Aid groups and public health experts are warning that a series of devastating earthquakes could worsen Syria’s cholera epidemic that was first detected last year.
The warnings come after rescue operations were suspended in both opposition and government parts of Syria – and hope dwindled amid remaining searches in Turkey – six days after a series of earthquakes struck the region. On Sunday, the death toll exceeded 35,000 in the two countries, with at least 4,500 dead in Syria.
Across war-torn Syria, where the UN estimated that 5.3 million people were left homeless by the disaster, “a perfect storm was brewing before the earthquake – increasing food insecurity, collapsing health systems, lack of access to safe water and poor sanitation.” , said Eva Hines, head of communications for the United Nations Children’s Fund (UNICEF) in the Syrian capital, Damascus.
“More than half of the people in Syria depend on insecure alternative water sources for their water needs. And that, of course, increases vulnerability to the rapid spread of waterborne diseases such as cholera,” Hines told Al Jazeera.
Last September, the Syrian government declared an outbreak of cholera – a diarrheal infection caused by consuming food or water contaminated with the bacterium Vibrio cholerae. The disease can prove fatal, especially for children.
The outbreak is largely attributed to the country’s war-torn water infrastructure, which has forced residents to drink and irrigate fields with contaminated water from the Euphrates River in the country’s northeast.
The disease quickly swept through largely opposition-held parts of northwestern Syria, where at least 1.7 million people displaced by the country’s decade-long civil war live in overcrowded camps and about four million depended on humanitarian aid before the disaster.
As of January 18, nearly half of the country’s 77,500 suspected cholera cases were in the northwest region, according to the United Nations Office for the Coordination of Humanitarian Affairs (OCHA), with 18 percent detected in camps for internally displaced people.
Meanwhile, more than 2.1 million people in northwestern Syria live in “sub-districts most at risk for cholera outbreaks,” according to OCHA.
➡️ Cholera epidemic
➡️ Economic decline and fuel shortage
➡️ Holes for winterThe number of people in need of humanitarian aid in #Syria increased from 14.6 million in 2022 to 15.3 million in 2023.
Read the latest humanitarian information on Syria: https://t.co/ZHpAORNLYN pic.twitter.com/cqPE8QAMq1
— Humanitarian (@UNOCHA) February 2, 2023
Marc Schakal, Syria and Turkey program director for Doctors Without Borders (Doctors Without Borders or MSF), which operates in opposition-controlled areas, told Al Jazeera: “There have been very serious difficulties and concerns about the general infrastructure [the internally displaced camps]and now even more because of damage in urban and other environments.”
He said the increased risk of cholera was one of a number of complex risks to public health in areas controlled by armed opposition groups, where 37 health facilities were damaged in the earthquake and 20 were forced to suspend part or all of their operations. Schakal added that the disaster also upended the treatment of patients with chronic illnesses and increased mental health concerns.
A pre-existing disease
The already existing cholera infection rate in Syria increases the chances of a wider spread, Ilan Kelman, a professor of disaster and health at the University of London, told Al Jazeera.
Major earthquakes usually cause disruptions in sanitation and access to clean water, forcing the population into overcrowded temporary camps or shelters, he said. This in turn leads to an increase in diseases such as cholera, typhoid and typhus.
However, these diseases “generally do not occur after a disaster unless they are already present,” he said.
For example, after the 2010 earthquake in Port-au-Prince, Haiti, a cholera outbreak was later linked to UN peacekeepers deployed on the Caribbean island rather than residents. The epidemic led to more than 9,000 deaths.
“In most cases, a disease has to be endemic or already present to spread after a disaster,” Kelman told Al Jazeera. “Cholera is present in Syria, which is a big concern right now and, yes, it could absolutely end up crossing the border into Turkey if proper hygiene measures are not taken.
“In the immediate post-disaster environment, the risk of pre-existing disease immediately increases. It is both an immediate threat and a slow burn risk.”
The UN says up to 5.3 million people in Syria could be homeless after the earthquake, while nearly 900,000 people urgently need hot food in Turkey and Syria.
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Meanwhile, rescuers say the slow delivery of humanitarian aid to opposition-held northwest Syria, where there is only one UN-sanctioned border crossing with Turkey, has severely hampered efforts in the crucial hours and days after the initial tremors.
Now, risk barriers to aid delivery are exacerbated by a range of false threats, MSF’s Schakal said.
“Turkey receives international aid and search and rescue teams from different countries, and that is very appreciated, very valuable and necessary, but today Syria is being left a little bit aside,” he said.
“Some aid is now arriving in Syria, but it is the sixth day since the earthquake. Our teams cannot do everything without external support. And so far there is very little resource reinforcement.”