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Iraq Health and WASH Cluster Acute Diarrheal Disease (including Cholera) Preparedness and Response Plan [EN/AR]

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Cholera is endemic in Iraq, with periodic outbreaks recorded since 1966. Outbreaks typically follow seasonal increase in water contamination starting from July, with an increase in acute diarrhea (AD) and reach the peak in September. While the most notable large-scale outbreaks in Iraq are reported in the table below, it is important to underscore the endemic nature of cholera throughout the country before, during, and after the outbreaks mentioned in the table.

The most recent cholera outbreak was officially declared on 15 September 2015 by the Ministry of Health (MoH), following laboratory confirmation of a suspected case from Diwaniya Governorate by the MoH Central Public Health Laboratory (CPHL). The CPHL identified the causative strain as Vibrio cholerae 01 Inaba. Other governorates along the Euphrates River subsequently detected an increase in acute diarrhoea cases from early September (Epi Week 36). The cholera outbreak peaked during Epi Week 39, and resulted in 2868 cumulative cases (out of 119,983 samples from acute diarrhoea cases) confirmed at provincial laboratories as of 06 December 2015. Three-quarters of these cases were from eleven districts within Babylon, Baghdad, Diwaniya and Muthanna governorates, however all the governorates reported laboratoryconfirmed cases (Sulaimaniya reported only two imported cases). Furthermore, several neighbouring countries (Kuwait, Bahrain, Iran and Oman) reported a small number of cases linked to recent travel history in Iraq.

According to the 2018 Humanitarian Needs Overview (UNOCHA), over 8.7 million Iraqis currently require some form of humanitarian assistance. Furthermore, as per the Iraq Humanitarian snapshot of 30 September 2018, there are currently, at least 1.89 million people displaced across Iraq. The vulnerable populations remain concentrated in camps, informal settlements and within host communities which often pose the risk of exposure to and transmission of communicable diseases, including cholera because of crowded living conditions. Furthermore, people, who are living in newly retaken areas and returnees to East Mosul and other retaken towns and villages across Iraq may also be considered to be at risk of cholera due to infrastructure damages that limit access to safe water and sanitation as well as healthcare. As displacement protracts, people exhaust their income and assets, and their needs outpace the capacity of service providers to scale up activities. The health and water services in the country continue to be overwhelmed, with disruption in delivery due to underinvestment, destroyed or damaged facilities, insufficient personnel, and lack of essential supplies.

In June 2015, the Iraq Health and WASH Clusters, in consultation with the relevant line authorities, developed a joint Cholera Preparedness and Response Plan to set out the required stages to prepare for an acute diarrheal disease outbreak (cholera or dysentery) in the country. This plan has now been updated incorporating the lessons learned by the Government of Iraq (GoI), WHO, UNICEF and WASH and Health Cluster members in responding to and containing the cholera outbreaks in Iraq since 2015, with to the goal of improving prevention of and preparedness for future outbreaks.

The purpose of this acute diarrheal diseases preparedness and response plan is to ensure a proactive and coordinated approach to cholera response across sectors and stakeholders for this season. The plan also includes information on generic response activities, roles and responsibilities in the event of an outbreak, and determines the needs and required resources to address them.