BAGHDAD — The price of bicycle pumps has more than quadrupled in Sadr City, for reasons that have nothing to do with cycling. Residents of Baghdad's worst slum use them to coax water from the district's battered supply lines. It's either that or use their mouths as though they're siphoning gas.
But there's a problem -- the water is making them sick.
Typhoid and hepatitis E are running rampant through Sadr City this summer, as residents rely heavily on a sewage-tainted water supply to endure temperatures of 115 degrees and up. The outbreak has strained local healthcare facilities and left Health Ministry officials able to only guess at the scope of the problem.
The increase in typhoid (known as "tee-pho" here) is a regular summer occurrence in Iraq because of increased water consumption, but officials say this year's infection rates are much higher than usual. Hepatitis E, although present in the country for decades, is more rare.
"We would read about it in books," said Dr. Qassim Nuwesri, director of Sadr City's Ali bin Abi Talib Hospital.
Sadr City's aging water system was crumbling before last year's U.S.-led invasion to oust Saddam Hussein. But the postwar looting of a sewage treatment plant brought the crisis to a new level. Broken water lines allow raw sewage to seep into the regular water supply. Frequent electrical shortages stop the municipal water pumps, and innovative means of pumping water from the dry pipes end up bringing in extra sewage.
"It's always been bad, but now it's getting worse every day," said Faliha Ahmed, 32, a scrawny typhoid patient in the hospital's crowded infectious disease ward. "What can we do? We're thirsty."
At least four people have died from hepatitis E, and the number of reported cases of the disease in the first half of 2004 -- about 12,000 -- has already surpassed the amount for all of 2002. Faced with a shortage of diagnostic kits, the government's communicable disease center sent a team to test a limited sample of patients at Sadr City health centers. Twelve of 16 people tested positive for hepatitis E.
As the brutal Baghdad summer heads toward its traditional August peak, health officials and Sadr City residents expect the infection rate of both diseases, and the death toll, to keep rising.
Both diseases are characterized by high fever and gastrointestinal ailments. Typhoid is treatable with antibiotics, unlike hepatitis E, which is also characterized by jaundice, is particularly dangerous for pregnant women and has no known vaccine.
Other parts of the country are bracing for a disease-ridden August. The United Nations has warned of a humanitarian crisis in the southern city of Basra, also because of high temperatures and a suspect water supply.
In Sadr City, a packed and squalid urban landscape filled with more than 2 million impoverished Shiite Muslims, the crisis is already in full swing.
Marked by standing pools of raw sewage, the district "has every condition you could ask for" to prompt an outbreak, said Dr. Atallah Salmany, a hepatitis expert at the communicable disease center.
The cause is as plain as the solution is seemingly distant.
"Improve the services, improve the drinking water, fix the sewage network," said Nuwesri, the hospital director.
But U.S. Army commanders in the area acknowledge that almost no serious reconstruction has been accomplished in Sadr City. Contractors, they say, have been scared off by frequent attacks by members of the Al Mahdi militia.
Residents are left with a revolting water supply.
"If I showed you the water in our house, you would not believe it," said Taiha Abdel Reda, 45. "We turn on the tap and the water has a foul smell and we see threads of [human waste] in it."
Those who end up hospitalized don't fare much better.
Nuwesri said his hospital often uses water that's "just as contaminated as the water in the homes."
Even that tainted supply has been known to disappear for up to 18 hours. Several times, Nuwesri said, he's had to appeal to local fire stations to provide the hospital with emergency water tankers.
The hospital director shrugs off the irony of serving tainted water to patients made sick by tainted water. A 35-year resident of Sadr City, Nuwesri shares his neighbors' sense of helpless resignation.
"We can't even get contaminated water!" he said. "Let's first get some and then we'll worry if it's hygienic."
Health officials, meanwhile, admit there's little to be done in the short term but chronicle the scope of the outbreak -- and even that is hampered by a lack of facilities.
"Since 1991, we've had no studies, no programs," said Salmany of the communicable disease center.
Salmany's office has worked with the World Health Organization to distribute 48,000 20-liter water jugs and 2 million purification tablets to residents.
But the efforts have made little impact in District 74, a Sadr City neighborhood that health officials regard as an infectious disease hotbed.