Hepatitis spreads in 2 Iraqi districts

James Glanz/NYT
Hepatitis spreads in 2 Iraqi districts
Fri Sep 24, 2004 00:14

Hepatitis spreads in 2 Iraqi districts
James Glanz/NYT

Collapse of water and sewage systems is believed to be at root of the illness

BAGHDAD A virulent form of hepatitis that is especially lethal for pregnant women has broken out in two of Iraq's most troubled districts, Iraqi Health Ministry officials said in interviews here this week, and they warned that a collapse of water and sewage systems in the country is probably at the root of the illnesses.

The disease, called Hepatitis E, is caused by a virus that is often spread by sewage-contaminated drinking water.

The officials said that their limited ability to test for the virus had already been overwhelmed by the hepatitis outbreaks, suggesting that only a fraction of the actual cases have been diagnosed. But in Sadr City, a Baghdad slum that for months has been convulsed by gun battles between a local militia and American troops, as many as 155 cases have turned up.

The second outbreak is in Mahmudiya, a town 56 kilometers, or 35 miles, south of Baghdad that is known as much for its kidnappings and drive-by shootings as for its poverty, where 60 suspected cases have been seen. At least nine pregnant women are believed to have been infected, and one has died. There have been five reported deaths overall. "We are saying that the real number is greatly more than this, because the area is greatly underreported," said Dr. Atta-alla Mekhlif al-Salmani, head of the viral hepatitis section at the Health Ministry's Center of Disease Control.

The World Health Organization is rushing Hepatitis E testing kits, water purification tablets, informational brochures and other materials to Iraq to help with the outbreaks, said Dr. Naeema al-Gasseer, the health agency representative for Iraq and a UN health official, who is now based in Amman, Jordan.

But viral hepatitis comes in numerous forms, and another ominous set of statistics suggests that the quality of water supplies around the country has deteriorated since the American-led invasion last year, Salmani said. In 2003, there were 70 percent more cases of hepatitis of all types reported across Iraq than in the year before, he said.

During the first six months of 2004, there were as many cases as in all of 2002.

In yet another indication of the deteriorating safety of both water and food in Iraq, the number of reported cases of typhoid fever is up sharply this year, said Dr. Nima S. Abid, the ministry's director general of public health and primary health. Hospitals across the country are also full of children with severe forms of diarrhea, Abid said.

The reports have come just as the Bush administration has proposed shifting $3.46 billion in reconstruction money for Iraq to programs that would train and equip tens of thousands of additional security forces. The training would include police officers, border guards and national guardsmen in hopes of regaining control of a security situation that has spiraled out of control. The shift would have to be approved by Congress.

The financing transfer would gut what had been an ambitious program to rebuild Iraq's crumbling water and sewage systems, forcing the cancellation or delay of most of the projects that had been planned. Last autumn, Congress approved $18.4 billion for Iraq's reconstruction. So far, only about $1 billion has been spent.

"The problem is the whole infrastructure," Abid said of the mounting health problems. Abid added that many of them stemmed from neglect that began long before last year's invasion. But he said: "Definitely no major intervention has been done in this last one and a half years to repair the problem."

Viral hepatitis comes in numerous forms and with a variety of different consequences, from benign to fatal. The most common type, Hepatitis A, can be spread from person to person or through contaminated water. Like all forms of the disease, it infects liver cells and can cause jaundice and other symptoms, but once a recovery is made there is often no permanent damage, said Dr. William Schaffner, chairman of the Department of Preventive Medicine at the Vanderbilt University Medical Center in Nashville, Tennessee.

Hepatitis E is most dangerous for pregnant women, who can lose their unborn children and die from the disease, Schaffner said. The World Health Organization and other health agencies are currently battling large outbreaks of Hepatitis E among thousands of displaced people in the Darfur region of Sudan and among refugees across the border in Chad.

The immediate reason for the outbreaks in Sadr City and Mahmudiya appear to be easy to pin down, Abid said. The lack of infrastructure induces families to tap into water mains with improvised hoses, he said, citing his own visits to the communities. They then use small electric pumps to bring water into their homes.

But in these same communities, sewage either seeps from damaged pipes into the ground or runs freely in the streets. So, through cracks and holes in people's hoses, sewage is sucked in too, becoming mixed with the drinking water and spreading the virus.

"The problem is that there is a leakage in the sewer system of Sadr," said an assistant to the director general for water in the Baghdad municipality. "Our treatment plant produces water with WHO specifications," said the assistant, who asked to be identified only as Khalid, "and our test records are very good."

The assistant said that there had been a major water project under way for Sadr City, but that the dangerous security situation had made it impossible to proceed.

"Man is the only animal that deals in that atrocity of atrocities, War. He is the
only one that gathers his brethren about him and goes forth in cold blood and
calm pulse to exterminate his kind. He is the only animal that for sordid wages
will march out... and help to slaughter strangers of his own species who have
done him no harm and with whom he has no quarrel.... And in the intervals
between campaigns he washes the blood off his hands and works for
"the universal brotherhood of man" - with his mouth.
-------Mark Twain



CIA's 'just guessing'
Posted by lakshmi on September 22, 2004 @ 10:07AM

Here is George Bush's take on the CIA's National Intelligence Estimate predicting a grim future for the U.S. occupation on Iraq: "The CIA laid out several scenarios. It said that life could be lousy, life could be OK, life could be better. And they were just guessing as to what the conditions might be like." Pop Quiz: What illegal substance is the president on these days?

Iraq Spins Out of Control
David Sirota, Christy Harvey and Judd Legum, Center for American Progress. September 13, 2004.
Contrary to the claims of the White House, the events of this past weekend reveal a nation enmeshed in chaos and violence.

The Five Biggest Lies Bush Told Us About Iraq

Main Page - Sunday, 09/26/04

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