Cholera in Iraq: Recurring Outbreaks, Public Health Gaps and the Urgent Need for Sustainable Control Strategies

Abstract

Cholera remains a serious public health threat in Iraq. Since the start of the 21st century, the country has experienced multiple outbreaks, with the most recent epidemic occurring in 2022. In this paper, we examine cholera outbreaks in Iraq from 2020 to 2025, focusing on distribution patterns, public health challenges, and the impact of the COVID-19 pandemic on monitoring and control of cholera, with the aim of translating these findings into practical recommendations. Key contributing factors to recurring outbreaks are still prevalent in many areas of the country, including a shortage of access to safe drinking water, inadequate sewage infrastructure, conflicts, internal displacement, and low health literacy. Additionally, the COVID-19 pandemic has substantially impacted Iraq’s already exhausted health system and indirectly hindered cholera preparedness and response. In Iraq, cholera outbreaks tend to follow a geographical and seasonal pattern, with most outbreaks typically peaking between late summer and early winter. Despite predictable patterns, the government’s responses have remained exclusively reactive. A coordinated, forward-thinking approach is needed, with strengthening early alert systems, advancing local monitoring, and funding clean water and sewage facilities to achieve sustainable cholera control.