At a time when Lebanon is facing an intensification of conflicts, the health consequences could prove disastrous. Today more than ever, it is urgent to strengthen vigilance in the face of potential epidemics.
Faced with the escalation of hostilities between Israel and Hezbollah, Lebanon finds itself at a critical turning point. And this, for more than one reason. This crisis has had devastating consequences for the country, resulting in massive material destruction, an incessant exodus of residents from areas affected by the war, as well as an alarming deterioration in the living conditions of a growing number of displaced people. These cumulative factors could lead to significant gaps in the public health system, increasing the risk of epidemics. In this context, the detection and control of emerging infectious diseases pose major challenges, requiring particular attention and appropriate interventions.
According to the World Health Organization (WHO), wars and humanitarian crises are often associated with an exacerbation of epidemic outbreaks. The conditions of hygiene, prevention and detection of infections are, in fact, less rigorous there. In these unstable areas, there are serious concerns about the capacity of often weak local health systems to manage communicable diseases. As a result, conflict-affected countries often face a heavy burden of morbidity and mortality, with more than 70% of cases of epidemic diseases recorded globally, such as cholera, measles and meningitis, according to statistics from the UN body. So what about Lebanon?
Increased risk
MP Abdel Rahman Bizri, infectious disease specialist and author of several epidemiological studies, recently reported a “real deficit in securing accommodation needs”, warning of the risk of spreading communicable diseases. In an interview with the Voice of Lebanon, he said that although the situation in the accommodation centers is currently considered acceptable and no epidemic has been reported at the moment, efforts are being made to prevent any contamination. , in particular by guaranteeing access to drinking water. Its observations echo those of the WHO, which is now sounding the alarm. Speaking from Beirut, Ian Clarke, WHO deputy incident director for Lebanon, warned at a press conference in Geneva on October 8 that, with limited access to care, Lebanon faces to “a situation where the risk of epidemics is considerably increased”.
Contacted by Ici Beirut, Dr Bizri clarified that the current situation is completely different from that of Syrian refugees, who contributed to the transmission of certain pathologies from Syria to Lebanon. “With the Syrian exodus, we have mainly observed, in Lebanon, an increase in water-borne infectious diseases, such as cholera, as well as vaccine-preventable diseases, such as measles, without forgetting the emergence and spread of cutaneous leishmaniasis,” explains the Lebanese doctor, noting that cases of cholera are mainly linked to the influx of individuals from Syria, where an epidemic outbreak was underway. According to a genomic analysis carried out by the team of Dr Ghassan Matar and published in Nature Communications in August 2024, the cholera outbreak in Lebanon between 2022 and 2023, associated with Syrian refugees, revealed two distinct strains: one originating from South Asia and the other from Yemen. “This is likely linked to the movements of pro-government and anti-government fighters from various countries during the Syrian war,” says Dr Bizri.
Epidemiological reality
“Today the situation is completely different,” he repeats. Internal travel does not significantly alter the epidemiological reality. However, they have led to a phenomenon of overpopulation, increasing the transmission of skin diseases.” In this regard, several cases of parasitic infestation of the skin, particularly pediculosis (infestation of the hair and scalp by lice) and scabies, have been reported in some centers, but they were quickly taken care of. “It is crucial to monitor these cases, because the spread of these parasites can be rapid,” comments the infectious disease specialist. Antiparasitic shampoos, lotions and creams are currently available in Lebanon, both in pharmacies and through primary care centers.
Furthermore, Dr Bizri notes that the risk of transmission of infectious diseases linked to water remains worrying, due to the lack of adequate health infrastructure in accommodation centers. The lack of appropriate sanitation measures worsens this situation, exacerbating the risk of the spread of pathogens, such as the hepatitis A virus and Vibrio choleraethe bacteria responsible for cholera. Children are particularly vulnerable to diarrheal illnesses caused by pathogens present in untreated water. “A vaccination campaign against cholera was initiated ahead of the conflict, with the aim of containing and preventing epidemics, particularly in villages bordering Syria. Now, the war threatens to compromise these efforts,” laments the Saida MP.
Conducive factors
In addition, collective kitchen practices amplify the risks of cross-contamination, during the different stages of preparation, transport and service, and in the event of non-compliance with the hot and cold chain. “Recently, several cases of gastroenteritis and acute diarrhea were reported in the centers, but they were quickly treated,” says the doctor, himself a member of the parliamentary health committee. As winter approaches, concerns are also emerging about the transmission of respiratory diseases, in this case acute respiratory infections, such as influenza, pneumonia, viral bronchitis as well as measles and Covid-19 , which can “spread rapidly in community settings and harm the health of the most vulnerable people”. And Dr Bizri concludes: “All the factors likely to favor the emergence of potential epidemics are present. This does not necessarily mean that an outbreak will actually occur, but it is crucial to implement appropriate preventative measures to mitigate the risk.”
