[music]

Melissa Harris-Perry: Welcome back to The Takeaway. I'm Melissa Harris-Perry. This year, at least 26 countries have seen outbreaks of cholera. It's a bacterial infection that spreads through contaminated water and food and with the right treatment can easily prevent severe harm, but if left untreated, cholera can kill.

Speaker 2: In Haiti, health professionals are battling a cholera outbreak in the country's capital.

Speaker 3: Malawi is currently experiencing one of the worst cholera outbreaks in years.

Speaker 4: Cholera in Syria is fast spreading, more than 70 people have died. Yemen, Kenya, Lebanon.

Melissa Harris-Perry: Officials at the World Health Organization say that this year's average fatality rate is almost three times as high as the average of the past five years. Though the outbreaks vary in size and severity, the affected countries have one issue in common, poor water infrastructure.

Joining me now is Dr. Sasha Fahme who's an Assistant Professor of Medicine at the Weill Cornell Medical College and Research Associate at the American University of Beirut. Sasha, welcome to the show.

Sasha Fahme: Thank you so much for having me.

Melissa Harris-Perry: Haiti was close to being certified cholera-free after an outbreak that was almost a decade long, how does it go from seeing Cholera nearly eliminated to a deadly outbreak like this?

Sasha Fahme: I think in your opening segment, the countries that were announced, all of these countries have one thing in common and that's not only do they not have sufficient water infrastructure but also these are countries in the global south that have battled with decades of political turmoil and many of them active conflict.

The current outbreak in Haiti bears many similarities to what we're seeing in the Middle East which is that there is a state of protracted political instability and violence leading to these sort of man-made determinants of health. Fuel shortages, road closures are essentially preventing people from accessing clean water, sanitation, and health services. As a result, the most marginalized populations are being impacted.

Melissa Harris-Perry: Can you help us understand a bit about how some of these affected countries how water is distributed and managed? Maybe we can take Lebanon and Syria.

Sasha Fahme: In Lebanon and Syria, the water infrastructure is heavily fragmented, privatized, and essentially destabilized by years of conflict, political turmoil, and neglect. In both countries, there are decentralized water stations, but these are often operating at reduced capacity and are unable to meet the needs of the populations that they serve which forces people then to rely on polluted and unsafe sources of water.

For instance, in Syria, prior to the conflict, around 95% of the population had reliable access to safe water just by turning their faucets just like in many countries in the West. Since the onset of the conflict, that figure has dropped by roughly 40%. There are multiple reasons for that.

First of all, wastewater treatment plants, water pumping stations have been deliberately targeted in the conflict. Actually, the UN estimates that two-thirds of water treatment plants, half of the water pumping stations, and about a third of water towers have been damaged during the conflict.

Secondly, there has been an attrition of engineers and other technical staff members from the workforce who are responsible for maintaining these systems. That attrition is estimated to be around 30% to 40%, and so these systems are no longer being adequately maintained.

Thirdly and this is true both in Syria and Lebanon, massive and prolonged shortages in electricity which in some regions of these countries are near 100%, meaning total blackouts, prevent water and sanitation systems from operating altogether because they're dependent upon electricity for pumping.

As a result of that, only around half of the previously functional water and sanitation systems in Syria are now operational, and that's left 14.6 million Syrians without access to safe water according to data.

Melissa Harris-Perry: Pause with me here for just a moment. We'll be right back on The Takeaway.

[music]

Melissa Harris-Perry: Thanks for sticking with us on The Takeaway. I'm Melissa Harris-Perry. We've been talking about the challenges facing water infrastructure and the ways that it's contributed to cholera outbreaks across the world. Still with me is Dr. Sasha Fahme. Dr. Fahme, can you continue it here in talking more about the electricity and power outages and how those are, again, part of this water infrastructure question?

Sasha Fahme: Yes, absolutely. Water and sanitation hygiene systems depend upon electricity to pump water. There has been a crisis for many decades now affecting both Syria and Lebanon worsened in the past two years due to acute fuel shortages that has led to near entire blackouts in some parts of the country. As such, water and sanitation hygiene systems are no longer able to pump water.

For instance, in Lebanon, there are four independently operating public water providers which, in the context of these power blackouts for the last two years, have operated at significantly reduced capacity such that half the population requires alternative sources of water. Those alternative sources are typically privatized trucked water which gets little, if any, quality oversight.

Organizations like UNICEF have raised concerns in the past as well about the lack of, for instance, chlorine-- The use of chlorine in these water systems to clean the water before it's distributed. One outcome of this, this reliance, or this overreliance on privatized trucked water has been an astronomically increased cost of water because the price of water is directly linked with the price of fuel because trucks require gasoline to distribute the water.

As gas prices globally have increased over this past year, it's led to these just drastically increased costs of water that have made water a very precious resource for people here and prohibitively expensive, forcing people to rely on what they already know to be contaminated sources.

For instance, in Syria, the source of this current outbreak is thought to be the Euphrates river which runs from Turkey into Syria through Syria and into Iraq. Despite the fact that residents are very well aware of the contamination of this river with sewage, over 5 million Syrians still depend on this water for drinking and for irrigation because the alternative would be to not have water at all.

Melissa Harris-Perry: Want to talk about the fact that cholera is treatable and indeed there's vaccine. I want to listen for just a moment to Lebanon's health minister last week.

Firass Abiad Interpreter: There is the issue of cholera vaccine. We're asking the international community to help bring the vaccine to Lebanon. Unfortunately, there's a shortage because there are many outbreaks across the world.

Melissa Harris-Perry: Talk to me about this global shortage of the vaccine.

Sasha Fahme: It's pretty devastating. This global shortage of the cholera vaccine has actually led the international coordinating group which is the organization that manages the emergency supply of vaccines, the global supply of vaccines, to actually temporarily, I guess, recommend a single-dose approach rather than the standard two-dose vaccination regimen in order to conserve resources. Yet we haven't yet had vaccines on the ground here, and they are, I would say, one very important arm in the response to a cholera epidemic, but they're certainly not the only necessary intervention.

Melissa Harris-Perry: As you've talked about the challenges of water infrastructure, I can't help but to think about American cities where we're seeing some similar problems. What lessons might the US learn from the experience of the world and the water infrastructure?

Sasha Fahme: I recently wrote a piece on cholera, and I wrote that cholera and epidemics like it are going to emerge at the intersection of conflict and climate change. Sometimes that conflict is not necessarily overt.

I think that these greater crises that are occurring globally, and that includes the crisis of systemic racism in the United States, will always lead to the disproportionate impact of water scarcity on the most marginalized populations, be it Black and brown populations in the United States, be it refugees in the global south. In order to address these fairly, we have to address the underlying structural determinants of health, and access to clean and safe water is absolutely at the top of that list.

Melissa Harris-Perry: Dr. Sasha Fahme is Assistant Professor of Medicine at the Weill Cornell Medical College. Thank you so much for joining us.

Sasha Fahme: Thank you so much.

[music]

Copyright © 2024 New York Public Radio. All rights reserved. Visit our website terms of use at www.wnyc.org for further information.

New York Public Radio transcripts are created on a rush deadline, often by contractors. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of New York Public Radio’s programming is the audio record.