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New York, USA, 21 September 2022 —  The ̽����ѡ has warned today of a new crisis in Syria, as the first confirmed cholera outbreak in years continues to grow at a rapid pace.  

Suspected cholera cases have risen to 2,092 in the northeast of Syria (NES) since the outbreak was announced on 10 September according to the NES NGO Health Working Group. So far there have been 10 reported deaths. There are fears that there is likely to be a significant under-reporting of suspected cases, not only in the northeast but in other areas across the north of the country. If left unchecked the numbers of people getting severely sick will continue to increase. 

Cholera is caused by ingesting contaminated water or food - something that can be hard to avoid in times of drought, conflict or over-crowding. The disease can spread quickly in contexts such as Syria where there are currently more than 7 million internally displaced persons. Many are living together in small tents and makeshift homes, with limited access to basic services such as safe water, latrines, washing facilities and rubbish disposal.  

Access to safe drinking water is a huge challenge in the war-torn country. There is now 40% less drinking water than before the conflict began over a decade ago. Water scarcity is being further compounded by climate change. The cause of the cholera outbreak is suspected to be contaminated water from the Euphrates River, which is the main water source for between 800,000 - 1.2 million people. In the rural areas of Syria, the piped water supply does not meet the basic needs of the population, and many are left looking for alternative sources. Because of the combined effect of infrastructure breakdown and scarcity of water, an increasing proportion of the population depends on trucked water, often provided by private companies that are not regulated, expensive, and use unprotected water sources such as the Euphrates, where sewage is discharged directly into the river. 

Tanya Evans, the ̽����ѡ’s Country Director in Syria, said: 

“The outbreak of cholera threatens more misery on hundreds of thousands of Syrians already at risk from hunger, conflict and the coming winter. Across the country some 70% of the population now need help to meet their basic survival needs. A decade of conflict has left the healthcare system in Syria extremely fragile and severely under resourced, making it much harder to mobilise a response to any potential epidemics or outbreaks such as this. Despite the vast needs both levels of funding and the political attention required to address the crisis are diminishing. This outbreak of cholera demonstrates how now, more than ever, we must not neglect Syria.” 

The impact of the conflict on Syria’s health system has, more than 70% of the total population in the country. Almost half of those in need of health support are in the northeast (NES) where we are currently seeing the highest concentration of cholera cases, and in northwest Syria (NWS), an area almost exclusively reliant on cross-border health assistance. Across the country, only 65% of hospitals and 56% of public health care centres are fully functional.  

The ̽����ѡ has been working to provide essential supplies for cholera prevention, control, and treatment to all health facilities with which we work in Syria. These interventions include training of clinical staff and community health workers on case detection, management, and referral, as well as health education and hygiene awareness through house-to-house visits, and distribution of oral rehydration therapy and ZINC tablets at the community level.  

With swift and urgent action now critical, the ̽����ѡ calls on the international community for immediate additional funding to water, sanitation and hygiene projects (WASH) as well as further support to health actors, for supplies, equipment and cholera treatment facilities to try to halt the spread before the situation becomes even more dire.  

The ̽����ѡ has been working in Syria since 2012, responding to needs in the northwest and northeast. The ̽����ѡ promotes economic recovery with job training, apprenticeships and small business support. ̽����ѡ teams support early childhood development and provide counselling and protection services for women and children, particularly for survivors of violence. We support health facilities and mobile health teams with lifesaving trauma services, and with primary, reproductive and mental health services. Our COVID-19 response includes promoting awareness campaigns and training health workers in infection prevention and control. The ̽����ѡ also supports Syrian refugees in Jordan, Iraq and Lebanon. 

According to the WHO, no cases of cholera had been reported in Syria since 2009. 

As of 19 September, according to the NES NGO Health Working Group, health facilities across Northeast Syria have reported a total of 2,092 suspected cases of acute watery diarrhea (suspected cholera), since the beginning of the cholera outbreak on 4 September. This includes 311 new suspected cholera cases reported on 18 September and 646 on 19 September. A total of 94 cases have been confirmed as cholera out of 219 processed samples (positivity rate of 42.5%). There are 10 reported cholera-related deaths (4 in Deir ez-Zor; 2 in Raqqa; 2 in Shahbaa and 2 in Hasakah).