Lebanon faces its first cholera outbreak in three decades : Goats and Soda Several crises in the country — including political instability, COVID and financial collapse — have created deteriorating conditions that have allowed the bacteria to spread.

Amid vaccine shortages, Lebanon faces its first cholera outbreak in three decades

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RACHEL MARTIN, HOST:

We've got some grim news on the global health front to report this morning. Cholera is surging around the world. Twenty-nine countries are reporting outbreaks. Poverty, conflict and climate change are fueling the spread. NPR's global health reporter Ari Daniel is here.

Hi, Ari.

ARI DANIEL, BYLINE: Hi there, Rachel.

MARTIN: First off, just remind us how people contract cholera.

DANIEL: Certainly. People get cholera from contaminated water, which can then cause extreme diarrhea and dehydration. And if it's not treated, it can kill someone in a matter of hours.

MARTIN: Wow. How do you treat it?

DANIEL: There's a very effective oral vaccine, actually, but there's not enough of it to meet current demand. In fact, last month, the international group managing emergency vaccine supplies decided to reduce the standard two-dose regimen to a single dose to stretch the supply.

I spoke with Tarik Jasarevic. He's with the WHO.

TARIK JASAREVIC: This is really emergency measure, and it's a temporary measure. We hope that cholera outbreaks will be brought down not only by the vaccines, but also by other measures that we have at our disposal.

MARTIN: What does he mean by other measures?

DANIEL: Well, cholera spreads in water where there's poor sanitation. So for many, it's a matter of securing clean water.

MARTIN: And you're actually talking to me from Lebanon, right?

DANIEL: Yeah.

MARTIN: You went there to get a firsthand look at the cholera outbreak that they're going through, which is the first in decades.

DANIEL: Yes. The first case was discovered a month ago, and already, there are more than a couple thousand cases here, and it's spread across the entire country.

I went to the Bekaa Valley in the east and visited a health center in the village of Douris. Darine Al-Ahmar runs the place. Now, this village doesn't have any cholera yet, but we stood out in front of the health center and Al-Ahmar looked in the direction of a town where there is a cholera outbreak. It may soon show up here, too, she told me.

DARINE AL-AHMAR: It's a big problem if the groundwater become populate.

DANIEL: Oh, become populated with the bacteria...

AL-AHMAR: Yeah.

DANIEL: ...Like, gets contaminated.

AL-AHMAR: Yeah.

DANIEL: The groundwater fills the wells that villages in this area depend on for showering, irrigating farms, brushing teeth, washing vegetables. And here's the issue. The wastewater flowing out of the toilets and sinks from homes here and from the numerous informal settlements for refugees - it's not being treated before returning to the lakes and rivers.

AL-AHMAR: Our water become dirty.

DANIEL: So the problem is that the water is all connected.

AL-AHMAR: From there to here.

DANIEL: So this whole area is in danger.

AL-AHMAR: Yes, of course.

DANIEL: Over the last few years, Lebanon's been hit with crisis upon crisis - a financial collapse, political instability, COVID, a fragile health care system and widespread power shortages, which means there's not enough energy to fuel the water filtration plants, allowing the bacteria to spread.

AL-AHMAR: I'm very, very upset. Why Lebanon comes to these days? Why Lebanon don't have electricity? Why Lebanon don't have water?

DANIEL: Al-Ahmar walks me inside the health center. It's tidy and bright. Thirty people are waiting - a bunch of kids and families. Thirty-four-year-old Mona Ghorly tells me she's not afraid.

MONA GHORLY: Because I didn't see anyone have cholera.

DANIEL: But Chahina Ghorly, her 48-year-old aunt, says it's only a matter of time.

CHAHINA GHORLY: (Through interpreter) They see that the water is polluted. They see the sewage passing by. So, yes, we are afraid that the cholera will be more in this area.

DANIEL: It's a well-founded concern. Josette Najjar who directs the Lebanese branch of the Merieux Foundation. It's a global health NGO headquartered in France

JOSETTE NAJJAR: Today, mainly in the rural areas, I'm not sure that we have the means to resolve these structural problems linked to the water, to the wash.

DANIEL: Which is why the health centers approach focuses on education.

AL-AHMAR: Cholera.

DANIEL: Since early October, Darine Al-Ahmar has been making daily cholera announcements to the patients. Today, she's addressing half a dozen women and a few children in the waiting area.

AL-AHMAR: (Through interpreter) Like corona, we have now cholera, so you should be aware. So the steps to avoid cholera yourselves is tick, tick, tick, tick.

DANIEL: Like washing your hands thoroughly and adding chlorine to your water to kill the cholera bacteria.

AL-AHMAR: (Through interpreter) And anyone of you feel any these symptoms, don't wait to go to the doctor.

DANIEL: This clinic and others like it are expecting vaccine deliveries to arrive soon, and it's about to start stocking oral rehydration solution. But in the meantime, Al-Ahmar explains how to make it at home, which can literally save someone's life.

AL-AHMAR: (Speaking Arabic).

DANIEL: Al-Ahmar's audience listens closely. "Don't worry," she tells them. "The clinic will care for you if you get sick."

MARTIN: So, Ari, what's the Lebanese government doing to respond to the cholera outbreak?

DANIEL: The Ministry of Public Health told me they've boosted water surveillance, and they're working to get electricity to water treatment stations. The WHO has helped Lebanon secure 600,000 vaccine doses. The first wave of an immunization program starts tomorrow.

MARTIN: Oh. But it reminds me of hurricane season - right? - where communities know a disaster is coming, and they just have to wait.

DANIEL: Except there's one big difference, Rachel. The conditions that create cholera are often caused by us. One doctor told me that it's 2022, and people should have clean water. It should be a source of life.

MARTIN: NPR's Ari Daniel reporting from Lebanon. Thank you so much.

DANIEL: Thank you.

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