CGH Faculty Dr. Sasha Fahme speaks with NPR about the intersection of epidemics, water infrastructure and conflict in Center focus areas

At the end of October, Center for Global health (CGH) faculty and Assistant Professor of Medicine, Dr. Sasha Fahme, spoke with NPR about the parallels between water infrastructure and disease epidemics, specifically in regards to recent and ongoing cholera outbreaks in the Middle East and Haiti. Dr. Fahme is conducting research among Syrian refugees in Lebanon and seeing cholera’s impact first-hand on these groups, while GHESKIO and CGH faculty in Haiti are currently responding to continuing community spread of the disease in greater Port-au-Prince.

Cholera is a bacterial infection spread through contaminated food and water. Although appropriate treatment prevents severe disease and harm, cholera may be deadly if left untreated. It’s average fatality rate is almost three times its average over the past five years and poor water infrastructure is a common denominator among all countries affected by recent outbreaks.

After a decades-long battle with cholera, Haiti is experiencing a severe resurgence centered in Port-au-Prince and nearby Cité Soleil. These areas are simultaneously enduring extreme civil unrest and displacement as a result of gang violence, exacerbating poor water infrastructure across the country. Lebanon and Syria are similarly experiencing unprecedented cholera outbreaks as a result of both insufficient water infrastructure in the context of decades of political instability and active conflict.

These countries’ constant state of instability and violence has led to the proliferation of manmade determinants of health. Water, sanitation and hygiene systems depend on fuel to pump water, and Syria, Lebanon and Haiti in particular are experiencing shortages of these resources as well, only worsening already deficient access to water, sanitation and health services.  

Dr. Fahme explains that the water infrastructure in Syria and Lebanon is heavily fragmented, destabilized, and privatized due to years of conflict and neglect. Decentralized water stations which operate at reduced capacity are unable to meet basic needs of their populations, forcing them to rely on polluted and unsafe water.

In Syria, wastewater treatment plants, water pumping stations, and water towers are targeted. This in combination with the attrition of engineers and prolonged electricity shortages have prevented water and sanitation systems from operating. According to UNICEF, only half of water and sanitation systems in Syria remain viable, leaving 14.6 million Syrians without access to safe water.

In Lebanon, four independently operating public water providers have operated at reduced capacity for the past 2 years, due to severe fuel shortages leading to prolonged power outages. Consequently, half of the country’s population has been forced to use alternative sources for water. Many rely on privatized water trucks, which are subject to little quality control, in part because there is not enough chlorine to clean water before it’s distributed. Additionally, the price of water has increased astronomically because the cost of water is directly associated with the cost of fuel.

Although vaccines are an effective way to mitigate cholera outbreaks across the globe, the WHO announced a worldwide shortage of vaccines this past October, severing limiting access to this life-saving preventative tool where it’s needed most. The International Coordinating Group of the WHO, which manages cholera vaccine stockpiles globally, has recommended a switch to a single, and thus less effective, dose approach to conserve resources.

Dr. Fahme says that cholera outbreaks will continue to emerge at the intersection of conflict and climate change, and thus it is imperative to mitigate the latter. Conflict will always lead to a disproportionate impact on marginalized populations so we must address the underlying structural determinants of health in order to promote health equity and reduce future outbreaks of disease like cholera.

Listen to the entire podcast here:

Article by Megan Willkens

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