The arrival of cholera to the camps of northwestern Syria is no longer an “expectation”, but rather a “reality”, according to doctors and humanitarian workers, following 3 cases were recorded in the Kafr Lusin area in the Idlib governorate, while tests are being conducted for dozens of suspected cases.
Although the outbreak of the disease has become present in most Syrian regions and governorates, especially in the east of the country, its infiltration into the camps may result in a “catastrophic situation”, due to considerations related to the fragility of the medical sector there on the one hand, and the lack of infrastructure from safe water sources and sewage networks, from On the other hand.
According to a statement published by the “Response Coordinators in the North of Syria” team, it announced that “the camps of northern Syria have entered the stage of danger, significantly, following the casualties were recorded.”
The director of the humanitarian team, Muhammad Hallaj, warned of its large expansion, and the “inability to control the spread”, due to “the weak capabilities necessary to confront the disease,” noting that they had previously launched an appeal for urgent funding for camps in the water and sanitation sector, in order to contain cholera before the outbreak of the disease. The camps become a “hot spot for the disease.”
Statistics from the “Early Warning and Epidemic Response Program” indicate that the number of injuries in north and east Syria exceeded the 4000 mark in the past days, while the number of deaths reached 18, in the areas controlled by the Kurdish “Self-Administration”.
In northwestern Syria, which includes the countryside of Aleppo and Idlib, a total of 58 injuries were recorded, following 19 were detected until Monday. As for the “Spring of Peace”, which includes the cities of Ras al-Ain and Tal Abyad, 50 injuries were recorded in a recent statistic.
Doctor Muhammad Salem, head of the “early warning” program, told Al-Hurra that the doubling of cases is “a serious matter”, and that “cholera has become a reality in northwest Syria, and is no longer expected.”
Salem added: “The outbreak has spread in all Syrian regions, and what increases the danger is that we are at the end of the summer. There is a great drought, and rains are coming, and thus increase the pollution coming from the sewage networks.”
Regarding the camps for the displaced, the Syrian doctor spoke that “there is fragility in the health sector and poor capabilities in the infrastructure. The camps lack sewage networks and safe water sources, and in their surroundings are cities that were established without engineering studies.”
Cholera usually appears in residential areas where drinking water is scarce, or where sewage systems are lacking. It is often caused by eating contaminated food or water, and leads to diarrhea and vomiting.
The first infections were concentrated in areas near the Euphrates River, which the United Nations believes is the source of the epidemic, due to people drinking unsafe water from the river and using contaminated water to irrigate crops, which led to food contamination.
‘No lines of defense’
In 2008 and 2009, Syria recorded the last outbreaks of the disease in the governorates of Deir ez-Zor and Raqqa. After an 11-year conflict, the country is witnessing a severe water crisis, with the destruction of the water and sanitation infrastructure, which prompted many citizens to rely on unsafe drinking water, especially from the Euphrates River.
The last final analyzes of samples from the river confirmed the presence of “cholera vibrio” in it, according to what the head of the “Health Authority” in the Autonomous Administration, Joan Mustafa, previously told Al-Hurra.
He added that “the continuing drop in the water level in the river will lead to an increase in infections. It will become a focus for the spread of diseases in the region,” and that “there are things that must happen urgently. In al-Hasakah there are a million people. This area is dangerous, and there are fears that the disease will get out of control.” .
In turn, the co-chair of the Kurdish Red Crescent, doctor, Hassan Amin, explains that “the reasons for the increase in infections are related to the fact that the underlying cause of the disease has not disappeared so far, which is the contamination of the water that citizens obtain from the Euphrates River, as well as the contamination of foods and vegetables.”
The doctor added to Al-Hurra: “The level of the Euphrates River is very low, and the swamps that were formed remain. People continue to drink from them, and through unsterilized tanks.”
Although the situation in eastern Syria, where the “Autonomous Administration” controls, seems catastrophic, given the number of injuries that exceeded four thousand, the western regions of the country are not isolated from that either, according to the director of programs in the “Al-Ameen” humanitarian organization, Dr. Rami Kelzy.
Kelzy explains to Al-Hurra that “the injuries in general come from polluted water, especially groundwater, which portends a rapid spread of the epidemic in an environment such as camps, where infrastructure is absent, while resources are scarce.”
The Syrian doctor adds: “Therefore, the first line of defense is almost absent. Cholera is by nature a fast-spreading disease, and therefore we will rely on the second line to combat it, which is case management.”
The injuries recorded so far in northwestern Syria are divided into 80% “asymptomatic”, and the majority of them are moderate and severe. “Severe injuries, if not treated appropriately, can have a mortality rate of up to 50 percent.”
The doctor in the “Al-Amin Organization” indicates that they have started training for cadres in Turkey and field teams working in Syria, and are also working on preparing 9 isolation units for case management with a capacity of 300 beds and perhaps up to 500.
He continues, “These centers require special conditions in terms of distance from the population of at least 100 meters, and to have a special sewage network, as well as mechanisms for other steps to sterilize and dispose of waste through trucks, and then re-sterilize it.”
Although these “solutions” are available, it is not easy to get hold of them by hand. “It takes a lot of time and budgets,” says Kelzy. “Everyone is trying their best.”
“The sun is not covered by a sieve”
Meanwhile, given Syria’s division between several influential parties, the statistics of each health authority differ from the other, and while the numbers of the “Self-Administration” converge with the “Early Warning and Epidemiology Program”, what is published by the Ministry of Health of the Syrian regime varies greatly.
The Ministry of Health said, on Monday, that 29 people have died of cholera, and rapid assessment tests confirmed the presence of 338 cases in the country since the epidemic first appeared last month, and that most of the deaths and injuries are in Aleppo Governorate in the north.
However, the Syrian doctor, Muhammad Salem, questions these statistics, and considers that they are not transparent, explaining that “the lack of transparency in epidemics confirms the spread of the epidemic significantly.”
Salem says: “The regime hid the real number for two months, so cholera spread in a way that we can no longer control. The foci must be known and counted.”
He added, “The sun is not covered by a sieve, and cholera is not hidden. Cases filled hospitals and some areas were out of response.”
In turn, the Syrian doctor, Rami Kelzy, considered that the fight once morest cholera, following the number of infections doubled, “is not a simple matter.” He believes that the control steps are not only related to the medical sector, but there are steps that must be taken by the “sanitary sector”.
“This sector should start with a water chlorination process at the level of a single dwelling, so that families can ensure access to a safe and clean water source. However, chlorination requires huge budgets and teams to act,” Kelzy explains.
It appeals to all international organizations working in the fields of health and the environment to intervene “to work quickly and urgently” in order to provide the necessary support to health facilities, and to repair and sterilize damaged water stations.
When the first cases were recorded this month, the Syrian Observatory for Human Rights linked the spread of cholera in the western countryside of Deir ez-Zor to the local authorities’ cessation of distributing chlorine to water stations during the past three months.
Subsequently, the Kurdish Autonomous Administration, which controls the western countryside of Deir ez-Zor, announced the resumption of chlorine distribution, and its provision of support to medical facilities, including Al-Kasra Hospital.