Enab Baladi – Christina al-Shammas

The workshop organized by the Syrian Ministry of Health in collaboration with the World Health Organization (WHO) last week in Damascus was not just an awareness-raising event about cholera. It included serious discussions about the fears and challenges related to the potential spread of the disease in the near future in Syria.

Under the title “Identifying Priority Areas for Multi-sectoral Interventions to Combat Cholera in Syria,” the workshop, held from May 11 and lasting three days, discussed the epidemiological investigation of the disease, the importance of health awareness about its risks, prevention methods, and infection control measures.

The cholera epidemic poses a real threat to public health, given the challenges facing the health sector in Syria, prompting the Ministry of Health to race against time to address it.

Dr. Razan Tarabishi, Director of the Primary Health Care Directorate, told Enab Baladi that there are concerns about the spread of cholera due to weak infrastructure and a lack of supplies of clean and sterilized water.

She added that the significant challenges lie in changing personal behaviors, especially regarding the storage, preparation, and handling of food products, which increases the likelihood of the spread of epidemic diseases.

Tarabishi explained that the workshop’s outcomes focused on identifying high-priority areas for rapid intervention to implement environmental health measures, the need to monitor and chlorinate drinking water, the application of oral vaccines, improving environmental sanitation, and conducting health, environmental, and population surveys.

She identified several areas as being at high risk for cholera spread, which are more likely to record high numbers of cases, increasing infection and mortality rates in the event of an outbreak, and thus they are given top priority.

Health ministry plans

The Director of Primary Health Care discussed the Syrian Health Ministry’s plans to take preventive measures against cholera in coordination with relevant authorities to monitor the chlorination of drinking water and provide clean water to citizens.

She also emphasized the importance of health education and educating citizens to adhere to healthy practices, ensuring hospitals are prepared to receive confirmed cases and providing the necessary logistics, in addition to implementing the correct treatment protocols.

She stressed the importance of continuous cooperation with relevant authorities to ensure regular garbage collection, monitor water tankers, and implement environmental repair operations.

Challenges in the health sector

Tarabishi pointed out several challenges facing the ministry, most notably:

• Weak financial resources.
• Lack of trained health personnel.
• Reliance on central laboratories and the non-activation of peripheral laboratories.
• Difficulty in changing behavior and habits, which takes time.
• Poor and dilapidated sewage network, causing the leakage of contaminated water and mixing with drinking water.
• Delays in taking preventive measures, leading to increased disease spread.

Multi-sectoral response

Dr. Yasser al-Farouh, Director of the Communicable Diseases Department in the Ministry of Health, told Enab Baladi that priority areas have been identified in collaboration with the World Health Organization, based on data and statistics from the previous two epidemics between 2022 and 2024. This helped outline a clear plan for future response.

He clarified that combating cholera requires a multi-sectoral response, through the collaboration of the Ministry of Health, the World Health Organization, the Public Water Authority in the Ministry of Energy, and UN organizations such as UNICEF.

There are risk factors that signal an impending epidemic, most notably water scarcity and the lack of safe sources of drinking water in some areas, which requires an immediate response from all sectors.

Dr. Yasser al-Farouh, Director of the Communicable Diseases Department

First line of defense

Mohammad al-Haj, Director of Drinking Water at the Public Water Authority affiliated with the Ministry of Energy, stated that the classification of priority areas was based on infrastructure, risk levels, and surrounding conditions.

He confirmed joint efforts with health personnel to assess the areas, identify intervention priorities, and determine the needs of water and sewage laboratories, while developing a contingency plan to limit the spread of the epidemic.

Al-Haj noted that the Public Water Authority is responsible for providing drinking water and sewage services, representing “the first line of defense” to ensure public health and prevent disease spread.

Urgent need for surveillance system

Dr. Mohammed Yasser al-Idlibi, Director of Early Warning Data for Rapid Response, indicated that the central epidemiological investigation team in the Ministry of Health is working to enhance integrated epidemiological surveillance.

He explained that the surveillance system is fundamental for preparing the national plan, which is built around any emerging disease like cholera, through which rapid response scenarios are developed and circulated to all health directorates.

Al-Idlibi confirmed that surveillance helps estimate the annual vaccine needs, determine the quantities required for each governorate, and activate the oral vaccine as a preventive measure.

He added that rapid response teams regularly monitor suspected cases of communicable diseases.

What is cholera?

Dr. Akram Khoulani, a family medicine specialist and member of the American Academy of Family Physicians (AAFP), told Enab Baladi that cholera is a bacterial infection that affects the small intestine due to ingesting large quantities of bacteria.

He explained that some bacteria are killed by stomach acids, while others settle in the intestine and multiply, producing toxins that lead to significant losses of water and salts, causing severe watery diarrhea.

He pointed out that the infection is transmitted through the consumption of exposed food or contaminated drinks or unfit water, especially when sewage spills into drinking water networks or when tanks become contaminated.

Approximately 20% of infected cases show severe symptoms such as vomiting and diarrhea, which can lead to acute dehydration that results in death in half of the cases if untreated, while deaths drop below 1% with appropriate treatment.

Treatment methods

Treatment is primarily focused on fluid replacement:

• In mild cases: Oral rehydration solutions are given and achieve response within 3–6 days.
• In severe cases: Fluids are given intravenously due to large losses of water, which requires rapid emergency treatment.

Additionally, patients receive antibiotics to reduce diarrhea, along with zinc supplements.

Prevention methods

• Properly disinfect vegetables and fruits.
• Boil water before use.
• Avoid drinking unsafe water.
• Wash hands with soap and water for at least 20 seconds.
• Cook food thoroughly.
• Do not consume exposed food.
• Maintain housing cleanliness and avoid shared bathrooms.
• Administer vaccines in outbreak areas.