Cholera's return to Lebanon exposes clean water crisis

• Economic crisis hits sanitation services, water supplies
• Most Lebanese unable to afford bottled water, tankers
• Lebanon had been cholera-free since early 1990s

HALBA, Lebanon - Maha El Hamed and her family can no longer afford to buy bottled water when the taps run dry - a regular occurrence in her refugee camp in northern Lebanon.

"When we don't have tap water, we rely on the nearest pond," the Syrian said as she sat beside the hospital bed of her seriously ill 4-year-old son - victim of a cholera outbreak that is bringing more misery to crisis-hit Lebanon.

In just one month, the outbreak has spread throughout the country of six million, infecting nearly 2,000 people and killing 17, according to the latest health ministry data.

Lebanon had been cholera-free since 1993, but its public services are suffering under a brutal economic crisis now in its fourth year, while infighting among the country's faction-riven elite has paralysed its governing institutions.

Cholera, a diarrhoeal disease spread by ingestion of food or water tainted with human faeces, can kill within hours if untreated, with children most at risk.

El Hamed, whose son needed resuscitation when he was admitted to Al-Rassi Governmental Hospital in Akkar district last week, said she was praying he would recover - and dreading going home to the same dire situation.

"We will have to return to drinking the same infectious water that brought us here," the 34-year-old Syrian told Context as she waited at the hospital for doctors to update her on her son's condition.

Contaminated

The U.N. children's agency UNICEF says cash-strapped refugees and Lebanese families are being forced to rely on contaminated water sources due to inadequate piped supplies and the rising cost of private alternatives.

Access to sufficient supplies of clean tap water has become patchy as distribution systems fail - partly due to widespread power cuts that bring pumping stations and purification plants to a standstill, according to UNICEF.

"We're suffering from the chronic inability to deliver clean water and electricity to homes and camps. This leads to more problems with sewage treatment and disposal," said Ghassan Dbaibo, director of the Center for Infectious Disease Research at the American University of Beirut Medical Center.

Like many people in Lebanon, El Hamed is suspicious about the safety of the tap water - even when it does flow, preferring to buy bottled water for drinking and cooking instead.

But soaring inflation has seen the price of bottled water increase by three to five times over the past year, putting it out of reach of many people in Lebanon, where 80% of the population now lives in poverty.

El Hamed said her husband's pay as a construction worker could no longer stretch to bottled water, forcing them to drink the "filthy" tap water.

For their other water needs, such as washing and laundry, El Hamed's family and their neighbours share tankers of filtered water from private suppliers, but that is also becoming increasingly expensive - leaving the pond as their only option.

The cholera outbreak could also put further strain on short-staffed and underfunded healthcare facilities.

At the Al-Rassi hospital, director Muhammad Khadrin said some cholera patients required emergency treatment, potentially causing a shortage of beds.

"We're trying to expand the department to be able to handle more cases, but the situation today is very difficult, and we don't know to what extent the ministry will be able to afford the expansion," he said.

The World Health Organization's representative in Lebanon, Abdinasir Abubakar, said he feared the worst was yet to come in the cholera outbreak despite the entity's efforts to supply clean water and sanitation kits.

Syria outbreak

Government officials think the cholera cases stem from an outbreak in neighbouring Syria.

Syria's Health Ministry declared a cholera outbreak in Aleppo in September, reporting nine deaths. The cases are thought to be related to individuals drinking contaminated water from the Euphrates River, the United Nations said.

Lebanon's outbreak risks fuelling hostility towards the roughly 1.5 million refugees Syrian refugees who have sought refuge in Lebanon during their nation's 11-year war, according to the Samir Kassir Foundation (SKF), a Beirut-based freedom of expression nonprofit and a funding partner of the Thomson Reuters Foundation.

"In October, when cholera first appeared in Lebanon, we saw an increase in hate speech directed at Syrians," said Widad Jarbouh, a researcher at the SKF.

Around the world, conflicts and natural disasters have resulted in an unprecedented rise in cholera outbreaks globally, the WHO said last month, prompting moves to ration vaccine supplies.

Lebanon received its first batch of vaccines earlier this month. The vaccines will play "an essential role" in limiting the disease's spread, Health Minister Firass Abiad told a news conference.

A spokesperson for the Ministry said that so far, the vaccines would be given to frontline healthcare workers with the rest destined for families living in high-risk areas, including the northern towns where health authorities have set up an emergency field hospital.

There are also concerns that cholera could reach the country's overcrowded and squalid prisons.

"The outbreak is still ahead of us," said the WHO's Abubakar.

(Reporting by Tala Ramadan; Editing by Helen Popper.)