International Medical Corps

Girls school receives hygiene items.

Photo: International Medical Corps Girls school receives hygiene items.

Children laugh as jerry cans and hygiene items are distributed.

Photo: International Medical Corps Children laugh as jerry cans and hygiene items are distributed.

IMC Education officer provides health and hygiene for cholera.

Photo: International Medical Corps IMC Education officer provides health and hygiene for cholera.

IMC and UNICEF Partner to Halt Outbreaks of Cholera

Photo: International Medical Corps

Children laugh as jerry cans and hygiene items are distributed.

The first confirmed cases of Cholera in Iraq in the 2008 season arose in late August. A child returning from Eastern Iraq had died in Baghdad. As government testing facilities mobilized, International Medical Corps prepared for the worst. Supplies were already in place and IMC staff members were put on heightened alert, relying on their networks of healthcare workers and local leaders as a ground-level early warning system for any potential outbreaks. By October, IMC had reached tens of thousands of Iraqis at risk of falling victim to cholera in Anbar, Baghdad, and Babil governorates. Below are snapshots of how cholera struck different communities, and how IMC and its partners mobilized to contain the problem.

Babil
Early September brought rumors and speculation of a major cholera event in Babil governorate’s central city of Hilla and the surrounding area. UNICEF, International Medical Corps’ partner in an emergency response program called IMPACT, asked IMC to investigate reports of dozens of deaths and hundreds of additional cases flooding the hospitals and Primary Healthcare Centers of this area immediately south of Baghdad. By working closely with Directorate of Health (DoH) officials and healthcare administrators IMC was able to establish within four hours that early reports of twenty deaths and 200 to 500 cases were exaggerated. Media outlets had reported that one hospital had set up tented spaces to receive the overflow of cholera cases, as a sign that the hospital was already full. Media also reported that the tents themselves were already full with patients. Ultimate, these tents were never needed, since the preparation for and treatment of actual cases outpaced their onset.

International Medical Corps recognized immediately, however, that the two confirmed deaths and 22 confirmed cases were only the beginning and an outbreak could occur rapidly if the DoH and its facilities were not prepared. Cholera kills by dehydrating its victims within days of diarrheal episodes. With timely and proper treatment, even in the most severe cases, fatalities are almost always preventable. In addition to determining the actual number of cases, IMC identified all of the affected areas and began assessing the capacity of local services to respond.

Photo: International Medical Corps

IMC Education Officer provides health and hygiene education for cholera.

Within seven hours of receiving the alert International Medical Corps and the Babil DoH had established a response plan including distribution of 45,000 units of Oral Rehydration Salts (to replace electrolytes lost by diarrhea), 1.5 million household water purification tablets to ensure immediate access to safe drinking water, eight 5,000-liter community water storage tanks to be installed, and subsequent tankering of clean water to the affected communities. The Iraqi government, including the Prime Minister’s Office, quickly offered to handle all tankering to affected areas, allowing IMC to focus on supporting DoH capacity, extending emergency response efforts already planned, and launching a safe water and hygiene awareness campaign, as well as distribution for the schools within affected communities. Ultimately, the project was expanded to 53 water storage tanks in all, with communities helping defray costs by providing many of the materials and labor for the bases on which the tanks rest.

At UNICEF’s request, International Medical Corps quickly planned and implemented a school-based clean water and hygiene awareness campaign for the affected areas. This project, covering 17 schools in the hardest-hit areas, included the distribution of 5,167 hygiene kits, 5,300 jerry cans, 1.2 million household water purification tablets and the education of more than 5,000 students and teachers about the importance and methods of water purification and hygiene.

Over the coming cholera season Babil would emerge as the most affected governorate in Iraq. As of mid-October there were three deaths among 230 cases of cholera confirmed in Babil. But the close coordination among International Medical Corps, the Directorates of Health, Water and Education, UNNICEF and local communities, prevented the outbreak from becoming far worse.

Baghdad
As cholera began to surface in August 2008 it was Baghdad which would see it first. The late August stories of a girl returning from eastern Iraq and dying shortly thereafter put International Medical Corps on alert. After being assured by the UNICEF Chief Facilitator for Health and Nutrition that the Baghdad Department of Health was well prepared for any outbreak, IMC staff began to look for alternative routes to respond. While some assistance was provided directly to the DoH in the form of Oral Rehydration Salts the bulk of IMC’s cholera response in Baghdad centered on the distribution of water purification tablets and jerry cans to students and teachers, larger water purification tablets for the school’s water supply and a health awareness campaign on the safe handling and use of water. Distribution to six schools has already been completed, where 2,272 students and 101 teachers were provided with a total of 569,500 household tablets, 2,373 jerry cans and 1,200 school water storage tank purification tablets in addition to being instructed on safe water use. The additional nine schools should raise the number of children directly targeted to nearly 5,800.

Photo: International Medical Corps

Girls School receives hygiene items.

Anbar
In mid-September International Medical Corps received reports of possible cholera cases in an area of Anbar governorate outside of Falluja. An assessment of the situation uncovered two cases and several other suspected cases from Naoimiyah, a community of eight tribes comprising 2,200 families. IMC staff soon discovered that the water treatment plant serving the population was not providing potable water, and there was a lack of information among the people about the links between treating water before drinking, personal hygiene and health and wellness.

Within a few days International Medical Corps distributed 800 child hygiene kits, 1,170 adult hygiene kits, 1,210 family water kits and installed 14 5,000-liter community water storage tanks to serve the 1,296 families most immediately at risk from contaminated water. The Directorate of Water (DoW)and IMC immediately began sending eight water trucks to the affected areas daily, with tankering going directly to people’s homes until the community tanks could be installed. While the DoH conducted mobile water and hygiene awareness campaigns, IMC and the DoW began the rehabilitation of the Dafar water treatment plant serving the area. IMC also provided 200 jerry cans for the transportation of chlorine for water treatment plants from the regional supply hub in Babil governorate to Anbar.

This rapid mobilization by International Medical Corps, UNICEF, and the Directorates contributed to the halt of cholera cases in Anbar, with just nine confirmed cases and no deaths.

Bill Clinton With Nancy Aossey, CGI 2008

Photo: International Medical Corps Former President Bill Clinton with International Medical Corps CEO, Nancy Aossey, and PATH CEO, Christopher Elias, at the 2008 Clinton Global Initiative Annual Meeting. PATH and IMC are partnering up to bring new health technologies to Liberia for their 2008 Commitment.

IMC and PATH partner with 2008 Clinton Global Initiative Commitment

Photo: International Medical Corps

Former President Bill Clinton with International Medical Corps CEO, Nancy Aossey, and PATH CEO, Christopher Elias, at the 2008 Clinton Global Initiative Annual Meeting. PATH and IMC are partnering up to bring new health technologies to Liberia for their 2008 Commitment.

International Medical Corps (IMC) and PATH have developed a pilot project to make rapid diagnostic testing for malaria and sexually transmitted infections available to health clinics in Liberia as its 2008 Clinton Global Initiative (CGI) Commitment to Action. Introduced at the fourth annual CGI Annual Meeting this fall, the commitment focuses on simple, low-resource testing services so that the diagnosis, treatment, and prevention of infectious and sexually transmitted diseases can be done more accurately and effectively. This initiative comes at a time when Liberia is working to rebuild its health care infrastructure after two decades of civil war.

PATH is an international, non-profit organization that works with private firms to develop and promote access to simple tests in low-resource settings that lack laboratory facilities. International Medical Corps and PATH will work together to expand access to these technologies in relief and post- crises environments. PATH will provide training on the technologies that will be introduced in 22 International Medical Corps health clinics across three different counties. Through the training, local health care workers will be able to administer the tests and improve the well-being of their communities, an objective that is tightly aligned with IMC’s dedication to education and self-reliance.

In Liberia, where the World Health Organization (WHO) estimates life expectancy at just short of 42 years, the rapid diagnostic technologies will enhance the local health care system’s ability to combat two common infectious diseases that are often causes of mortality. According to the WHO, 19 percent of deaths under five years of age are caused by malaria. With approximately 1.1 million malaria cases every year, it is critical for health care workers to be able to identify the disease quickly so they can treat it and start to prevent new cases from occurring.

Sexually transmitted diseases, such as syphilis can also be deadly. For pregnant women infected with syphilis, the risk of prenatal death is estimated at a very high 40 percent by the Centers for Disease Control and Prevention. This leads to approximately 500,000 prenatal deaths every year. The WHO predicts that there are 340 million new cases of curable sexually transmitted diseases and 5 million new cases of HIV every year. Rapid diagnostic testing technology is a critical element in treating existing and preventing new infections in the developing world.

International Medical Corps began work in Liberia in 2003, right after the signing of the Accra peace accord which removed President Charles Taylor from office. As Liberia now moves from a period of crisis to one of stability and growth, IMC is adapting is programming from emergency care to strengthening the country’s health systems. IMC currently manages 35 health facilities Lofa, Bomi, and Cape Mount, where the majority of displaced have resettled. The Commitment will bring the testing technologies to all three counties, training approximately 280 health care workers to effectively identify and treat malaria and syphilis.

The Clinton Global Initiative, founded in 2005 by Former President Bill Clinton, brings together the world’s best minds and innovators to create sustainable solutions to issues worldwide issues. A CGI member, International Medical Corps, contributed to the nearly $46 billion in commitments made by the community over the past four years, impacting more than 200 million lives in 150 countries. IMC’s 2008 Commitment, ‘Closing the Human Resource Gap,’ trained 600 women in Burundi, Democratic Republic of Congo, Liberia, Mozambique, Sierra Leone, and Uganda to provide women’s health care services.

Congolese boy outside of IMC clinic.

Photo: International Medical Corps. Congolese boy outside of International Medical Corps clinic.

Military tank in Democratic Republic of Congo

Photo: International Medical Corps Military tank patrolling through DRC.

The Children of Sadr City: Restored Hope for an Education

By Yehya Othman

Photo: IMC/Usama Jalel Nahee

Young students in Sadr City enjoy being back in class. IMC rehabilitated their school, which had been destroyed during the war.

Baghdad, October 2008 - Sadr City, located in the eastern Rusafa District of Baghdad, is home to nearly three million Iraqis densely packed into about eight square miles. The area has seen numerous clashes, most recently in late March 2008. Eyewitnesses described the situation at the time as “catastrophic,” even “inhuman”. International Medical Corps recognized the population was in desperate need of help - and that those paying the highest price were the children.

Along with the emotional pain of seeing atrocities first-hand and being shut in their homes as fighting tore through their streets, thousands of children missed the final exams required to pass them onto the next grade and had their schools demolished by the fighting.

Photo: IMC/Haider Muhsin

IMC helped rebuild this and several other Sadr City schools destroyed during the war.

During the weeks of the conflict, International Medical Corps quietly shuttled food and essential supplies into Sadr City. With security restored, the people of Sadr City, not least its children, can now receive the basic services they need. IMC has undertaken rehabilitation of four schools under a program called IMPACT, in partnership with UNICEF. These facilities, serving nearly 4,000 children under the age of 12 were over 70 percent destroyed, with broken doors and windows, soot on the walls, damaged furniture, and bullet-hole reminders of the fighting. The children who attended these schools, if they were allowed outside at all, had been forced to travel long distances to already overcrowded classrooms.

Work on Shairah al Arabia and al Farakhed schools began in July, while Sfeen and al Khulafaa schools were started in August. Amazingly, International Medical Corps was able to complete all of the rehabilitations in time for the start of classes after the Eid al-Fitr holiday in early October.

Photo: IMC/Usama Jalel Nahee

Young students outside their Sadr City school, which IMC rehabilitated after it was destroyed during the war.

For children who once feared they might never be able to go back to school, their return was full of the smiles and excitement that only a first-day of classes can bring. Teachers and staff walked into a professional workplace better than the one they had before fighting began. The children who had experienced immense misery and sorrow now had a place to get a proper education and to develop into normal adults through play and social interaction with their peers. These schools had become not just houses of education, but gardens for the blooming youth of Iraq to escape the fate of the uneducated and neglected.

International Medical Corps brought these places of learning back to life, where children can study in newly refurbished classrooms, play in new playgrounds and enjoy the right to education that they deserve.

Students outside Sadr City school.

Photo: IMC/Usama Jalel Nahee Young students outside their Sadr City school, which IMC rehabilitated after it was destroyed during the war.

IMC helps rebuild Sadr City school.

Photo: IMC/Haider Muhsin nternational Medical Corps helped rebuild this and several other Sadr City schools destroyed during the war.

Students in Sadr City school.

Photo: IMC/Usama Jalel Nahee Young students in Sadr City enjoy being back in class. IMC rehabilitated their school, which had been destroyed during the war.

Global Food Crisis

The global food crisis still threatens the health and well-being of millions of people around the world.

Children affected by Pakistan earthquake

Photo: International Medical Corps The earthquake, measuring 6.5 in magnitude, left an estimated 20,000 displaced. With temperatures already below freezing, those who lost their homes to the earthquake are in immediate need of blankets, winterized tents, and other materials to protect them from the cold.

IMC doctor examines baby after earthquake

Photo: International Medical Corps International Medical Corps has already treated more than 500 people throughout District Ziarat, an area badly hit by last week’s earthquake.