3 people have died in Deir ez-Zor and Raqqa due to cholera

The Health Board of AANES has announced that 3 people have died in Deir ez-Zor and Raqqa due to cholera, and reportedly hundreds of others have developed symptoms over the past few days.

There has been a reported lack of water sterilization and filtering at water stations over the past few months, as well as unhygienic waste disposal practices, leading to contamination in drinking water supplies.

This situation is linked to the declining water flow in the Euphrates River. Cholera is a water-borne bacteria and reduced freshwater supply is associated with increased risk of cholera outbreaks.

Since January 2021 the flow of water in the Euphrates River entering NES from Turkey has dropped considerably, falling below 200 m³/s, despite a 1987 Syria-Turkey agreement which stipulated that Turkey will not reduce the amount of water flowing into Syria below 400 m³/s.

Turkey has continued constructing irrigation and energy projects on the Euphrates, giving it the ability to heavily restrict the water flow into NES and weaponize its position as an upstream state.

Turkey has also refused to sign the 1997 UN Water Convention and was one of only three countries to vote against it in the UN General Assembly. This convention requires countries to share rivers equitably and not cause significant harm to co-riparian states.

The falling level of the Euphrates has affected the operations of NES’ 3 dams, with dam turbines becoming inoperable as water flow is too little. Water stations have been forced to reduce or completely stop their activity.

Fawaz Awad al-Atish, the deputy director of the Drinking Water Directorate, recently commented that 65 water stations in Deir ez-Zor have been forced to cut their operating hours due to the decreasing level of the Euphrates River.

Tishreen dam director and engineer Hammoud al-Hamadin has explained that when water flow is reduced in a river, contaminants, pollutants and waste concentrations are higher. River levels dropping also creates some stagnant pools and quagmires where bacterial pathogens can thrive.

Furthermore, when water is reduced in quantity and usual sources run dry, as has been the case with the Euphrates in NES, people are forced to revert to risky drinking behaviours, consuming unclean water.

This is not the first instance of disease outbreak due to Turkey restricting the Euphrates’ flow: cases of leishmaniasis have risen sharply, since the sandflies which spread the disease thrive around swampy, drying riverbeds.

Furthermore, in June 2021, the Chief Physician at Heseke’s Public Hospital shared that they were dealing with over one hundred cases of diarrhoea and water-borne illness every day.

Walat Darwish, the co-chair of AANES’ Energy Office recently commented that, “[NES’] population depends heavily on the Euphrates River in their daily lives, whether it is with drinking water, agriculture, fisheries, energy, and the lack of water negatively affects [their] lives”

The Health Committee in western Deir ez-Zor has made a distress appeal to the concerned authorities and NGOs to support the health sector and provide health aid such as medical supplies, serums, and beds, amidst rising cases of cholera.

With an estimated new 38-46 infections per day, the local Al-Kasra hospital cannot accommodate all cases. The total number of cases in Deir ez-Zor has exceeded 300.

Following a rapid assessment conducted by health authorities, the source of the outbreak is reported to be unsafe water from the Euphrates River being used for drinking and irrigating crops. Warnings against using unsterilized Euphrates water are now in place.

Yesterday, WHO delivered 30 tons of medical supplies to Damascus to deal with the outbreak, and another load of aid is reported to arrive tomorrow, yet no aid has been directly delivered to NES. WHO refuses to support AANES as an independent body.

In recent years, only a small fraction of the aid sent to Damascus has ever reached NES. In the context of the COVID-19 pandemic, RIC detailed the consequences of the failure of international bodies to ensure aid can directly reach AANES

The outbreak is not confined to NES. A recent CARE International report stated that 5 out of 14 Syrian provinces have cases; a number that has since risen to 7, with the first NW Syria case confirmed today, in Jarablus.

Yet, Jolien Veldwijk, CARE’s Syria Country Director, stated that in NES, “the risk of rapid and wide transmission of the disease is very high and poses a serious threat”, as “70% of people in NES rely on unsafe water sources and have very poor hygiene and sanitation conditions.”

There have been over 700 infections in NES since the start of the outbreak, and 4 people have died. In Heseke and Shehba particularly, a lack of safe water sources was already a problem prior to the outbreak, making these areas particularly vulnerable to illness epidemics.

In Heseke, people have reportedly been drinking water from tankers filled from wells that are left unwatched and untreated. This is because the Turkish-backed SNA cut the water supply from Alouk Station, which normally feeds the city.

Heseke is currently experiencing another water crisis due to the Turkish-backed forces near Sere Kaniye disrupting the water supply from Alouk station. Alouk provides clean drinking water to an estimated 460,000 civilians. Since the 20th of July the station has been inoperative.

Alouk station is located within territory controlled by Turkey. AANES negotiated access through a Russian-brokered deal in 2019, in which AANES will feed the occupied territories electricity from its power station in Darbasiyah, in exchange for water from Alouk.

In Shehba, residents also depend on unsafe wells for drinking water, because provision by humanitarian NGOs is limited or none. The confirmed number of infections is 40, whilst over 100 more people have symptoms.

The SAR government has imposed levies on medicines entering Shehba, so they are very expensive. Furthermore, this outbreak comes at a time when IDP camps in Shehba report that 812 families lack a heater or sufficient blankets for the coming winter.