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Cholera on the Euphrates: water scarcity and public health in northern Syria

Um Ahmad is among one of the many displaced caregivers in Syria who are facing a water and sanitation crisis. Photo: CARE

Um Ahmad is among one of the many displaced caregivers in Syria who are facing a water and sanitation crisis. Photo: CARE

The first confirmed case came in September, 2022.

Then came an official alert from the Deir ez-Zor, a governorate in northeast Syria that straddles both banks of the Euphrates – which, along with its twin Tigris River, were pivotal in the development of all Mesopotamian civilizations.

Now, the ancient river was linked to a potentially devastating crisis.


The Euphrates river in Türkiye. Photo: Carole Raddato via WikiCommons

The Euphrates runs diagonally from north to south Syria through the eastern region and depends on the downstream flow of water from Türkiye, as well as seasonal rainfall, to replenish its water levels.

The Euphrates is the single most important source of water for an estimated 5.5 million people in the governorates of Aleppo, Deir ez-Zor and Raqqa.

Because so many people rely on the Euphrates for drinking water, sanitation, and irrigation, and because cholera is a fast-moving bacterial infection transmitted through contaminated water and food, the region was particularly vulnerable to an outbreak.

The regional conflict, lack of adequate sewage disposal and treatment systems, as well as record low water levels caused by historically poor rainfall have all made the situation even more precarious.

Many of the communities in the northeast have told CARE that the water they’ve been getting from the Euphrates is dirty and smells bad, but that they can’t afford filtered water, so they are forced to still drink from the river and use its waters to irrigate their crops.

Over the span of seven months, between August 25, 2022 and January 21, 2023, approximately 85,000 suspected cholera cases were reported across Syria, with a fatality rate of 0.12 percent. Cases in northeast Syria represent 48% of the total number, Deir ez-Zor (24.43 percent) and Raqqa (19.34 percent).

Children are the most affected, and many parents have told CARE that once their children are infected, they don’t have money to pay for treatment.

Four years ago, Abdul-Ghafour, 65, and his family were forced to leave their land and home, fleeing to a camp housing displaced people, where now water quality and sanitation are major concerns. Photo: CARE

A precious resource

For many people in the northeast region, including the internally displaced living in camps, water is not accessible at the turn of the tap.

Water is treated as a commodity to be communally shared and rationed.

This means that water is stored in tanks and jerrycans, often becoming stagnant and contaminated.

One assessment conducted by CARE in one of the most water-scarce locations in the northeast revealed that 89 percent of respondents did not have access to safe drinking water.

An elderly man who was displaced four years ago as a result of the conflict and who now lives in a camp in Idlib, Northwest Syria. Photo: CARE

"I carry him with my hands"

The recent cholera outbreak has compounded the already-dire situation in Syria. The struggle is especially hard for care-givers like Um Ahmad who have children with disabilities.

Since the outbreak, CARE has deployed rapid response teams to ensure the early detection of cases and timely referrals to health partners for treatment across northern Syria.

CARE Türkiye’s cross-border water, sanitation, and hygiene (WASH) program has helped make clean water accessible to over 700,000 people over the past year, alongside providing desludging services, rehabilitation of sewage networks and hygiene promotion and distribution of soap to internally displaced communities.

CARE also introduced preventative measures, including water quality monitoring and hygiene kit distribution, as well as chlorination programs that have already disinfected more than 40 million liters of water in the region.

To learn more about CARE’s work on water and sanitation, please visit the Water+ page here, and to learn more about CARE’s work specifically in Syria, please visit the crisis response page here.

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