Public Health

War aftermath causes communicable disease crisis in Iraq

Last Updated: 2003-08-06 14:05:32 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Public health officials in Iraq cannot respond effectively to major communicable disease outbreaks because the disease surveillance system there has broken down following the recent war. According to a report in the August 6th issue of the Journal of the American Medical Association, security issues prevent adequate functioning of public health facilities.

In reporting their findings, Dr. Marta Valenciano, associated with the World Health Organization in Lyon, France, and colleagues explain that a communicable disease surveillance and control intervention implemented by the WHO failed to prevent a cholera outbreak and increases in viral hepatitis and vector-borne diseases.

During the 1990s, Iraq was already experiencing increases in infant mortality rates, in the incidence of vaccine-preventable disease, and waterborne diseases. Before hostilities broke out in February of this year, the WHO had coordinated the humanitarian response, distributing drugs such as antibiotics, oral rehydration salts and analgesics.

Afterward, they discovered that supplies of oxygen were inadequate, as were drugs to treat chronic diseases, such as hypertension and diabetes, cancer and visceral leishmaniasis.

"Moreover, unsolicited donations of medical supplies, medicines and field hospitals brought into the country by other governments and NGOs constituted a challenge for the management of supply systems," Dr. Valenciano and associates write. The local Department of Preventive Medicine, which had depended on centralized organization prior to the war, subsequently had difficulties in prioritizing and planning activities, the report indicates.

Damage during the war, subsequent power outages and looting contributed to highly contaminated water supplies. Furthermore, security issues disrupted communicable disease control programs and health education activities. Surveillance was limited to syndromic-based notification.

"Restoring public health laboratory function should be a priority," the authors conclude.

JAMA 2003;290:654-758.