Spraying a cow with pesticides, health workers point to blood-sucking ticks at the heart of the worst outbreak of fever detected in Iraq that causes people to die of despair.
The vision of health workers, dressed in a full protective kit, has become commonplace in the Iraqi camp as the Crimean-Congo hemorrhagic fever spreads, jumping from animals to humans.
This year, Iraq has reported 19 deaths among 111 cases of CCHF in humans, according to the Word Health Organization.
The virus has no vaccine and its onset can be rapid, causing severe bleeding both internally and externally and especially through the nose. It causes death in up to two-fifths of cases, according to doctors.
“The number of registered cases is unprecedented,” said Haidar Hantouche, a health official in Dhi Qar province.
A poor agricultural region in southern Iraq, the province accounts for nearly half of Iraq’s cases.
In previous years, cases could be counted “with the fingers of one hand,” he added.
Transmitted by ticks, guests of the virus include wild and farm animals such as buffalo, cattle, goats and sheep, all of which are common in Dhi Qar.
– Tick bites –
In the village of Al-Bujari, a team disinfects animals in a stable next to a house where a woman was infected. With masks, goggles and monkeys, workers spray a cow and her two calves with pesticides.
A worker shows ticks that have fallen from the cow and have been collected in a container.
“Animals are infected by the bite of infected ticks,” according to the World Health Organization.
“The CCHF virus is transmitted to people by tick bites or by contact with the blood or tissues of infected animals during and immediately after slaughter,” he adds.
This year’s increase in cases has taken officials by surprise, with figures far exceeding the 43 years since the virus was first documented in Iraq in 1979.
In his province, only 16 cases had been reported that resulted in seven deaths in 2021, Hantouche said. But this year Dhi Qar has reported 43 cases, including eight deaths.
Figures are still small compared to the Covid-19 pandemic, where Iraq has reported more than 25,200 deaths and 2.3 million registered cases, according to WHO figures, but health workers are concerned.
Endemic to Africa, Asia, the Middle East and the Balkans, the CCHF mortality rate is between 10 and 40 percent, the WHO says.
WHO representative in Iraq Ahmed Zouiten said there were several “hypotheses” for the country’s outbreak.
They include the spread of ticks in the absence of livestock spraying campaigns during Covid in 2020 and 2021.
And “with great caution, we attribute part of this outbreak to global warming, which has lengthened the period of tick multiplication,” he said.
But “mortality appears to be declining,” he added, as Iraq had launched a fumigation campaign while new hospital treatments had yielded “good results”.
– Slaughterhouses under control –
Because the virus is transmitted “primarily” to people through ticks in livestock, most cases are among farmers, slaughterhouse workers and veterinarians, the WHO says.
“Human-to-human transmission can occur as a result of close contact with the blood, secretions, organs or other body fluids of infected people,” he adds.
In addition to uncontrolled bleeding, the virus causes intense fever and vomiting.
Doctors fear there may be an explosion of cases after the Muslim holiday of Eid al-Adha in July, when families traditionally sacrifice an animal to feed guests.
“With the increase in animal slaughter and more contact with meat, there is fear of an increase in cases during Eid,” said Azhar al-Assadi, a doctor specializing in hematological diseases at a hospital in Nasiriyah.
Most of those infected were “about 33 years old,” he said, although his age ranged from 12 to 75.
Authorities have launched disinfection campaigns and are cracking down on slaughterhouses that do not follow hygiene protocols. Several provinces have also banned the movement of livestock across their borders.
Near Najaf, a southern city, the slaughterhouses are controlled by the authorities.
According to workers and officials there, the virus has negatively affected meat consumption.
“I used to slaughter 15 or 16 animals a day; now they’re more like seven or eight,” said butcher Hamid Mohsen.
Fares Mansour, director of Najaf Veterinary Hospital, which oversees the slaughterhouses, said the number of cattle arriving at the slaughter had been reduced by about half to normal levels.
“People are afraid of red meat and think it can transmit infection,” he said.