Showing posts with label measles. Show all posts
Showing posts with label measles. Show all posts

Friday, May 15, 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

Friday, April 03, 2009

February 2009 U.N. Humanitarian Report On Iraq

At the end of February 2009 the United Nations Office for the Coordination of Humanitarian Affairs released its latest progress report on Iraq. This paper covers refugees, returns, prisoners, casualties, measles, and the plight of Iraq’s women.

The Displaced

The major issue in the second half of 2008 going into 2009 is the return of Iraq’s refugees. The numbers that have come back is still a small percentage of the total, estimated at over 4 million, but they are increasing. The vast majority is made up of internally displaced. In January 2009 the Iraqi Ministry of Displacement and Migration registered approximately 4,600 returnees. 3,590 of them were displaced, while 1,010 were refugees coming back from other countries. This was more than a 50% decrease from December 2008 when 11,910 Iraqis were recorded coming back. 9,820 were displaced and 2,090 were refugees. In January Baghdad saw the most returns with 44% of the total. All of them were displaced. Ninewa with 13%, Diyala with 11%, all displaced, and Najaf at 8%, which received a mix of displaced and refugees followed it. Most of the refugees, 370 of them, came from Iran. The province also accounted for 37% of refugee returns in that month. Most returnees from abroad came from Iran, the U.S., Syria, Jordan, and Sweden, in that descending order.

United Nations’ Estimates On Iraqi Returns – January 2009

Displaced Returns:
Baghdad 2,000
Ninewa 590
Diyala 500
Wasit 250
Basra 120
Babil 100
Maysan 10
Salahaddin 10
Dhi Qar 10

Refugee Returns:
Najaf 370
Basra 220
Babil 110
Karbala 90
Wasit 90
Maysan 60
Qadisiyah 20
Muthanna 20
Irbil 20
Dhi Qar 10

The number of Iraqis that have returned is over 200,000. The United Nations High Commissioner for Refugees reported that 221,260 Iraqis returned in 2008. That was an average of 18,438 per month. The International Organization for Migration (IOM) counted around 296,592 people. The IOM said that 31,521 families went to Baghdad, 8,818 went to Diyala, and 4,542 returned to Anbar.

As reported before, the IOM has done extensive surveying of Iraq’s displaced. Their latest data from February found that 36% of returning Iraqis did so because of the improved security situation. Another 36% said they returned because of a combination of their hard living conditions and better security. 69% of returnees were displaced within their home province, 20% came back from another governorate, and 11% were refugees in another country.

To encourage Iraqis to come back, the government has been offering cash payments, which may now be ending. In January 2009 the Ministry of Displacement and Migration registered 12,969 returning families, who then became eligible for $870 from the government for coming back. The IOM thinks that the Ministry has registered only 26% of those that have returned. Only around 22,000 displaced families in total have received their money. The problem now is that the authorities have stopped signing up returnees. The government said that they had one year to register, and because of the improved security most displaced have gone back home. That’s obviously not true, and puts the whole motivation behind the payments in question. Has the government run out of funds, was it simply a publicity stunt, or just meant to create an incentive to get the process of return going? Whatever is the answer, on February 12 the Ministry stopped registering the displaced. Some provinces had stopped doing so earlier. Tamim for example ceased registration on February 2, and Kurdistan stopped on January 1. The Ministry is now supposed to focus upon monitoring those that have already gone back rather than those that are still in the process of doing so or considering it.

25% of the displaced say housing is their greatest concern. 59% of those surveyed by the IOM said they are renting, 22% said they live in a collective settlement or are squatting, 18% live with another family, and 1% are in tents. Rents are also going up, placing a financial strain on the displaced. The reason why many have not gone back is because they can’t go to their homes. Only 16% of the displaced since February 2006 have access to their houses. 38% said they don’t know if they can go back. 39% said they don’t want to go back. Of those 22% said they want to stay where they are, and 17% would like to move to another country. That still means the vast majority however, 61%, would like to go back some time.

The displaced also lack basic services. 19% of those displaced since February 2006 say they don’t have access to the government’s food ration system. 44% said they only have periodic access. The displaced also lack jobs, electricity, and health care.

Iraqi Prisoners

Under the Status of Forces Agreement the U.S. is in the process of transferring all of its prisoners to Iraqi control or setting them free. The U.S. military said they are releasing around 50 prisoners a day since the beginning of January 2009. That has caused a decrease in the number they hold from around 26,000 in 2007 to approximately 14,000 in 2008. Others are being handed over to the Iraqi authorities.

Violence

Violence in Iraq has seen a steady decline. The number of casualties in February 2009 was lower than in the previous month. In February an average of 5 civilians were killed per day. That was down from an average of 13 per day in 2008. The number of civilians killed dropped from 192 in January to 164 in February. The number of wounded also declined from 591 in January to 516 in February. February’s numbers did not include 48 bodies found in the streets and six government officials killed. That meant in total 395 people died in that month. The majority of the casualties happened during the Arba’een religious ceremony where there were several attacks costing the lives of at least 84 people. According to the U.N. 11,230 people were killed in 2008, 4,663 of which were civilians, and 18,251 were wounded, including 12,660 civilians.

Measles

As recently reported here, a measles epidemic began in 2008, and is now getting worse. The Ministry of Health reports that that there are cases in 13 of Iraq’s 19 provinces. Last year there were a total of 8,134 cases, but in the first nine months of 2009 there have already been 8,411 more. Children are the most vulnerable, and the movement of people with the improved security has helped spread the disease. Many kids have not been vaccinated over the last several years as well because of the security situation, which has made the situation worse. Measles is now spreading north to Sulaymaniya, Irbil and Dohuk, and south to Najaf and Maysan. This is putting up to 800,000 children at risk.

Iraq’s Women

In 2009 the U.N. is trying to focus upon the country’s women. The U.N. is worried that the violence and war has severely set back their status. Women are more likely to end up poor, be unemployed, and lack food, and other basic necessities. 1 in 10 families are headed by women, and 80% of those are widows, having lost their husbands to the fighting. Only 17% of women have jobs or are looking for them compared to 81% of men. Illiteracy is also high, affecting 24% of women over 10 years old compared to 11% for men. Many girls have also stopped going to school because of the violence.

Oxfam International recently conducted a survey of 1,700 Iraqi women that highlighted their problems. They questioned women from Baghdad, 35%, Basra, 19.5%, Ninewa 19.5%, Tamim, 13%, and Najaf, 13%, who were 21-65 years old. 25% were widows. 60% said they received no aid from humanitarian groups. 76% of widows declared they got no help from the government. 45% said their income had declined from 2006-2008, and 30% said it was the same. 40% thought security was worse in 2008 compared to 2007, 38% said it was improving, and 22% said it was the same. 55% said they had been displaced at least once since 2003. As a sign of this almost 50% said they were sharing their home with another family. Many lacked basic services. One quarter said they had no daily access to water, and almost 50% said they had no potable water. 69% said their water situation had gotten worse since 2006. 1/3 said they lacked power for more than 3 hours a day, the other 2/3 said they only had power for six hours or less. 50% said their health care was worse in 2008 compared to 2006-2007. 79% received their food rations, but 45% said it was irregular.

Conclusion

The humanitarian report shows the changes and continued problems facing Iraq. Refugees and the displaced are returning, but in small numbers compared to the total. Violence is down, and looks to be getting better in 2009. At the same time several million Iraqis are still without their homes, and face increasing problems such as jobs and housing. The war has also disrupted the health care system, and set back the country’s women. There is also a measles epidemic that is quickly spreading throughout most of the country. There is still fighting and dying going on in Iraq, but it is receding. That has put humanitarian issues and services to the fore as the country has suffered through decades of war and sanctions, and has yet to recover.

SOURCES

United Nations Office for the Coordination of Humanitarian Affairs, “Humanitarian Update Iraq February 2009,” 2/28/09

World Health Organization, “Weekly Feedback on Measles in Iraq,” WHO Representative’s Office in Iraq, 3/8/09

Wednesday, April 01, 2009

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

Monday, March 02, 2009

February 2008 UNICEF Report on Iraq

UNICEF recently released a report on Iraq. It not only focused upon the country’s children, but health, education, poverty, and the displaced. The organization said that with the reduction in violence there was greater access to Iraq’s communities. That was revealing more examples of poverty and deprivation than anyone knew about previously.

The biggest issue UNICEF reported on was a developing measles threat. It said that nine provinces had reported measles affecting 6,000 people since early 2008. The Iraqi Ministry of Health is worried that it could spread. Najaf, Sulamaniya, Irbil, Maysan, and Dohuk were endangered by this disease, while a more recent report from the United Nations’ IRIN news agency said that Salahaddin, Tamim, Anbar, Diyala, Baghdad, Babil and Dhi Qar were hit the hardest. Most victims were small children under the age of six. Government officials said that the main cause of the spread of measles was the lack of security, which kept health workers out of many areas.

The United Nations agency also went to a few schools in the northern provinces of Diyala, Irbil, and Dohuk. All of them were lacking basic services, especially access to clean water. In Dohuk the schools lacked bathrooms, while children in two villages in Irbil were suffering from water born diseases.

The displaced was another issue the report dealt with. In Tamim, 900 children were found begging on the streets of Kirkuk. 100 of them were orphans. Around half were internal refugees. All of them were trying to support their impoverished families. Internal refugees that were returning to the province lacked shelter, and access to water and sanitation. In Basra 250 squatters in an old navy had no sanitation, health care, or clean water. On the positive side 1,325 displaced families returned to the city of Mosul in Ninewa.

In 2008 Iraq suffered a sever drought. The worst hit areas were in the north. UNICEF traveled to Irbil and Ninewa and saw the drought’s lingering effects. In two areas of Irbil there was high poverty exacerbated by the lack of water that destroyed their farms, which were also their main source of food.

Examples of impoverishment were also found in Anbar. The outskirts of the province had deep poverty. Two areas by Ramadi that suffered because of the violence are now improving because the government has started programs for children. They still lack adequate health, sanitation and other basic services however.

The last part of the report detailed the various projects UNICEF was working on in Iraq. So far, the organization has committed $8 million for humanitarian projects in 59 communities. Those have mainly focused upon water, schools, and health campaigns. The major problem is that United Nations can hardly meet its obligations. UNICEF is short 89% of the money it needs for its various programs.

UNICEF is hoping that the provincial elections will lead to more responsible local governments that will address the needs of the country’s children. They are afraid about the spread of measles. The lack of services is also a large problem across the country. Iraq’s infrastructure has not been kept up because of the violence. Even as that has declined, there is still large-scale neglect. Finally poverty is another major issue. It has led to children begging, and kept them from going to school. More and more of these cases are being discovered as attacks have declined. The lack of money for both the United Nations and the Iraqi government after the fall in oil prices will probably mean these issues will not be solved any time soon however.

SOURCES

IRIN, “IRAQ: Measles emerges in violence-hit regions,” 2/24/09

UNICEF, “UNICEF Humanitarian Action Update Iraq,” 2/17/09
 
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