The Iraqi Kurdistan region imposed strong control measures against COVID-19 from the early stages of the outbreak. These measures included cross-border movement limitation with health screening that was followed by complete border closure, banning flights and COVID-19 testing for all people returning to the region from abroad. Furthermore, other measures were implemented, including the closure of schools, universities, public places, suspension of government offices, and quarantining anyone who had been in contact with infected people in the previous 14 days. Finally, a curfew was imposed in all governorates.

The number of COVID-19 related deaths and serious cases remained small in the region compared to some other governorates in Iraq and neighbouring countries. As on 22 May 2020, 461 cases were diagnosed, including five deaths. The majority of diagnosed cases were either asymptomatic or had mild symptoms. Consequently, many individuals did not seek medical care. Many individuals who tested positive for COVID-19 were returning expats who were summarily tested and placed in routine quarantine. The five cases that had died had not been admitted to hospital, and were only diagnosed with COVID-19 post mortem. During the outbreak, no patients needed intensive care or ventilator support.

Ironically, the Kurdistan government’s success in curbing COVID-19 prevalence resulted in negative public and social media scrutiny. For instance, the social media claimed that reported cases having COVID-19 were fake. Some people even claimed that the regional ministry of health has falsely announced the presence of these cases to get more funds from the Iraqi central government’s COVID-19 response budget. Besides, on-going political tension in the region and lack of public trust in the government prevented the former from taking COVID-19 as a serious threat to human life.

As a result, many public members have shown little concern in contracting COVID-19. This has contributed in reluctance in maintaining protective behaviours after the ending of the lockdown period. This situation was exacerbated by some government members easing COVID-19 protective measures during meetings and public events.

Furthermore, social distancing has been difficult to apply during the COVID-19 pandemic due to social traditions (i.e. handshaking, hugging, kissing, and organizing and attending funerals), which emphasise close physical proximity. These practices have been difficult to abandon and were responsible for super spreading the infection in this region.

The public’s apparent indifference to implement protective measures, as well as the government’s failure to apply home quarantining for suspected cases, has resulted in a lack of compliance.

The COVID-19 pandemic remains a critical challenge in countries neighbouring Iraq. There is a possibility that current easing of public lockdowns and quarantining in Kurdistan Iraq may witness the resurgence of COVID-19 cases.

It is essential to raise the public awareness regarding COVID-19, and the details and justifications of the governments’ preventive measures and response should be explained to the public in a culturally sensitive manner. Regaining the trust in the government is vital for public welfare and in maintaining protective behaviours which are necessary to control and manage COVID-19.

About the authors:

Nazar P Shabila, MSc, PhD is Assistant Professor of Public Health at the Department of Community Medicine, Hawler Medical University, Erbil, Kurdistan Region of Iraq. His research interests include epidemiology of communicable diseases, health services research and conflict and health. Twitter: @NShabila

Arthur Saniotis, PhD is an Adjunct Senior Fellow in the Adelaide Medical School, at the University of Adelaide. He also has affiliations with the Ludwik Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, and the Institute of Evolutionary Medicine at the University of Zurich. His research interests include evolutionary medicine, anatomical variations, public health and bioethics.

 Competing Interests:           

No competing interests to declare.