Risk of cholera multiplied by sewage collapse in Baghdad

By Oscar Grenfell
21 February 2008

With the northern summer approaching, fears have been voiced that the dysfunctional state of the Iraqi sewerage system will cause a major outbreak of cholera or other water-borne diseases in Iraq’s desperately poor working class districts. Cholera is an acute intestinal infection that causes severe diarrhoea, vomiting and dehydration and can lead to death if untreated. The disease spreads by the ingestion of water or food that has been contaminated by the waste of infected people.

At a press conference on February 3, US Brigadier General Jeffrey Dorko and Tahseen Sheikhly, a spokesman for the Iraqi government, described a public health catastrophe-in-waiting. Dorko reported that one of the three main sewage treatment plants servicing Baghdad had been “damaged over time” and “is just totally out of commission”. The waste pumped to the plant “does go untreated”, he said.

Two other treatment plants are functioning, but not at full capacity due to a range of maintenance problems. Across the city, blockages and damage to sewerage pipes means that raw effluent continues to flow into the streets. One major sewerage trunk pipeline through the city’s south is so blocked that a “sewage lake” has formed due to the mass of waste leaking out.

Sheikhly told journalists: “If you look at Baghdad through Google Earth, you can see that there is a black spot in southern Baghdad due to the accumulation of the sewage there.”

Ultimately, a large proportion of the city’s sewage ends up in the Tigris River or, worse, finds it way into the city’s water system. Millions of Baghdadis are forced to treat all their water with purification tablets or buy bottled water if they can afford it.

The crisis is by no means confined to the capital. Approximately 70 percent of Iraqis do not have access to clean drinking water, in part due to the contamination of water sources. Only around 20 percent of families outside Baghdad have access to some sort of sewerage service.

Claire Hajaj, a spokeswoman for the United Nations Children’s Fund (UNICEF), told the British Guardian last December: “Iraq’s water and sanitation networks are in a critical condition. Pollution of waterways by raw sewage is perhaps the greatest environmental and public health hazard facing Iraqis—particularly children. Water-borne diarrhoea diseases kill and sicken more Iraqi children than anything except pneumonia. We estimate that only one in three Iraqi children can rely on a safe water source—with Baghdad and southern cities most affected.”

Previous outbreaks of cholera in Iraq had been largely confined to less developed urban areas in the north, such as the slums of Kirkuk and Irbil. Last year, however, the country suffered its worst bout of the disease in 40 years, with 4,691 reported cases and 24 confirmed deaths. An outbreak in August spread rapidly from Kirkuk to 11 other provinces, including Baghdad, according to Adil Abdul-Muhsin, the General Inspector of the Ministry of Health. Two children at a Baghdad orphanage died from cholera in November 2007.

Ni’man Mohammad, a Baghdad physician, was cited in an Institute for War and Peace Reporting (IWPR) article on February 4 warning that this year will be worse. “Nothing can prevent a cholera outbreak next summer,” he declared. The greatest risk, he said, was “in areas with dense populations and poor basic services, like eastern parts of Baghdad such as Sadr City and the surrounding neighbourhoods.” His statement directly contradicted the assurances given by the Iraqi deputy health minister that the authorities “had completely controlled the disease”.

A major cholera epidemic in Baghdad could claim dozens of lives—particularly among the young, old and ill—due to the lack of adequate medical services and a shortage of trained doctors and nurses. Sadr City, for example, is home to approximately 2.5 million people but has just three hospitals. Ra’id al-Rubai’i, a physician at the district’s main hospital, told IWPR: “The hospitals in the city can’t cover all the areas because the resources are limited”.

Compounding the precarious situation in the working class suburbs are the health consequences of overcrowded housing conditions, the systemic shortages of electricity and the rising costs and shortages of petroleum products. Iraqis are still regularly forced to endure up to 18 hours a day without any power from the electricity grid. Millions rely on diesel-powered generators, as well as kerosene-fuelled heaters during the cold winter months. Fuel costs cut into the limited resources that families have available to purchase food and basic medicines.

Jaafar Dhia Ali, a 44-year-old father of six living in East Baghdad—near Sadr City—told the UN newsagency IRIN last month: “We have not had electricity for a week now and it took me about four hours to buy fuel for my car. Meanwhile our kerosene for heaters is running out. There are 20 of us living in this house as I’m now hosting my two displaced brothers’ families. We three are all government employees [on low salaries] and can’t afford to buy from the black market. We need at least 10 litres a day to stay warm which means that we need to pay $US300 a month for fuel.”

General Dorko told the February 3 press conference that the “large capital investments” needed meant it could take “two or three or four years” to fix the lack of sewage treatment. In many parts of Baghdad, the situation today is just as bad as it was following the 2003 war, when every aspect of Iraq’s basic infrastructure was in complete collapse due to more than a decade of United Nations sanctions and the impact of US bombing.

At the same conference, Dorko also made it clear that there was no resolution to the power crisis in sight. In response to a hypothetical question that it could take 10 years before Baghdad received electricity 24 hours a day, Dorko’s reply was non-committal. He stated: “There are so many variables ... but I think it will be less than 10 years.”

Five years after the illegal invasion of Iraq, the absence of adequate sewerage treatment, clean water and reliable power supplies are glaring exposures of the lie that the US occupation has any concern for the well-being or rights of the population. Every death and illness that is caused by the infrastructure crisis is the responsibility of the Bush administration.

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