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Iran: Public Health Sector Wins International Praise During Cholera Outbreak --> Children in a poor neighborhood of Tehran (file photo) By Bill Samii and Fatemeh Aman

Iran is seeking international assistance in dealing with an outbreak of cholera that has already killed at least 10 people. And while the World Health Organization (WHO) has praised the Iranian public health sector's response, some Iranian newspapers have been more critical.

Dr. Mahmud Sorush, an official with Iran's Ministry of Health, Treatment, and Medical Education, said on 22 August that 56 new cases of cholera were reported the previous day, the Iranian Students News Agency (ISNA) reported, bringing the national total to 810. He added that 10 people had died of the disease since a rash of cases began in July.

On 21 August, the ministry had suggested that it managed to bring the outbreak under control, although it expressed concern that infections could surge again in the south of the country. In fact, the outbreak has spread rapidly. As of 24 August, there were more than 1,000 reported cases.

How Cholera Spreads

Cholera is an acute, diarrheal illness caused by bacterial infection of the intestine. People can get cholera by drinking water or eating food that is contaminated with the cholera bacterium, according to the U.S. Center for Disease Control. When there is an epidemic, the source of the contamination is often an infected person's feces. The disease can spread rapidly in areas with inadequately treated sewage and drinking water.

In the Iranian case, the cholera outbreak has been attributed to several sources. A Health Ministry official identified by state radio only as "Dr. Akbari" said on 5 August that illegal immigrants from Pakistan who have settled near Qom are carriers of the bacteria, state radio reported. Regarding the spread of cholera around Tehran, the capital, Akbari said this can be traced to the consumption of unwashed vegetables. "Therefore, I cannot stress enough the importance of thoroughly disinfecting vegetables," Akbari added. "The easiest way is to use high water pressure to wash vegetables. Then add a spoonful of bleach to them and let it sit for a minute before washing them again."

Dr. Mobasher Sheikh, the World Health Organization (WHO) representative in Iran, confirmed in a 15 August interview with Radio Farda that although the outbreak was initially attributed to immigrants and pilgrims from Pakistan and Afghanistan, it is now believed to be connected with other factors, such as unwashed vegetables.

The Health Ministry recently banned the sale of green vegetables for two months. According to AFP on 18 August, this has cost farmers a minimum of $55.5 million. President Mahmud Ahmadinejad has ordered the Agriculture Jihad Ministry to compensate vegetable farmers whose livelihoods are adversely affected by the produce ban, IRNA reported on 22 August. The national police force is taking action against peddlers of contaminated foods, "Iran Daily" reported on 23 August.

International Appeal

Tehran has reached out to the international community for help in preventing the spread of the disease. Dr. Claire-Lise Chaignat, head of the WHO's Global Task Force on Cholera Control, told Radio Farda on 15 August: "We have been informed by our WHO representative that there is an outbreak going on in Iran. We had an official request from the Ministry of Health asking for support from WHO to provide support for the investigation of this outbreak."

Chaignat said the WHO is taking measures to stop the spread of the disease. "What we have to do to stop an outbreak is to ensure that the water resources is safe and not contaminated and that we provide health education to the population," Chaignat said. "Because once have it in the environment, it is there and it is a question of the behavior of the community in order to stop the spread." Chaignat told Radio Farda that the WHO sent an epidemiologist to Iran and that person is working with the Health Ministry.

WHO officials said Iran is dealing with the cholera outbreak in a praiseworthy manner. Chaignat pointed out that cholera can come to a country at any time, and she praised Iran for detecting the disease quickly. "In fact, because Iran has a good surveillance system, the country could identify the first cases as soon as they occurred," Chaignat said. "And that's why their alert system in fact functions very well, and that's why we have been aware they are quickly of the outbreak going on in Iran. This is because of a good infrastructure in Iran."

Iran's quick reaction to the outbreak has prevented a much greater problem, Chaignat added. "I think that Iran has taken the measure that is needed to take immediately and that is probably why there has not been a bigger outbreak so far," she said.

Sheikh also praised the public health sector's response. "They have a fairly good system of water and sanitation and they are sort of running fairly competent campaign for awareness in the media," Sheikh said in his 15 August interview with Radio Farda. "It is very likely to be controlled in coming days."

Sheikh described some of the steps being taken by the WHO and the Health Ministry to confront the cholera outbreak. "We are working very closely with the national authorities in strengthening the surveillance system, for early detection and help recreating awareness to the general public."

Sheikh told Radio Farda on 24 August that the WHO epidemiologist looked into the functioning of the surveillance system in an effort to determine the major sources of the infection and ways to limit its spread. The epidemiologist was impressed with the way Iranian authorities are handling the situation and with their initial responses, according to Radio Farda.

Local Reaction

While international agencies that must work with Tehran are praising the Iranian government's efforts, the Iranian press is less enthusiastic. Commentator Rauf Pishdar wrote in "Etemad" on 22 August that the government is withholding the truth on the cholera outbreak. Officials initially denied that there was a problem, and after there were too many patients for the denials to work, they only revealed part of the truth. "The result was that a larger number of people fell ill and a few people died," according to the commentary. Pishdar wrote that in an article he wrote in the 1980s, he described the excessive use of chemicals on vegetables in southern Tehran. Officials denied these allegations on state radio and television, but a subsequent scholarly report noted that students in that area got sick after consuming vegetables from that part of Tehran that were treated with raw sewage. Pishdar argued that this reflects a regular pattern of obfuscation.

Another newspaper noted that the outbreak harms Iran's international reputation."The cholera epidemic is spreading across the epidemic not only gives rise to a human disaster, but also mars our international reputations," "Iran Daily" commented on 18 August. "The spread of cholera in the 21st century informs the international community that the Iranian government and health system are inefficient. This is what the world already thinks about Afghanistan."