Kőrösi: Cholera in Lebanon Won’t Become Epidemic

The number of cholera cases in Lebanon has exceeded 1,400 with over 17 deaths according to the latest official figures, while the President of the United Nations General Assembly, Csaba Kőrösi, said Wednesday in a statement to Asharq Al-Awsat he was very confident that cholera will not become a major epidemic in the country. Lebanon has recorded more than 1,400 cholera cases and 17 deaths as of Tuesday, since the first case appeared in the country on the fifth of October, according to the “World Health Organization” (WHO).

Commenting on this outbreak, Kőrösi expressed to Asharq Al-Awsat his confidence that despite the major crises that Lebanon is experiencing, cholera will be contained in the country. “I am very confident that cholera is not going to become a major epidemic in Lebanon, it should be contained,” he stated. He also pointed out that there might be some other very dangerous outbreaks that need to be prevented worldwide.

Concurrently, cholera continues to spread in Syria on a large scale, bringing the number of infections to about 25,000 cases, according to the latest figures, with more than 80 deaths.

Origins of Cholera

As reported by WHO, cholera transmission is closely linked to inadequate access to clean water and sanitation facilities. Menaced areas include outskirts slums, and camps for displaced persons or refugees, where clean water and sanitation lack the minimum requirements. The consequences of a humanitarian crisis, such as disruption of water and sanitation systems, or the displacement of populations to inadequate and overcrowded camps, can increase the risk of cholera transmission, should the bacteria be present or introduced.

Symptoms

According to WHO, cholera is an extremely virulent disease that can cause severe acute watery diarrhea. It takes between 12 hours and 5 days for a person to show symptoms after ingesting contaminated food or water. It affects both children and adults and can kill within hours if untreated. Most people infected with cholera do not develop any symptoms, although the bacteria are present in their body for 1-10 days after infection and are shed back into the environment, potentially infecting other people. Among people who develop symptoms, the majority have mild or moderate symptoms, while a minority develop acute watery diarrhea with severe dehydration. This can lead to death if left untreated.

Cholera spread in Syria and Lebanon

In Syria, the outbreak has likely started, according to the international NGO “Save the Children”, due to communities consuming contaminated water and food irrigated by the Euphrates River, which is experiencing historic low water levels mainly due to Syria’s worst drought in decades.

In Lebanon, cholera has been diagnosed firstly in rural areas bordering Syria, and is "probably due to population movements," according to the head of World Health Organization (WHO) technical team in Lebanon, Alissar Rady. “Most cholera cases in Lebanon have been in the camps, among the roughly 1 million Syrians who have taken refuge over the past decade from the conflict in their homeland”, according to Lebanese Health Minister Firass Abiad. While the outbreak was initially confined to northern districts, it has spread rapidly, said WHO’s office in Lebanon on Tuesday, with laboratory-confirmed cases reported from all eight governorates and 18 out of 26 districts.In Syria, cholera has already spread over the 14 Governorates of the country.

Tackling the disease

To contain the spread of the disease, the World Health Organization recommends improving access to proper and timely case management of cholera cases, prevention, and control in healthcare facilities, improving access to safe drinking water and sanitation infrastructure, as well as, improving hygiene practices and food safety in affected communities, with these counting as the most effective means of controlling cholera.

Oral cholera vaccine should be used in conjunction with improvements in water and sanitation to control cholera outbreaks and for prevention in targeted areas known to be at high risk for cholera. Key public health communication messages should be provided to the population.

Surveillance for early case detection, confirmation, and response in other provinces and regions of Lebanon should be reinforced especially at the district level while expanding community-based surveillance.

According to information provided by Hala Habib, the communications officer of WHO Lebanon, the long-term solution for Cholera control lies in economic development and universal access to safe drinking water and adequate sanitation. Actions targeting environmental conditions include the implementation of adapted long-term sustainable WASH solutions to ensure the use of safe water, basic sanitation, and good hygiene practices in cholera hotspots.

In addition to cholera, such interventions prevent a wide range of other water-borne illnesses, as well as contribute to achieving goals related to poverty, malnutrition, and education. The WASH solutions for cholera are aligned with those of the Sustainable Development Goals (SDG) number 6.

Vaccination

WHO recently announced that the standard two-dose vaccination for cholera will be suspended temporarily to allow for the available doses to be used in more countries, although Lebanon took delivery on Monday of its first vaccines to combat the worsening cholera outbreak from donor nation France. However, despite global shortages in cholera vaccines, WHO is supporting the Lebanese Ministry of Public Health to secure 600,000 doses for those most at risk, including frontline workers, prisoners, refugees, and their host communities.

Humanitarian Aids

In Lebanon, WHO is joining with the Ministry of Public Health and other health partners to curb the evolving cholera outbreak. For instance, WHO and other humanitarian partners have supported the Ministry to develop a national cholera preparedness and response plan, outlining the most urgent response interventions required, while scaling up surveillance and active case-finding in hotspot areas. UNICEF distributed thousands of liters of fuel to water pumping stations and waste-water treatment stations in locations with confirmed and suspected cholera cases. It has procured emergency medical supplies to support the treatment of several thousands of cholera cases and symptoms including moderate to severe diarrhea. It delivered Chlorinated Trucked water, wastewater desludging, and ensured disinfection in informal settlements with suspected or confirmed cases.

UNICEF trained over 4000 frontline workers and partners on cholera awareness, including transmission, symptoms, treatment, prevention, and referral mechanisms, scaled up safe water deliveries, and increased desludging to over 250,000 people living in informal settlements. In Lebanon also, the “Save the Children” organization is responding with partners through the interagency cholera prevention, preparedness, and response Plan. “Save the Children” will be working to ensure children in schools and communities are protected from possible water-related outbreaks, have access to safe water, sanitation, and hygiene, and affirm that their well-being is maintained. This includes awareness messaging, health hygiene promotion in schools, and distribution of soap, hygiene kits, and chlorination tablets for supported communities, as well as providing support for sustainable solutions such as UV solar-powered systems for cleaning water.

In Syria, UNICEF is distributing millions of water treatment tablets to more than 350,000 people in affected governorates. It distributed over 400 tons of sodium hypochlorite during the first two weeks of October to increase chlorine dosages and concentration, as chlorine is often distributed in cholera response because it effectively inactivates the Vibrio cholerae bacteria, that causes cholera. Since the beginning of the cholera response, more than a ton of sodium hypochlorite has been distributed, providing more than 13 million people with safe and clean water. UNICEF delivered acute watery diarrhea (AWD) kits to support treating thousands of moderate and severe Cholera cases. UNICEF also trained hundreds of healthcare workers and hygiene promotion teams across Syria.

Save the Children’s response to cholera in Syria, is helping the restoration of basic services, including water and sanitation, as key to helping communities recover from the impact of conflict. Save the Children’s response plan includes chlorination of restored water, water quality monitoring, distribution of hygiene and cleaning kits, as well as hygiene promotion.

President Donald Trump’s announcement that the US will ease sanctions on Syria could eventually facilitate the country’s recovery from years of civil war and transform the lives of everyday Syrians.

But experts say it will take time, and the process for lifting the sanctions — some of which were first introduced 47 years ago — is unclear.

“I think people view sanctions as a switch that you turn on and off,” said Karam Shaar, a Syrian economist who runs the consultancy firm Karam Shaar Advisory Limited. “Far from it.”

Still, the move could bring much-needed investment to the country, which is emerging from decades of autocratic rule by the Assad family as well as the war. It needs tens of billions of dollars to restore its battered infrastructure and pull an estimated 90% of the population out of poverty.

And Trump’s pledge has already had an effect: Syrians celebrated in streets across the country, and Arab leaders in neighboring nations that host millions of refugees who fled Syria’s war praised the announcement.

What are the US sanctions on Syria? Washington has imposed three sanctions programs on Syria. In 1979, the country was designated a “state sponsor of terrorism” because its military was involved in neighboring Lebanon's civil war and had backed armed groups there, and eventually developed strong ties with the Iran-backed Hezbollah group.

In 2003, then-President George W. Bush signed the Syria Accountability Act into law, as his administration faced off with Iran and Tehran-backed governments and groups in the Middle East. The legislation focused heavily on Syria's support of designated terror groups, its military presence in Lebanon, its alleged development of weapons of mass destruction, as well as oil smuggling and the backing of armed groups in Iraq after the US-led invasion.

In 2019, during Trump's first term, he signed the Caesar Act, sanctioning Syrian troops and others responsible for atrocities committed during the civil war.

Caesar is the code name for a Syrian photographer who took thousands of photographs of victims of torture and other abuses and smuggled them out of the country. The images, taken between 2011 and 2013, were turned over to human rights advocates, exposing the scale of the Syrian government’s brutal crackdown on political opponents and dissidents during countrywide protests.

What has been the impact of US sanctions on Syria? The sanctions — along with similar measures by other countries — have touched every part of the Syrian economy and everyday life in the country.

They have led to shortages of goods from fuel to medicine, and made it difficult for humanitarian agencies responding to receive funding and operate fully.

Companies around the world struggle to export to Syria, and Syrians struggle to import goods of any kind because nearly all financial transactions with the country are banned. That has led to a blossoming black market of smuggled goods.

Simple tasks like updating smartphones are difficult, if not impossible, and many people resort to virtual private networks, or VPNs, which mask online activity, to access the internet because many websites block users with Syrian IP addresses.

The impact was especially stark after a devastating 7.8 magnitude earthquake hit Türkiye and northern Syria in February 2023, compounding the destruction and misery that the war had already brought.

Though the US Treasury issued a six-month exemption on all financial transactions related to disaster relief, the measures had limited effect since banks and companies were nervous to take the risk, a phenomenon known as over-compliance.

Interim Syrian President Ahmed al-Sharaa — who led the insurgency that ousted President Bashar al-Assad — has argued the sanctions have outlived their purpose and are now only harming the Syrian people and ultimately preventing the country from any prospect of recovery.

Trump and Sharaa met Wednesday.

Washington eased some restrictions temporarily in January but did not lift the sanctions. Britain and the European Union have eased some of their measures.

What could lifting the sanctions mean for Syria? After Trump’s announcement, Syria's currency gained 60% on Tuesday night — a signal of how transformational the removal of sanctions could be.

Still, it will take time to see any tangible impact on Syria's economy, experts say, but removing all three sanctions regimes could bring major changes to the lives of Syrians, given how all-encompassing the measures are.

It could mean banks could return to the international financial system or car repair shops could import spare parts from abroad. If the economy improves and reconstruction projects take off, many Syrian refugees who live in crowded tented encampments relying on aid to survive could decide to return home.

“If the situation stabilized and there were reforms, we will then see Syrians returning to their country if they were given opportunities as we expect,” says Lebanese economist Mounis Younes.

The easing of sanctions also has an important symbolic weight because it would signal that Syria is no longer a pariah, said Shaar.

Mathieu Rouquette, Mercy Corps’ country director for Syria, said the move “marks a potentially transformative moment for millions of Syrians who have endured more than 13 years of economic hardship, conflict, and displacement.”

But it all depends on how Washington goes about it.

“Unless enough layers of sanctions are peeled off, you cannot expect the positive impacts on Syria to start to appear,” said Shaar. “Even if you remove some of the top ones, the impact economically would still be nonexistent.”

Kőrösi: Cholera in Lebanon Won’t Become Epidemic

Cases exceeded 1,400 with over 17 deaths in the country