all will be scent and roses (btw, the regular flower greetings of US soldiers did fail only because the flower growing in the desert was/is still in the hand of the government. A no-bid contract should take care of that, 1500$ per rose, 1200$ per tulip).

[John Thullen]

Cholera is just MoveOn.org, al Qaeda, Hillary, Obama, Chuck Hagel, capital gains tax, socialized medicine, Democrat, benchmarks, and Congressional oversight spelled differently.

If the Iraqis had higher deductibles, they would have been more careful and this wouldn't have happened.

In my state of Cholerado, there is a plan afoot to force everyone to buy health insurance, roughly the Romney plan. It would be just like the laws making it illegal to drive without car insurance, except in this case it would be ilegal to contract cholera if you didn't have health insurance.

Water treatment plants would not be necessary (thus saving money for the beleagered taxpayer) because folks would be incentivized to stay away from precious bodily fluids, thus avoiding the temptation to collectivize, as well.

I call it the Shirley MacLain plan, wherein Jack Nicholson forces her to have a drink to kill that bug that has crawled up her a**.

[Tayi]

Wasn't chlorine one of the things that the economic sanctions made it difficult for the Iraqi government to buy? My memory is bad, but I seem to remember it can be an ingredient in chemical weapons. If this is true, I'm surprised we haven't seen cholera epidemics sooner.

[dutchmarbel]

Tayi: read this about the sanctions (Harpers article from 2002)

[Tayi]

Thanks, dutchmarbel. After reading that, I have to say I'm even more surprised that we haven't seen cholera epidemics all throughout the occupation of Iraq.

[Batocchio]

Man. As if they didn't have enough problems.

[Ugh]

Man. As if they didn't have enough problems.

What are you talking about? We're surging, progressing, reconcilating, reconstructing, and winning. Just look at all the ponies.

[BigHank53]

I'm trying to figure out where cholera lands on the whole Democracy! Whiskey! Sexy! spectrum, but I have to admit my wingnut goggles are not powerful enough.

[Hartmut]

According to (anonymous) Pentagon officials US commanders in Iraq are conducting constructive talks with the cholera leaders hoping that they would support US efforts in the fight against Al Qaeda. The lead bacilli have informally agreed provided that the US protects them from terrorist disinfectants. It is hoped that the paratyphus will join soon too.

[Donald Clarke]

Interesting article, and a good example of the mess that has been made out of Iraq. Should we even try to fix some of the mess, or should we just leave?

Here is another article by Michael Totten about events in Anbar.

http://www.michaeltotten.com/archives/001514.html

If we had left in summer 06, would the Anbar population have been better off? It looks like they did need some help to defeat AQI.

Is this something exportable to the rest of Iraq, or is it something that destroys the legitimacy of the central government? It does suggest that Sunni populations are not always going to be AQI refuges, unless AQI makes itself a more populist organization, along the lines of Hizbulla in Lebanon and Hamas in the Palestinian areas (Sunni, not Shia, but more empasis on public welfare).

I don't know. Maybe I am grasping at straws because I would like to think that my two tours in Iraq, 4,000+ coallition dead, and hundreds of thousands of Iraqi dead accomplished something besides work for the statisticians.

Donald Clarke

P.S. For what it is worth, if all of Iraq became completely peaceful tomorrow, I would still like to see Bush impeached for gross and downright malevolent incompetence.

[alphie]

Donald,

Judging by Totten's photos, there isn't much of a population left in al Anbar province.

Ethnic cleansing doesn't equal really equal peace.

[Donald Clarke]

Alphie,

Anbar always was a mainly Sunni area. The damage wasn't as much ethnic cleansing as US vs insurgents. Yes, it was destructive and until recently, we (specifically the USMC) had thought it hopeless. AQI capitalized on this until they overplayed their hand and wore out their welcome.

There are certainly potential problems, especially between the Sunni Anbar leadership and the mostly Shia central government. I suspect the Sunni don't want a partition because they wouldn't have any oil, but are they willing to be ruled by the Shia central government?

Donald Clarke

P.S. The author has comments active and I particularly appreciated two of his own comments:

1) I reserve the right to advocate a withdrawal from Iraq without being labeled a traitor. There's a real chance I will do exactly that if the surge looks bad next year.

Posted by: Michael J. Totten at September 11, 2007 03:10 PM

2) Dan: We have for too long in the blogosphere stuck with our "own kind" and all the straw men and incorrect assumptions about the "other side" that when conversing with our opponents, we discover they are not quite the demons we keep pretending they are.

This is exactly right.

Almost everyone I know is a liberal. Even though I'm not really a liberal anymore, it irritates me to hear most of my friends and family get lumped in with traitors.

I'm not really a conservative either, but it irritates me to no end to get lumped in with conservatives by people who simultaneously dismiss conservatives as war-mongering imperialist monsters who kill brown people so they can steal oil.

Everyone needs to calm down about the "other" side in politics.

Posted by: Michael J. Totten at September 11, 2007 10:44 PM

http://www.michaeltotten.com/archives/001514.html

[alphie]

Donald,

I guess ethnic cleansing was a bad choice of words.

Ramamdi had a population of 435,000 before our invasion, now it looks deserted.

Considering Jordan and Syria now have more Iraqi citizens living there than al Anbar province, why is "peace" there such a "success."

We can't depopulate all of Iraq.

[hilzoy]

Donald: I'm not sure the Anbar thing is exportable outside areas where AQI is active. AQI made itself hated, which was easier since it's led by outsiders, mostly. People turned against it. To export it, you'd need to find another place in which the same thing is true, and I don't know that there are many. I haven't read a lot about people in areas controlled by Sadr turning en masse against the JAM, for instance.

And if not, it's hard to see how something like what's happening in Anbar could be used to end the other serious conflicts: between the various Shi'a factions, between Sunnis and Shi'a.

I wish it could be, though.