NGO Forums representing over 150 humanitarian organisations are extremely alarmed about a fast-spreading cholera outbreak across Syria. The outbreak is threatening the lives of millions of people who are already suffering from more than a decade of conflict, rampant poverty and hunger. Humanitarian NGOs are calling for urgent action to scale up response and prevent further loss of life.

A cholera outbreak was declared in Syria on 10 th September 2022. Over 16,000 suspected cases (to 14th October 2022) have been recorded in all 14 governorates across the country, with numbers rapidly rising and likely to be much higher than recorded.This is the first such outbreak in Syria since 2009 when less than 350 infections were recorded in total and the scale of the current outbreak has not been seen in the country for decades. More than 70 people have died with thousands more seeking treatment, and many unable to access care in a context where health services have been decimated. Outbreaks of violence in northern Syria in recent days and the resulting displacements threaten to further accelerate the spread of the disease.

Cholera is highly contagious and spreads through contaminated water and food, causing acute watery diarrhoea and severe dehydration. If medical attention is received quickly, cholera can be treated easily.Without treatment it can lead to death within a matter of hours or days. People living in cramped conditions with little access to clean water are at a huge risk of contracting cholera and far less likely to have access to effective treatment.With more than 2 million people living in last-resort sites and camps with limited freedom of movement, the consequences of large-scale infections could prove to be devastating. Critically, Cholera outbreaks also exacerbate sexual and gender based violence risks and particulary those risks faced by women and girls in Syria.

“The cholera outbreak adds fuel to the fire of the already intolerable situation that Syrians have now lived day in and day out for more than 11 years. Further spread of infections will erode people’s ability to deal with increasing hardships, put millions more lives at risk and push people deeper into poverty.” -Garth Smith, Syria INGO Regional Forum Representative Humanitarian actors are highly concerned that 11 years of conflict, compounded by economic deterioration, chronic water scarcity, droughts driven by climate change, depleted water and sanitation infrastructure, as well as decimated healthcare systems have created the perfect conditions for cholera to rapidly spread across Syria and across the wider region. Fatal cholera cases have been confirmed in Lebanon in the past two weeks – the first such outbreak since the early 1990s – highlighting the risk of a wider spread across the region. Inside Syria, both international and Syrian NGOs have quickly mobilised to respond to the crisis, but humanitarian resources, funding and supplies are already overstretched. Crucial medications, vaccines, medical equipment, as well as water treatment materials have also been difficult to obtain, and are threatening to slow down critically needed response.

NGOs call for urgent scale up of support, so that a major humanitarian catastrophe and a further loss of life can be prevented. Immediate, rapid and coordinated action is absolutely critical for NGOs to be able to stem the spread of the outbreak, provide critical life-saving treatment and ensure that Syrians across the country urgently get unimpeded access to safe and clean water. Humanitarian organisations cannot stress enough the criticality of a prompt response for saving lives.

Recommendations on critical support:

● Immediate emergency funding to support humanitarian organisations to provide critical water, sanitation and hygiene (WASH) programming, increase the provision of health services, including for establishment of additional cholera treatment centres.

● Urgent access for humanitarian organisations to supplies of critical items through global and national UN andGovernment pipelines, and supply to front-line NGOs to supportWASH and health actors on the ground.

● Immediate strengthening of health detection, screening and information management across the country to ensure rapid targeted support in the right locations, and including regular information sharing across all parts of the country and between all relevant stakeholders and local authorities.

● Scale up of emergency rapid response teams (RRTs) nationwide to respond to outbreaks across the country as they occur.

● Unfettered access through all means for humanitarian supplies and personnel to respond to the outbreak, and all to all humanitarian needs in Syria.

● Support to further strengthen healthcare and water/sanitation infrastructure across Syria to ensure better resilience to manage the ongoing outbreak and future health crises.This must include support to those living in displacement in camps and in urban and rural communities with limited services to cope with the cholera outbreak. Support to agricultural systems is also critical to prevent further risk to food chains through contaminated irrigation.

Notes to editor

Statement by the Syria INGO Regional Forum (SIRF), supported by Damascus INGOs, Northeast Syria NGO Forum, NGO Forum Northwest Syria, and the Syrian NGO Alliance (SNA), collectively representing over 150 International and Syrian NGOs.

Additional statements from individual NGOs on the cholera situation, and interagency response plan can be found on agency website and ReliefWeb. The interagency cholera response plan can be found here: SyriaAWD/Cholera Response Plan September 2022.

Contact information: SIRF Representative, info@sirf.ngo, +961 77 571 99 00