UNICEF/Fouad Choufany

Neglecting the North: How cholera is disproportionately affecting North Lebanon

On October 6, Lebanon’s Ministry of Health announced the country’s first cholera case since 1993. Just a month later, the disease has been added to the list of crises that have crippled the country since late 2019.

The latest government numbers show that Lebanon currently has a total of 2,722 suspected cholera cases, of which 448 are laboratory-confirmed, in addition to 18 deaths. 

While the disease has spread across the country, the northern and northeastern areas are the most dramatically affected, with Akkar and other northern areas, such as the city of Tripoli, recording the highest number of cases.

Disproportionately affecting marginalized communities

Citizens of these historically marginalized areas now bear the brunt of yet another crisis, with little means to protect themselves from yet another hazard caused by neglect and unsustainable resource management. 

“This is purely a public health issue, I think the fact that a big chunk of society has been impoverished already tells us that people who have been vulnerable pre-crisis are even more vulnerable today,” said Hussein Cheaito, Development Economist at The Policy Initiative.

Mazen Yachoui, WASH Technical Advisor at Save the Children, an international NGO focusing on children’s healthcare, food, and shelter, as well as learning and child protection services, said affected people in the north and northeast do not have the capacity to provide energy and chlorine for their water establishments and cannot buy bottled water, leaving them with unclean sources as their only option. 

Furthermore, as the Lebanese state severely reduces providing water, people are at the mercy of private providers who also compromise the quality of their water while raising prices. With the exorbitant costs of living decently, many families have no choice but to forgo such “luxuries” in favor of securing food and drink.

All these factors leave marginalized communities, such as Syrian and Palestinian refugees and lower-class Lebanese groups, especially vulnerable to the cholera outbreak.

“They are the first to compromise the quality of things,” added Yachoui.

Before the cholera outbreak hit Lebanon, the disease was already spreading across neighboring Syria, and it has spread across government and opposition-held areas, both of which are struggling to contain it. 

The outbreak there is believed to be due to people drinking unsafe water from the Euphrates river and using contaminated water to irrigate crops, infecting foods, according to the UN and the Syrian Ministry of Health.

While some have tried to blame Syrian refugees for bringing the disease from Syria to Lebanon, all the conditions for a cholera outbreak in Lebanon are present regardless of the outbreak in Syria, according to Yachoui. 

Indeed, with continuously soaring inflation, lower class individuals buy any water they can get, regardless of quality, says Yachoui. 

Above that, the poor infrastructure in northern Lebanon leaves the area vulnerable to diseases.

“The northern parts of the country, where most cases are concentrated, have very, very poor infrastructure,” said Cheaito, adding that the poor infrastructure means those affected will find it more difficult to access healthcare, which is already highly privatized and unaffordable.

The response to the outbreak

The Lebanese government, along with some organizations on the ground (including Save The Children), have been trying to mitigate the spread of the disease by trying to provide clean water and raising awareness. Lebanon recently received a batch of cholera vaccines to help curb the spread of the illness. 

Leaving the outbreak untreated could lead to the creation of yet another long-term burden for Lebanon’s refugees and lower-class citizens, further widening the country’s already-stark rich-poor divide.

Lebanon’s response to the outbreak, while presented with a clear plan to tackle the issue, remains reactionary, according to Yachoui. 

A long-term solution would include tackling the source of contamination, the regulation of providers, sanitation management and the providing of chlorine and good-quality water to homes, says Yachoui.

Leaving the vulnerable infrastructure as-is risks to not only keep cholera as a threat, but to also introduce other diseases, such as hepatitis.