A wave of cholera approaching epidemic proportions is rising in the Middle East, but Arab governments have been slow to disclose the extent of the infection - and in many cases even to take effective public steps to stop its spread - because the disease is a political embarrassment.
In Syria, more than 3,000 cases of cholera are known to government health officials, according to knowledgeable international experts. The Damascus government has admitted that cholera has claimed 47 lives and Health Ministry sources in Damascus said that there have been 61 deaths. An additional 90 cases were announced Wednesday, most in the Damascus area.
U.S. Ambassador Richard Murphy has declared the country a disaster area and is using the $25,000 in the ambassador's disaster-relief fund to donate medical supplies. He confirmed 1,000 cases last week.
Well-informed sources here say Syria realized as long ago as June that infectious cholera had appeared on a threatening scale, but no public acknowledgment was made until this month. By then the disease had spread to neighboring Turkey, Lebanon and Jordan.
[In Jerusalem today it was reported that one case of cholera had been confirmed in israel and that three suspected cases were under observation, Agence France-Presse reported. Vegetables grown on the West Bank of the Jordan River have been destroyed and all imports of food and vegetables from Jordan have been banned.]
Cholera, a water-born virus, is easy to treat but can be fatal if neglected. Periodically it runs through an epidemic cycle in the Middle East, where large parts of the population, particularly in refuge camps and over-crowded slums, lack adequate clean water supplies and health education about sanitation. Cholera victims suffer diarrhea, and babies can dehydrate and perish in the heat.
Otherwise healthy people who get treatment recover without difficulty, but the epidemic itself often takes weeks to bring under control. The current one is gaining strength to match the 1970 epidemic, which took several hundred lives in this region, health officials say.
Despite the clear threat, Arab governments, notably Syria and Lebanon, have conspicuously failed to react as vigorously as many experts want. Both governments have refused to launch vaccination campaigns - essential, many experts say, to curb the epidemic.
Publicly, the Lebanese Health Ministry argues that anti-cholera vaccine is only partially effective and can even be counter-productive if it lulls the beneficiaries into neglecting sanitary precautions.
International health officials find this reasoning specious.
"There are other reasons - lack of vaccine, lack of skilled manpower to administer it, and in Syria, perhaps, lack of money to buy it," one source said.
The World Health Organization's representative here said Lebanese officials had told him to refer all questions to the government, which is sensitive to press criticism that too little is being done.
Lebanon, in aftermath of civil war, is more prone to cholera than usual. The virus generally spreads through contaminated water but it also can be carried by files feeding on garbage mounds and by the broken sewers that are only gradually disappearing from the streets of this once-smart, now-dilapidated capital.
While admitting only three cases, Lebanese health officials reportedly have discovered nearly a score of instances of the spread of the disease. Suspected cases have been isolated, but the authorities have conspicuously failed to start the immunization campaigns launched in infected localities during the last epidemic. The foreign community here, still very small, is unlikely to be affected even by a widescale out break, but war-weakened Lebanese admit their concern about the disease - even though the strain of the current epidemic appears mild.
The official Lebanese reaction appears motivated primarily by a concern of adding to grumbling about President Elias Sarkis' failure to make faster progress in reviving the country.
The Syrian posture most medical people feel, has similar motives - with less excuse of a special crisis.
"They had it last year, too, but managed never to report it," a public health official disclosed.
"Syrians are prone to cholera, the government lacks all the tools to cope with it but refuses to admit it," another doctor said.
Even public education campaigns urging people to boil water and take other precautions would involve using the word "cholera" - a word still loaded with overtones of dread for many villagers who remember how it decimated previous generations.
"Until the Damascus government can clean up the water supply and handle the vaccination campaigns, they're liable to prefer a cover-up," one source explained. Even this year, the Syrian authorities apparently were reluctant to admit the problem and raise any questions that might reflect on their competence or the quality of administration in Syria.
Cholera has become harder to control because of the accelerated movement of people and goods throughout the Middle East. Considerable trade, including heavy smuggling, exits between Syria and its northern neighbor, Turkey. Some 30,000 Syrian troops are presently in Lebanon helping keep the peace. Syria and Jordan have steadily stepped up their commercial contacts, and there is even sufficient trade across cease-fire lines for cholera to have moved recently into the Israeli-occupied West Bank of Jordan.