Mother holds her child diagnosed with cholera in a hospital in Deir Al Zour, Syria. Image Credit: AP

BEIRUT: A recent outbreak of cholera in Syria has hit nearly all its provinces and spread to neighbouring Lebanon, triggering alarms in both countries, where economic crises have exacerbated deteriorating health conditions.

Syria’s cholera outbreak was declared on September 10, and, by the end of the month, surveillance data showed more than 10,000 suspected cases across the country, Unicef said this week.

By Friday, Lebanon had recorded two cholera cases in Akkar province, the northernmost part of the country bordering Syria, according to Public Health Minister Firass Abiad. No cholera vaccines are available in the country at this time, Abiad told The Washington Post.

Both Syria and Lebanon are mired in economic meltdowns that have wreaked havoc on every facet of life, including health conditions and water sanitation.

Unicef, the United Nations children’s agency, said that the cholera cases have been concentrated in northern Syria but that the waterborne disease is “rapidly spreading” across other governorates.

Syria, especially its northern areas, has a growing, severe water crisis due to the large-scale damage inflicted on water and sanitation infrastructure over the course of an 11-year war that has ravaged much of the country. The current economic crisis, persistent fighting, displacement of people and prolonged drought has left 47 per cent of the population reliant on “alternative and often unsafe water sources,” said Unicef.

“At least 70 per cent of the discharged sewage is untreated which presents major risks for disease outbreaks, including cholera,” the agency reported, estimating that the conflict had damaged two thirds of the country’s water treatment plants, half its pumping stations, and one third of water towers.

Syrian children get vaccinated at a health centre in Al Bab, on the border with Turkey, in Syria's northern Aleppo province. Image Credit: AFP

Syria’s Ministry of Health said on Tuesday it had confirmed 594 cases via rapid tests, mainly in Aleppo province, and recorded 39 deaths from the disease.

The reported number of deaths, carried by government state media, is significant. By contrast, Syria was slow to admit the spread of COVID-19 after the pandemic hit, prompting a rare outcry in 2020 from inside government-held parts of the country where physicians, at risk to their own lives, publicly disputed official numbers.

Awareness campaigns

In light of the recent outbreak, the Ministry of Health launched awareness campaigns in schools and called on residents to wash their hands; drink water from “safe sources” where available and otherwise boil water before usage; wash fruits and vegetables well and consult physicians early about any suspected case.

But in much of Syria, these preventive measures are not possible. Water accessibility became a significant issue this summer across the country, meaning residents have no guarantees of safe water sources. The health care system has been decimated by the war and lack of funds and medicine. Western sanctions have made the situation worse.

Unicef also drew attention to the spread of cholera in camps hosting internally displaced peoples, or IDPs, saying the situation there is “particularly critical.” There are more than 6 million IDPs living in Syria, according to United Nations estimates.

Beyond finding stopgap measures to halt the spread of this disease, the agency said a restoration of water and sanitation systems is necessary to prevent repeated outbreaks in the future.

But the prospects for restoration are bleak: The government has not been able, or willing, to carry out such reconstruction projects. International donors suffer from “a certain fatigue” when it comes to Syria, said the European Union’s foreign policy chief, Joseph Borrell, who reminded an international donor conference in May that, “Now, there is Ukraine on the headlines, but do not give up on Syria.”

Lebanon's Health Minister Firas Abiad speaks during a press conference on the first case of cholera, in Beirut, on October 7, 2022. Image Credit: AP

Lebanon’s fate is in many ways tied to Syria. Their economies are intertwined; shortages of goods in Lebanon reverberate across Syria, and vice versa. Wheat, oil, medicine and foodstuffs are frequently smuggled across the border both ways, more typically from Lebanon into Syria.

The World Health Organisation, or WHO, is working with the Lebanese government to provide vaccines, said Abiad, the health minister. Alissar Rady, WHO’s team lead in Lebanon, said it is working alongside the ministry, Unicef and other partners to put in place a plan that focuses on surveillance and early detection, and to prep hospitals to receive cases that require advanced care. Community engagement is also key, she added. “And there is a lot of work with the national authorities to see how we can enhance water quality monitoring and periodical water testing.”

Lebanon has long had water sanitation issues. Running water - now just a dream in the most economically-hit parts of the country - has not been drinkable for decades. The coastline, especially around the capital Beirut, contains high levels of contamination and fecal matter.

And the health care system has been struggling to stay afloat as the economy collapses and hordes of medical professionals leave. The WHO estimated last year that nearly 40 per cent of Lebanon’s doctors and 30 per cent of nurses had departed since 2019.

The lack of electricity has also worsened health conditions in the country. Last year, an outbreak of E. coli added to the woes of overcrowded hospitals. Food poisoning has been on the rise the past two summers, in part a result of the absence of constant electricity and food refrigeration.