Saturday, May 9, 2009

Measles Update

In 2007 and 2008 Iraq had a cholera outbreak. This year the country is now dealing with measles. The causes are the lack of security, which prevented health officials from serving all of Iraq’s population, bad government planning, and lack of resources as the country’s health care system has been decrepit for decades, dating back to Saddam’s rule. The outbreak started slowly in 2008, but now appears to be at its height affecting almost all of Iraq’s provinces.

The first cases of measles were reported in Anbar and Salahaddin in 2008. By the end of the year it had spread to Ninewa, Tamim, Dohuk, Irbil, Sulaymaniya, and Najaf. In that year 8,134 reports of the disease were made.

The government responded with a vaccination campaign that largely shut down the spread of measles in those provinces. The problem was that the rest of the country was not given shots and it quickly spread to Baghdad, Qadisiyah, Babil, Karbala, and Diyala in 2009. Baghdad now has the most cases at 27% of the total. By the first 14 weeks of 2009 there were 16,831 cases. That is triple the amount reported in the last World Health Organization (WHO) report on the epidemic made nine weeks into 2009. As a sign of its rapid spread, in 2008 only about 50 cases were reported a week. Now it’s up to 1,100 per week. 62% of the cases are children younger than 5, and so far 3 babies have died in Qadisiyah as a result.

The WHO has broken down the outbreak into 3 successive waves, each lasting several weeks. Iraq is now at the height of the 3rd wave. A fourth and final phase is expected unless the government steps in, and carries out a countrywide vaccination campaign.

At the root of the problem is the fact that Iraq’s health care system has been falling apart for several decades. The international sanctions of the Saddam era, followed by the U.S. invasion and war devastated hospitals and the ability to acquire medical supplies, while the violence prevented health officers from serving large portions of the public. There was also a massive brain drain of professionals, including doctors from the country. It was not by coincidence that the disease began in some of the most unstable provinces where these problems would be the most acute.

The WHO believes that this whole affair could’ve been prevented if the government had started given shots to the entire country as soon as the first cases of measles were detected. Instead Baghdad responded to only those provinces directly affected, allowing it to spread to the others. WHO, UNICEF, and the Ministry of Health are now planning a nationwide vaccination program to try to stop the spread of measles. The Ministry needs to rely upon those international organizations for the supplies and know how, while the government overall has to show the desire and leadership to make this successful.

Number of Measles Cases - % of Total

Dohuk 35 - less than 1%
Irbil 54 - less than 1%
Sulaymaniya 117 - less than 1%
Najaf 278 - 1%
Tamim 407 - 2%
Salahaddin 659 - 3%
Basra 683 - 3%
Ninewa 696 - 3%
Maysan 805 3%
Muthanna 853 - 3%
Dhi Qar 973 - 4%
Anbar 1,107 - 4%
Karbala 1,482 - 6%
Diyala 1,609 - 6%
Qadisiyah 2,269 - 9%
Babil 2,858 - 11%
Wasit 3,251 - 13%
Baghdad 6,829 - 27%

Total Number of Cases Reported By Period
2008 8,134
1st 9 weeks of 2009 8,411
1st 14 weeks of 209 24,963

SOURCES

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

United Nations Office for the Coordination of Humanitarian Affairs, “Humanitarian Update Iraq, March” United Nations, 4/27/09

WHO Representative’s Office in Iraq, “Weekly Feedback on Measles in Iraq,” World Health Organization, 3/8/09
“Weekly Feedback on Measles in Iraq, Report no. 46 International week 14 ending 05/04/2009,” World Health Organization, 4/21/09

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