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Lebanon’s Health Ministry announced on June 17 a spike in the number of Hepatitis A cases that jumped to 590 from 174 only a few days earlier.
The first cases were detected in Tripoli, Lebanon’s second-largest city, while other cases were documented in the Bekaa region, east of Beirut, the country’s capital.
The disease is regarded as endemic to the country, and the Health Ministry consistently records a large number of cases throughout Lebanese areas. According to the local publication L’Orient Today, at least 776 cases of hepatitis A were reported in 2017, while 899 cases were reported in 2018. The year after saw a staggering decrease to 426. As for 2020, the outbreak of COVID-19 took the limelight, and no data could be found. In 2021, 429 cases were reported.
Public health officials point the recent outbreak to contamination caused by maintenance work done on a local water system in April. Similarly, the Ministry of Public Health said that it was likely due to worsening infrastructure which “led to a mixture between drinking water and sewage water.”
However, according to the North Lebanon Water Corporation, Tripoli’s water is suitable for drinking and household usage, which raises multiple questions regarding the source of the contamination and veracity of opposing claims.
Hepatitis A is transmitted via food and water that has been contaminated by human fecal material containing the virus. Although 90 percent of cases are asymptomatic, symptoms may vary from long-term fatigue, headaches, nausea, vomiting, loss of appetite, muscle and joint pain to the yellowing of the skin – a telltale sign.
Children, on the other hand, usually present milder symptoms.
According to health experts, Lebanon, like other crisis-riddled countries in the MENA region is at risk of severe public health deterioration if infrastructural issues are not addressed as a preventative measure to curb diseases.
A polluted gem
A study conducted by the American University of Beirut in collaboration with the University of Georgia on 14 major perennial rivers across Lebanon, demonstrates that fecal contamination from untreated sewage systems has severely damaged irrigation water from these rivers.
The assistant professor for food safety at the University of Georgia and researcher on infectious diseases, Dr. Issmat Kassem, told Fanack that water pollution is particularly significant as it is used directly on produce fields such as fruits and vegetables that are routinely consumed raw in Lebanese households.
“92% to 95% of the sewage water we produce is discharged into rivers or the sea untreated. Only primary care is provided to the remaining 5-8 percent. The issue is that we lack the resources and governmental commitment to address environmental problems,” Kassem said.
Lebanon has been suffering from compounded crises, most notably the financial collapse of 2019 that caused the value of the local currency to drop by more than 90%. Basic services such as electricity and garbage collection are rarely provided. No power means the country is one of the most polluted in the MENA region due private generators needed to produce electricity.
Furthermore, Kassem notes that the country’s mismanagement of solid waste, combined with air and water pollution could lead to further outbreaks that may break Lebanon’s fragile health sector.
This comes at a time when the world is battling with reemerging epidemics.
A new health crisis?
The most recent health scare to reemerge is the spread of monkey pox beyond central and West African countries where it was contained. The viral disease was first discovered in 1958 following two outbreaks in colonies of monkeys kept for research, according to the CDC. In 1970, the first human case was recorded, however more recently, several cases were detected in over 40 countries, mostly in Europe.
The World Health Organization is currently undergoing talks to decide whether the spiraling outbreak warrants being declared a global emergency, similar to the COVID-19 pandemic.
Even though the disease, which is mainly transmitted through direct human or animal contact is said to be an irregular occurrence in the Middle East, the UAE has reported four confirmed cases, Iran has reported three suspected cases and Lebanon has reported one.
People in the region will be affected disproportionally if new outbreaks are to occur, Kassem contends. “While oil-rich Gulf nations may have the funds to invest in an efficient health sector, poorer countries, and peoples afflicted by years of political instability and war, will struggle,” he said.
In a recent study on emerging and reemerging infectious diseases in Eastern Mediterranean, political conflicts were pinned as breeding grounds for infectious diseases. Internal displacement of citizens, overcrowded camps with little to no access to basic social services and worsening living conditions, marred with poverty and lack of sanitation, were cited as the main culprits.
Conflict wreaks havoc on a country’s healthcare industry and restricts access to the required drugs, personnel, and equipment. Lack of transportation and security concerns makes access to whatever facilities are available all the more difficult.
Syrian refugees fleeing the crisis that broke out in 2011 have faced interrupted access to healthcare services, and war-related surgical diseases resulted in people developing multidrug and pathogen resistance, one study on the Syrian crisis found. Polio, tuberculosis, and measles were particularly prominent during the war.
Yemen, on the other hand, experienced the worst cholera outbreak in modern history with UNICEF reporting that 96% of its governorates was affected. The longstanding war has severely damaged water infrastructure sites and degraded the sanitation and hygiene systems.
Environmental changes such as increased rainfall, flooding, and severe winds aided the spread of cholera-contaminated waters and flying insects.
Diseases without borders
Recent outbreaks of EIDs and RIDs in the MENA region include the chikungunya virus, transmitted by mosquitos in Sudan, cholera in Somalia, diphtheria in Yemen, influenza H5N1 in Egypt, leishmaniosis in Syria, Q-fever in Iraq and the Middle East respiratory syndrome (MERS) in the Arabian Peninsula.
Limited data is available on the prevalence of the hepatitis A virus and hepatitis E virus across the MENA region, however, the highest volume of reported cases were found predominantly in Egypt, Libya, and Iraq, followed by Iran, Yemen, Tunisia, and Morocco. The numbers were most concentrated in rural areas.
For better prevention, experts say that a regional collective approach is needed. Early detection to biological threats as they arise and collaborative efforts are necessary to promptly devise locally crafted solutions and emergency plans.
Because viruses evolve unpredictably and rapidly, WHO has detected more than 30 new micro-organisms that spread infectious diseases worldwide over the course of 30 years. These pathogens continue to cause high mortality rates and travel easily across all borders.
Kassem highlights the importance of the “One Health” approach, in which multiple sectors communicate and work together to implement programs, legislation, and research contributing to better public health outcomes.
“It’s a one-dimensional approach, when governments want to tackle diseases without looking at pollution and animal health,” he said. “If left untreated, we will see genetic alterations in the generations that follow, as more diseases are being detected in children.”