Two confirmed cases of cholera and dozens of others with hepatitis A. This is not the final tally of two epidemics reemerging in the country after a long absence, but rather the beginning of what is to come, whether in terms of rising numbers of cholera and hepatitis cases or the emergence of new epidemics. "This is a natural certainty," says infectious diseases specialist Dr. Abdel Rahman Al-Bizri, adding that it is "natural."
**Global Causes**
The decisive tone in Al-Bizri’s speech stems from a series of accumulated causes that have led us to this point. He first points to global factors that have resulted in the emergence of new viruses and epidemics, or "what is called the new behavior of old epidemics like monkeypox," which has occurred in many countries including Lebanon. Secondly, there are local factors that have created an environment conducive to the reappearance of old epidemics, including the newly emerging cholera epidemic after thirty years (the last recorded case in Lebanon was in 1993).
On a global level, Al-Bizri outlines four main causes: the first being human expansion and encroachment on nature—specifically tropical forests—where humans have acted as incidental hosts in that environment, affecting the life cycles of viruses. Next is the issue of global warming; "some diseases require vectors (rodents), and heat alters the distribution map of vectors, contributing to the emergence of varieties in areas where they did not previously exist, leading to the appearance of diseases there." The last two causes are related to changes in habits and lifestyles on one hand, and the ease of travel on the other, which in turn allows for the rapid spread of epidemics and diseases between countries.
**Local Causes**
However, all these reasons, despite their significance, are not sufficient to justify the arrival of cholera in Lebanon, even though it may have been imported from Syria, where the number of infections has exceeded ten thousand. There are local reasons that have led to cholera today being "half imported and half local." Al-Bizri attributes the local causes to the political collapse which has affected various state institutions, most importantly the breakdown of the healthcare service structure. Today, most Lebanese areas lack clean drinking water and electricity, which reflects poorly on food security and lacks public oversight "with sewerage systems in disrepair." This equation undoubtedly leads to hepatitis, cholera, and other diseases. Based on this, and due to the failure of healthcare services, Lebanon "is susceptible to epidemics related to infrastructure maintenance," Al-Bizri asserts.
Open and uncontrolled borders also play a role in the emergence of cholera. Al-Bizri references the neighboring country where cases of polio recently appeared, and "since August we have been monitoring the emergence of cholera there, particularly in government-controlled areas where services are less effective."
There are additional significant factors related to answering a fundamental question: what kind of generation are we "educating" today in terms of health? Recent studies indicate a decrease in vaccination rates among children to around 40%, meaning we face a generation without immunity and exposed to contracting epidemics and viruses more rapidly. Al-Bizri fears the coming winter under these dilapidated conditions, "especially if it is as heavy as last year, as sewage systems may overflow in many areas, worsening those diseases."
In addition to all these reasons, the lack of resources in all state agencies contributes to the problem, while solutions lie in one place: addressing the healthcare infrastructure. By doing so, "we could hit two birds with one stone, restoring the sector and eliminating epidemics."
