BAGHDAD, Sept. 11 — A cholera epidemic in northern Iraq has infected approximately 7,000 people and could reach Baghdad within weeks as the disease spreads through the country’s decrepit and unsanitary water system, Iraqi health officials said Tuesday.
The World Health Organization reported that the epidemic is concentrated in the northern regions of Kirkuk and Sulaimaniya and that 10 people are known to have died. But Dr. Said Hakki, president of the Iraqi Red Crescent Society, a relief organization that has responded to the epidemic, said that new cases had turned up in the neighboring provinces, Erbil and Nineveh, indicating that the disease had spread.
Most significant, Dr. Hakki said, were two cases in a village on the border between Kirkuk and Diyala Provinces, one involving a young girl. Baghdad is next to Diyala.
Because of that geographic spread, Dr. Hakki said, health officials at the Red Crescent estimate that cases will begin turning up in Baghdad in late September or early October, when temperatures are especially favorable for the growth of the bacteria Vibrio cholerae, which causes the disease by infecting the intestine.
Dr. Cerko Abdulla, chief of the Sulaimaniya health directorate, also said that the epidemic had begun spreading in adjacent provinces. “The water system represents the main problem,” he said. “The disease can spread widely through water, and that’s a very serious matter.”
In Baghdad, Iraq’s deputy health minister, Dr. Adel Mohsin, said that he was not aware of any cases on the Diyala border. But he said that further spread of the epidemic was “very likely” unless government agencies followed strict guidelines on water testing and maintaining sufficient levels of chlorination, which kills the bacteria.
In a chilling reminder of how difficult it may be to maintain those levels, Dr. Mohsin said that chlorine imports had been severely curtailed as a result of recent insurgent bombs that had been laced with chlorine, which in concentrated form can be deadly.
Dr. Hakki, of the Red Crescent, said that shallow wells contaminated by sewage around Sulaimaniya — which had at least two cholera outbreaks in the decades before the American-led invasion in 2003 — could have set off the epidemic. But problems that have developed since the invasion, like poor control of chlorination levels, have the potential to make this outbreak more dangerous, he said.
“If the water has low chlorination, Vibrio cholerae will go through the central supply,” Dr. Hakki said, and the disease will spread “like a fire in a haystack.”
Dr. Burhan Omar, deputy director of Kirkuk General Hospital, said that because of such problems, water purification plants themselves could be contaminated with the bacteria. Those plants, in turn, can “bring the disease from the northern parts to the middle and southern parts of Iraq.”
In fact, if those plants are contaminated, the epidemic could hopscotch all the way to Basra, in the south, Dr. Omar said.
Cholera is caused by infection of the intestine with the bacteria Vibrio cholerae. The infection can be mild or even have no symptoms, but about one in 20 infected people become extremely ill, with profuse watery diarrhea, vomiting and leg cramps. Without treatment, rapid loss of body fluids causes dehydration and shock, and a person can die within hours.
Cholera does not usually spread directly from person to person, so casual contact with infected people is not risky, and quarantine is not necessary. But household members, who have closer contact, may contract it, and can sometimes avoid getting sick by taking the antibiotic tetracycline.
People contract cholera by drinking water or eating food contaminated with the bacteria, which comes from the feces of an infected person. Exposure to raw sewage and contaminated, untreated drinking water can cause epidemics. If treated water is not available, boiling will kill the bacteria. During epidemics, people need to avoid raw vegetables.
The major human displacement caused by the Iraq conflict — people being driven from their homes or simply choosing to leave — is likely to be driving the epidemic, officials say.
Fadela Chaib, a spokeswoman for the World Health Organization, said: “Frankly speaking, it’s possible that cholera will spread to neighboring provinces and even to Baghdad, because there is a lot of people movement. People can be carrying the bacteria in their bodies and show no symptoms, and the bacteria can stay in the body for 7 to 14 days and be shed, potentially contaminating other individuals.”
She said the health organization had sent two truckloads of medical supplies to Erbil, in the north, including oral rehydration salts and intravenous fluids. The group is also testing water samples for contamination and helping the local government to distribute pamphlets and posters urging people to wash their hands and purify their water by boiling it or adding chlorine tablets to kill the bacteria.
Although there are vaccines to prevent cholera, Ms. Chaib said they were “not efficient,” and the health organization did not provide them or recommend them, preferring to emphasize hygiene, clean drinking water, sanitation and education.
Ms. Chaib said that health organization personnel were working in the north and that “it may be more easy for them to be in the north than in Baghdad, for example, because the situation in the north is more manageable than in the rest of the country.”
Should cholera break out in Baghdad, it would be far more difficult to send in health workers and protect them.