WHO Iraq Update July 11

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Posted by Sadie from ? ( on Tuesday, July 15, 2003 at 3:34PM :

11 July 2003

500 tonnes of medical supplies reached Baghdad this week – including urgently needed insulin for a quarter of a million diabetic people

Forty truckloads of medical supplies from Oil-for-Food contracts were shipped by the World Health Organization from Amman and arrived safely in Baghdad this week. The items, weighing 500 tonnes, include badly needed insulin, intravenous fluids (IV fluids), antiseptics, laboratory reagents and other medical items in sufficient quantities to meet projected needs of Iraqis nationwide until the end of August The supplies and drugs will be dispatched from the main warehouses to the 18 governorates, including Baghdad, as needs arise.

The insulin in this shipment will be sufficient to cover the initial needs of over 250 000 diabetes patients.
Intravenous fluids will be used in treatment of dehydration and diarrhoeal diseases which represent 1 of every 5 cases of illness in the country.
Laboratory reagents will be used to perform essential laboratory tests.
Antiseptics and disinfectant products will disinfect operation theatres, hospitals and health facilities including surgical and medical instruments.

The national drug supply system broke down as a consequence of the war and its immediate aftermath. Computerized and paper inventory management systems were destroyed. This has made it difficult to determine current stock levels or to properly plan distributions to governorate warehouses.

Emergency rehabilitation of the main KIMADIA warehouses has now begun, as has the restitution of the computerized inventory management system supported by ‘spot-check’ stocktaking. The drug supply situation at governorate level is, as a result, steadily improving. The situation will improve further now that multiple stakeholders have engaged in a four-phase strategy of rehabilitation that includes, among other things, security, temperature and humidity control, and vehicle fleet maintenance. However, targeted looting continues to hamper these efforts.

WHO, the Ministry of Health and the Office of the Coalition Provisional Authority (OCPA) continue work to ascertain exactly what critical shortfalls remain in vital health supplies.

WHO supports removal of wastes from Baghdad hospitals

Collection of refuse and wastes in Baghdad municipality nearly stopped during and after the war leading to an accumulation of large amounts of garbage in the city. This created a health hazard, particularly in areas around hospitals where hospital wastes--from activities such as immunizations, diagnostic tests, medical treatments and laboratory tests--accumulated in large amounts. Approximately 20% of the total wastes generated by healthcare activities is considered hazardous material that may be infectious, toxic or radioactive. Healthcare waste is a reservoir of potentially harmful micro-organisms that can infect hospital patients, healthcare workers and the general public. Wastes and by-products can also cause injuries, such as sharps-inflicted injuries, poisoning and pollution. In order to protect the health of Iraqis, WHO supported the removal of waste from many Baghdad hospitals. The total volume of garbage and wastes removed in June was nearly 1400 cubic meters

Surveillance reveals high level of diarrhoea and respiratory infections

The main goal of the health surveillance system is to reduce illness and death in the population. The objectives are to detect any increase in infectious diseases, to detect outbreaks and emerging diseases, and to plan and evaluate the effectiveness of health interventions.

Routine surveillance activities were conducted in all 18 governorates of Iraq. While surveillance was carried out on a weekly basis in governorates with little or no damage to infrastructure (e.g., the three Northern governorates), daily surveillance was conducted in Baghdad as it was exposed to severe damage and has a large population (nearly 25% of the entire population of Iraq). Sentinel surveillance reporting sites involve 120 focal points across all 82 health districts. Data were sent by the reporting sites to the Directorate of Health, and then to WHO in Baghdad.

Reports from all sentinel sites show that diarrhoea constituted 22% of the total consultations with a three-fold increase compared to the same period of last year. Watery diarrhoea is now at its peak, both in under-fives and over-fives. Over two weeks since the beginning of June, there have been over 6800 cases of acute watery diarrhoea in patients over the age of five--this is very suggestive of a large cholera outbreak in the Lower South of Iraq.

The incidence of cholera in Iraq is typically higher from April to November and rural areas are especially affected. The first case of cholera in Iraq this year was confirmed at the beginning of May. Since then, there have been 102 laboratory confirmed cases of cholera in Iraq, but the true number of cases is likely to be much greater.

Early detection and containment of cases of cholera is critical to reduce transmission of the disease. The most important risk factor for cholera is lack of safe water and poor sanitation--people are infected as a result of drinking contaminated water, eating food (fruits and vegetables) contaminated through water, faeces or during preparation; eating contaminated seafood or from their unclean hands.

In the absence of proper treatment the disease can have a very high fatality rate: 5-40% of infected people can die. Cholera patients are treated with oral rehydration salts (ORS). ORS was one component of cholera kits WHO positioned in Iraq prior to the start of the conflict and has made more available in the past several weeks. The availability of this effective treatment, administered quickly and by trained health workers as soon as cases were reported through surveillance activities, has likely saved many lives in a situation where tens of thousands of people lacked (and continue to lack) access to safe water.

Bloody diarrhoea and typhoid fever are also public health problems in Iraq, due to the lack of safe water, the lack of proper sewage disposal as well as poor environmental sanitation. However, due to the still weak surveillance system, good data on such cases are not yet available.

Acute upper respiratory infections constituted another 22% of the total consultations. Acute respiratory infections are the leading cause of death in children in Iraq.

The reported increase in the number of cases, particularly among infants and pre-school children, of measles, whooping cough (pertussis), mumps and diphtheria may indicate a failure in vaccination coverage due to the interruption of immunization activities. WHO is investigating the cause of these cases, and will decide on the best technical response to prevent other cases from occurring.

Injuries due to unexploded ordnance increased in Baghdad

An increase in the number of injuries due to unexploded ordnance between 3 May and 9 June 2003 was reported from sentinel sites in Baghdad. These injuries were reported among under-fives as well as older children and adults.

For more information, please contact Fadéla Chaïb, WHO information officer, Baghdad: Tel: 001 914 360 31 83, Satellite phone: 00 88 216 33 33 07 39; E-mail: chaibf@who.int

-- Sadie
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