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.

FEATURE: The Forgotten & Unprotected - Rainbow Refugees

Most refugees are fleeing war or violence. But for rainbow refugees like Sulah, identifying as LGBTQ+ is reason enough to flee violence and persecution back home.

Sulah Mawejji, a refugee from Uganda, went to live with relatives after his mother and later father passed away—both from HIV. When those relatives learned he was gay, Sulah was bullied and told to leave at just 16 years old.

A friend helped Sulah flee to Nairobi where he found safety and support through Safe Place International. He smiles now and shares how Safe Place helped him reclaim his life. Now he serves as County Director for Kenya for the Dream Academy program at the organization.

“Being responsible for others has given me a new definition. I have been told I am nothing…These people love you with a lot of love. It’s a place where they let you be free. Every child deserves that,” Sulah says.

His experience is common for refugees who identify as LGBTQ+. Many come from countries, like Uganda, that punish or abuse individuals who identify as such, or migrate to countries where conditions are similar—receiving little support for both the emotional trauma they have endured or to safely transition into their new home. The war in Ukraine is shedding some light on the additional battle rainbow refugees face, regardless of country of origin or refugee status.

Uganda and other African nations have a history of LGBTQ+ discrimination, causing many to flee regardless of war. But Eastern Europe also shares a past of discrimination.

Hungary, for instance, passed a law in 2020 requiring all identification documents to state an individual’s gender at birth. This makes it almost impossible for those who identify as transgender to legally change their identity. The country, which is actively accepting refugees from Ukraine right now, adds additional elements of risk for those fleeing the war who identify as LGBTQ+.

There are 70 UN member states that criminalize consensual same-sex acts, according to the UNHCR, and 11 states where the death penalty is a potential reality for those who identify as LGBTQ+.

Lack of reporting and risk of persecution make it difficult to know how many refugees around the world identify as LGBTQ+. Doing so can lead to continued violence, rape and discrimination.

In Kenya though, Sulah was arrested. Sitting in a room of bright orange and yellow walls, he shares via Zoom how grateful he is for Nairobi, despite challenges as a gay man. Through the training and support services he received with Safe Place, he knew it was in his right to refuse anal testing if arrested—a common practice used as a dehumanizing tactic by authorities to provide evidence of homosexual activity. Kenyan courts made the practice illegal in just 2018.

“I still know who I am, but I still have doubts. I’m still self-conscious that I’m not a man and I feel intimidated…But we’re not bad kids,” Sulah says.

Gagotheko Gybian “GG” Mothai, originally from Zambia, now lives in Botswana and regularly struggles with an emotional and psychological burden all too common for rainbow refugees.

“My sexuality and identity has made it hard for me to find a job, so my finances are strained and my freedom of religion is also being deprived of me because I am always judged for who I am and no religious leader wants their church to be associated with an LGBTQ+ person…I have been made to feel that I am an outcast,” GG says.

Like Sulah, GG has found support through Safe Place. Speaking with them via WhatsApp voice messages due to internet connectivity issues, GG is optimistic that Safe Place will continue serving as their new family and support system, helping them find emotional relief and clarity from all they have experienced as LGBTQ+.

Rainbow refugees continue to face mental health struggles long after leaving their homes, and finding resources and services to help them cope is often limited.

According to the Center of Victims of Torture (CVT), many of their LGBTQ+ clients opt out of housing in refugee camps, preferring to stay in cities where they have to fend for themselves. Refugee camps are often in rural areas and contain the same issues of homophobia and discrimination or violence that rainbow refugees fled. They forgo registration which means limited access to basic services. All of these issues compound the treatment they dealt with back home.

“While we care for all survivors…we know that LGBTQ+ survivors have a very unique experience on persecution and therefore have unique needs in terms of healing and the kind of hope that we can help build with them,” says Simon Adams, Ph.D. and President and CEO of CVT.

EVENT COVERAGE: Emotions Run High at Start of UN Human Rights Council Meeting, Over Invasion of Ukraine

Russia’s attack on Ukraine has remained a primary focus at the United Nations Human Rights Council (UNHRC) session in Geneva this month as delegates walked out on the Russian Foreign Minister in protest.

More than 100 UN members left the assembly hall as Russian Foreign Minister Sergey Lavrov spoke on the second day of the Council's session where he accused Ukraine of its goal to acquire nuclear weapons—which the country abandoned in exchange for security in 1994.

Ukraine urged fellow representatives to recognize Russia’s invasion as “not only on Ukraine but on every UN member state of the United Nations and on the principles that this organization was created to defend,” said Yevheniia Filipenko, Ukrainian Ambassador to the UN.

“It is the duty of the Human Rights Council to demonstrate its credibility and relevance and to take appropriate action to put an end to the gross and systematic violations of human rights, stemming from the Russian aggression,” said Filipenko.

Ignazio Cassis, President of Switzerland—broke from his country’s longstanding tradition for neutrality—spoke of Russia’s blatant violation of international humanitarian law and violation of the most fundamental principles of the UN Charter. Switzerland, like many other nations, voiced its readiness to welcome Ukrainian refugees and called upon all nations in the Council to protect and treat all civilians with humanity.

The UNHRC session opened on day one with an immediate petition from Ukraine for a vote for a special debate to discuss Russia’s invasion. The approval of the debate passed and was later held with UN members calling for the establishment of a special commission to investigate Russia’s war crimes and violations of human rights.

Antony Blinken, U.S. Secretary of State, denounced Russia for its grave human rights abuses and violations, citing its deliberate attacks on civilians, including schools, residential buildings and even ambulances. In response, he suggested Russia be removed from the United Nations.

"We must reject Russia’s attempts to falsely justify this attack as a defense of human rights – misappropriating terms that we reserve for the worst atrocities and disrespecting every victim of those crimes,” said Blinken.

“One can reasonably ask whether a UN member state that tries to take over another UN member state—while committing horrific human rights abuses and causing massive humanitarian suffering—should be allowed to remain on this Council,” said Blinken.

Ukraine has continued to call for the withdrawal of Russian troops and plead for support against the invasion, which has led to the displacement of over 6.5 million people within Ukraine and over 3.2 million refugees, according to the U.N. migration agency.

The Council session has just a couple of weeks left, but the invasion of Ukraine has continued to be a primary focus of discussions and messaging thus far with UN ambassadors around the world calling on Russia to end its aggression, citing Russian President Vladimir Putin as a war criminal.

BREAKING NEWS: More Than Half of Adult Refugees In Jordan Now Vaccinated Against COVID-19, Thanks To New Vaccine Centers

Over 90 percent of adults in Syrian refugee camps in Jordan have received at least one dose of the COVID-19 vaccine, due to new vaccination centers.

Over 74 percent of adult refugees are fully vaccinated in Azraq Refugee Camp—located in northern Jordan and created after the Syrian Civil War in 2014—according to the National Centre for Security and Crisis Management (NCSCM) as issued in a statement this week by the United National High Commissioner of Refugees (UNHCR).

“Over the last few months, we have seen significant progress in facilitating refugee vaccinations in Jordan,” said Dominik Bartsch, UNHCR Jordan Representative. “Amid the current spike of COVID cases in Jordan, it is reassuring that refugee communities remain committed to getting vaccinated.” 

Awareness of Jordan’s national vaccination program among refugees has substantially increased since the launch of new clinics in October. Registrations for the vaccine rose by 500 percent between January and December 2021, accounting for almost 96 percent of the Jordan refugee population, according to surveys performed by UNHCR.

The vaccination clinics are located in three registration centers close to the majority of Jordan’s refugee population—in the capital city of Amman and in the northern regions of the country. Za’atari Refugee Camp, closest to a clinic in Mafraq, is the largest camp for Syrian refugees in the world with more than 80,900 residents as of January 2022, according to UNHCR. The centers provide in-person access to doctors and nurses who are available to answer questions and concerns.

Many women are concerned about the impact vaccines may have on fertility. Others worry it will affect the growth of their children who are eligible for the vaccine. Having direct access to local healthcare workers and volunteers has helped counter misinformation. Refugee community volunteers help run the clinics and encourage fellow refugees to get vaccinated.

“The presence of vaccination centers in our communities has had a positive impact on the number of refugees getting vaccinated. It makes it much easier for refugees, like me, to get vaccinated close to home in a safe and welcoming environment,” said Hajj, a Sudanese refugee community volunteer at the Nuzha Community Centre. 

UNHCR has recently commended the Jordanian government for actively addressing and including its refugees in its response efforts since the beginning of COVID-19.