[Vision2020] 08-04-04 LA Times: Water Offers Deadly Relief in a Blistering Iraqi Slum

[Art Deco aka W. Fox]

http://www.latimes.com/news/nationworld/world/la-fg-disease4aug04.story
Water Offers Deadly Relief in a Blistering Iraqi Slum
Typhoid and hepatitis E run rampant because sewage has tainted nearly the entire
supply.
By Ashraf Khalil
Special to The Times

August 4, 2004

BAGHDAD - The price of bicycle pumps has more than quadrupled in Sadr City, for
reasons that have nothing to do with cycling. Residents of Baghdad's worst slum
use them to coax water from the district's battered supply lines. It's either
that or use their mouths as though they're siphoning gas.

But there's a problem - the water is making them sick.

Typhoid and hepatitis E are running rampant through Sadr City this summer, as
residents rely heavily on a sewage-tainted water supply to endure temperatures
of 115 degrees and up. The outbreak has strained local healthcare facilities and
left Health Ministry officials able to only guess at the scope of the problem.

The increase in typhoid (known as "tee-pho" here) is a regular summer occurrence
in Iraq because of increased water consumption, but officials say this year's
infection rates are much higher than usual. Hepatitis E, although present in the
country for decades, is more rare.

"We would read about it in books," said Dr. Qassim Nuwesri, director of Sadr
City's Ali bin Abi Talib Hospital.

Sadr City's aging water system was crumbling before last year's U.S.-led
invasion to oust Saddam Hussein. But the postwar looting of a sewage treatment
plant brought the crisis to a new level. Broken water lines allow raw sewage to
seep into the regular water supply. Frequent electrical shortages stop the
municipal water pumps, and innovative means of pumping water from the dry pipes
end up bringing in extra sewage.

"It's always been bad, but now it's getting worse every day," said Faliha Ahmed,
32, a scrawny typhoid patient in the hospital's crowded infectious disease ward.
"What can we do? We're thirsty."

At least four people have died from hepatitis E, and the number of reported
cases of the disease in the first half of 2004 - about 12,000 - has already
surpassed the amount for all of 2002. Faced with a shortage of diagnostic kits,
the government's communicable disease center sent a team to test a limited
sample of patients at Sadr City health centers. Twelve of 16 people tested
positive for hepatitis E.

As the brutal Baghdad summer heads toward its traditional August peak, health
officials and Sadr City residents expect the infection rate of both diseases,
and the death toll, to keep rising.

Both diseases are characterized by high fever and gastrointestinal ailments.
Typhoid is treatable with antibiotics, unlike hepatitis E, which is also
characterized by jaundice, is particularly dangerous for pregnant women and has
no known vaccine.

Other parts of the country are bracing for a disease-ridden August. The United
Nations has warned of a humanitarian crisis in the southern city of Basra, also
because of high temperatures and a suspect water supply.

In Sadr City, a packed and squalid urban landscape filled with more than 2
million impoverished Shiite Muslims, the crisis is already in full swing.

Marked by standing pools of raw sewage, the district "has every condition you
could ask for" to prompt an outbreak, said Dr. Atallah Salmany, a hepatitis
expert at the communicable disease center.

The cause is as plain as the solution is seemingly distant.

"Improve the services, improve the drinking water, fix the sewage network," said
Nuwesri, the hospital director.

But U.S. Army commanders in the area acknowledge that almost no serious
reconstruction has been accomplished in Sadr City. Contractors, they say, have
been scared off by frequent attacks by members of the Al Mahdi militia.

Residents are left with a revolting water supply.

"If I showed you the water in our house, you would not believe it," said Taiha
Abdel Reda, 45. "We turn on the tap and the water has a foul smell and we see
threads of [human waste] in it."

Those who end up hospitalized don't fare much better.

Nuwesri said his hospital often uses water that's "just as contaminated as the
water in the homes."

Even that tainted supply has been known to disappear for up to 18 hours. Several
times, Nuwesri said, he's had to appeal to local fire stations to provide the
hospital with emergency water tankers.

The hospital director shrugs off the irony of serving tainted water to patients
made sick by tainted water. A 35-year resident of Sadr City, Nuwesri shares his
neighbors' sense of helpless resignation.

"We can't even get contaminated water!" he said. "Let's first get some and then
we'll worry if it's hygienic."

Health officials, meanwhile, admit there's little to be done in the short term
but chronicle the scope of the outbreak - and even that is hampered by a lack of
facilities.

"Since 1991, we've had no studies, no programs," said Salmany of the
communicable disease center.

Salmany's office has worked with the World Health Organization to distribute
48,000 20-liter water jugs and 2 million purification tablets to residents.

But the efforts have made little impact in District 74, a Sadr City neighborhood
that health officials regard as an infectious disease hotbed.

"The water we drink is the same as this," said Khadar Abbas, pointing to an open
sewer outside his home. He had only vaguely heard of the purification pill
distribution program.

The Abbas family draws water from an outdoor spigot with a bicycle pump and
stores it in a yellow plastic barrel, boiling a portion each morning for
drinking. The barrel is now discolored with brown and green streaks, and the
boiling hasn't prevented one of Abbas' sons from contracting hepatitis E.

Down the street, a funeral banner hangs for Amal Kadhim.

"The condition started with vomiting. At first I was happy because I thought she
was pregnant," said Kadhim's widower, Qassim Wussfy. She died three days after
checking into a hospital, heavily jaundiced and gasping for breath.

Municipal officials offer little short-term hope.

"We're not just sitting here," said Jaleel Abaidy, a spokesman for the Baghdad
Municipality, which is responsible for city public works efforts.

A new project, scheduled to begin this month, will provide 33 million gallons of
clean water to Sadr City, he said.

But that will take nine months, at best, to complete, and Abaidy acknowledged
that there's little to be done to help Sadr City's residents bear the rest of
the summer.

"We inherited an existing problem," he said. "The whole system has expired."

Special correspondent Caesar Ahmed contributed to this report.
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