Doctors Without Borders/Médecins Sans Frontières (MSF) is working with local authorities to respond to a major cholera outbreak that has been spreading in parts of Syria since September 2022. First linked to contaminated water near the Euphrates River and the severe water shortage in northern Syria, the outbreak has now spread across the country, and more than 13,000 suspected cases have been reported, including 60 deaths as of October 14.
In northeastern Syria, MSF has partnership with local health authorities to respond to the outbreak. MSF is supporting a cholera treatment center (CTC) in Raqqa, where capacity was recently increased from 40 to 65 beds. Within the first two weeks, almost 600 patients were admitted, of which a third were severely ill and another third were treated as outpatients.
To respond to the outbreak in northwestern Syria, in September, MSF's teams began conducting community-based health promotion activities and training health care workers. MSF is supporting one CTU and setting up two others to isolate and treat patients in Idlib and Aleppo governorates. Our teams also operate and support five Oral Rehydration Points (ORPs) points to provide initial treatment to patients and have distributed preventive hygiene kits that include water jerrycans, soap, and chlorine tablets to more than 20,000 families in displacement camps. We also test the water in the camps and support clean water points in the community. In Tal Abyad and Ras Al-Ain, we support a local organization engage the community and distribute hygiene kits to families.
Extremely contagious, cholera is caused by ingesting bacteria of fecal origin—Vibrio cholerae—found in dirty or stagnant water. Causing diarrhea and vomiting, cholera leads to rapid dehydration and, without prompt care, can kill within hours. According to Raqqa National Hospital, this is the first-time cholera has been confirmed in northeast Syria since 2007.
Accessing safe water remains a challenge
Staff and supplies have been increased and MSF is working with other local organizations to support water and sanitation services, including the chlorination of water trucks, water quality assurance, and supporting wastewater stations with chlorination processes. Epidemiological data is being used to identify priority areas in Raqqa for support.
Assessments have also started in Hassakeh. Though people there depend on boreholes and trucking for water instead of the Euphrates, access to clean water can still be a challenge as water trucks can unwittingly source contaminated water.
The cholera outbreak is adding another layer of complexity to an already dreadful humanitarian situation, including a looming harsh winter, recent escalation of fighting, and the disruption of cross-border aid. As access to health care and to water and sanitation services has been severely affected by the ongoing conflict, the main challenge today is the health system's ability to deal with another outbreak amidst funding shortfalls and enormous health needs.
Across northeastern Syria and northwestern Syria, local and international humanitarian organizations are trying to fill the gaps and respond to the many needs, but the overall accessibility of sufficient and clean water remains a worrisome issue. In 2021, water, sanitation and hygiene (WASH) operations represented only four percent of the entire humanitarian response budget for the whole of Syria, which is less than one-third of what was spent in 2020 for the same activities.
Helping people protect themselves
Fifteen years have passed since the last cholera outbreak in Syria, so it’s particularly important that people understand how the bacteria spreads and how to treat it.
A group of community workers are now based in the Raqqa CTC and are meeting with patients and their families to explain how to prevent the spread of cholera and answer their questions. Even if access to clean water and sanitation infrastructure remains challenging in northeast and northwest Syria, there are simple and effective measures people can take to protect themselves.
The community workers explain the importance of handwashing before and after meals, and of washing and cooking fruit and vegetables at a high temperature to kill bacteria. They also explain how to recognize the early symptoms of cholera, and what to do if they suspect that they or a family member has the disease.
After 11 years of war, a record 14.6 million people in Syria need humanitarian assistance. Syria has the highest number of internally displaced people (IDPs) in the world, with 6.9 million people—most of whom are women and children—displaced from their homes. Many have been forced to flee repeatedly and live in precarious conditions.
MSF operates in Syria where we can, but ongoing insecurity and access constraints continue to severely limit our ability to provide humanitarian assistance that matches the massive scale of the needs. Our repeated requests for permission to operate in areas controlled by the Syrian Government have not been granted. In areas where access could be negotiated, such as northwest and northeast Syria, we run and support hospitals and health centers and provide health care through mobile clinics.