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Hepatitis spreads in Iraq

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    Collapse of water and sewage systems is believed to be at root of the illness Hepatitis spreads in 2 Iraqi districts James Glanz/NYT New York Times Friday,
    Message 1 of 1 , Oct 14, 2004
      Collapse of water and sewage systems is believed to be
      at root of the illness

      Hepatitis spreads in 2 Iraqi districts
      James Glanz/NYT
      New York Times
      Friday, September 24, 2004

      [Note: Even before the recent military occupation, Iraq was losing
      2000 people a month, mostly children under the age of 5 due to water-
      born diseases because of the US sanctions against Iraq importing

      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

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

      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

      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

      "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

      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

      The New York Times




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