NASIRIYAH - Spraying a cow with pesticides, health workers target blood-sucking ticks at the heart of Iraq's worst detected outbreak of a fever that causes people to bleed to death.

The sight of the health workers, dressed in full protective kit, is one that has become common in the Iraqi countryside, as the Crimean-Congo haemorrhagic fever spreads, jumping from animals to humans.

This year Iraq has recorded 19 deaths among 111 CCHF cases in humans, according to the Word Health Organization.

The virus has no vaccine and onset can be swift, causing severe bleeding both internally and externally and especially from the nose. It causes death in as many as two-fifths of cases, according to medics.

"The number of cases recorded is unprecedented," said Haidar Hantouche, a health official in Dhi Qar province.

A poor farming region in southern Iraq, the province accounts for nearly half of Iraq's cases.

In previous years, cases could be counted "on the fingers of one hand", he added.

Transmitted by ticks, hosts of the virus include both wild and farmed animals such as buffalo, cattle, goats and sheep, all of which are common in Dhi Qar.

Tick bites

In the village of Al-Bujari, a team disinfects animals in a stable next to a house where a woman was infected. Wearing masks, goggles and overalls, the workers spray a cow and her two calves with pesticides.

A worker displays ticks that have fallen from the cow and been gathered into a container.

"Animals become infected by the bite of infected ticks," according to the World Health Organization.

"The CCHF virus is transmitted to people either by tick bites or through contact with infected animal blood or tissues during and immediately after slaughter," it adds.

The surge of cases this year has shocked officials, since numbers far exceed recorded cases in the 43 years since the virus was first documented in Iraq in 1979.

In his province, only 16 cases resulting in seven deaths had been recorded in 2021, Hantouche said. But this year Dhi Qar has recorded 43 cases, including eight deaths.

The numbers are still tiny compared with the Covid-19 pandemic -- where Iraq has registered over 25,200 deaths and 2.3 million recorded cases, according to WHO figures -- but health workers are worried. Endemic in Africa, Asia, the Middle East and the Balkans, CCHF's fatality rate is between 10 and 40 percent, the WHO says.

The WHO's representative in Iraq, Ahmed Zouiten, said there were several "hypotheses" for the country's outbreak.