'We’re scared to send our children to school': Cholera outbreak threatens Syria and the region  

A rare cholera outbreak has left dozens dead and thousands falling ill – predominantly in Aleppo and northeastern Syria – with health officials scrambling to contain the quickly spreading crisis and families fearing for their children’s safety at schools.

After sluggishly recovering from a devastating Covid-19 pandemic, the emerging cholera crisis promises to push the country’s crippled health service to the absolute limit.

UN officials expressed their concern about the crisis worsening and potentially escalating beyond Syria, in the words of the UN’s Humanitarian Coordinator on Syria Imran Riza, this outbreak “threatens the whole region.”

"Most of those who got sick had really bad diarrhoea and vomiting, it was unbearable”

Cholera is an infectious disease that is often contracted from contaminated water supplies and is potentially fatal if not treated immediately.

In Aleppo, Majida, a 37-year-old part-time textiles worker, says the outbreak has been terrible for her neighbourhood and she was reluctant to send her children to school.

“Several people in my block of flats got it [cholera], we thought it was like Covid-19 but this was different. One old man we know even died, they didn’t know what it was. Most of those who got sick had really bad diarrhoea and vomiting, it was unbearable.”

She continued: “I have two children and when school re-opened [in early September] after summer and we heard about the disease I didn’t send them for almost ten days, now its better because the school has taken heavy precautions, but you can imagine we were scared to send our kids to school.”

Contaminated water supply

While the disease may have caught many by surprise, its causes are rooted in the deficiencies in Syria’s water supply and treatment infrastructure.

People were drinking unsafe water from the Euphrates River and in turn, used the contaminated water to irrigate crops, which led to the food becoming infected and as the supply chain continued normally, people became ill as the disease spread.

The lack of water-treatment technology in Aleppo due to the treatment facilities lacking parts or maintenance to operate at full capacity allowed for cholera to grow and spread.

After reports of deaths came in thick and fast, Syrian health authorities immediately banned certain water-based vegetables and foods such as parsley, mint, watercress, lettuce, tomato, radish, and cucumber.

"Stores and markets were banned from selling salads and restaurants were stopped from serving certain vegetables in meals to lessen the risk of the spread of disease"

In Damascus – which hasn’t reported an outbreak thus far – stores and markets were banned from selling salads and restaurants were stopped from serving certain vegetables in meals to lessen the risk of the spread of disease.

Drinking water pumped by the Aleppo Water Company in Northern Syria is treated and safe, yet well water inside the city is close to sewage water and contaminated, leaving little time to take action to stop any further outbreak.

The Director of Aleppo Health, Dr Ziad Hajj Taha, has urged those feeling unwell to visit hospitals immediately, stating that "the deaths of an elderly couple due to cholera had been due to their reluctance or delay in visiting the hospital.”

“The danger lies in not going to the hospital directly, especially when diarrhoea or vomiting occurs as it is possible to obtain treatment from a single dose and be cured immediately. After five days of diarrhoea, the elderly couple lost large amounts of fluids, latterly suffering from kidney failure and severe dehydration, then death,” he explained.

Amal Rahmouni [26] is a nurse working at one of Aleppo’s major hospitals, she describes the situation: “A lot of people were not aware of cholera or how it was being transmitted, but it’s serious and we need to increase awareness of what to do.”

She continued: “I’ve seen people dying because of this, some come in and don’t even know what they have. Cases of those who were sick came in and we registered them, but many didn’t, so we don’t have a precise number. I would say that unofficial cases could be in the thousands, but they all suffer the same – heavy vomiting, bad diarrhoea and dangerous levels of dehydration.”

“A lot of people were not aware of cholera or how it was being transmitted, but it’s serious and we need to increase awareness of what to do”

A quick response?

Despite the rapidly growing crisis which had a semi-official UN account of around 900 cases in Syria, some measures have been taken to stem the infection rate.

The Ministry of Health in Damascus promised that it is "carrying out epidemiological surveillance of the disease around the clock and taking appropriate measures to surround it in cooperation with the concerned authorities.”

It was also noted that provisions have been taken in hospitals, “treatment is available in all its forms, and hospitals have been strengthened and provided with an additional stock of treatment in anticipation of any increase in cases.”

This comes as several cholera cases in the city of Lattakia were announced which has led to a campaign to raise awareness on how to prevent the spread of the disease.

Ahmed Al-Mandhari, the World Health Organisation's [WHO] regional director was highly concerned, stating: “It [cholera] is a threat to Syria, to the region, (to) neighbouring countries and the whole world.”

The WHO confirmed it will send a plane load of supplies to deal with the crisis and another will follow in due time.  

The head of the European Union mission to Damascus, Dan Stoenescu, also stated his concern at the outbreak. “Access to safe drinking water and sanitation are internationally recognised human rights. There is a serious need to contain this outbreak before it spreads further and affects even more people in the whole of Syria and the region.”

The return of cholera – last seen before the war in 2011 – is another step back for the country. Syria’s pro-government al-Watan newspaper described it as “The disease that Syria bid farewell to 14 years ago, returns.”

Seemingly it will take another monumental effort for it to disappear again.

Danny Makki is an analyst covering the internal dynamics of the conflict in Syria, he specialises in Syria’s relations with Russia and Iran.

Follow him on Twitter: @danny_makki