VZCZCXRO5468
RR RUEHBC RUEHDA RUEHDH RUEHKUK
DE RUEHGB #0166/01 0221621
ZNR UUUUU ZZH
R 221621Z JAN 10
FM AMEMBASSY BAGHDAD
TO RUEHC/SECSTATE WASHDC 6241
INFO RUCNRAQ/IRAQ COLLECTIVE

UNCLAS SECTION 01 OF 02 BAGHDAD 000166 
 
SIPDIS 
 
E.O. 12958: N/A 
TAGS: PGOV KFLU KHIV TBIO KOCI
SUBJECT: PRT DIWANIYAH:  H1N1 UPDATE:  A LESSON IN 
GOVERNANCE IN DIWANIYAH PROVINCE 
 
¶1.  This is a PRT Diwaniyah reporting cable. 
 
¶2.  (SBU) SUMMARY:   Diwaniyah officials responded 
effectively to the H1N1 pandemic during Fall 2009, 
strengthening both their governance and their healthcare 
capacity. The initial response could be characterized as 
disjointed as Provincial officials and health officials were 
slow to identify and treat the early influenza cases.  At the 
same time, duplication of effort by Provincial officials, 
healthcare workers, and civil organizations emerged and 
hindered responses. As time progressed and numbers of cases 
increased, Diwaniyah health officials turned to prevention 
and treatment rather than dwelling on securing high-tech 
equipment to identify cases.  Efforts at educating the public 
improved as officials, including the Governor, went on the 
air waves to discuss what people should do.  Provincial 
officials, academic institutions and NGOs, with prodding from 
the PRT, strengthened their abilities to work toward a common 
goal by forming an H1N1 interagency working group and a 
Diwaniyah H1N1 Operations Center. The H1N1 healthcare 
experience had a beneficial political component as the public 
judged provincial officials and agencies as responsive to 
public needs, in contrast to the public,s usual view here 
that provincial officials, including the Governor, are 
unresponsive.   END SUMMARY. 
 
¶3.  (U)  Of the Iraq nation-wide total of 2,328 cases and 42 
deaths (among Iraqis, excluding multinational forces) 
reported by the World Health Organization (WHO) as of 19 
January 2010, 248 cases and five deaths occurred in Diwaniyah 
Province.  Diwaniyah, with about five percent of Iraq,s 
population, had about 11% of the cases and about 10% of the 
deaths.  Among multinational forces in Iraq, none of the 628 
confirmed H1N1 cases reported by WHO occurred in Diwaniyah. 
(FYI:  Iraq is a participating member of the WHO,s Eastern 
Mediterranean Region Office ) EMRO ) providing daily case 
counts to the WHO.) 
 
DETECTING AND PREVENTING H1N1 
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 
 
¶4.  (SBU) Initially, it appeared that Diwaniyah Province 
officials, health officials, and civil organizations devoted 
a large amount of time and effort in what appeared to be an 
orchestrated campaign to obtain high tech detection and 
identification equipment from the PRT.  Various agencies and 
NGOs besieged the PRT, arguing that the local public health 
laboratory urgently needed PCR (polymerase chain reaction) 
diagnostic equipment to process samples for H1N1.  The 
officials saw this as shortening the time to six to eight 
hours doing tests locally, rather than over a week, perhaps 
two weeks, if samples were sent to the Baghdad Central 
Laboratory.  Local officials here viewed the Baghdad public 
health bureaucracy as inefficient, slow and barely 
responsive.  When the PRT convinced officials that such 
testing would only identify mutations, and that treating 
symptoms was better, the pressure and requests for PCRs 
finally slackened. 
 
¶5.  (SBU)  Provincial officials used the media to advantage. 
Preventive measures among the public took hold following 
radio and TV reports and interviews with officials, including 
the Governor.  Hand washing was emphasized, though on a visit 
to primary schools in one town, the PRT saw only unusable 
hand washing facilities and no hand sanitizer, suggesting 
that despite the words, little support trickled down to the 
local level.  School and health officials expressed pride 
that they were spraying schoolrooms, desks, chairs and common 
areas with disinfectant. 
 
¶6.  (SBU)  The province,s Health and Education Departments 
Q6.  (SBU)  The province,s Health and Education Departments 
conducted special classes and  train-the-trainers, 
sessions, which instructed teachers on the basics of disease 
surveillance.  The trainees were expected to return to their 
schools and instruct all teachers in surveillance, detection 
and reporting.  The PRT heard reports that some schools 
received only five to ten forehead thermal strip thermometers 
for schools with several hundred students, indicating poor 
preparedness planning and unresponsive medical logistics 
support from the national and provincial authorities. 
 
¶7.  (SBU)  NGOs and government departments deluged the PRT 
with requests to provide bottles of hand sanitizer, face and 
surgical masks, thermometers, vaccines, and antivirals.  PRT 
Diwaniyah counseled officials that face and surgical masks 
were inappropriate for general, daily, and full-time wear as 
their effectiveness was limited, might cause undue panic 
among a less-educated public, and were better used in family 
or close-quarters situations if a family member was suspected 
of having H1N1 (or seasonal flu). The PRT also counseled that 
leaflets and posters showing people with face masks could add 
to public worry.  PRT Diwaniyah designed H1N1 leaflets, with 
 
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simple instructions in Arabic, based on the Centers for 
Disease Control (CDC) H1N1 website where simple instructions 
in Arabic were posted. 
 
INTERAGENCY COORDINATION 
- - - - - - - - - - - - - - - - -  - - - - - - 
 
¶8.  (SBU)  Initially, multiple agencies and NGOs were all 
involved and duplicating each other,s efforts, either 
because each saw a role, was trying to outdo the other, had 
genuine humanitarian concerns, or was acting out of 
self-interest could not be determined.  Those seeking our 
assistance all urged that we work only with them, not with 
others. 
 
¶9.  (SBU)  After several instances of this behavior, the PRT 
met with Director General (DG) of Health Abdulameer Leelo and 
Provincial Council Health Committee Chair Thamir Naji Skhale 
to strongly recommend a collaborative inter-agency approach 
to the H1N1 problem.  We underscored that just as an 
inter-agency response worked in the U.S., it would be a 
useful approach in Diwaniyah.  Those two competent officials 
organized the first of several inter-agency meetings and 
involved the Governor, several key DGs, academics from 
Qadissiyah University, the medical and nursing schools, the 
Diwaniyah Teaching Hospital, the Provincial Chief of Police, 
and several NGOs. The PRT was asked to participate and offer 
comments. 
 
¶10.  (SBU)  The first inter-agency meeting focused on 
understanding the H1N1 problem, hearing what each participant 
could provide and accomplish, and assigning responsibilities. 
 That meeting was chaired by Deputy Governor Faisal Salman 
and the PC Health Committee Chairman Thamir Naji.  Most 
attending saw it as a success.  Officials stressed that 
agencies should follow the established GOI and Provincial 
plans for responding to pandemics, using the experience of 
the earlier avian flu outbreak as guideposts.  This strategy 
worked. 
 
RESPONDING TO AND TREATING H1N1 IN DIWANIYAH PROVINCE 
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- - - - - - - - - - - - - - - - - - 
 
¶11.  (SBU)  The most important thing Diwaniyah officials did 
was focus on detecting H1N1 in the schools.  This area of a 
concentrated and vulnerable population was a primary place 
for spreading the disease by human contact and sneezing 
children. Diwaniyah officials responded with a focus on 
detecting and treating symptoms.  Limited closures of 
specific classrooms and schools occurred in the city most 
affected, Ash Shamiyah, in accordance with policy and school 
preparedness plans.  (Note:  Initially, Ash Shamiyah 
officials stated that many cases in their city were 
concentrated among persons who had attended the Hakim funeral 
at the Imam Ali Mosque in Najaf ) just across the Euphrates 
River.) 
 
COMMENT 
- - - - - - - - 
 
¶12.  (SBU)   Diwaniyah,s response to H1N1 offers a case 
study of mostly how to respond correctly and efficiently, and 
a little of how not to respond to a pandemic. The governance, 
preparedness and response lessons learned in Diwaniyah are 
not new:  have a plan, assign responsibilities, authorities 
and funding, coordinate effectively across agencies and NGOs, 
keep the public informed, teach and institute surveillance, 
treat symptoms, and, limit large gatherings (such as school 
populations).  Provincial authorities made some initial 
mistakes on both the health and governance fronts, but with 
coaching from the PRT at key junctions, they adapted their 
approaches.  As best we can determine, the concerted effort 
by political leaders to step out front and provide informed 
advice to the public muted complaints about an unresponsive 
provincial government ) whereas in other issue areas the 
Qprovincial government ) whereas in other issue areas the 
Diwaniyah Provincial government is seen as unresponsive. 
Another governance problem exists at the Ministry of Health 
level : though additional waves of H1N1 influenza are 
anticipated,  permission to begin vaccination of Iraqis has 
not been given due to liability waiver issues  with the drug 
(vaccine) manufacturers. 
HILL