Syria and Lebanon have witnessed cases of cholera, an acute infection that causes diarrhea and results from eating food or drinking water contaminated with cholera bacteria. What are the possible causes? What is the future of disease control? What is the global status of cholera?
Last Friday, the Lebanese Minister of Health, Firas Al-Abyad, announced that two cases of cholera had been recorded in a gathering of displaced Syrians in Akkar (northern Lebanon).
And the Minister of Health announced in a statement to the local LBC channel that "so far, two cases of cholera have been recorded in a gathering of displaced Syrians in Akkar, and we are working to investigate other cases."
A statement issued by the Ministry of Health announced last Thursday that one of these two injuries was recorded on the fifth of October in the Akkar governorate, and the patient's condition is stable and is receiving treatment in the hospital.
This is the first infection in Lebanon since 1993; History of the last cholera outbreak.
Accordingly, the Ministry of Health has formed a crisis cell that includes experts and specialists to respond to the cholera outbreak, according to what the Ministry of Health was quoted by the official National Media Agency as saying.
cholera in Syria
This comes at a time when neighboring Syria, since last September, has witnessed an outbreak of cholera in several governorates, for the first time since 2009.
And the Syrian Ministry of Health reported last Tuesday night that the cumulative total number of confirmed infections amounted to 594, distributed over 11 governorates out of a total of 14 in the country, and the largest number of them is in Aleppo Governorate (north).
The ministry recorded 39 deaths, 34 of them in Aleppo, explaining that "most of the deaths are caused by the delay in seeking early medical advice or by people suffering from chronic diseases."
It was not clear if the ministry's statistics included injuries and deaths in areas outside the government's control.
And the World Health Organization warned last Tuesday that the situation "is worryingly worsening in the governorates" where the disease has spread, and "infections are expanding to new areas."
Injuries in Iraq
And last June, 13 cases of cholera were discovered in Iraq , 10 of them in the Sulaymaniyah Governorate in the Kurdistan Region, which has not witnessed the disease for 10 years, with no deaths recorded.
The spokesman for the Ministry of Health, Dr. Saif Al-Badr, told the Iraqi News Agency - at the time - that early diagnosis of the disease speeds up recovery from it, noting that it is transmitted through contaminated food and drink from the infected person to the healthy person.
He stressed that the elderly and children are the most vulnerable and vulnerable to disease, and called on community members to pay attention to personal hygiene and the safety of food and drinks.
Cholera usually appears in residential areas that suffer from scarcity of drinking water or lack of sewage networks, and is often caused by eating contaminated food or drinking water, and leads to diarrhea and vomiting.
Contaminated water may be behind cholera
As part of efforts to curb the spread of the disease, the Syrian Ministry of Agriculture announced last week that "all vegetables that are irrigated from contaminated water in Aleppo and eaten raw will be destroyed."
Humanitarian organizations and workers are alerting the dangers of an outbreak of the disease in overcrowded camps for displaced people, especially in the northwest of the country, after reports of several infections.
And based on a quick assessment it conducted with its partners, the United Nations suggested that the outbreak of infection is mainly related to drinking unsafe water sourced from the Euphrates River, as well as using contaminated water to irrigate crops.
About half of the population in Syria depends on alternative sources that are often unsafe to meet or supplement their water needs, while at least 70% of wastewater is not treated, according to the United Nations Children's Fund (UNICEF).
In Geneva, the Director-General of the World Health Organization, Tedros Adhanom Ghebreyesus, said - during a briefing to reporters last Wednesday, "in Syria, more than 10,000 suspected cases of cholera have been reported during the past six weeks."
The Middle East is not alone with cholera
On September 30, 2022, the head of the Cholera and Epidemic Diarrheal Diseases Team at the World Health Organization, Philip Barbosa, reported that there is an alarming increase in cholera outbreaks around the world. In the first 9 months of this year alone, 26 countries reported cholera outbreaks.
"We have not only seen more outbreaks, but it has been bigger and more deadly," Barbosa said - in press statements from Geneva.
He explained that the reported death rate in 2021 increased about 3 times if compared to the average of the previous five years, and in Africa the rate is currently 3%.
Although most infected people develop mild symptoms, cholera can kill within hours if not treated, and it is easy to treat, but many people do not have the resources required for it.
Climate change and poverty fuel cholera
Barbosa stressed that cholera outbreaks occur especially in areas suffering from poverty and conflict, and “today we face an increasing threat with climate change,” such as hurricanes, droughts and floods, which reduces access to clean water; This creates a fertile environment for cholera to thrive.
He noted that cholera can be prevented by ensuring access to safe water, hygiene and sanitation, with increased access to health care and active community involvement.
Despite the "seriousness of the situation", it is "not hopeless," the UN official said, adding that "cholera can be prevented and is a curable disease."
Limited cholera vaccination
In response to a question related to the outbreak of the disease in Syria, Barbosa said that the situation in Syria is complex and evolving, and there are laboratory confirmed cases.
He explained that concern is growing about the situation in the Indian subcontinent, the Horn of Africa, West Africa and the Middle East.
As for vaccination, Felipe Barbosa said that the available vaccinations are very limited, and demand always exceeds supplies and this year it has been more complex.
"It is clear that we do not have enough vaccinations to respond to severe or even less severe outbreaks to be able to implement preventive campaigns that can be a way to reduce risks for many countries," he added.
In response to a question about the existence of a shortage in vaccinations, Barbosa attributed this to the presence of only one factory that produces vaccinations.
And last Wednesday, the World Health Organization said that the number of cholera outbreaks has increased around the world this year.
The Director-General of the World Health Organization said that during the first 9 months of the year, 27 countries declared cholera outbreaks (after counting Lebanon).
The World Health Organization did not address the estimate of the number of infections around the world.
In mid-September, the European Center for Disease Control and Prevention said it had recorded about 40,000 cholera cases in a month.
Ghebreyesus described this development as worrying, given that the problem is not limited to an increase in the number of cases of the disease, but because deaths are increasing.
He said that the death rate this year is three times higher than the rate in the past five years, noting that cholera is spreading in places suffering from poverty and conflict, and in places where people are struggling to face the repercussions of climate change.
What is the future of controlling cholera in the Middle East in particular and the world in general?
According to a study published in April in the Lancet medical journal, cholera is characterized by mild to fatal watery diarrhea, and immediate dehydration is the cornerstone of treatment.
Since 2014, the Global Task Force on Cholera Control (a coordinated network of partners from the World Health Organization) has been working with many countries to develop national cholera control strategies, the paper said.
The Global Cholera Roadmap focuses on stopping cholera transmission in cholera hotspots through vaccination and improving water, sanitation and hygiene, with the goal of reducing cholera deaths by 90% and eliminating local transmission in at least 20 countries by 2030.
Therefore, the course of cholera in the countries of the Middle East in particular, and the world in general, depends on these factors: vaccination and improving water, sanitation and hygiene. The success of countries in providing these matters means controlling cholera, otherwise there is a possibility of this outbreak continuing.
Cholera infection is caused by a type of bacteria called Asiatic cholera, and the deadly effects of the disease are the result of a toxin secreted by the bacteria in the small intestine, causing the body to secrete huge amounts of water, which leads to diarrhea and rapid loss of fluids and salts.
Cholera bacteria may not cause disease in all people exposed to it, but they can still pass the bacteria in their stool and can contaminate food and water supplies.
For its part, the World Health Organization says that there are many serogroups of Vibrio cholerae, but only two of them (O1 and O139) cause outbreaks. 1) In all recent outbreaks, while Vibrio cholera (or 139) - first identified in Bangladesh in 1992 - has caused outbreaks in the past, but only recently have caused sporadic cases, and their presence has not been revealed Never outside of Asia.
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