Cholera is endemic in northern Iraq, and now, because of the current violence that has forced half a million people from their homes in the autonomous region of Kurdistan, there is a risk of a repeat of the outbreaks that occurred in 2007, 2008 and 2012 that led to large-scale disease and deaths.
The risk of cholera outbreaks arises from a combination of factors. As well as trying to cope with half a million displaced people - which puts strain on housing, water supply and sanitation - the region is already home to some quarter of a million Syrian refugees, says the United Nations UNCHR. Also, many of the Syrian refugees are living in overcrowded camps where living conditions, water and sanitation are overstrained.
Plus, as summer approaches, there is the added threat of water shortages, which increases the possibility of epidemic diarrheal diseases.
Given the situation, the Iraqi authorities have asked the World Health Organization to help them prepare for possible cholera outbreaks. They have also asked them to give crash courses for national health staff in how to manage and control diarrheal diseases, especially in refugee camps.
In response to the request, WHO sent three experts from the International Center for Diarrheal Disease Research in Bangladesh to Kurdistan. Two of the experts are case management specialists and one is a lab specialist. In Kurdistan they were joined by other communicable disease experts from WHO's regional and country offices.
The experts are assessing the risk of cholera and other epidemic diarrheal disease outbreaks in camps and also looking at the strength of surveillance, outbreak preparedness and response capacity. They will also be advising the Iraqi Ministry of Health on how to update their cholera preparedness plan, based on the result of the risk assessment.
The team has already trained 23 health professionals in Erbil on the management of diarrheal diseases, has instructed trainers on how to deliver training throughout the rest of Kurdistan, and has given other workshops to national health staff on the management of diarrheal diseases.
Iraq authorities 'extremely concerned' about risk of cholera and other diseases
Dr. Rekawt Hama Rasheed, Kurdistan's Minister of Health, says, "we are extremely concerned about the risk of communicable diseases, especially cholera." He says they want to make sure their "health system and staff are fully prepared to handle all cases so that the risk of outbreaks is minimized."
WHO estimate that globally there are up to 5 million cases and up to 120,000 deaths every year due to cholera - an acute diarrheal disease that can kill within hours if left untreated. However, if they receive oral rehydration salts promptly, 8 in 10 infected people make a successful recovery.
Cholera poses a serious public health problem in developing countries - there are 783 million people in the world without access to improved sources of drinking water.
According to WHO, global rates of cholera have been rising steadily since 2005, with outbreaks affecting several continents. In 2012, nearly half of reported cholera cases occurred in the Americas, mostly in Haiti, where an earthquake in 2010 largely destroyed the country's already inadequate water and sewer systems.
Successful control of cholera relies on a combination of prevention, preparedness and response, say WHO, with safe water and sanitation being critical factors in reducing the impact of cholera and other waterborne diseases.
WHO also urge that cholera vaccines be treated as an additional means of control, and not used to replace these measures.
In July 2013, Medical News Today learned how a genome study revealed clues to cholera resistance. After searching the genomes of people who live in a region where cholera has been endemic for centuries, the researchers discovered genetic factors that may explain why some people are more susceptible to the disease than others. They found signs of possible natural selection pressure in parts of DNA linked to water regulation and immune function.