Blood, ticks, and broken systems: The resurgence of CCHF in Iraq

Shafaq News/ In the spring of 2025, Iraq is once again facing a deadly virus it never fully eliminated. Crimean-Congo Haemorrhagic Fever (CCHF) has re-emerged, resulting in fatalities in Kirkuk and reaching provinces previously considered low-risk. The deaths of a young doctor and a village butcher have unsettled communities already under pressure, as rising tick populations and unregulated livestock movement contribute to the virus’s continued spread.

Each new case reflects broader challenges, a strained healthcare system, under-resourced rural areas, and a country navigating the combined impact of climate shifts and long-term underinvestment.

Understanding CCHF

Crimean-Congo Haemorrhagic Fever (CCHF) is a deadly but often overlooked viral disease caused by a Nairovirus. Transmitted primarily through Hyalomma ticks, it can also spread via contact with the blood or bodily fluids of infected animals, and in some cases, from human to human, particularly in healthcare settings.

The disease typically begins with nonspecific symptoms such as fever, dizziness, and muscle pain, but can rapidly progress to internal bleeding, liver failure, and, in many cases, death. With a mortality rate ranging from 10% to 40%, rapid diagnosis and isolation are essential to containing outbreaks and saving lives.

CCHF is endemic in more than 30 countries, spanning regions of the Middle East, Central Asia, and Africa. Yet Iraq has emerged as one of the hardest-hit. The World Health Organization (WHO) classifies it among the most severely affected countries in the Eastern Mediterranean. A 2024 bulletin from the International Society for Infectious Diseases highlighted the dire situation, warning that rural Iraqis face some of the highest exposure risks in the region.

Escalating Numbers

Iraq has witnessed a steady and deeply troubling rise in CCHF cases over the past five years. Between 2020 and early 2022, the country recorded over 300 confirmed infections, marking its most severe outbreak in decades.

In 2020, Iraq registered 63 confirmed cases. That figure more than doubled in 2021. By May 2022, the country had already documented 212 cases, a sixfold year-on-year increase. The surge was concentrated in the south: Dhi Qar reported 90 cases, Mayan 72, and al-Muthanna 61. Together, these three provinces accounted for more than 60% of all infections that year.

But the trend did not stop there. In 2023, Iraq recorded 511 confirmed cases, an unprecedented annual total, with a fatality rate of 14%, resulting in approximately 72 deaths.

By spring 2025, the virus had crept into new territory. Kirkuk registered 19 confirmed infections and two fatalities. In Nineveh and Diyala, veterinary authorities reported rising tick populations around farms, signaling a worrying northward shift in the disease’s geographical footprint. “We are witnessing vector migration northwards,” explained Shafaq News, Dr. Samira al-Obeidi of Baghdad University.

“Climate and unregulated trade are redrawing Iraq’s epidemiological map.”

The human toll has grown more personal. In Kirkuk, the virus claimed the life of Dr. Adnan Rauf, a 34-year-old physician at Azadi Teaching Hospital. Known for his dedication, he continued treating patients even after protective equipment ran out. “He wouldn't stop treating people, even when he knew the risks,” recalled a colleague.

The second fatality in Kirkuk was 42-year-old Khalid Mahmoud, a butcher from Laylan district. He had handled sheep bought from an unregulated vendor, an all-too-common practice in underserved areas. “He had no choice... We couldn't afford to say no,” his brother shared from quarantine. Three other villagers later developed similar symptoms.

While the southern provinces, particularly Dhi Qar, Maysan, and al-Muthanna, have historically borne the brunt of CCHF outbreaks, the recent fatalities in Kirkuk have sparked growing alarm.

Northern regions, with their weaker surveillance systems and limited public health outreach, may be ill-prepared to face a full-scale spread.

A Tangle of Risk Factors

Multiple interconnected factors have heightened Iraq’s vulnerability to the CCHF.

Since 1970, average temperatures in the country have risen by 1.6°C, lengthening the active season of Hyalomma ticks, the primary vectors of the virus. This climate shift, compounded by porous borders and traditional livestock practices, has created a perfect storm for transmission.

Unregulated animal movement across Iraq’s borders with Iran and Syria plays a critical role. Livestock are frequently smuggled into the country, bypassing health inspections entirely. “Animals are being smuggled in without any health inspection,” explained veterinary epidemiologist Dr. Latif al-Khalidi to Shafaq News. Once mixed with local herds, these animals can introduce the virus deep into Iraq’s interior.

Inside rural communities, protective measures are alarmingly scarce. Gloves are rarely used, and awareness of the disease remains limited. A 2024 Ministry of Agriculture survey revealed that fewer than 22% of herders in high-risk zones had received any training on CCHF prevention, leaving both livestock handlers and their communities dangerously exposed.

The risks intensify during Eid al-Adha (the second of the two main festivals in Islam alongside Eid al-Fitr,) when the transport and ritual slaughter of animals dramatically increase. In 2023 alone, more than 2.4 million animals were sacrificed, often in unsanitary open-air markets with no veterinary oversight. “In rural towns, there are often no municipal slaughterhouses,” noted Basim Karim, a public health officer in al-Diwaniyah. “Animals are slaughtered on the street, sometimes by people who’ve never even heard of CCHF.”

While Iraqi regulations prohibit unsupervised slaughter, enforcement is weak. A 2023 review by the Iraqi Red Crescent found that only 28% of rural towns implemented hygiene measures during Eid. The report also pointed to a combination of insufficient personnel and local resistance to outside intervention as the main obstacles.

Progress Amid Persistent Gaps

Since 2022, Iraqi authorities have stepped up efforts to contain the spread of Crimean-Congo Haemorrhagic Fever (CCHF). Joint campaigns by the Ministries of Health and Agriculture rolled out large-scale acaricide spraying and livestock dipping programs, particularly in high-risk provinces. By 2024, over 120,000 animals were treated across Saladin and al-Wasit alone, marking one of the most extensive veterinary mobilizations the country has undertaken in years.

Preventive health approaches were also broadened. In Kirkuk, six unauthorized slaughterhouses were shut down in early 2025. Medical teams began distributing gloves, masks, and disinfectants to butchers and farmers, targeting those on the front lines of exposure. Public awareness campaigns are also adapting to rural realities, utilizing local radio and TikTok to relay information in dialects specific to remote communities.

These measures represent significant progress, but the impact has been uneven. Tick infestations remain widespread in several provinces, and human transmission continues to rise, particularly in regions with weak infrastructure. “The problem isn’t effort, it’s reach,” explained Dr. Haidar Al-Kinani, Director of the Communicable Diseases Control Center in Baghdad. “Many of our campaigns don’t penetrate remote areas. We need mobile clinics, local mediators, and most critically, a consistent funding stream.”

Indeed, funding has emerged as a persistent bottleneck. Despite multiple fact-finding missions by the World Health Organization (WHO) and the Food and Agriculture Organization (FAO), Iraq has struggled to secure long-term international backing. The UN Central Emergency Response Fund (CERF) declined Iraq’s 2023 appeal, citing poor regional coordination and the absence of a cohesive national strategy.

These limitations are especially evident in rural health infrastructure. Most clinics outside major cities lack isolation units, and many hospitals remain short on personal protective equipment. The country has only two biosafety level 3 laboratories capable of diagnosing hemorrhagic fevers. “We’re stretched thin,” cautioned Dr. Luma Abdel-Qader, a virologist at the Central Public Health Laboratory in Baghdad. “Between delays in sample transport and limited testing capacity, we’re constantly playing catch-up.”

Compared to Iraq’s fragmented response, neighboring countries have implemented more structured approaches. Iran has deployed over 500 mobile veterinary teams in endemic zones. Jordan requires health certifications before animal slaughter. Saudi Arabia has invested $6 million in tick-related research and enforces strict livestock quarantine protocols.

Despite its vulnerability, Iraq remains excluded from regional platforms like the WHO Eastern Mediterranean Zoonoses initiative. A 2024 WHO report emphasized that the country “lacks a centralized zoonotic disease strategy, leaving provincial authorities to respond in isolation.”

Non-governmental organizations, which might have helped fill the gaps, have also scaled back. “It’s a difficult working environment,” confessed to Shafaq News, Noura Yassin, a program coordinator at MedGlobal. “The risks are high, and local systems aren’t always ready for partnership.”

While Iraqi officials deserve credit for launching serious initiatives, the results remain constrained by deeper structural issues. According to Medical Intern Ibrahim Saleh, the campaigns have delivered progress, but not containment. “Without sustained investment, a centralized disease control strategy, and regional collaboration, the fight against CCHF risks remaining reactive and insufficient.”