DIRTY WATER OR BOMBS MORE DANGEROUS IN IRAQ?

Like people in so many parts of the world, Iraqi citizens face daily challenges in securing safe drinking water. Both bombs and looters further damaged drinking water and wastewater treatment systems, already degraded before the war. In the aftermath of combat, frequent power outages and a shortage of chlorine threatened to usher in a public health disaster for Iraq's 24 million citizens. A broad-based effort by the U.S. government, the United Nations, and humanitarian relief organizations has restored basic water services in many areas, and appears to have headed off widespread outbreaks of cholera and other waterborne diseases.

However, establishing a safe and reliable water supply remains long-term task. Neglected Water Infrastructure Further Damaged by War. Although degraded by years of neglect in the 1990s, water and sewage treatment services were largely functional in Iraq before the war. In April of this year, however, the United Nations Children's Fund (UNICEF) and CARE conducted a survey of 177 water treatment plants in southern and central Iraq. About one quarter of these facilities were operating poorly or not at all. Treatment plants and water distribution systems appear to have suffered less direct damage than during the first Gulf War, but services were severely undermined in certain areas. In July, none of Baghdad's three sewage treatment plants was functioning.

As a result, the city's raw sewage (an estimated 500,000 tons daily) was discharged directly into the Tigris River, the primary drinking water source for millions of people. Lack of Safe Water Spreads Disease, Threatens a Health Crisis. According to UNICEF, Iraqi children suffer from diarrhea about 14 to 18 times a year, compared to the average of two or three cases per year in areas with access to clean water. UNICEF reported that in one three hour period in May, one Baghdad hospital reported 300 cases of children admitted with diarrhea. In areas where chlorine supplies ran out, UNICEF reported a "parallel rise in diarrhea." Executive Director Carol Bellamy stated, "Young children have developing immune systems and low body weight. Add a bout of diarrhea picked up from dirty water, and we can lose them very quickly."

During the hot summer months, the specter of widespread cholera outbreaks loomed over the country. Cholera is characterized by profuse diarrhea, which can lead to severe dehydration and death if left untreated. The World Health Organization (WHO) reported a total of 73 laboratory-confirmed cholera cases in Iraq from April 28 to June 4 - 10 times more than WHO officials found during the same period last year. Most of these cases were reported in the Basra region. Other waterborne diseases, including typhoid and dysentery also rose sharply in the spring. With the hottest summer months still to come, WHO officials warned that massive outbreaks were yet to occur.

What about the Danger of bombs...

The effects of Bombing on Disease Occurrence in Baghdad is blunt to say the least: "Increased incidence of diseases will be attributable to degradation of normal preventive medicine, waste disposal, water purification/distribution, electricity, and decreased ability to control disease outbreaks. Any urban area in Iraq that has received infrastructure damage will have similar problems." The document proceeds to itemize the likely outbreaks. It mentions "acute diarrhea" brought on by bacteria such as E. coli, shigella, and salmonella, or by protozoa such as giardia, which will affect "particularly children," or by rotavirus, which will also affect "particularly children," a phrase it puts in parentheses. And it cites the possibilities of typhoid and cholera outbreaks.

Many politicians, both in the U.S. and in the Middle East have warned and blamed the United States for public health problems created by the military conflict. Disease Outbreaks in Iraq rise as conditions are favorable for communicable disease outbreaks, particularly in major urban areas affected by coalition bombing. Infectious disease prevalence in major Iraqi urban areas targeted by coalition bombing (Baghdad, Basrah) undoubtedly has increased since the beginning of conflict there. Current public health problems are attributable to the reduction of normal preventive medicine, waste disposal, water purification and distribution, electricity, and the decreased ability to control disease outbreaks.

Most likely diseases occurring are(descending order): diarrheal diseases (particularly children); acute respiratory illnesses (colds and influenza); typhoid; hepatitis A (particularly children); measles, diphtheria, and pertussis (particularly children); meningitis, including meningococcal (particularly children); cholera (possible, but less likely)." Medical Problems in Iraq continue as communicable diseases in Baghdad are more widespread than usually observed and are linked to the poor sanitary conditions (contaminated water supplies and improper sewage disposal) resulting from the war. According to a United Nations Children's Fund (UNICEF)/World Health Organization report, the quantity of potable water is less than 5 percent of the original supply, there are no operational water and sewage treatment plants, and the reported incidence of diarrhea is four times above normal levels.

Additionally, respiratory infections are on the rise. These diseases particularly have affected children. However, there are indications that the situation is improving and that the population is coping with the degraded conditions even though conditions in Baghdad remain favorable for communicable disease outbreaks.