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How war brought cholera and polio back to the Middle East

A child receives treatment at a hospital amid a serious cholera outbreak in Sanaa, Yemen's capital, on June 14. ( <span class="text">Yahya Arhab/European Pressphoto Agency</span>)

BEIRUT — As war ravages public health systems in Yemen and Syria, doctors are treating epidemics and diseases they once thought were things of the past.

In Yemen, it is cholera, a bacterial disease spreading so fast, about 160,000 people have been fallen sick since April.

In Syria, it is polio, almost two decades after government efforts to eradicate the illness were hailed as a textbook example of a good practice.

“It’s easy to think only of trauma cases when you think of war, but the damage it does to infrastructure is even more serious,” said Natalie Roberts, the head of emergency operations for Doctors Without Borders France.

Yemen’s health network has virtually collapsed during a two-year war that has left more than 10,000 people dead and displaced millions more. Around half of the country’s medical facilities have been closed or destroyed, mostly by Saudi-led airstrikes, and despite aid agencies' best efforts, only 30 percent of required medical supplies are being imported into the country.

Against that backdrop, the World Health Organization said this week that its doctors were witnessing cholera on an “unprecedented scale.” If left untreated, the illness causes fatal dehydration. The U.N. has recorded 166,976 suspected cases since mid-April. By Tuesday, the death toll had risen to at least 1,146.

Cholera is not difficult to treat. Nor does it travel fast when water is clean and conditions sanitary. But Yemen’s crumbling economy — another byproduct of war — has halted the salaries of public servants, meaning that garbage collection has become irregular, and more than eight million people now lack access to safe drinking water.

Those conditions have created “a perfect storm for disaster,” according to Mansour Rageh, the chief economist for the Beirut-based Sanaa Center for Strategic Studies.

“Everything has knock-on consequences. The economy is in turmoil so civil servants don’t get their salaries. Civil servants don’t get their salaries so the waste doesn’t get cleared. Then cholera spreads, and Yemen doesn’t have the means to treat it. It’s a disaster,” he said.

Yemen is battling a cholera outbreak that has led to more than 500,000 suspected cases, according to the World Health Organization (Video: The Washington Post)

Much of Syria’s health system has also been crippled by war. In areas controlled by armed groups opposing President Bashar al-Assad’s government, hospitals and clinics have been bombed systematically.

Hundreds of medical workers have also been killed, mostly by pro-government forces. Earlier this year, the Lancet medical journal described Syria as “the most dangerous place on Earth for healthcare providers.”

Diseases have often spread along conflict lines as aid agencies struggle to consistently deliver vaccinations and other lifesaving medical services to millions of Syrians living in areas controlled by the opposition or Islamic State.

The World Health Organization said this week that it had confirmed 15 new cases of polio, including a child who may have caught the disease in the Islamic State-held capital of Raqqa.

“We are very worried, because obviously if there is already one case of polio of a kid that is paralyzed it’s already an outbreak. We know for example that for one kid that is paralyzed there are almost 200 asymptomatic so it means that virus circulating, so it is very serious,” WHO spokesman Tarik Jasarevic said at a U.N. briefing on Tuesday.

United Nations aid trucks are being prepared to ship polio vaccine into Deir al-Zour province, where U.S.-led coalition airstrikes have surged in recent months as Washington and Tehran-backed forces race to capture the area from the Islamic State. But health experts say the damage is already done. A disease might be contained in one area but still pop up in another. 

The Syrian American Medical Society, a nonprofit, said this week that the vaccination gap has also caused measles to spread. In the rebel-held south, dozens of cases have been detected, even among children who had been vaccinated.

In several cases, doctors said, the vaccinations may have failed because of storage problems that make it difficult to keep medicine cold. In others, the government-provided vaccines are believed to have been out of date.

“When the war started, one of the first things to stop across huge parts of the country was the program of vaccinations. And with hospitals being bombed and health supplies largely being unable to cross the front-lines, there were many facilities that simply could not keep up,” Roberts said.

For civilians across Yemen and Syria, displacement and hunger have also accelerated the spread of disease.

“Malnutrition and cholera are interconnected. Weakened and hungry people are more likely to contract cholera and cholera is more likely to flourish in places where malnutrition exists,” Jamie McGoldrick, the U.N. humanitarian coordinator for Yemen, said last month.

“We're looking at a disaster,” Roberts said.

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