To some, water sanitation issues are more worrisome than ongoing violence. Cassandra Nelson/Mercy Corps

Cholera in Iraq continues to spread after early reports in September indicated health officials had a handle on the outbreak. The World Health Organization (WHO) has confirmed more than three thousand cases and estimates another thirty thousand people have come down with a milder form of the disease. So far, more than a dozen people have died. In Kirkuk, a city that accounts for two-thirds of the cases, one resident told the Associated Press: "Now we fear cholera more than the violence." The WHO also believes the Iraqi outbreak has spread to Iran via Iraqi refugees.

Cholera is a bacterial infection that causes diarrhea and rapid dehydration, and can lead to death. Risks of cholera epidemics increase when poverty, war, or disasters force people into crowded conditions with poor sanitation. In 2006, the WHO reported more than 240,000 cases of cholera worldwide, including more than six thousand deaths. The majority of cases occurred in Africa. In Iraq, a lack of clean water—a chief culprit for spreading the illness—makes it hard for health officials to halt the outbreak.

Hundreds of million of dollars have been spent by the United States to repair Iraq's water infrastructure. But getting so many systems up and running, as well as maintaining them, has proven beyond the capabilities of the Iraqi government and the US-led coalition.

Some health experts point to restrictions on chlorine—a chemical widely used to disinfect water—which have grown tighter since insurgents began using chlorine on trucks in bombing attacks in the spring of 2007. Earlier this year, UN agencies noted that Iraq still relied on the United Nations to provide the majority of the country's chlorine and other water-treatment chemicals, and pointed out that "administrative bottlenecks" were preventing the government from using its "largely unspent resources" to address the issue.

Iraqi health officials, however, view the chlorine debate as a diversion. Instead, they fault dilapidated water infrastructure savaged by years of sabotage, war, and neglect. Hundreds of million of dollars have been spent by the United States to repair Iraq's water infrastructure. But getting so many systems up and running, as well as maintaining them, has proven beyond the capabilities of the Iraqi government and the US-led coalition. Security concerns, a lack of trained personnel, and a dearth of necessary chemicals and other supplies have slowed down many ongoing projects, and left some completed projects "inoperable" or "operating below capacity," the Government Accountability Office (GAO) reported in 2006. As of July 2005, the GAO shows the United States spent 450 million USD for Iraq's water and sanitation. Of that amount, 143 projects, worth 200 million USD, had been completed.

Other issues, too, present hurdles. Hydroelectric dam construction in Turkey has cut overall water flow and helped foul water downstream on the Euphrates River. Allied air attacks ruined many Iraqi water facilities during the Gulf War in the early 1990s, and many of those left unscathed were poorly conceived in the first place. "The water is so dirty when it gets down to Basra [from the north] that they didn't even drink the municipally supplied water," said one U.S. official. About 10 percent of Iraqis have access to sewage treatment and only 4.6 million of the country's 27 million people have "improved" access to potable water, according to the U.S. Army Corps of Engineers.




Toni Johnson is a staff writer at the Council on Foreign Relations. Reprinted with permission from cfr.org.

To read another Global Envision article about water sanitation, see The Silent Sanitation Scandal.



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