Concern over cholera outbreak in Kurdish region of northern Syria

The warnings of the international community, which has been warning for years about the danger of outbreaks of major diseases - so far under control - in a Syria ravaged by more than ten years of war and the consequences of climate change, have now become a reality. Since the end of August, the Syrian provinces of Aleppo and Deir al-Zour have become the epicentres of a new deadly outbreak of cholera. The disease has not been reported in the country since 2009. 

According to the UN Resident and Humanitarian Coordinator for the Syrian Arab Republic, Imran Riza, at least eight people have lost their lives to the disease, and nearly 1,000 have reported symptoms between 25 August and 10 September, when the Syrian Ministry of Health officially declared the outbreak after confirming 15 cases in Aleppo province. "The epidemic poses a serious threat to the people of Syria and the entire region," warned Riza. That is why "urgent action is needed to prevent further transmission and more casualties [in the country's 14 provinces]".

"We call on all national and international organisations and agencies [...] to help raise awareness against cholera and provide medicines and medical supplies to hospitals and medical centres in the Deir al-Zur region," the office of Humanitarian Organisations Affairs in the province controlled by the Kurdish-Sunni alliance, the Syrian Democratic Forces (SDF), said in a statement released on social media.

Most of the suspected cases (almost 75 per cent) have been reported in the northern province of Aleppo, followed by Deir al-Zour (more than 20 per cent), Ar-Raqqa, Al Hasakeh, Hama and Lattakia. However, according to Sana, the state news agency in Damascus, the official number of laboratory-confirmed cases is just over 60. 

Syria's water infrastructure was already deficient before the start of the 2011 civil war. Now, more than a decade later, the consequences of the conflict and the effects of climate change - which have deepened the shortage of safe drinking water - have left much of the country's population of nearly 5 million without direct access to safe water sources. According to UNICEF data, two out of every three water treatment plants in the country, half of the pumping stations and a third of the water towers have been damaged by the war; and today, about half of Syrians rely on alternative water sources, while most of the wastewater remains untreated. 

This situation has pushed many Syrian inhabitants to make direct use of wastewater from the Euphrates River - which flows through most of the affected governorates - both for daily consumption and to irrigate fields. And this could be the focus of the epidemic. Several experts and observers have warned that, if the Vibrio cholera bacterium was present in the river water, it would have caused the acute infection when drunk directly or ingested through contaminated food, causing severe diarrhoea and vomiting, headaches, hypotension and high fevers. This has already been confirmed by initial laboratory tests.

Thus, the emergence of this outbreak as an indicator of inequity only sheds new light on a situation that has plagued the country for several years now. Things are not much different in Idlib, for example, a northern province occupied by Islamist and Al-Qaeda-linked groups. The region is home to hundreds of refugee camps that were forcibly displaced during the civil conflict, and these have become frequent witnesses to outbreaks of disease linked to poor water quality. 

In response to the emergency situation, the Syrian Ministry of Health, in close coordination with the World Health Organization (WHO), UNICEF and a wide network of partners on the ground, is implementing surveillance and early warning, prevention and response programmes such as the Water, Sanitation and Hygiene (WASH) initiative. 

In addition, important health supplies have been mobilised, including the delivery of more than 4,000 diagnostic tests or intravenous fluids and oral rehydration salts to regions and facilities where most of the suspected cases have been reported. At the same time, chlorination activities - to disinfect water - and the transport of clean and safe water are intended to replace the use of contaminated water. 

In addition to these "urgent" measures called for by the UN, local leaders and volunteers are working together to train health workers and local citizens in good hygiene practices and early recognition of symptoms.