Measles Outbreak In Iraq

In the summer of 2008 Iraq was hit by a cholera epidemic. Now the country is facing a new health crisis, this time from measles. The United Nations IRIN news agency reported on March 25 that 3 babies in Qadisiyah had died from the disease. Measles is transmitted through breathing or contact with fluid from the nose and mouth. It can lead to blindness, encephalitis, and pneumonia. The first cases were detected in the very beginning of 2008, but didn't take off until the summer. Three waves of infection have swept across the country since then with the largest occurring during the first nine weeks of 2009. The government is trying to respond with a vaccination program, but it has been haphazard, and limited by security concerns.

The United Nations was the first agency to warn of this new epidemic. The last United Nations Office for the Coordination of Humanitarian Affairs and UNICEF reports on Iraq both talked about the spread of measles, and now the World Health Organization has released a comprehensive report on it.

The measles outbreak started slowly in the beginning of 2008, picked up momentum during the summer, and then took off in late 2008/early 2009. The first cases, 5 total, were reported in week one of 2008. This was the beginning of three waves of measles that have swept the country. The first lasted until late May 2008, the second up to the end of September, and the third is still on going. Each lasted around 19 weeks in duration.

Measles were first detected in central Iraq, and is now moving north and south. The initial cases were found in Anbar and Salahaddin, and then spread to Ninewa and Tamim. Those provinces lacked adequate vaccination programs because of the lack of security. The government started an emergency response effort in those four areas, which were effective in stopping the spread of measles. However shots were not given in the rest of the country, which led to the outbreak spreading to Basra, Najaf, Dhi Qar, Muthanna, Maysan, Karbala, Diyala, Qadisiyah, Babil, Wasit, and the three provinces of Kurdistan.

The number of cases has more than doubled since 2008. In that year 8,134 people were infected. In just the first nine weeks of 2009, 8,411 new cases have been reported. In 2008 less than 140 cases were found each week, compared to almost 1,000 per week in the beginning of 2009. In the first nine weeks of 2009 there were 68 cases in the three provinces of Kurdistan, 276 in Anbar, Salahaddin, Ninewa and Tamim, 887 in Basra, Maysan, Dhi Qar, and Muthanna. Ninewa has been hit the hardest with 2,395 in the Karkh and Resafa districts, and an additional 235 in the rest of the province.

The World Health Organization (WHO) notes that the whole affair could have been avoided if there was an effective, nationwide vaccination program in place. Instead, the lack of security has meant only limited coverage. Those most affected are children under five years old, 64% of the total, showing that there has been a lack of vaccinations over the last four years. The WHO itself couldn't provide as much support as it hoped for during that time, because it and all the other U.N. agencies have not been able to raise enough money to cover all of its activities. Iraq's national health system has also suffered during the violence. As a recent public opinion poll of Iraqis found, 60% said medical care was bad in their neighborhood. Hopefully Iraq and the U.N. have enough resources to expand their vaccination program to cover the entire country of this outbreak could become worse, but that might be difficult in the current financial climate.

Measles Cases 2008 to first 9 weeks of 2009

Province	2008 cases	2009 Cases	Total Existing Cases	% of Cases
Ninewa	2,630	1,816	2,668	23%
Qadisiyah	1,076	654	1,408	13%
Babil	843	1,104	1,246	11%
Anbar	1,056	15	1,070	10%
Wasit	268	1,852	978	9%
Karbala	711	377	902	8%
Salahaddin	637	14	637	6%
Dhi Qar	482	248	577	5%
Muthanna	402	172	518	5%
Ninewa	364	235	466	4%
Tamim	344	12	350	3%
Maysan	173	278	256	2%
Diyala	80	651	197	2%
Basra	113	189	191	2%
Najaf	68	147	141	1%
Sulaymaniya	30	35	44	0.4%
Dohuk	28	5	29	0.3%
Irbil	7	28	21	0.3%
Iraq	8,134	8,411	11,233	100%

SOURCES

IRIN, "IRAQ: Three die of measles in Diwaniyah Province," 3/25/09

UNICEF, "UNICEF Humanitarian Action Update Iraq," 2/17/09

United Nations Office for the Coordination of Humanitarian Affairs, "Humanitarian Update Iraq, December 2008-January 2009" United Nations, 1/31/09

World Health Organization, "Weekly Feedback on Measles in Iraq," WHO Representative's Office in Iraq, 3/8/09