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.

It was their most challenging mission.
US Army soldiers in the 7th Transportation Brigade had previously set up a pier during training and in exercises overseas but never had dealt with the wild combination of turbulent weather, security threats and sweeping personnel restrictions that surrounded the Gaza humanitarian aid project.
Designed as a temporary solution to get badly needed food and supplies to desperate Palestinians, the so-called Joint Logistics Over-the-Shore system, or JLOTS, faced a series of setbacks over the spring and summer. It managed to send more than 20 million tons of aid ashore for people in Gaza facing famine during the Israel-Hamas war.
Service members struggled with what Col. Sam Miller, who was commander during the project, called the biggest “organizational leadership challenge” he had ever experienced.
Speaking to The Associated Press after much of the unit returned home, Miller said the Army learned a number of lessons during the four-month mission. It began when President Joe Biden announced in his State of the Union speech in March that the pier would be built and lasted through July 17, when the Pentagon formally declared that the mission was over and the pier was being permanently dismantled.
The Army is reviewing the $230 million pier operation and what it learned from the experience. One of the takeaways, according to a senior Army official, is that the unit needs to train under more challenging conditions to be better prepared for bad weather and other security issues it faced. The official spoke on condition of anonymity because assessments of the pier project have not been publicly released.
In a report released this week, the inspector general for the US Agency for International Development said Biden ordered the pier's construction even as USAID staffers expressed concerns that it would be difficult and undercut a push to persuade Israel to open “more efficient” land crossings to get food into Gaza.
The Defense Department said the pier “achieved its goal of providing an additive means of delivering high volumes of humanitarian aid to the people of Gaza to help address the acute humanitarian crisis.” The US military knew from the outset “there would be challenges as part of this in this complex emergency,” the statement added.
The Biden administration had set a goal of the US sea route and pier providing food to feed 1.5 million people for 90 days. It fell short, bringing in enough to feed about 450,000 people for a month before shutting down, the USAID inspector general's report said.
The Defense Department’s watchdog also is doing an evaluation of the project.
Beefing up training Army soldiers often must conduct their exercises under difficult conditions designed to replicate war. Learning from the Gaza project — which was the first time the Army set up a pier in actual combat conditions — leaders say they need to find ways to make the training even more challenging.
One of the biggest difficulties of the Gaza pier mission was that no US troops could step ashore — a requirement set by Biden. Instead, US service members were scattered across a floating city of more than 20 ships and platforms miles offshore that had to have food, water, beds, medical care and communications.
Every day, said Miller, there were as many as 1,000 trips that troops and other personnel made from ship to boat to pier to port and back.
“We were moving personnel around the sea and up to the Trident pier on a constant basis,” Miller said. “And every day, there was probably about a thousand movements taking place, which is quite challenging, especially when you have sea conditions that you have to manage.”
Military leaders, he said, had to plan three or four days ahead to ensure they had everything they needed because the trip from the pier to their “safe haven” at Israel's port of Ashdod was about 30 nautical miles.
The trip over and back could take up to 12 hours, in part because the Army had to sail about 5 miles out to sea between Ashdod and the pier to stay a safe distance from shore as they passed Gaza City, Miller said.
Normally, Miller said, when the Army establishes a pier, the unit sets up a command onshore, making it much easier to store and access supplies and equipment or gather troops to lay out orders for the day.
Communication difficulties While his command headquarters was on the US military ship Roy P. Benavidez, Miller said he was constantly moving with his key aides to the various ships and the pier.
“I slept and ate on every platform out there,” he said.
The US Army official concurred that a lot of unexpected logistical issues came up that a pier operation may not usually include.
Because the ships had to use the Ashdod port and a number of civilian workers under terms of the mission, contracts had to be negotiated and written. Agreements had to be worked out so vessels could dock, and workers needed to be hired for tasks that troops couldn't do, including moving aid onto the shore.
Communications were a struggle.
“Some of our systems on the watercraft can be somewhat slower with bandwidth, and you’re not able to get up to the classified level,” Miller said.
He said he used a huge spreadsheet to keep track of all the ships and floating platforms, hundreds of personnel and the movement of millions of tons of aid from Cyprus to the Gaza shore.
When bad weather broke the pier apart, they had to set up ways to get the pieces moved to Ashdod and repaired. Over time, he said, they were able to hire more tugs to help move sections of the pier more quickly.
Some of the pier's biggest problems — including the initial reluctance of aid agencies to distribute supplies throughout Gaza and later safety concerns from the violence — may not apply in other operations where troops may be quickly setting up a pier to get military forces ashore for an assault or disaster response.
“There’s tons of training value and experience that every one of the soldiers, sailors and others got out of this,” Miller said. "There’s going to be other places in the world that may have similar things, but they won’t be as tough as the things that we just went through.”
When the time comes, he said, “we’re going to be much better at doing this type of thing.”
One bit of information could have given the military a better heads-up about the heavy seas that would routinely hammer the pier. Turns out, said the Army official, there was a Gaza surf club, and its headquarters was near where they built the pier.
That "may be an indicator that the waves there were big,” the official said.

Kőrösi: Cholera in Lebanon Won’t Become Epidemic

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