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BMJ. Sep 29, 2007; 335(7621): 637.
PMCID: PMC1995465

Aid agencies launch appeal for Iraqi refugees, while cholera spreads in northern Iraq

International health agencies launched a coordinated appeal last week for $85m (£42m; €60m) to help more than 2.2 million Iraqis who have fled to neighbouring countries. The appeal comes as another 1.2 million Iraqis have been internally displaced, partly as a result of the rapid spread of a cholera outbreak that began in the Kurdish north of Iraq.

Cholera was confirmed by laboratory testing of samples from a 25 year old woman in Baghdad last week, and it is likely that more cases will be confirmed there soon, the World Health Organization said last Friday.

On the same day the first case of cholera appeared in Iraq's second city, Basra, when a 7 month old baby tested positive for cholera. Diyala province, the scene of heavy fighting, is also reporting a surge in diarrhoeal disease.

In the northern provinces of Erbil, Sulaymaniyah, and Kirkuk, more than 1500 cases of cholera have been confirmed, out of more than 24 000 cases of diarrhoeal disease. Ten deaths were reported from acute diarrhoeal disease in August and the first 10 days of September.

Cholera is endemic but rare in Iraq. About 30 cases are reported in an average year, the health ministry says. But water quality has declined since the US invasion, as the electricity grid has proved unable to support purification plants.

In May WHO estimated that 70% of Iraqis lacked access to clean water. Since then the problem has been exacerbated by a US ban on imports of chlorine, in response to insurgents' use of chlorine trucks as bombs.

About 100 000 tonnes of chlorine were held up at the Jordanian border, but arrangements are now being made to bring it to secure warehouses in Baghdad, said Naeem al-Qabi of Baghdad Municipal Council. The city doubled the concentration of chlorine in its water when cholera was first reported, and it currently has less than a week's supply left.

Meanwhile, the burden on the health systems of Jordan and Syria, which host respectively 750 000 and 1.5 million refugees from Iraq, has become overwhelming, WHO says. Both countries agreed in July to give displaced Iraqis full access to their health systems, while international donors committed to providing financial help.

The United Nations Population Fund, UN Refugee Agency, Unicef, the World Food Programme, and WHO are jointly appealing for $85m to support the host governments. The United States has provided a further $122m in refugee aid to Iraq's neighbours.

WHO said that funds gathered by the UN organisations will be spent on improving access to basic health care and health services for mothers and children, addressing nutritional deficiencies, strengthening information and surveillance systems, and maintaining vaccination programmes.

If the appeal is successful it will support the host governments until the end of the year, WHO estimates.


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