The Last Word: Kenny Gluck

The war in Iraq seriously damaged the country's clean-water supply and sewage-treatment systems, causing a wave of diarrheal diseases, including but not limited to cholera. Although the World Health Organization has confirmed only four cholera cases in Basra, local hospitals have identified dozens of victims, prompting the WHO to declare a cholera "outbreak" in southern Iraq. If identified early, cholera is treatable. But Iraq's hospitals remain in a chaotic state, facing shortages of doctors and supplies. Kenny Gluck, the director of operations for Medecins sans Frontieres, the international humanitarian group, recently returned from Basra, where his team of aid workers is helping to restore the health-care system of Iraq's second largest city. Gluck spoke with NEWSWEEK's Malcolm Beith in mid-May. Excerpts:

Is Basra on the verge of a cholera epidemic?

We don't think so yet, but it's really hard to tell. We're looking at the demographics of the [current] cases to see whether this is really out of the normal endemic pattern for cholera in that area. Cholera has been [in Basra] before.

It's been controlled in the past, right?

Yes. The health-care staff [in southern Iraq] are accustomed to dealing with cholera. But right now, the public-health system is in such disarray that they've lost the capacity to deal with even common problems. For me, it's shocking that the hospital-supply [system] has not yet been re-established when the world's biggest logistics machine is operating there.

You're referring to the Coalition forces.

Yes. It's not complicated stuff, but they haven't bothered to provide hospitals with what they need to keep functioning. The doctors there are very worried [about cholera]. They told us, "Yes, we could deal with it very easily, but if we don't get the supplies we need, it's going to turn into a very dangerous [situation]."

Are supplies the only issue?

At this point, the [entire system] is so disorganized that the [staff] don't know who to turn to. They don't know who is responsible for their salaries. They don't know who is responsible for providing drugs. They don't know who to make the drug orders out to. The [chaos] is undermining any response capacity. These are basic governmental functions that the United States and Great Britain, when they took over the country, assumed the responsibility for. They've been neglecting them to a great extent. I really find that inexcusable.

What should the Coalition be doing?

First, they must provide security to medical facilities so that the doctors, nurses and other staff can come to work in safety. Beyond that, there's the re-creation of systems. This is not about building a new country; this is just getting systems restarted that were in place and functioning before the war. The hospitals had supplies of medicine and medical materials before the war; now they're running out, and they don't see where supplies are supposed to come from. That's a very scary thing, because we're entering a season when a lot of infectious diseases could break out.

What other potential problems do you see?

One disease, more dramatic than cholera, is kala azar, a form of leishmaniasis [a lethal parasitic disease]. It's a disease that is 100 percent fatal and in Iraq affects almost exclusively children under 5. It's endemic in southern Iraq, but none of the facilities we visited had any drugs for it. Where was the Coalition? Why didn't they have a plan for [dealing with] some of the diseases that were there? Given the kala azar caseload in southern Iraq, you might be talking about between 200 and 300 children dying a month--for the lack of a simple drug that's produced in England, by the way.

Anything else?

The disorganization in the hospitals means that a lot of wounded people are being [pushed] out of the facilities. [So] they're not getting appropriate postoperative care. That will mean a second wave of infections. We're also very worried about the interruption of the supply of tuberculosis drugs. Without them, not only will individuals who were under treatment relapse, but the interruption of treatment will create multi drug-resistant tuberculosis. That is not being treated at all in Iraq, and [hence] is going to be 100 percent fatal. That could become a real public-health crisis.

What should the WHO and other organizations be doing to improve global health care?

We're hoping that WHO will start to pay more attention to neglected diseases like kala azar. The medicines being used in most of the world for malaria were invented in the 1930s. It is the largest killer of children in Africa, but they're using drugs that are no longer effective. The WHO needs to be helping countries move toward more effective treatments. They need to be lobbying wealthier countries for support. The new drugs are very effective, but they're more expensive and more complicated to use.

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