Conflict and economic crisis fuel cholera outbreak in the Middle East

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 Conflict and economic crisis spark cholera surge in Middle East

Cholera has swept through Lebanon, Syria and Iraq, fueled by destroyed infrastructure, unrest and large concentrations of conflict-displaced refugees. Last month, Lebanon reported its first case of cholera in nearly 30 years.

This year, the bacterial infection has spread around the world in dozens of countries, with outbreaks in Haiti and the Horn of Africa, as well as the Middle East. Outbreaks of hundreds of thousands of cases, fueled by conflict, poverty and climate change, are a major setback to global efforts to eradicate the disease.

“Cholera thrives in poverty and conflict, but now it's being exacerbated by climate change,” — said Inas Hamam, regional representative of the World Health Organization.— “Regional and global health security is under threat.”

Efforts to fight cholera are focusing on vaccination, clean water and sanitation. Last month, the WHO announced a temporary suspension of its two-dose vaccination strategy as production could not meet growing demand. Officials are now administering single doses so more people can benefit from vaccines in the short term.

Cholera is contracted by eating food or water contaminated with the bacterium Vibrio cholerae. Although most cases are mild to moderate, cholera can be fatal if not treated properly.

Syrian authorities announced last month that a cholera outbreak had swept across the country. According to the United Nations and the Syrian Ministry of Health, the outbreak is due to people drinking untreated water from the Euphrates River and using the contaminated water to irrigate crops.

Government-controlled areas of Syria and the northeast of the country held by US-backed Kurdish forces have since recorded about 17,000 cases of cholera and 29 deaths.

In the rebel-held Syrian province of Idlib, most of the 4 million people have been displaced by the conflict. They depend on international aid and live in tent cities without basic sanitation and hygiene.

More than half of the inhabitants of Idlib do not have constant access to water. Many families use contaminated water from wells close to the sewer. The province of Idlib has reported 3,104 cases of cholera and five deaths. Dr. Abdullah Hemeidi of the Syrian American Medical Society expects a spike in cases this winter.

Hemeidi said.— “Medical organizations and local councils are trying to disinfect the water and hold workshops to limit the spread of the disease.”

Three years ago, Lebanon fell into an economic crisis. Most Lebanese now rely on privately-supplied water and private generators to generate electricity. Utilities cannot buy fuel or pump water to households.
Since last month, Lebanon has recorded 2,421 cases and 18 deaths. About a quarter of the cases are children under the age of five. Vibrio cholerae bacteria has been found in drinking water, sewage systems and irrigation water.

more than a million Syrian refugees. The Lebanese Ministry of Health reports that most cases of cholera have been detected in refugee camps. Like most households in Lebanon, camp residents buy water delivered by private providers. The water is not tested for safety by the government.

WHO is working with Iraqi health authorities to help them strengthen their cholera control efforts by visiting last month, water treatment facilities and testing labs in Baghdad.

UNICEF said it urgently needed $40.5 million to continue its work in Lebanon and Syria over the next three months.
“These camps — fertile ground for an outbreak”, — Hemeidi of the Syrian American Medical Society said. “We won't be able to properly respond to this unless there is an intervention with medical equipment and assistance.”

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