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Case study

Outbreak of cholera in Iraq during a humanitarian crisis, 2015: a teaching case-study

Outbreak of cholera in Iraq during a humanitarian crisis, 2015: a teaching case-study

Omar Al-Hadeethi1,&, Haneen Al-Jawaldeh1


1Global Health Development (GHD) / Eastern Mediterranean Public Health Network (EMPHNET), Amman, Jordan



&Corresponding author
Omar Al-Hadeethi, Global Health Development (GHD) / Eastern Mediterranean Public Health Network (EMPHNET), Amman, Jordan




Cholera is an infectious disease caused by the consumption of contaminated food or water with the bacterium Vibrio cholera. V. cholera has many subgroups; only two (O1 and O139) of them can lead to outbreaks. Recent cholera outbreaks were all caused by V. cholera O. The availability of safe water and sanitation is vital for controlling transmission of cholera and other waterborne diseases. Several Cholera outbreaks were reported in countries of the Eastern Mediterranean Region (EMR) in the last decade, including Afghanistan, Djibouti, Iraq, Pakistan, Sudan, Somalia and Yemen. Cholera is endemic in Iraq; it was first reported in Basrah, in the year 1820. Over the last 5 decades, Iraq experienced many epidemics all together because of underdevelopment and infrastructure damage as a result of wars and conflicts. In addition to bad sewage system, shortages in the supply of safe water exacerbated several outbreaks in the last decade. In Iraq, cholera outbreak was declared by the Iraqi Ministry of Health (MoH) in 2015, during a humanitarian crisis. The outbreak continued to rapidly spread throughout the country, and by October 2015, a total of 1,656 cases were confirmed. This case study is based on the actions taken by the Iraqi MoH during this outbreak to prevent the spread of cholera, where it targeted around 255,00 displaced persons above the age of 1 with a 2-dose oral cholera vaccine (OCV). Individuals who received vaccines were in refugee camps, internally displaced persons camps, and collective centers. This case study is designed to train basic level field epidemiology trainees or any other health care workers who work in fields related to public health and develop their skills to investigate and respond to outbreaks based on cholera outbreak in Iraq, in 2015. It is administrable in 2-3 hours. The case study is used as an optional training material, provides the trainees with the expertise to investigate an outbreak in preparation for the actual real-life experience of such outbreaks.



How to use this case study    Down

General instructions: this case study should be used as adjunct training material for novice epidemiology trainees to reinforce the concepts taught in prior lectures. The case study is ideally taught by a facilitator in groups of about 20 participants. Participants are to take turns reading the case study, usually a paragraph per student. The facilitator guides the discussion on possible responses to questions. The facilitator may make use of flip charts to illustrate certain points. Additional instructor´s notes for facilitation are coupled with each question in the instructor´s guide to aid facilitation.

Audience: this case study was developed for novice field epidemiology students. These participants are commonly health care workers working in the county departments of health whose background may be as medical doctors, nurses, environmental health officers or laboratory scientists who work in public health-related fields. Most have a health science or biology background.

Prerequisites: before using this case study, participants should have received lectures on disease surveillance and outbreak investigation.

Materials needed: Flash drive, flip charts, markers, computers with MS Excel

Level of training and associated public health activity: Novice - Outbreak investigation

Time required: 2-3 hours

Language: English



Case study material Up    Down



Competing interest Up    Down

The authors declare no competing interests.



Acknowledgement Up    Down

We wish to acknowledge the Eastern Mediterranean Public Health Network (EMPHNET) for their support to develop this case study.



References Up    Down

  1. Zgheir Shakir, Mustafa Nabil, Ali Ali, Al-Diwan Jawad. Cholera outbreak in Iraq, 2017. Indian Journal of Public Health Research & Development. 2019;10(7):686-691. Google Scholar

  2. Al-Abbasi A, Aema S. The cholera epidemic in Iraq during 2015. TOFIQ Journal of Medical Sciences. 2015;2(2):27-41. Google Scholar

  3. Lam E, Al-Tamimi W, Russell SP, Butt MO, Blanton C, Musani AS, Date K. Oral cholera vaccine coverage during an outbreak and humanitarian crisis, Iraq, 2015. Emerg Infect Dis. 2017 Jan;23(1):38-45. PubMed | Google Scholar