Author Affiliations: WHO, Communicable Diseases, Communicable Disease Surveillance and Response, Epidemiology Strengthening, Lyon, France (Drs Coulombier and Valenciano); Centers for Disease Control and Prevention, National Center for Environmental Health, International Emergency and Refugee Health Branch, Atlanta, Ga (Dr Lopes Cardozo); WHO, Emergency and Humanitarian Action, Geneva, Switzerland (Dr Colombo); Basrah Department of Public Health, Basrah, Iraq (Drs Alla and Samson); WHO, Communicable Diseases, Program on Communicable Diseases Complex Emergencies, Geneva, Switzerland (Dr Connolly).
Section Editor: Annette Flanagin, RN, MA,
Managing Senior Editor.
The recent war in Iraq presents significant challenges for the surveillance
and control of communicable diseases. In early April 2003, the World Health
Organization (WHO) sent a team of public health experts to Kuwait and a base
was established in the southern Iraqi governorate of Basrah on May 3. We present
the lessons learned from the communicable disease surveillance and control
program implemented in the Basrah governorate in Iraq (population of 1.9 million)
in April and May 2003, and we report communicable disease surveillance data
through June 2003. Following the war, communicable disease control programs
were disrupted, access to safe water was reduced, and public health facilities
were looted. Rapid health assessments were carried out in health centers and
hospitals to identify priorities for action. A Health Sector Coordination
Group was organized with local and international health partners, and an early
warning surveillance system for communicable disease was set up. In the first
week of May 2003, physicians in hospitals in Basrah suspected cholera cases
and WHO formed a cholera control committee. As of June 29, 2003, Iraqi hospital
laboratories have confirmed 94 cases of cholera from 7 of the 8 districts
of the Basrah governorate. To prevent the transmission of major communicable
diseases, restoring basic public health and water/sanitation services is currently
a top priority in Iraq. Lack of security continues to be a barrier for effective
public health surveillance and response in Iraq.
Valenciano M, Coulombier D, Lopes Cardozo B, Colombo A, Alla MJ, Samson S, Connolly MA. Challenges for Communicable Disease Surveillance and Control in Southern Iraq, April-June 2003. JAMA. 2003;290(5):654-658. doi:10.1001/jama.290.5.654