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disputed waters
Health Ministry Stops Releasing Cholera Numbers
The final number is 900: Official blames the media, other ministries, victims
By DANIEL W. SMITH 11/18/2008 6:13 PM ET
Dr. Ehsaan Jafa'r of the Ministry of Health
Photo: Daniel W. Smith
Dr. Ehsaan Jafa'r of the Ministry of Health

BAGHDAD - Dr. Ehsaan Jafa’r, the Health Ministry’s Director General of Public Health appeared at a press briefing, alongside two officers with the U.S. Army Corps of Engineers. Dr. Jafa’r gave a talk about the spread of cholera and anthrax, in which he stated that the Ministry of Health was no longer releasing the official count of cholera victims. The final number given of those who have been made sick by the water-borne disease since the epidemic started this summer was 900.

The two officers spoke briefly about the improving services provided to Iraqis in various provinces, in terms of both the availability of potable water and the construction of healthcare facilities. Their presentations were straightforward, but seemed a little odd when one of them, Lieutenant Colonel Jared Purdue, displayed a full water bottle as proof of clean water coming out of a Sadr City treatment plant. He held it up, saying that we could all “see how clean and beautiful it is”. It looked fine to me, but he didn’t speak at all to any tests that might’ve been done on the sample. The Special Inspector General for Reconstruction in Iraq (not known for mincing words about project shortcomings lately) gave the plant very good grades in a recent report, so we’re willing to give him the benefit of the doubt for now.

What appeared to be a little more difficult to swallow, for as least most of the Iraqi journalists present, was Dr. Jafa’r’s speech, the first and most lengthy of the three. An Iraqi government official told me over the weekend that, lately, Dr. Jafa’r has worked with two to three media coaches, provided by the Americans. He was certainly poised, seemed confident, and smiled a lot – but came across as very defensive, and sometimes downright hostile toward the press. Given the history of the cholera outbreak and what he was saying, that might make sense.

The Iraqi press has had a difficult time probing into the matter of how large the cholera epidemic actually is. Sure, the Health Ministry releases numbers, but with little or no access to hospitals and medical clinics in areas of large-scale infection, verifying those numbers is very difficult. Journalists have often complained about being turned away from hospitals guarded by Iraqi security forces for “security reasons”. As in many Iraqi ministries, people seem to be speaking publicly less and less. Many have drawn the conclusion that the actual numbers of people with cholera are much higher than what is being reported by the MoH.

Dr. Jafa’r blamed other ministries for the outbreak six times (“The base for our cholera emergence is not within the responsibility of the Ministry of Health... cholera is a water transported disease”) and he blamed the Iraqi people themselves, four times (“the citizens are violating the water networks, the matter that leads to leakages of polluted water to the main tankers”, and he cited victims dying because of insuficient treatment due to “negligence of the family members”).

It is true that the responsibility of providing clean water falls under the jurisdiction of the Ministry of Municipalities and Public Works and the offices of the Water Authority throughout the provinces, and it is also true that citizens can make the problem worse - but treatment of the patients is the MoH’s responsibility, as is informing the public. As far as informing the press about treatment, it didn’t get any more nuanced than, “all of them have received the needed and the necessary treatment and they’re all doing well now.” As for informing the public about the amount of people that have contracted cholera, that is another matter.

The numbers that the Ministry of Health gives out are highly disputed in the Iraqi press. Dr. Jafa’r announced that, because journalists had not acted responsibly in reporting the “official” figures released, they were ceasing to release any numbers at all. They were stopping at the number 900, and not going any higher than that. He said, “We at the Ministry of Health decided not to deal with numbers, with media.”

After the press conference, Iraqslogger asked Dr. Jafa’r why, since the reason for much of the speculation was the lack of complete information given and the perception of a cover-up, that they didn’t just make all of the information available, rendering the speculation obsolete? He told us, “They have acted unethically before, and they will not get more information.”

Iraqslogger spoke to another Ministry of Health official on the phone, who put week’s figure at 877, off-the-record. We then checked with Adel Muhsin, the Inspector General of the Health Ministry, who said He said, “I don’t know why we would need to cover up the cholera cases. It is also very difficult to fake them, because all the groups, like the WHO, are monitoring us.” He said that the numbers were being withheld, he said, was that some Iraqi politicians were trying to use the numbers to their own advantage, against the Iraqi government.

He also made the valid point that there are also many diarrhea-based sicknesses that present symptoms similar to cholera, but which aren’t actually cholera. “It can not be clinically observed. It must be tested. That is why many in the media do not get the number right.”

When asked why the policy was not to simply release both numbers to the press, he replied, “Well, lab tests are needed to determine one from another. It takes scientific knowledge to tell the difference.”

To see a joint World Health Organization/Iraqi Government report on the cholera epidemic in Iraq, released on November 4, click here.

Lieutenant Colonel Jared Purdue and his clean-looking water
Photo: Daniel W. Smith
Lieutenant Colonel Jared Purdue and his clean-looking water


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