A Syrian camp in the Bebnine area of Akkar during Lebanon’s cholera outbreak in November 2022. (Credit: Nicholas Frakes)
BEIRUT — As cholera cases surge across the border in Syria, Lebanon — with no cases detected — continues to take proactive measures to prevent the outbreak from spreading to it, as it did in 2022. Lebanon's Health Ministry has been conducting a vaccination campaign for three weeks, targeting high-risk areas.
Between October 2022 and January 2023, a cholera outbreak occurred in Lebanon, with 671 confirmed cases and 23 deaths. However, no cases of cholera have been reported in Lebanon this year, Head of the Preventive Medicine Department at the Health Ministry Atika Berri confirmed to L'Orient Today.
This was also confirmed by the World Health Organization (WHO) representative in Lebanon, Abdinasir Abubakar. He added that, however, "Lebanon's public health landscape is severely challenged by vulnerabilities in water and sanitation infrastructure," conditions that "create a persistent risk of outbreak hence the urgent need for preventive measures."
The WHO is part of the national cholera task force and has distributed lab supplies and training to key hospitals, in collaboration with the Health Ministry.
The Cholera threat
Cholera is an acute diarrheal disease caused by the bacterium Vibrio cholerae, primarily spread through contaminated water or food. The disease can lead to severe dehydration and death if not treated promptly. However, cholera is generally easily treatable by administering an oral rehydration solution. Severely dehydrated patients are at risk of shock and require the rapid administration of intravenous fluids.
While many infected individuals do not exhibit symptoms, the bacteria can still spread through their feces, posing a risk to others.
The rapid transmission of cholera is often exacerbated by inadequate sanitation and lack of access to clean water, issues that are particularly prevalent in regions hosting displaced populations.
Vaccination campaign
The current vaccination initiative is financially supported by various organizations, including UNICEF and the United Nations High Commissioner for Refugees (UNHCR). A team from the ministry has been administering the vaccine in the neighborhoods of Amrousieh and Hay al-Sellom in southern Beirut, Halba, Bibnine, and Deir Daloum in Akkar, Bar Elias, Qabb Elias, and Saadnayel in Bekaa, as well as in Arsal (Baalbeck-Hermel).
A team from the ministry has been administering the Oral Cholera Vaccine (OCV) in the neighborhoods of Amrousieh and Hay al-Sellom in southern Beirut, Halba, Bibnine, and Deir Daloum in Akkar, Bar Elias, Qabb Elias, and Saadnayel in Bekaa, as well as in Arsal (Baalbeck-Hermel).
Targeted areas include the 2022-2023 cholera epicenter in Akkar, Baalbek-Hermel, and northern regions such as Tripoli and Miniyeh-Dinnieh. These areas host vulnerable communities residing in areas with poor infrastructure and refugees living in informal settlements with poor sanitation and water conditions, Berri explained.
The vaccine can be administered to anyone aged one year and above, the ministry has said in a statement. The ministry has urged residents of the abovementioned areas to get vaccinated, even if they have already done so two years ago during a previous campaign.
Last week, the Ministry announced that it has administered 133,887 vaccines since the start of the campaign. Vaccination is carried out on the ground by 133 ministry teams, in partnership with Médecins Sans Frontières, the Amel Association and the NGO Medair.
"Cholera vaccines are in short supply globally, making it particularly fortunate for Lebanon to have access to this crucial preventive measure," Abubakar said.
In addition to vaccination, the WHO representative advised citizens to ensure safe drinking water from treated sources, avoid risky foods by consuming only well-cooked meals prepared in clean conditions, and practice good hygiene by washing hands thoroughly with soap and clean water.
Water inspection in North Lebanon
During the country's 2022-2023 cholera outbreak, experts placed much blame for the disease spread on water sources.
A July 2022 UNICEF report warned that most Lebanese households depend on bottled water for their drinking needs, in part because of concerns over the quality of tap water.
Gaby Nasr is head of the technical department at the North Lebanon Water Establishment (NLWE), the country’s third largest water network, with more than 560,000 people connected. His jurisdiction includes the epicenter of the last cholera outbreak.
Nasr confirmed to L'Orient Today that cholera was not detected in any of the establishment's water sources in the north.
He said that all of their network’s water sources are equipped with sampling stations to test the water quality — a central lab in Tripoli and eight others, one for each northern district, Batroun, Zgharta, Halba, Koura, Bsharri, Minyeh, Dinnieh and Qobeiyat.
"The lab is well-equipped and can test for all sorts of bacteria and diseases except for heavy metals. For that, we send our samples to different labs, such as those at the American University of Beirut," Nasr explained.
"We test samples from water stations every day and samples from crude water twice a month," he added.
The water is treated with one of three types of chlorine: Powder, liquid, or gas. While all three types have the same effect, liquid chlorine is used in overcrowded areas, for instance, to avoid dispersing gas that could affect residents, Nasr explained.
While cholera wasn't detected in any of the NLWE's water sources, Nasr pointed out that many rely on privately supplied water from unregulated sources.
In a statement on Thursday, the health minister inspected the work of the Ministry's epidemiological surveillance team, who are also conducting periodic tests on drinking water in the North.
Abiad pointed out "the irregularity of pumping water due to the lack of electricity ... and the lack of chlorine usage for sterilization, stressing the need for cooperation between primary health care centers and government hospitals in order to confront and address these issues."
For his part, Nasr said that the lack of electricity is a major hurdle in pumping water. "Around 50 of the total 200 wells in the North are now powered by solar energy. We also have 145 standby generators but we cannot operate them 24 hours a day."