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Cholera outbreak lays bare Lebanon's shortfalls

November 5, 2022

More than 2,500 cholera cases are suspected or have been confirmed in Lebanon. However, the government has reacted quickly, prompting the population to remain calm — for now.

A Syrian refugee child is treated for cholera by a nurse, following an outbreak in the north of Lebanon.
Cholera numbers are spiking in Lebanon one month after the first case was recorded. Image: Marwan Naamani/picture alliance/dpa

Exactly a month ago, the first cholera bacteria were recorded in Lebanon's north.

According to Lebanon's Public Health Ministry,there are now 2,524 confirmed and suspected cases of the the bacterial illness, which spreads through contaminated water, food and sewage. Eighteen people have died.

The Public Health Ministry, headed by Firass Abiad, has asked for international aid to combat the outbreak while officials domestic officials work to keep the numbers down.

"Since the numbers are not yet very high, hospitals are able to treat the infected patients," Abiad told DW. "If the case numbers rise significantly, hospitals won't be able to cover it anymore," he said.

Earlier this week, the philanthropic arm of the French health care company Sanofi donated 13,440 vaccination doses, and Egypt has pledged help, as well.

"Also, the government has launched countrywide TV and radio campaigns to raise awareness on handwashing, and they have even started chlorinating water trucks," said Megan Ferrando, a nonresident scholar with the Climate and Water Program at the Washington-based think tank the Middle East Institute.

And yet, according to Wednesday's Situation Report by the World Health Organization, the "WHO has graded the overall risk of the Cholera outbreak in Lebanon to be very high at the national level and high at the regional level."

Water 'already fragile'

The past three years have been dominated by a string of political and economic crises in Lebanon that were exacerbated by climate change, the pandemic, the 2020 Beirut port blast and a shortage of grains as a consequence of Russia's invasion of Ukraine.

The World Bank reclassified Lebanon from an upper-middle-income country to lower-middle-income in July. At the beginning of November, the president stepped down, leaving the country with a caretaker government and no head of state.

Despite authorities' assuring words and the incoming international aid, the cholera outbreak highlights the consequence of years of neglected infrastructure maintenance.

"The water sector was already fragile before the start of the crisis in 2019," Ferrando wrote in a report posted on the Middle East Institute's website in October.

The combination of years of mismanagement and the current fuel and financial crises have caused a public water crisis, Ferrando wrote.

"On the other hand, the mere fact that water and sanitation infrastructure exist reduces the risk of widespread contamination," Ferrando, who is based in Beirut, told DW.

Infographic shows regions of Lebanon where cholera has been reported or identified
Many confirmed or suspected cholera cases are in the north of Lebanon, near Akkar

Lebanese people who can afford it drink bottled water — although it now costs eight times more than it did in 2019.

"But vulnerable groups are at a high risk, and you can see that cholera has spread in places where people don't have access to (proper) water and sanitation infrastructure," Ferrando added.

This is what happened in the northern Akkar area, which has a long border with Syria. "In Akkar, the main water source is contaminated," Health Minister Abiad said.

Meanwhile, the Office of the United Nations Special Coordinator for Lebanon has confirmed that patients in Akkar have caught a similar cholera strain to the one in Syria.

Children play in cholera-contaminated water at refugee camp in the north of Lebanon
Some refugee camps in northern Lebanon have water supply contaminated with choleraImage: Marwan Naamani/picture alliance/dpa

Waiting for rain

The cholera outbreak has not just hit Lebanon at a difficult moment in history, but at an unfortunate time of year, as well: Autumn is the season when the otherwise water-rich country — with snow-capped mountains, 40 rivers and aquifers that cover more than half of the landscape — is facing its lowest levels of the year.

"It only rains or snows between October and May, so water has to be stored for the summer," Heiko Wimmen, who oversees the International Crisis Group's program for Lebanon, Syria and Iraq, told DW.

"But there are not enough reservoirs to cover the whole year," Wimmen said, "and, currently, the water reservoirs are nearly empty."

As the state water company only provides piped water for a couple of hours every three or four days even at times when the reservoirs are full, every household has its own rooftop water tank for storage.

Following a long summer with no rain, patches between access to piped water tend to last longer than the stored supply does, Wimmen said. "Not all of these water delivery companies are properly monitored for the quality of the water," he added.  

And, given the drastic inflation of the Lebanese pound, the "average cost for trucked water has increased sixfold since 2019," Ferrando said, "making a weekly water tank refill more expensive than the monthly minimum wage."


A couple is taking a selfie on Mount Lebanon, a source of water in Lebanon
Lebanon has abundant water; however, the storage reservoirs are not sufficientImage: Bilal Jawich/Xinhua/picture alliance

Cholera isn't COVID-19

Wimmen said the cholera outbreak bore no resemblance to the coronavirus pandemic, which shut down Lebanon for months in 2021.

"Cholera can be treated, the country is small enough for people to reach medical facilities, and the government has promised to cover the treatment costs," he said.

UNICEF spokesperson Ettie Higgins told DW that the different protections for the coronavirus and cholera could cause confusion.

"Much of the population was aware of COVID-19 safety measures but not of those of cholera which has a much faster transmission speed," she said.

Wimmen isn't too worried about catching cholera himself, as the bacteria are not often dangerous for adults in good health who have the means and the information to seek immediate medical attention.

"The worry is for people who are already highly vulnerable and who may have to rely on unsafe water for lack of means," Wimmen said.

Lebanon's drinking water crisis

Jennifer Holleis
Jennifer Holleis Editor and commentator focusing on the Middle East and North Africa