The Next Cholera Epidemic

How the Disease Could Spread from Syria

A man inspects a site hit by what activists said were airstrikes by forces loyal to Syria's President Bashar al Assad, in the Douma neighborhood of Damascus, Syria, November 7, 2015. Bassam Khabieh / Reuters

A cholera outbreak that began in Iraq in mid-September has spread into war-torn Syria. From there, a massive flow of desperate refugees could carry the disease deep into the Middle East and even into southern Europe.

Humanitarian aid physicians working in Syria report that three cases have been confirmed in two cities controlled by the self-proclaimed Islamic State (also known as ISIS): Deir ez-Zor, in eastern Syria; and Aleppo, in the northwestern part of the country. Undoubtedly, these cases are just the tip of the iceberg. Under the best conditions, clinicians usually diagnose only 30 percent of the cholera cases that occur during epidemics; in Syria, where hospitals and clinics have been destroyed by air strikes, they’re likely diagnosing far fewer.

Syrians refugees wait to register their names to go back to their homeland at Al Zaatari refugee camp in the Jordanian city of Mafraq, near the border with Syria, November 1, 2015. Muhammad Hamed / Reuters

This outbreak was predictable. Cholera is caused by a bacterial pathogen that passes between people via human waste and is easily spread through contaminated food and water. If introduced

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