How's This For a Script? Warning - It's a Tough Read.

Young men and women, conscripts, manning the ramparts at Festung (fortress) Europa as legions of desperate migrants approach seeking safety. As the steely commander shouts the order the young defenders reluctantly open fire on the horde knowing they have no other choice - the migrants carry among them a highly infectious strain of cholera.

Sounds like utter dystopia, doesn't it? Well, relax, there is no Festung Europa yet and no infectious horde is marching on Europe yet, but... an outbreak of cholera is now sweeping Iran and experts warn that the impacts of war, climate change and this year's powerful El Nino, create ideal conditions for it and other infectious diseases associated with extreme, mass suffering to spread rapidly and far. From Foreign Policy:

Although the scope of the current outbreak is moderate so far, with fewer than 11,000 illnesses confirmed, it has already spread across an expanse far larger than the 1997 epidemic, taken a greater toll in the Middle East, and still threatens to travel with refugee populations to a even wider geographic area. Moreover, there is ample reason to believe the official tally is grossly undercounted.

At least 2,000 people in Iraq have contracted cholera since mid-September, and Vibriobacteria have contaminated the Euphrates River, possibly the Tigris, as well. The epidemic is thriving amid a perfect storm of failed-state capacity in Baghdad, even worse “state” failures in Anbar province and other regions controlled by the self-declared Islamic State, encampments of millions of Syrian refugees and other homeless displaced people, and harsh downpours slamming parts of Africa and the Middle East thanks to one of the worstPacific El Niño climate events in recorded history.

On Oct. 26, the Syrian American Medical Society, a nongovernmental organization providing aid inside the war-torn country, said it was “very likely” a child living outside of Aleppo died from cholera, possibly due to a widespread contagion in the area. Since January, UNICEF has reported more than 105,000 cases of acute diarrheal disease in Syrian children inside the country, though no laboratories there are available to determine the infectious cause of most of the illnesses. Some, perhaps many, could be due to cholera.

And there’s reason to fear the epidemic could spread further afield, too. Turkish officials have assured their people that no cases of cholera have been confirmed among Syrian refugees living in that country. In Lebanon, where millions of refugees reside and government chaos is responsible for a nearly four-month cessation of garbage collection,doctors warn that conditions are ripe for an explosive spread of the disease. On Oct. 2,Greek health officials placed a Dutch tourist in treatment in Athens after the individual developed acute diarrhea on the island of Kos, a landing point for thousands of Syrian refugees. Although cholera was feared, it was never confirmed. Nevertheless, there isgrowing concern in Europe that with the refugees will come the Vibrio cholerae.

But this year’s cholera crisis already goes far beyond the borders of Iraq or even the lengths of the Euphrates and Tigris Rivers.

...Cholera bacteria can travel from one place to another via two ways: through water systems or through infected people. When contaminated human waste is dumped into a river, cholera is carried downstream. Food that is irrigated with contaminated water, and then shipped to another region or country, may carry the disease to new areas if the produce is eaten raw and unwashed. In 1979, I was in a cholera epidemic in Tanzania that spread far and wide on cashew nuts that were packaged by the unwashed hands of people who were infected. International travelers may unknowingly carry cholera and pass it with their waste, spreading Vibrio bacteria from one country to another.

The El-Nino Conveyor.

Climate and weather play a key role. In the 1997-1998 epidemic, the disease’s spread was hastened by torrential downpours and mudslides from a periodic climate swing that occurs when transpacific winds change, for reasons unknown, pushing ocean currents out of their normal patterns. This weather pattern is called El Niño.

...By mid-October, the El Niño drama was clearly unfolding. The weather system was blamed for holding toxic air in a stagnant dome over Singapore, sending killer typhoons across the Philippines and Southeast Asia, causing a drought in usually drenched parts of West Africa, and showering parts of East Africa with sporadic rains of such force that mudslides and floods resulted. Changes in the hunting patterns of King Penguins have been blamed on El Niño, along with an overall East African drought so dire that the United Nations warns thatsevere food insecurity may loom. And on Oct. 25, an atmospheric scientist from Colorado State University credited El Niño with feeding Hurricane Patricia, which had record-breaking winds as high as 200 miles per hour.

El Niño’s impact on the Middle East, coupled with climate change, has been two-fold: First, temperatures from southern Iraq all the way into Turkey reached record highs this summer, topping more than 122 degrees Fahrenheit. The entire region is now locked in a severe drought, worse than the one some have credited with spawning the Syrian uprisings of 2011 that led to the Assad regime’s crackdown and current civil war.

Climate change, meanwhile, has hit the South Asia/Middle East region with severe drought causing some major rivers such as the Tigris and Euphrates to be dammed by the countries they pass through. This slows or halts the flow of the rivers increasing the growth of cholera bacteria. Getting ISIS to open the Ramadi dam they control will not be easy. Meanwhile the river water and produce grown with that water become increasingly dangerous.

The Good News

So far the cholera that has spread from the Middle East into Africa is just one strain, Inaba, that is relatively easily treated and for which an effective and inexpensive vaccine is available but there are inadequate stocks of it. The World Health Organization (WHO) has a million doses but it intends to use half of that to vaccinate 250,000 displaced people in government-controlled regions of Iraq.

The Future

More than 10 million Iraqis, Syrians, and Kurds are now living in squalor, displaced within their own countries or in refugee settlements in the region. Among refugees over the last four years have been outbreaks of measles (1,000 cases currently inside Iraq), typhoid fever, hepatitis A, Crimean-Congo hemorrhagic fever, and even polio, which was once all but eradicated from the Middle East. Conditions are ripe for a cholera epidemic that might take hold for a very long time.

Epidemiologists have been warning us for years that mass-migrations of the sort foreseen for much of this century will trigger and spread highly lethal epidemics. We live in a world in which more than one in three has no access to basic sanitation. In the Third World more people have cell phones than the number with toilets. Putting these people to flight from any cause - war, famine, water shortages, sea level rise, whatever - magnifies the risk of rapidly spreading, lethal epidemics.

This cholera epidemic is the world's wake-up call. Will we even hear it?

It is  

Homecoming Without A Home

Encouraged by the reported success of the US Army's "surge" in Baghdad and running out of money in exile, large numbers of Iraqi refugees are heading home. Unfortunately when they get back they often find no home to return to. The top map shows Baghdad in April 2006. The bottom is the city in November, 2007. The blue areas are predominantly Sunni neighbourhoods. The yellow are mixed Shia, Sunni, Christian neighbourhoods. The red are Shia dominated zones. The biggest demographic change is the enormous expansion of Shiite occupation of Baghdad and the commensurate decline in the city's mixed neighbourhoods.

The city has been pretty thoroughly ethnically cleansed. Houses vacated by those who fled for their lives were quickly re-occupied or looted, even destroyed. If you're a Sunni returning to what has, during your absence, been transformed in Shia territory, what do you think your chances are of telling the Shiite in your home to get out? From the Washington Post:

"It's very easy to say, 'Come home,' " said Guy Siri, the U.N. deputy humanitarian coordinator in Iraq. "But come home where, and how? It's much more complex than that. You have to look at the whole environment, how the community will accept them, whether it's economically viable. There's a whole lot of thinking on the government side to be done."

U.N. refugee officials immediately advised against the move, saying any new arrivals risked homelessness, unemployment and deprivation in a place still struggling to take care of the people already here. For the military, the prospect of refugees returning to reclaim houses long since occupied by others, particularly in Baghdad, threatened to destroy fragile security improvements.

"It's a problem that everybody can grasp," said a senior U.S. diplomat here. "You move back to the house that you left and find that somebody else has moved into the house, maybe because they've been displaced from someplace else. And it's even more difficult than that, because in many cases the local militias . . . have seized control and threw out anybody in that neighborhood they didn't like."

At least one of every six Iraqis -- about 4.5 million people -- has left home, some for other parts of Iraq, others for neighboring nations.