As sewage seeps into al-Bab water supply, typhoid outbreak affects dozens

AMMAN: A former Islamic State stronghold in Syria’s northern Aleppo province is now facing a public health crisis “beyond the city’s capabilities,” sources on the ground tell Syria Direct, as dozens of residents are contracting typhoid fever daily as a result of contaminated water.  

The source of the outbreak is likely contaminated drinking water from makeshift wells inside al-Bab, a city still reeling in the aftermath of a months-long military campaign by Turkish-backed rebels to drive the Islamic State (IS) from its last remaining northern Syria stronghold earlier this year.  

Free Syrian Army (FSA) forces supported by Turkish and United States-led coalition airstrikes fought for three and a half months to take the city, which lies roughly 40km northeast of Aleppo city and 30km south of the Turkish border.

Before IS withdrew in late February, an estimated 30,000 of the city’s 150,000 residents had fled both the airstrikes and strict IS rule, according to the United Nations.  

Those who returned home after IS was driven out found a city in ruins, now controlled by Turkish-backed FSA rebels. Landmines, planted by IS fighters as they fled, dotted the streets. Residents discovered their homes had been flattened under bombs, their personal possessions looted by retreating gunmen.  

An estimated “75 percent” of the city was reduced to rubble, one returning resident told Syria Direct in March.  

Still, tens of thousands of residents began streaming back home to al-Bab in February and March as battles further east were just beginning to set up the conditions for the current typhoid outbreak.  

Forces loyal to Syrian President Bashar al-Assad in northern Aleppo province were waging their own, separate campaign to reclaim a swathe of towns and villages from IS outside al-Bab. In early March, pro-Assad forces seized hundreds of kilometers of mostly rural farmland along the eastern bank of the Euphrates.  

Among the gains in March was a major water pumping station located an estimated 45km southeast of al-Bab that once provided the city’s sole source of safe running water.  

Though pro-regime news outlets reported soon afterwards that the water station began operating once again, people in al-Bab say the water is not flowing.

 Al-Bab on Tuesday. Photo courtesy of Malek Taleb.

Without an active water source, al-Bab’s residents “are now digging their water out from wells inside the city,” said one local activist, who spoke with Syria Direct on condition of anonymity.  

The wells are basic, constructed with little regard—or likely any technical knowledge—of appropriate locations.  

Some of the makeshift wells are being built directly above what remains of the city’s sewage system, multiple sources told Syria Direct. As a result, raw sewage is leaking into water used for drinking, cooking and cleaning in private homes.  

“This is the main cause for the current typhoid outbreak,” the activist in al-Bab said. 

Typhoid, a potentially deadly bacterial infection, spreads via contaminated feces and urine—meaning al-Bab’s raw sewage leakage is a likely culprit for the recent outbreak, says Dr. Mohammad Ismail, who runs a private clinic inside the city and is treating 10 to 15 new typhoid patients each day. 

Ismail’s clinic is one of at least 10 new medical practices in al-Bab that have opened since IS withdrew from the city.  

But the scale of the water contamination is “simply beyond the city’s capabilities,” the doctor told Syria Direct. 

Among the ruins left behind in al-Bab is the city’s healthcare system. Even before the FSA and its allies began their battle late last year to seize the city, IS fighters prevented anyone but their own “personnel and families” from receiving medical care, 37-year-old resident Abdelsalam Abu Essam told Syria Direct in February.  

Today, with IS gone, healthcare is available to all—but only one public hospital and a field clinic remain standing to treat the dozens of city-wide residents contracting typhoid. Others must turn to small private clinics such as Ismail’s. For everyone, medicine and equipment are in desperately short supply.  

Typhoid is typically treated with antibiotics that kill the disease-causing bacteria. But even the blood and urine tests that Ismail would have once used to diagnose typhoid patients are now “unavailable.”  

Al-Bab’s medical sector is pitifully “ill-equipped and underserved,” the doctor says, creating a potent breeding ground for “the spread of infectious, communicable disease.” 

‘I’m afraid they’ll get sick’ 

Al-Bab’s typhoid outbreak is the latest health crisis in Syria as the war shatters a once self-sufficient healthcare system in all areas of the country.  

As early as 2013, the World Health Organization (WHO) warned that the war would “create a potential risk of outbreaks.” Up to 70 percent of Syria’s medical workforce had already fled by the summer of 2013, according to the same statement.

 Residents pump water from a makeshift well in al-Bab on Tuesday. Photo courtesy of Bahaa al-Halabi. 

“We are anticipating a number of public health risks from water-borne diseases, specifically hepatitis, typhoid, cholera and dysentery,” Dr. Jaouad Mahjour, director of the Department for Communicable Diseases at WHO’s regional office said in the 2013 release.  

Now, more than four years later, healthcare is “a casualty” of the conflict as medical facilities across the country “lack clean water, electricity and sufficient medical and surgical supplies,” according to a March 2017 WHO press release.   

Al-Bab residents caught in the middle of their own public health crisis say they have few alternatives to avoid illness. Clinics in the city can do little to help, and bottled water prices have risen by 50 percent in recent weeks, making it a luxury for most.  

Umm Abdo is a single mother who cannot afford to buy bottled water for her three-year-old son. Last week, his stomach “began to hurt, and his body temperature rose,” she told Syria Direct. After three days, she finally took him to a doctor who diagnosed him with typhoid fever.  

“He said the well water was likely the cause of my son’s illness.” 

Now, a week after he began feeling sick, she says her son is not improving.  

Malek Taleb, a 30-year-old father in al-Bab, was more fortunate. An employee in a money exchange, he still manages to afford small amounts of bottled water for his own toddler in an effort to stave off typhoid.  

The children of Taleb’s sister fell ill in with typhoid in recent weeks after drinking contaminated well water. Seeing his sick nieces and nephews scared Taleb into purchasing bottled water “to prevent [my own child] from getting typhoid,” he told Syria Direct. 

“My wife and my daughter—I’m afraid they’ll get sick.”