BREAKING NEWS: Climate Change and Conflict Further Impact Spread of Cholera in Middle East

AMMAN, Jordan: As cholera grows rampant across drought-stricken countries, impacted further by climate change, war-torn regions such as Syria and Lebanon face additional challenges from the disease, leaving medical and volunteer teams scrambling to keep up.

If 2020 was the year of COVID, 2022 will be marked as the year of cholera, especially in Syria and Lebanon where climate change and conflict add an additional layer of economic insecurity, impacting how and where cholera spreads in the region.

According to medical professionals and climate experts, the resurgence of cholera is directly related to climate change and extreme climate events such as floods, droughts and cyclones. In the Middle East, droughts are especially common reducing access to clean water for many communities.

“We should not have outbreaks of cholera in our region in the 21st century, and definitely, people should not be dying from it. Access to clean water and appropriate sanitation facilities should be available to all and is a basic human right,” said Dr. Al Mandhari, WHO Regional Director for the Eastern Mediterranean, in a recent press statement.

Cholera, an acute diarrheal illness, is caused by an infection of the intestine from the Vibrio cholerae bacteria, according to the CDC. Though the infection can sometimes be mild, it can also be a severe and life-threatening illness that spreads quickly through contaminated water and food. Left untreated, those with cholera can become severely dehydrated, losing up to 25 liters of fluid per day, eventually leading to kidney failure, shock, coma and death within hours.

According to the WHO, 29 countries have reported cholera outbreaks since January 2022. Basic sanitation, hygiene and access to clean water are the easiest ways to prevent cholera, but in the Middle East, water levels are at a record low.

As of early November, an estimated 35,569 cases in Syria and 3,369 in Lebanon had been reported, according to UNICEF and the Ministry of Public Health in Lebanon. However the Middle East Institute reports that only a small fraction of cases have been accounted for accurately in various databases to track those inflicted.

In Lebanon, the prolonged economic crisis due to conflict, along with limited access to clean water and proper sanitation is exacerbating the risk of cholera among those in the country. According to the UN, the economic crisis has led to disrupted supply chain issues and a lack of affordable energy supply, which is weakening the ability of hospitals and healthcare facilities to treat those with cholera.

“Cholera is deadly, but it’s also preventable through vaccines and access to safe water and sanitation. It can be easily treated with timely oral rehydration or antibiotics for more severe cases,” said Dr. Abdinasir Abubakar of the WHO, in a statement issued last month. “The situation in Lebanon is fragile as the country already struggles to fight other crises—compounded by prolonged political and economic deterioration.”

In a recent press briefing, the WHO explained that a one-dose strategy for cholera vaccines is currently underway, which provides more people with short-term protection from cholera. Under normal circumstances, a standard two-dose vaccination is administered, but due to the resurgence of cholera around the world, medical teams are also dealing with a shortage of vaccines.

In Lebanon, a national campaign was launched in November to target hotspot areas, and so far the country has received 600,000 doses of oral cholera vaccine (OCV) from the International Coordination Group for OCV (ICG). The campaign is currently targeting all individuals over 12 months old, including those pregnant or nursing, and includes only a single OCV dose.

The United Nations High Commissioner for Refugees (UNHCR) has been working to convert its COVID-19 facilities into cholera response facilities in the Halba and Tripoli Governmental hospitals in Lebanon, according to Paula Barrachina, Head of Communications for UNHCR Lebanon.

According to Barrachina, UNHCR is leading the national vaccination campaign within Lebanon to ensure all populations in high-risk areas have access to the oral cholera vaccine. As of now, over 250 vaccination teams have been mobilized to raise awareness, engage the community, distribute educational materials, and are offering vaccine inoculations door-to-door.

UNHCR Lebanon is also working to cover the hospital admission costs for patients with more severe and life-threatening cases of cholera, whether they be Syrian refugees in Lebanon or local residents. According to Barrachina, the majority of those needing extra assistance live in inadequate shelters with limited access to clean water and basic services.

In Syria, Relief International (RI) has established oral rehydration posts in existing health facilities to treat those with less severe symptoms of cholera and install treatment centers in the areas most impacted by cholera.

It has been almost 12 years since the conflict in Syria began. Today almost 7 million people remain internally displaced, with more than 2 million living in refugee camps and temporary shelters, according to Relief International. The ongoing conflict has led to the damage of more than two-thirds of the country’s water treatment plants, one-third of its water towers and half of all pumping stations in the country, according to UNICEF.

“Cholera is a climate disease. But in Syria, it’s completely related to the water scarcity crisis,” said Jennifer Higgins, Syria Policy, Advocacy and Communications Coordinator for International Rescue Committee - Amman (IRC).

According to the IRC, only 50 percent of the water sanitation systems in Syria are functioning properly leaving the rest unsafe for consumption and daily use. As a result of climate change, there is also 40 percent less drinking water than a decade ago, based on recent findings from the IRC, according to Higgins.

The ongoing conflict in Syria means a deterioration of the country’s water infrastructure and economic decline, all of which are compounded by the effects of climate change and decreased access to water. As a result, many local communities, especially in northeast Syria have to rely on private trucking companies to distribute water.

Many of the private companies not only charge a high rate for the water but also take the water from the Euphrates River and then sell it directly to communities without treating the water first, which is a direct cause of the cholera outbreak in northeast Syria, according to Higgens.

In addition, medical and volunteer organizations now face yet another challenge as the continuation of the cross-border aid mechanism—which connects aid workers from Turkey into northwest Syria and provides humanitarian support to more than 4.4. million people in the area—will be voted on in January.

As Higgens explains, most NGOs in the region are preparing for the upcoming United Nations Security Council (UNSC) to vote down the extension—a direct result of Russia’s veto for the UN cross-border mandate, in response to its current conflict in Ukraine.

The ending of the cross-border aid mechanism will impact UN and various NGO aid efforts to both treat cholera in the region, as well as educate on and prevent the spreading of the disease.