IMC and UNICEF Partner to Halt Outbreaks of Cholera

Photo: International Medical Corps

Children laugh as jerry cans and hygiene items are distributed.

The first confirmed cases of Cholera in Iraq in the 2008 season arose in late August. A child returning from Eastern Iraq had died in Baghdad. As government testing facilities mobilized, International Medical Corps prepared for the worst. Supplies were already in place and IMC staff members were put on heightened alert, relying on their networks of healthcare workers and local leaders as a ground-level early warning system for any potential outbreaks. By October, IMC had reached tens of thousands of Iraqis at risk of falling victim to cholera in Anbar, Baghdad, and Babil governorates. Below are snapshots of how cholera struck different communities, and how IMC and its partners mobilized to contain the problem.

Babil
Early September brought rumors and speculation of a major cholera event in Babil governorate’s central city of Hilla and the surrounding area. UNICEF, International Medical Corps’ partner in an emergency response program called IMPACT, asked IMC to investigate reports of dozens of deaths and hundreds of additional cases flooding the hospitals and Primary Healthcare Centers of this area immediately south of Baghdad. By working closely with Directorate of Health (DoH) officials and healthcare administrators IMC was able to establish within four hours that early reports of twenty deaths and 200 to 500 cases were exaggerated. Media outlets had reported that one hospital had set up tented spaces to receive the overflow of cholera cases, as a sign that the hospital was already full. Media also reported that the tents themselves were already full with patients. Ultimate, these tents were never needed, since the preparation for and treatment of actual cases outpaced their onset.

International Medical Corps recognized immediately, however, that the two confirmed deaths and 22 confirmed cases were only the beginning and an outbreak could occur rapidly if the DoH and its facilities were not prepared. Cholera kills by dehydrating its victims within days of diarrheal episodes. With timely and proper treatment, even in the most severe cases, fatalities are almost always preventable. In addition to determining the actual number of cases, IMC identified all of the affected areas and began assessing the capacity of local services to respond.

Photo: International Medical Corps

IMC Education Officer provides health and hygiene education for cholera.

Within seven hours of receiving the alert International Medical Corps and the Babil DoH had established a response plan including distribution of 45,000 units of Oral Rehydration Salts (to replace electrolytes lost by diarrhea), 1.5 million household water purification tablets to ensure immediate access to safe drinking water, eight 5,000-liter community water storage tanks to be installed, and subsequent tankering of clean water to the affected communities. The Iraqi government, including the Prime Minister’s Office, quickly offered to handle all tankering to affected areas, allowing IMC to focus on supporting DoH capacity, extending emergency response efforts already planned, and launching a safe water and hygiene awareness campaign, as well as distribution for the schools within affected communities. Ultimately, the project was expanded to 53 water storage tanks in all, with communities helping defray costs by providing many of the materials and labor for the bases on which the tanks rest.

At UNICEF’s request, International Medical Corps quickly planned and implemented a school-based clean water and hygiene awareness campaign for the affected areas. This project, covering 17 schools in the hardest-hit areas, included the distribution of 5,167 hygiene kits, 5,300 jerry cans, 1.2 million household water purification tablets and the education of more than 5,000 students and teachers about the importance and methods of water purification and hygiene.

Over the coming cholera season Babil would emerge as the most affected governorate in Iraq. As of mid-October there were three deaths among 230 cases of cholera confirmed in Babil. But the close coordination among International Medical Corps, the Directorates of Health, Water and Education, UNNICEF and local communities, prevented the outbreak from becoming far worse.

Baghdad
As cholera began to surface in August 2008 it was Baghdad which would see it first. The late August stories of a girl returning from eastern Iraq and dying shortly thereafter put International Medical Corps on alert. After being assured by the UNICEF Chief Facilitator for Health and Nutrition that the Baghdad Department of Health was well prepared for any outbreak, IMC staff began to look for alternative routes to respond. While some assistance was provided directly to the DoH in the form of Oral Rehydration Salts the bulk of IMC’s cholera response in Baghdad centered on the distribution of water purification tablets and jerry cans to students and teachers, larger water purification tablets for the school’s water supply and a health awareness campaign on the safe handling and use of water. Distribution to six schools has already been completed, where 2,272 students and 101 teachers were provided with a total of 569,500 household tablets, 2,373 jerry cans and 1,200 school water storage tank purification tablets in addition to being instructed on safe water use. The additional nine schools should raise the number of children directly targeted to nearly 5,800.

Photo: International Medical Corps

Girls School receives hygiene items.

Anbar
In mid-September International Medical Corps received reports of possible cholera cases in an area of Anbar governorate outside of Falluja. An assessment of the situation uncovered two cases and several other suspected cases from Naoimiyah, a community of eight tribes comprising 2,200 families. IMC staff soon discovered that the water treatment plant serving the population was not providing potable water, and there was a lack of information among the people about the links between treating water before drinking, personal hygiene and health and wellness.

Within a few days International Medical Corps distributed 800 child hygiene kits, 1,170 adult hygiene kits, 1,210 family water kits and installed 14 5,000-liter community water storage tanks to serve the 1,296 families most immediately at risk from contaminated water. The Directorate of Water (DoW)and IMC immediately began sending eight water trucks to the affected areas daily, with tankering going directly to people’s homes until the community tanks could be installed. While the DoH conducted mobile water and hygiene awareness campaigns, IMC and the DoW began the rehabilitation of the Dafar water treatment plant serving the area. IMC also provided 200 jerry cans for the transportation of chlorine for water treatment plants from the regional supply hub in Babil governorate to Anbar.

This rapid mobilization by International Medical Corps, UNICEF, and the Directorates contributed to the halt of cholera cases in Anbar, with just nine confirmed cases and no deaths.