Iraq Faces New Outbreak of Cholera, 2022

During the twenty-first century, Iraq faced several outbreaks of cholera, most recently in 2015 and 2017. Specialists have suggested that the poor quality of drinking water in Iraq is the main cause of this serious health problem [1,2].

On 16 June 2022, the Health Directorate of Sulaymaniyah province /Kurdistan Region of Iraq expressed concern about the increasing number of people attending its hospitals with symptoms of vomiting and acute diarrhea similar to those of cholera. Stool samples and rectal swabs were collected and examined in these hospitals; among them, 56 samples were sent to the Central Public Health Laboratory (CPHL) in Baghdad province where 13 cholera cases have been confirmed, including ten cases from Sulaymaniyah, one case from Kirkuk, and two cases from Muthanna province [3].

On 19 June 2022, Sulaymaniyah Health Department announced there were about 4,000 suspected cases of diarrhea recorded in Sulaymaniyah's hospitals in the previous week. Later, hundreds of suspected cases were received in hospitals in the provinces of Sulaymaniyah, Erbil and Dohuk in northern Iraq. Overall, 67% of suspected cases were among housewives, children, and daily workers and 52% of them were aged 15-44 years old. As detailed in

Table 1. Numbers and distribution of confirmed cases of cholera in Iraq, 2022. 

Date	Total number of confirmed cases since 16 June 2022	Total number of confirmed cases distributed among Iraqi provinces
		The most affected governorates			Other Provinces
		Kirkuk	Baghdad	Dhi Qar
16 June 2022	13	1			12
26 June 2022	47				47
28 June 2022		1st death
30 June 2022	72		2nd death		72
3 Jul 2022	160	80	39	13	28
6 Jul 2022	208	106	52	19	31
24 Jul 2022	449	225 + 3rd death	124	61	39
31 Jul 2022	668	361+ 4th death	178	79	50
7 Aug 2022	783	450	193	52	88
14 Aug 2022	865	480	224	55	106

, numbers continued to increase until 28 June 2022 where the Iraqi Ministry of Health announced the first death in Kirkuk province from “cholera” [3,4]. As a response for this situation, on 20 June 2022, the World Health Organization (WHO) provided an urgent consignment of medicines and medical supplies to Sulaymaniyah province in order to support its response to the sudden cholera outbreak [5].

During the period 6-24 July 2022, the number of confirmed cholera cases doubled (Table 1), possibly due to large gatherings in public places during the Eid al-Adha holiday, a religious holiday in which Muslims celebrate exchanging food and drink, and family visits, and unfortunately adherence to preventive measures is declining. As cholera is a waterborne bacterial infection, it can spread quickly through a population by consuming water or food contaminated with Vibrio cholerae. It causes uncontrollable diarrhea that, if left untreated, can result in dehydration or death.

On 14 Aug 2022, the latest report by the WHO announced four deaths caused by cholera, including three deaths in Kirkuk province and one death in Baghdad. Cholera case management is effective as the mortality rate (CFR) is 0.5% as required by WHO standards (appropriate management of the cholera case should maintain CFR less than 1%) [4].

In Iraq, there is a defect in the supply of potable water, which has caused drought and water scarcity in many regions, where people rely on wells or water trucking from formal and informal sources. The public health department identified many contaminated sources of drinking water distributed by tanker vehicles. During the period from 15 June to 17 July 2022, 608 water samples were collected from house tanks, artesian wells, and tankers that sell water to people in northern Iraq. These samples have been tested, 11% of them were contaminated [4].

Of concern is the poor condition of Iraq's sewage systems and the use of shoddy water in the factories for ice production; most people use ice to cool drinking water in summer. In addition, there is poor health awareness, especially in popular, poor and rural areas, and a poor public response to health awareness calls related to disinfection of drinking water or washing vegetables and fruits well before eating them.