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Syria: Cholera surge sparks fears of uncontrollable outbreak in Idlib camps

Cases of the infectious disease are increasing in different parts of war-torn Syria amid damaged infrastructure and pollution of the Euphrates river
A child transfers water with a bucket from the open water tank to his tent in the IDP camp in Killi town, Idlib countryside, 14 September 2022 (MEE/Ali Haj Suleiman)
A child transfers water from the open water tank to his tent in the IDP camp in Killi town, Idlib, 14 September 2022 (MEE/Ali Haj Suleiman)

Cholera cases in Syria continue to surge, with the population having no choice but to rely on the contaminated Euphrates river for drinking water supplies.

The ministry of health in the areas controlled by the government of President Bashar al-Assad said on Monday that the cholera outbreak has killed at least 29 people, while the total number of confirmed infections through rapid testing has reached 338 since the outbreak of the disease was first recorded last month.

'The lack of treated drinking water through water stations and the irrigation of vegetables from the Euphrates river were the main cause of cholera infecting my wife and child'

- Nader, Syrian in al-Hasakah

Meanwhile, a health official in the Kurdish-controlled Autonomous Administration of North and East Syria announced last week that the number of suspected cholera cases reached 2,867, of which 78 were confirmed, while the number of deaths reached 16.

The official, Joan Mustafa, told reporters that the outbreak is linked to the presence of bacteria responsible for cholera in the waters of the Euphrates river, the river's water level has suffered a serious decline because of climate change and is, in many areas, transforming into swamp land.

“I tried as much as possible to protect my family from cholera, but I failed,” said Nader, a 40-year-old civilian who lives in the city of al-Hasakah in northeast Syria. “The lack of treated drinking water through water stations and the irrigation of vegetables from the Euphrates river were the main cause of cholera infecting my wife and child.”

Nearly 30 percent of the population in Syria relies on the Euphrates for drinking water, according to the UN.

Cholera usually appears in residential areas that suffer from scarcity of drinking water or lack of sanitation systems, and is often caused by eating contaminated food or water and leads to diarrhoea and vomiting.

syria sheep idlib 2022
A flock of sheep drinking from the sewage water that irrigates agricultural land near the town of Taftanaz, Idlib, 26 September 2022 (MEE/Ali Haj Suleiman)

Nader said that he had taken his wife and child to the hospital after they had spent two days experiencing severe diarrhoea and vomiting, in addition to suffering from excessive dehydration, only to find that they had cholera. His wife and child were placed on a five-day treatment journey with antibiotics and intravenous fluids.

"We do not have potable water because of the interruption of pipe water, which makes us buy water from tanks filled from surface wells, which are not subject to sanitary control at all," Nader told Middle East Eye.

The cholera crisis is partly a result of the effects of climate change but also a consequence of the civil war, which has been raging for more than a decade. 

According to the United Nations Children's Fund (Unicef), the war has damaged two-thirds of water treatment plants, half of pumping stations and one-third of water towers.

Nearly half the population relies on alternative and often unsafe sources of water while at least 70 percent of sewage goes untreated, Unicef said.

Water station not functional

The Alouk water station northwest of al-Hasakah has stopped pumping drinking water because of alleged electricity cuts, affecting al-Hasakah governorate and the surrounding countryside which rely on its supplies for drinking water. 

The station is under the control of the Turkish-backed Syrian opposition. Several international organisations said that stopping the work of the station is one of the major causes of cholera outbreak in the region.

"Three months ago, the water of Alouk station did not reach the city of Hasakah," said Zubair Sarhan, chairman of the North Charity Association for Relief and Development operating in the city, which is under the control of the SDF. 

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The US-backed SDF are predominantly Kurdish fighters that Turkey accuses of being linked to terror groups.

Turkey and the SDF have exchanged accusations on the other side’s responsibility for the station’s halt. 

Turkey has justified stopping the pumping of the station, claiming it was due to the cutting off of electricity by the SDF, which controls the power station in al-Darbasiyah, which feeds the Ras al-Ain and Tal Abyad regions.

Sarhan told MEE that Russia has tried several times, in agreement with Turkey, to pump water from the Alouk station, but these attempts were unsuccessful.

"We demanded several times that Alouk station come under international auspices and that a UN flag be raised on it in order [for it] not to be bombarded and interrupted," Sarhan said. "The conflict between Turkey, Russia, the SDF and Assad should not be at the expense of vulnerable people."

A source close to the local council in Ras al-Ain, controlled by Syrian opposition and supported by Turkey, told MEE that they do not have information about Alouk station except what is circulating on the street because the Turkish army is in charge of it.

The Syrian Observatory for Human Rights said earlier this month that cholera had spread in western parts of Deir Ezzor in northeast Syria after local SDF authorities stopped distributing chlorine to water pumping stations.

Fears in Idlib

On Monday, the Early Warning and Response Network, a local NGO, confirmed the first three cases of cholera in Idlib governorate, northwest of Syria, prompting fears of the spread of the disease among the displaced residents of camps.

The network recorded 20 new cases in the northwest region of Syria, 15 new cases were in Jarablus region, three in Afrin and two in Azaz, while the total number of cases reached 39.

'Our concerns are not about the spread of cholera within cities, but its spread within the camps, which are an incubator environment for infectious diseases'

- Mohamed Hallaj, director of Response Coordination Group

“Our concerns are not about the spread of cholera within cities, but its spread within the camps, which are an incubator environment for infectious diseases due to the weak humanitarian response in them,” said Mohamed Hallaj, director of Response Coordination Group, a local group collecting statistics on displaced civilians.

Hallaj told MEE that about 590 camps in the Idlib region suffer from a lack of clean drinking water and 226 camps suffer from meagre amounts of clean water. In addition, more than half of the camps suffer from an open sewage system, which is an incubator for the spread of infectious diseases such as cholera.

"The camps at the present time have entered the stage of danger after the positive cases were recorded, and we warn against the spread of the disease further and the inability to control it due to the weak capabilities necessary to confront the disease as a result of the fragile medical reality in the region," Hallaj said.

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