One thing is sure about all wars: disease follows in their trail. Pre-war Iraq was healthier than it currently is.
Water and sanitation were not as big a problem as they are now. Lack of clean water brings risk of cholera, which is a nasty, profuse, watery diarrhoea. Once you have it there is no actual treatment of the bacteria but you must keep rehydrated with a mixture of salt, sugar and water. There is also a risk of bloody diarrhoea – this is also known as dysentery. In the ancient ships it was known as ‘the bloody flux’. There are two causes of this – one is from a bacterium called shigella, the other is from an amoeba. Both need medical treatment.
If you are in a situation in Iraq where the water is of a doubtful source in terms of cleanliness, make sure you use a filter to filter out the obvious impurities and also treat the water either with iodine or chlorine. If you have sufficient time then you can always boil the water. This will also get rid of any bacterial or viral impurities. I think it is a good idea to include in your medical kit a Ciproxin tablet. This will treat some causes of travel-related diarrhoea. Also keep handy some Imodium and oral rehydration solution.
Not many people are aware that Iraq has malaria in areas outside Baghdad, mostly the non-fatal kind, but it can be predicted that post-war the malaria of a fatal kind and the non-fatal malaria will increase. This is because of a lack of control measures and a lack of treatment of those infected. What you need to remember is the A, B, C, D of malaria:
The A is for the awareness of the risk.
The B is for bite avoidance – you can try and avoid bites by using a good mosquito repellent such as those produced by Autan, Bayer, Jungle Formula and also Mosiguard. You can also wear long sleeves and trousers or leggings to prevent bites. Outside Baghdad it would be a good idea to buy a mosquito net that has been impregnated with a substance called permethrin.
The C consists of the chemoprophylactic drugs. For a business traveller I think the best one for the situation would be a drug called Malarone. It only needs to be started a day before arriving in the malaria area, it is continued daily while in the area and for seven days after. However, it is an expensive tablet.
The D is for diagnosis. Wherever you are in the world, if you have been in a malarious part of Iraq or any other part of the world and you go down with a fever or you are unwell, ask them to check first that you do not have malaria. This is a simple blood test and could save your life.
The B for bite avoidance also protects you against another mosquito-borne disease, which is called dengue fever. Dengue fever is like the worst, worst ‘flu that you have ever had. You will feel like you have been kicked by a mule for two to three days, you may recover for two days and then the mule manages to kick you again for another three days. [Eds’ comment: we can vouch for this.]
Mosquitoes are not the only things that bite. Rabid dogs are loose in Iraq. Post-war, one can expect that situation to only get worse. Rabies is fatal. A very effective vaccine is available for you before you travel. Ideally you will need to get three doses spread over a minimum of three weeks. If, for any reason, you ended up in Iraq without having the vaccine or a full course and you get bitten by a dog, you need to go quickly for treatment. The treatment will consist of cleaning the wound. You may well need a tetanus injection as well. You will need to have something called rabies immunoglobulin as well as doses of the rabies vaccine.
Another disease to watch out for is meningitis. Muslims who go to the Hajj have a vaccination to protect them. However, it is possible that one or two non-vaccinated individuals could bring it back to Iraq. The best vaccine to have is the meningitis ACWY.
There are, of course, other hazards in a place like Iraq. There is the security issue and even the UN are not safe on this. There is the issue of guns and many of us are very disappointed that the Americans only restricted the use of guns to two per household. None per household would have been preferable. The roads are not safe and there is a significant risk of road traffic accidents. Make sure you know your blood group before you go and it would also be an idea to have a registration with the Blood Care Foundation – this agency can ensure that you get clean blood anywhere in the world. Their contact number is +44 (0)1403 262652.
In places like Iraq the expat lifestyle is likely to be limited. You will need to be careful about the amount that you drink. You also need to consider the risk of unsafe sex and protect yourself against HIV and sexually transmitted diseases.
The heat is also a significant problem. If you have a tendency to heat rash, the best thing to do is to try and unblock your pores, ideally before you get to Iraq. This can be done by saunas, etc. and sometimes certain types of scrubbing brushes. However, the other problem you may face is sunburn and you should wear an appropriate skin protection factor.
Work in Iraq I am sure will be fascinating and interesting – but be careful to protect yourself and make sure that your company takes full responsibility for its employees.