Cholera outbreak in northwest Syria spirals into catastrophe

Since the declaration of the cholera outbreak, the number of cases in Syria continues to surge without respite.

Daily, official statistics demonstrate a disconcerting spike, prompting recent warnings from United Nations agencies about an impending "catastrophe" specifically targeting northwest Syria.

Fears are growing that this scenario may parallel the crisis in Yemen, characterised by a state of "settling."

"The United Nations Office for the Coordination of Humanitarian Affairs reported 105 cholera-related deaths between August 25, 2022, and September 2, 2023, alongside 189,374 suspected cases recorded across all fourteen Syrian governorates"

Cholera, an acute infectious disease causing severe diarrhoea, primarily spreads through the consumption of contaminated food or water.

It remains a persistent global public health threat, signifying stark inequalities and social underdevelopment, as emphasised by the World Health Organization.

The United Nations Office for the Coordination of Humanitarian Affairs reported 105 cholera-related deaths between August 25, 2022, and September 2, 2023, alongside 189,374 suspected cases recorded across all fourteen Syrian governorates.

A subsequent report released on September 20, 2023, documented 16,029 new suspected cases between August 2 and September 2, 2023, with no additional reported fatalities.

The report underscores that the governorates most severely impacted thus far are Idlib, accounting for 75,959 suspected cases at a rate of 40.1%, Aleppo with 63,255 suspected cases at a rate of 33.4%, Raqqa with 23,032 suspected cases at a rate of 12.2%, and Deir ez Zor with 20,797 suspected cases at a rate of 11%.

In an exclusive interview with Dr. Dureid Al-Rahma, Head of Primary Healthcare in Idlib, The New Arab unveiled how the alarming surge in cholera cases has forced many Syrians to the brink.

Dr. Dureid Al-Rahma said over the past week, the Special Response Organization for Epidemics reported approximately 3,934 new suspected cases of cholera.

Among these, 11 cases were positively confirmed following sample testing, and one fatality was recorded. This has elevated the mortality count from 25 to 26, with the latest incident transpiring in Darat Azza, Aleppo, where an 85-year-old elderly individual succumbed to the disease.

These statistics have revealed a discernible resurgence in cholera instances across Syria since the seismic event that began in the sixth month and continues to the present day.

Weekly records now consistently surpass the pre-earthquake period, with approximately 70% of these cases concentrated in the Idlib region, and the remaining 30% disseminated across Aleppo. These infections are particularly pervasive in major urban centres and densely populated camp areas.

Dr. Dureid underscored a multitude of contributing factors to this resurgence. Firstly, the establishment of makeshift camps for internally displaced persons has played a pivotal role. These encampments are characterised by woefully inadequate sanitation facilities and a glaring absence of basic hygiene standards. Secondly, the chronic scarcity of potable water and the escalating pollution resulting from sewage network complications have significantly amplified the contagion's spread.

Moreover, demographic shifts and suboptimal living conditions have also exacerbated the resurgence. Dr. Dureid noted that a pronounced uptick in cholera cases was observed on September 21, 2023. Since that date, cases have consistently disseminated and escalated

As explained by Dr. Dureid, cholera is an acute infection resulting in profuse diarrhoea, leading to rapid and life-threatening dehydration within a mere 72-hour window in the absence of timely intervention. Swift treatment is imperative to mitigate the dire ramifications of the disease.

The battle against cholera transcends the realm of healthcare alone. There exists a substantial deficit across various sectors, encompassing water, housing, and sewage infrastructure, all contributing to the ongoing epidemic.

Dr. Dureid elaborated that at the outset of the outbreak, eight cholera treatment centres were commissioned in Idlib.

These centres initially proved adequate, given the relatively low caseload. Nevertheless, with the advent of the first vaccine batch, approximately 1.7 million doses were administered, with a pronounced emphasis on high-risk camp areas characterised by deficient infrastructure. This strategic initiative has significantly curbed the rate of infection.

Dr. Dureid underscored that the first vaccine batch was received early in 2023. Subsequently, three months later, a second batch of 1.2 million doses was procured. These vaccines were extensively disseminated throughout high-risk regions, effectively transforming cholera cases into milder, more manageable infections. The vaccine serves to alleviate symptoms and mitigate the disease's severity.

"Meanwhile, the United Nations has reported that cholera has become widespread across most of Syria," the doctor explained to The New Arab. "They highlighted the difficulties in accurately determining the number of cases due to limited testing capabilities and a severely compromised healthcare system, with estimates indicating a much higher count than officially reported."

The Syrian Civil Defense issued a statement pointing out the increased number of cholera-related fatalities and infections in northwestern Syria. According to the statement, the death toll from cholera has reached 25 cases, with 1,111 confirmed positive cases since the outbreak began.

The statement further emphasised that their teams are consistently conducting awareness campaigns to promote preventive measures against waterborne diseases, proper waste disposal, and environmental preservation. They are actively working to expand water services, enhance sanitation, manage waste, and facilitate landfill operations.

"With Syria's protracted conflict now spanning over eleven years, the nation is confronted with a severe water crisis, owing to the decimation of water and sanitation infrastructure. This dire situation has compelled many citizens to turn to unsafe sources of drinking water, particularly the Euphrates River"

Omar Abdul Razzaq, a 42-year-old resident of a camp in northwestern Syria, finds himself ill-equipped to confront the looming threat of cholera, much like the entirety of refugees dwelling in these unofficial settlements.

He voices profound apprehension about the disease's swift encroachment within their already austere living conditions, particularly after he became privy to an alarming surge in mortality rates.

Abdul Razzaq reveals a personal tragedy; his nephew, residing in a nearby camp, fell victim to the disease, currently in a critical state with no signs of recovery.

His gravest concern centres around his five children, as he despairs their vulnerability to infection, given the challenging circumstances they grapple with daily. Underlining their vulnerability, Abdul Razzaq points out the apparent absence of guidance and preventive strategies imparted to him by organisations operating within northwestern Syria.

As for cholera prevention measures, Abdul Razzaq highlights the burgeoning presence of disease-transmitting insects, predominantly flies, within the campgrounds. Ironically, the camp management has yet to initiate insecticide-spraying efforts to combat the infestation.

In sum, despite the heightened risk, he remains uninformed about proper disease management, leaving him and others in a state of uncertainty, and underscoring the pressing need for international attention and assistance in these dire circumstances."

Médecins Sans Frontières (Doctors Without Borders) has previously sounded the alarm about the looming cholera threat in northwestern and northeastern regions of Syria. Contaminated water sources, a severe shortage of humanitarian response, and various other factors collectively pose a grave risk of the disease spreading across the entirety of Syria. Troublingly, access to clean and adequate water remains a persistent issue for the local population."

In an exclusive interview with Omar Al-Omar, a civil activist residing in the city of Qabasin, located in northern Syria's Bab region, he shared the harrowing account of a child's tragic demise last Monday.

The cause of death was none other than cholera, and this heart-wrenching incident has sent shockwaves through the local community, evoking deep-seated fear and concern, particularly for the welfare of their children.

Omar went on to reveal that the deceased child was a mere one year of age, highlighting a disconcerting pattern in which the disease is taking its toll on the younger population, further intensifying the worries of parents and guardians.

Previously, Médecins Sans Frontières (Doctors Without Borders) announced that regions in northwestern and northeastern Syria are facing a looming threat of a cholera epidemic.

Contaminated water sources, a dire shortage of humanitarian response, and several other compounding factors heighten the risk of a cholera outbreak throughout Syria. It remains evident that access to an adequate supply of clean drinking water for the local population continues to be a pressing concern.

With Syria's protracted conflict now spanning over eleven years, the nation is confronted with a severe water crisis, owing to the decimation of water and sanitation infrastructure. This dire situation has compelled many citizens to turn to unsafe sources of drinking water, particularly the Euphrates River.

Inhabitants of northern Syria have grappled with a lack of essential medical services since the outset of the crisis.

Government forces have relentlessly targeted medical facilities in regions beyond their control, prompting an exodus of numerous healthcare professionals seeking refuge abroad. The healthcare sector, left in disarray, appears incapable of mounting an effective local response to the cholera outbreak, a situation exacerbated by these circumstances.

Mouneb Taim is a producer and journalist based in the Middle East from Damascus, Syria. He was awarded TPOTY's Photographer of the Year and ICFJ's Best Young Male Journalist in 2020.

Follow him on Twitter: @mouneb_taim