Cholera exacerbates the crisis in Lebanon

A month ago, the first cholera bacteria were discovered in northern Lebanon. According to the Lebanese Ministry of Health, there are now more than 2,500 confirmed and suspected cases of the diarrheal disease, which is spread through contaminated water, sewage and food, across the country. Cholera can cause severe fluid loss, kidney failure and even death if not treated with medication. At least 18 people have died in Lebanon so far.

Health Minister Firass Abiad has asked for international help to fight the cholera outbreak – the first since 1993. The authorities are trying to keep the number of infections low. “As long as we have comparatively few cases, the clinics are able to treat the sick,” Firass Abiad told DW. “But when the numbers go up, the clinics can’t do it anymore.”

This week, the non-profit organization of the French pharmaceutical company Sanofi donated 13,400 vaccine doses. Egypt has also pledged support. “The government has also launched a nationwide campaign on radio and television to raise awareness of the importance of washing hands. And the contents of water tankers are chlorinated,” explains Megan Ferrando, who is in Lebanon for the US climate and water program -American think tanks Middle East Institute works.

Nevertheless, the World Health Organization (WHO) is deeply concerned about the situation and warns of a cholera epidemic. The situation is precarious.

Years of mismanagement

The situation is also precarious because Lebanon is caught up in the worst economic crisis in its history. The past three years have seen a chain of political and economic upheavals, compounded by climate change, the coronavirus pandemic, the explosion in the port of Beirut in August 2020, and grain shortages since the Russian invasion of Ukraine.

The World Bank downgraded Lebanon from an upper-middle GNI country to a lower-middle country in July. At the end of October, President Michael Aoun left office without a successor, leaving the country with an interim government without a head of state.

The cholera outbreak illustrates the consequences of neglecting infrastructure for years. “The water supply was already ailing before the crisis hit in 2019,” Megan Ferrando said in a report on the Middle East Institute’s website. The combination of years of mismanagement and the current fuel and financial crisis has produced a general water crisis. “On the other hand, the simple fact that there is an infrastructure for water and sanitary facilities reduces the risk of widespread contamination,” Ferrando told DW.

Lebanese who can afford it are drinking bottled water – even though prices have risen eightfold since 2019. “But vulnerable groups are at high risk,” Ferrando said. “Cholera has spread to areas where people don’t have access to clean water and sanitation.”

For example in Lebanon’s northernmost governorate of Akkar, which shares a long border with Syria. “In Akkar, the main water source is contaminated,” Health Minister Firass Abiad said. Meanwhile, the Office of the UN Coordinator for Lebanon has confirmed that patients in Akkar are infected with a similar strain of cholera as people in Syria. In the region, many Syrian refugees live in makeshift camps and commute back and forth between the two countries.

The cholera outbreak hits Lebanon not only at an extremely difficult moment in its history, but also at a bad time of the year. In autumn, the water levels are at their lowest in this country, which is actually water-rich with its snow-capped mountains and 40 rivers and aquifers.

Hoping for the fall rain

“It only rains between October and May, during which time the water has to be stored for the summer,” Heiko Wimmen, who is responsible for Lebanon, Syria and Iraq at the International Crisis Group, told DW. “But there aren’t enough reservoirs to cover the whole year. And now they’re almost empty.”

Even when the storage tanks are full, the state water supply only pumps water into the pipes for a few hours every three to four days. That is why every household has its own water tank on the roof. After a long summer without rain, the contents of the tanks are no longer sufficient to bridge the time without tap water, says Heiko Wimmen. “And not all water suppliers are checked for their water quality.”

With runaway Lebanese pound inflation, “the average price to load a water tanker has increased six-fold since 2019,” adds Megan Ferrando. “A weekly water filling costs more than the monthly minimum wage.”

Cholera is not COVID-19

Wimmen emphasizes that the current cholera outbreak is not comparable to the corona pandemic that paralyzed Lebanon for months in 2021. “Cholera can be treated. The country is so small that people can reach the polyclinics and the government has agreed to cover the costs of treatment.”

However, many people are confused by the different precautionary measures against coronavirus and cholera bacteria, Ettie Higgins, spokeswoman for UNICEF in Lebanon, told DW. “The population was largely familiar with COVID-19, but not with cholera, which spreads much faster.”

Heike Wimmen is not afraid that he could become infected himself because the bacteria rarely become dangerous to healthy adults if they seek medical treatment immediately. His concern is for people who are already very vulnerable and lack the means to get clean drinking water.

Adaptation from English: Beate Hinrichs