In an attempt to trace patient zero for cholera in Lebanon, it is not enough to look only to Syria, but also to Iraq, where northern provinces are experiencing a new outbreak of the disease that hasn’t occurred in ten years, without any recorded deaths so far. In Syria, close to the Lebanese border, cholera is spreading significantly. To combat it, the Syrian state has established initial response hospitals and clinics dedicated solely to rehydrating patients (administration of infusions), located in Tartus, Qusair, and the mountainous villages along the eastern chain. However, the most affected areas are the northern provinces, particularly Raqqa and Deir ez-Zor, where the number of suspected cases exceeds a thousand in each district of the province, and where specialized cholera treatment hospitals have been set up, bringing the total to 14.
Previous cases lead to the conclusion that despite the state of emergency in a neighboring country, the movement of people across its borders remained normal, showing no exceptional measures. Therefore, the arrival of cholera in Lebanon was only a matter of time, and it developed in Lebanon due to the collapse of health services in the country as a result of the economic crisis. The unrestricted movement of people between outbreak hotspots and unaffected areas will inevitably lead to wider spread across the Lebanese map. Just yesterday, southern suburbs and the village of Zefta were added to the list of cases, and it is not ruled out that other areas will join in the coming days if the treatment is left solely to awareness campaigns, without addressing the underlying causes related to electricity availability, operation of water treatment plants, and water distribution.
Returning to Syria, cholera has been spreading alarmingly for about three months in 9 out of 14 provinces, with reports from the UN Office for the Coordination of Humanitarian Affairs recording 5,856 cases of severe watery diarrhea, of which 43 have died, in addition to the 16,000 cases recorded officially. Cholera has thus infiltrated Lebanon completely unnoticed by the state and its agencies, which acted as if Lebanon were an isolated island. Due to poor sewage conditions, cholera will surely spread unless a true health emergency is declared, and electricity returns to the infected areas, at least to ensure water purification and disinfection. The responsibility here does not rest solely with the medical system, which addresses the consequences, not the causes. Declaring a health emergency first necessitates the establishment of field hospitals dedicated exclusively to treating cholera patients, without accepting other cases to prevent contagion and spread among patients.
Perhaps the most dangerous aspect of cholera is its spread in impoverished areas with weak healthcare services and dilapidated infrastructure. Moreover, the lack of community awareness regarding the prevalent epidemic contributes to its spread, as patients often claim that what they are experiencing today is merely “ordinary diarrhea,” similar to claims made during the coronavirus pandemic when symptoms were compared to those of the flu.
### The Role of Turkey
Cholera is also spreading in many conflict hotspots around the world, and Philippe Barboza, head of the cholera response team within the World Health Organization, has warned of “new cholera outbreaks that are larger and more deadly,” with a death rate three times higher in the poorest regions where primary medical care is not provided promptly. In Syria and Iraq, it is also essential to highlight Turkey's role as an influencing factor in the return of the disease, through the repeated lowering of the Euphrates River level, even cutting off water to Hassakeh province more than 30 times, driving people there to search for unsafe water sources that led to a significant spread of cholera.
