Lebanon tackles deadly cholera outbreak, the latest crisis plaguing the country

Rawan is turning 11 months old. But instead of celebrating, she and her mother, Amini Walid Aysa, are fighting off a cholera infection in a hospital in Akkar, in northern Lebanon.

"All the water is gone from her system," Amini, 30, told CBC News as she fed her baby a bottle filled with a bright-orange liquid, careful not to tangle the IVs in her arms.

Amini fell sick five days before her daughter, who also has spina bifida. "When I saw her, I got even more sick — I broke down," she said, pointing to the bags under her eyes.

The family is one of many recovering from the waterborne bacteria in this hospital. Relatives, friends and neighbours cross the hallway, visiting loved ones distributed in several rooms.

After being eradicated for 30 years, cholera took Lebanon by surprise. In less than a month, it killed 18 people and caused 2,250 infections since the first case was detected on Oct. 6. The outbreak that originated in Afghanistan travelled across the region until it crossed the border from Syria into Northern Lebanon, where Lebanese and refugees live under severe poverty levels.

In October, the World Health Organization warned that they've seen an "unprecedented rise" in Cholera outbreaks this year, due to floods, droughts, conflict, population movements and "other factors that limit access to clean water." They noted cases in 29 countries, with fatalities rising sharply.

The acute diarrhoeal disease can kill within hours if not treated.

Water supply compromised

"We've seen a rapid spread in vulnerable communities that are living in tented settlements that perhaps don't have access to clean running water all the time," Ettie Higgins, deputy representative for UNICEF in Lebanon, told CBC News from her office in Beirut. 

"Then what we're seeing is families resorting to other sources to look for water. And in some cases, they're buying water from illegal wells and perhaps are taking the water from contaminated rivers," she explained. 

Lebanon has a refugee crisis, hosting the highest number of refugees per capita worldwide, according to the UN Refugee Agency. The majority are from Syria, and are living in extreme poverty.

At the same time, Lebanon's water supply has been severely compromised by the country's economic collapse, which is now in its third year and has seen everyday items become unaffordable and banks tying up the savings of millions of people. The government has run out of cash to buy fuel to feed the country's power plants, meaning there's little to no electricity to keep water treatment stations running and to pump it into households. 

Lebanese Health Minister Firas Abiad told CBC News the current cholera outbreak "is a reflection of the status of our water and sanitation in Lebanon because of years of low investment."

The same applies to waste management, Abiad said, and the consequence is wastewater mixing with drinking water. 

"All of that is obviously making it easier for the outbreak to spread," he said.

'Not a disease that you can defeat in hospitals'

Cholera cases have now been detected across the country, including in the capital, although the government says the cases in Beirut and most of the country were "imported" from the epicentre in the northern regions.

The government's priority is to stem further spread of the bacteria. It has been distributing chlorine tablets among the most affected communities and installing water filters in hospitals and local water sources.

However, Abiad said he recognizes, "at the end of the day cholera is not a disease that you can defeat in hospitals."

"That's why we're working a lot on trying to, for example, restore or bring back electricity to the water pumping stations, or to the wastewater management facilities, so that at least we can decrease the opportunity for contamination and increase the supply of decontaminated water to the population," he said.

But the health minister added he's aware that any kind of deep reform of the water sector is unlikely in crisis-hit Lebanon, which has also been plagued with systemic government corruption.

He has recently warned that, if not stopped soon, cholera could become endemic to Lebanon, meaning it would become consistently present in the country.

And this concern grows ahead of the wet season. As the first winter rains have started, so have the posting of videos on social media showing rivers of brown rain water flowing through piles of garbage.

"We're going to see a big increase in rainfall … and there's a high likelihood that the spread will be even more rapid, because we will see sewers overflowing. Already we have wastewater treatment plants that are not operating effectively; we are seeing some of the lifting stations along the shoreline, spilling over with sewage and fluid; wastewater still being used to irrigate crops," Higgins said.

"The way we see it, now, it has the potential to get much, much worse." 

Lebanon's cycle of crisis has also weakened the country's health system, once one of the most revered in the region. Thousands of health-care workers have left the country and there are medicine shortages across the board.

On Oct. 31, the WHO said the "situation in Lebanon is fragile as the country already struggles to fight other crises — compounded by prolonged political and economic deterioration." 

'I was feeling like I was dying'

Lebanese hospitals are already feeling the pressure of this outbreak. The Abdallah El Rassi Governmental Hospital, where Amini and Rawan are slowly recovering, is one of them.

Chief Nurse Rola Moussa is running the cholera-dedicated ward, which used to be used for general surgery patients. All of its 16 rooms are already occupied with cholera patients.

"In the beginning of the outbreak, we had to start sending patients to other hospitals, like Tripoli," Moussa said. 

Wael Hussein, 27, has just arrived at the hospital. His hospital roommate, Adel Jaafar, is about to be discharged. Both men are surrounded by worried family members, though everyone is happy for Jaafar's improvement.

"I was feeling like I was dying, I was fainting. Today I'm feeling better, thank God," Jaafar said.

Moussa says it won't take long for someone else to take Jaafar's place: "[The rooms are] always complete. When a patient is out another patient is in."

The government has since set up a field hospital nearby to cope with the growing number of cases. The 500 beds in the emergency facility were filled in a matter of days. Officials are now setting up a second field hospital in the area. 

Still, the experienced nurse said she's not easily scared. After COVID-19, she said, this situation is manageable: cholera is less contagious and treatment is cheaper and simpler. Her team hasn't faced any shortages — "so far." 

Lebanon is set to receive 600,000 vaccines soon, which will be distributed in the most affected areas, as part of the government plan to curb the outbreak.