Monday, December 10, 2007 | James Palmer, Chronicle Foreign Service
Sulaymaniya, Iraq - The Kurdish region of northern Iraq has withstood the destruction of its villages and deadly gas attacks at the hands of Saddam Hussein. Now, as the semiautonomous Kurdish government strives to increase its independence, the region is coping with another adversary - cholera.
One of the areas hardest hit by the recent outbreak is Sulaymaniya, a province of nearly 1 million people in the northeast corner of Iraqi Kurdistan, which straddles the Iranian border. Local health officials said at least 1,217 people have been infected with the cholera bacterium since late August.
Azad Faraj, a microbiologist in Sulaymaniya's public health laboratory, said the recent outbreak is derived from a strain common throughout the Mideast. While officials have yet to determine the source, all indications point to contamination of the province's water supply. With a water shortage throughout the province and no sewage treatment plant, doctors say Sulaymaniya is fertile ground for the intestinal disease, which is commonly contracted by drinking water contaminated by human feces.
"Every few years, we face an epidemic," said Dlair Maroof, 34, a physician at the Sulaymaniya Teaching Hospital, the primary care center for cholera patients in the province.
According to a recent survey by Sulaymaniya's water department, the province is meeting only 27.5 percent of its water demand. Some officials fault the regional government, saying it failed to upgrade basic infrastructure to meet the requirements of a burgeoning population of Iraqis seeking the safety and stability offered by the region.
Farhad Sabin, Sulaymaniya's water director, said that while the city's population has skyrocketed 65 percent since 2003 to nearly 1 million people, the Kurdish central government has ignored his pleas to overhaul the province's water network. As a result, Sabin says residents are digging wells and using suction pumps to access water - possibly accelerating the spread of cholera.
"During the dry season, some parts of the ground have a higher concentration of sewage than water," he said. "The entire water system needs to be overhauled."
The province is making some moves to increase the supply of clean drinking water. A project is under way to pump 280,000 cubic feet of water per hour from the Dokan Dam 40 miles west, along with the construction of additional water storage tanks.
Meanwhile, the Sulaymaniya Teaching Hospital struggles to cope with an increase of cholera victims.
Maroof, the physician, said the emergency caused the hospital to establish an admission center specifically for potential cholera cases. The number arriving daily peaked at 250 in September, but has since fallen to between 70 and 90.
In a room crammed with about 20 beds, doctors and nurses scurried one day last month to assist the steady flow of arriving patients, while others were shuttled out.
Jamal Ishmael, 35, a secondary school teacher, brought her 32-year-old sister, Samira, to the center after she began to show symptoms. "We're afraid it's cholera," Ishmael said as her sister lay on a bed, curled up under a blanket and softly moaning.
Shukrya Mahmoud, 35, and her two daughters, Madia, 20, and Soleen, 17, were preparing to return home after a few hours of rehydration treatment. "We had been vomiting for three days, but now we feel better," Mahmoud said.
Maroof said the water shortage in the region is compounded by the lack of public health education.
"When clean drinking water is not available, people are most likely going to find it from a source that is not sanitary," he said.
Most of the hospitalized patients said they regularly drink water from household taps, and some living outside the city said they dug their own wells or used suction pumps to draw water.
Khalaf Sala, a 40-year-old toy vendor who earns an average of $10 per day to support his wife and five children, said he can't afford to purchase bottled water in the market - a 5-quart container costs about $1.50 - and has never considered boiling water from his tap.
Sabin, Sulaymaniya's water director, makes daily trips to the local hospital to learn more about how the sick contracted cholera. Then he visits the area to sample groundwater in an effort to pinpoint the source of the province's latest cholera outbreak.
Still, with no scientific verification to this point, the 52-year-old civil engineer remains skeptical that the source is groundwater.
"Everyone is blaming the water, but there's no proof yet," Sabin said as he displayed a sheaf of papers documenting his continuing survey.
There was little doubt, however, inside the women's ward for cholera at the Sulaymaniya Teaching Hospital.
Vien Aziz, 27, lay motionless with an intravenous tube running into her left arm. Her other hand delicately rested on her stomach as her 55-year-old mother, Naisreen Gharib, lingered anxiously over her bedside.
"I've been drinking water from inside the house," said Aziz, an administrator at Sulaymaniya University. "From now on, I'm going to buy it from the store."
The World Health Organization has confirmed more than 4,200 cases of cholera in Iraq since August, at least 23 of them fatal, including 14 in Sulaymaniya. Iraq usually reports about 30 cholera cases annually. Here are some facts about the disease.
What it is: Cholera is a painful intestinal infection contracted by consuming food or water tainted by the bacteria Vibrio cholerae.
How it affects people: Cholera infections are often mild, but about 1 in 20 victims becomes seriously ill, according to the U.S. Centers for Disease Control and Prevention. Those severely affected experience a rapid loss of body fluids due to profuse diarrhea and vomiting. The result is acute dehydration and shock; if not treated properly, cholera can lead to death within hours.
How it is contracted: According to the CDC, the feces of an infected person are frequently the source of contamination. The disease can proliferate swiftly in areas that lack clean drinking water and adequate sewage treatment.