Hepatitis continues to spread in Daraa governorate, southern Syria. The polluted drinking water is to blame, and the situation is exacerbated by the Syrian government’s (GOS) negligence, the healthcare system’s inability to cope, and the overall decline in the health situation within the governorate. More than 30,000 civilians are at risk of contracting the disease, despite their repeated requests for assistance.
In late September 2023, Daraa’s people, struck by a viral hepatitis outbreak, issued a statement appealing to international humanitarian, relief, and human rights organizations to intervene and assist with the crisis. The statement emphasized that no household was exempt from infection due to contaminated drinking water sources and GOS neglect. The people had sent many distress calls that were not adequately addressed. The government responded with spoiled medication and left them alone to face an unknown fate, as people described.
According to information obtained by Syrians for Truth and Justice (STJ) and verified by a local medical source, approximately 2,000 cases of hepatitis were recorded in Daraa Governorate between June and October 2023. STJ investigated the epidemic by talking to patients, their families, health and academic workers, and staff of the Water Directorate in the Yarmouk Basin area. The interviews aimed to determine the causes of the epidemic and the measures the Syrian government took to tackle the crisis. However, we discovered that the GOS’ response had failed to protect the populace.
Sewage-Contaminated Water Responsible for Hepatitis
STJ spoke to a farmer from al-Shajara town. He confirmed that his wife and daughter got Hepatitis after drinking irrigation water and showed symptoms of severe back and abdominal pain and yellow eyes and skin. The farmer recounted,
“I own a vegetable farm between al-Shajara town and Nafa’ah village. I rely on the streams that flow from the Ain Zikr spring to irrigate my crops. The streams’ water was clean years ago; however, it has become severely polluted due to other farmers extending their irrigation lines from the streams to their farms and leaving them there, causing the contaminated water to return to the main line. [Unfortunately], the state has rationed water to the farms, leaving us no choice [but to use this polluted water]. Buying water for irrigation is very expensive, and the rainfall in recent years has not been sufficient. As a result, I am forced to use this water to sell my crops and feed my family.”
Not only irrigation water but other water sources in Daraa were found to be contaminated. A seventh-grade female student in the town of al-Shajara contracted hepatitis after drinking water at school. The girl, in the presence of her family, narrated,
“The water looked clean; I used to drink from it every day. However, I began to experience stomach pain and a feverish sensation in my body. Initially, I assumed it was a common cold and did not pay much attention. But the symptoms worsened, and my eyes and skin turned yellow, causing me to become very frightened, particularly since everyone was talking about the spread of Hepatitis in town. My father took me to the town’s health center, where the doctors confirmed my infection [with the virus]. They advised me to avoid drinking contaminated water and boil it before consumption. Unfortunately, this is challenging since our village has no clean water and no electricity or gas to boil it.”
Some infected people in Daraa, especially those with preexisting health conditions, did not recover from the disease and eventually died. A teacher from Daraa countryside confirmed to STJ that two of his students were diagnosed with Hepatitis after drinking water from the school. The teacher noted that the school’s water supply came from the main line of al-Shajara town, which was contaminated with sewage. Unfortunately, one of the students passed away shortly after becoming infected. The teacher explained,
They had to go to the National Hospital of Nawa, very far from al-Shajara town, and wait in long lines for examinations and treatment. This hospital is the only government hospital in the region, and most residents of the villages and districts of Nawa go to it [to receive treatment]. The two students’ families had to spend a lot of money buying medicines and food as the hospital doesn’t provide any medication for Hepatitis, despite the prevalence of this disease in the Daraa region every year due to water pollution. I used to go to the hospital to check on the two students, especially after their condition deteriorated due to the allergy and asthma they had. I tried to support them, but that was not enough [to heal]. One of them died a few days later. The hospital’s medical report attributed his death to respiratory complications. The report said that liver disease or the medications he took were not the main cause of his death but rather the worsening of his allergies and lung weakness.
According to the World Health Organization (WHO), the Hepatitis virus is transmitted through ingestion of contaminated food and water or through direct contact with an infectious person. The disease is closely associated with unsafe water or food, inadequate sanitation, and poor personal hygiene.
The GOS’ Failure to Protect its Citizens’ Health
The sources STJ met concurred that the government medical centers are unable to receive patients due to a shortage of medical staff and appropriate medications for the disease. A nurse at the health center in rural Daraa’s Ain Zikr town reported that on 20 September 2023, she was summoned to the al-Shajara town health center due to the large number of Hepatitis cases and the absence of medical personnel at the center.
The nurse told STJ that the medical staff was using the same contaminated water to sterilize wounds and instruments, adding that she tried everything she could to help the patients,
“The Health Directorate in Daraa informed us that the concentration of infections in these towns and villages is due to contamination of drinking water sources by sewage there. So far, the center recorded 1519 [Hepatitis] cases, mostly of children and women. I witnessed patients [receiving treatment] in the street with intravenous (IV) fluid bags attached to them, due to the [major] outbreak of the disease and the center’s inability to accommodate all infected.”, the nurse said.
The nurse mentioned that despite the shortage of medicines and medical supplies in the center, they did not receive support from the Ministry of Health or nearby centers. The only assistance came from the people of Daraa and the expatriate residents of al-Shajara town. Worst of all, is that the center had to reuse injection tools for more than one patient, which increased the risk of infection. The witness added,
“There is a shortage of health centers in the region. The only health center available is situated in the town of al-Shajara. However, it is not functioning optimally as it lacks doctors and is operated by nurses who can only offer basic first aid by installing IVs. The work of the Health Directorate in Daraa is limited to educating citizens on hygiene, sterilizing water tanks, cleaning food, and avoiding sharing personal tools of an infected person.”
In addition to the direct effects of the disease, limited response and lack of medication increased the suffering and fears of people. A mother from al-Shajara town testified to STJ about her five-year-old son who was infected saying,
“We failed to find a doctor to treat our child. However, nurses helped us at the sole health center in town. They told me that [my son] needed IV fluids and medicines, which ran out because of the large number of infections. My son was in a lot of pain and crying all the time. I was very afraid for his life and the lives of the rest of my children. We took the child to al-Shifaa private hospital in Daraa, but they refused to receive him. They asked us to treat him at home and taught us how to administer IVs.”
The farmer (source above) confirmed experiencing the same situation. He narrated on this,
“I could not take my wife and daughter to the private hospitals in Nawa or Daraa as they were too far from our village, and I did not have a personal mode of transportation. We had to go to the town health center, which was very crowded. The nurses there asked us not to bring patients to them but instead to isolate them at home and administer IVs.”
The GOS’ Inability to Provide Drinking, Irrigation Water
In an effort to understand the reasons behind the dangerous contamination of drinking and irrigation water, and the devastating consequences it brings, STJ interviewed an engineer from the Water Directorate in the Yarmouk Basin. The engineer confirmed the accuracy of the information regarding the contamination of drinking and irrigation water with waste and germs. He explained,
“I work in the water testing laboratory. Since 15 September 2023, we started receiving complaints about water pollution in the Yarmouk Basin area and hearing reports of Hepatitis cases. I witnessed how the water used for irrigation and drinking in some villages was contaminated with waste and germs. The primary reason for the contamination is the damage caused to the livestock watering pipe that runs from the Ain Mali spring, also known as the Ain Zikr spring, to the al-Shajara town. Due to the unavailability of necessary chemicals, we were unable to disinfect the water adequately. As a result, we had to use a small amount of chlorine, and sometimes nothing at all, which posed a significant risk to the health of people, especially children and pregnant women. I informed my manager about the severity of the situation and urged him to notify the local and health authorities. However, he refused to take any action and asked me to remain silent, citing that the situation was widespread and we had no other option.”
The Rights to Health and Access to Safe Water from a Legal Perspective
Access to healthcare is a fundamental human right that is crucial for the enjoyment of other human rights. Every individual has the right to access the best possible healthcare services that promote a dignified life. Clean drinking water is considered an essential requirement to safeguard this right. The right to health is recognized in various international agreements; Article 25.1 of the Universal Declaration of Human Rights (UDHR) states, “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services,”
In the same vein, Article 12 of the International Covenant on Economic, Social, and Cultural Rights (ICESCR) affirms everyone’s right to enjoy the highest attainable standard of physical and mental health. To fully realize this right, the Article calls for the prevention, treatment, and control of epidemic, endemic, occupational, and other diseases, and the creation of conditions that ensure all medical services and medical attention in the event of sickness.
The right to health is also recognized in Article 5 of the International Convention on the Elimination of All Forms of Racial Discrimination (ICERD) of 1965, Articles 11 and 12 of the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) of 1979, and Article 24 of the Convention on the Rights of the Child (UNCRC) of 1989.
On 28 July 2010, the United Nations General Assembly adopted a resolution recognizing “the right to safe and clean drinking water and sanitation as a human right that is essential for the full enjoyment of life and all human rights” (A/RES/64/292). Enjoyment of this right requires access to safe, clean, accessible, and affordable drinking water and sanitation.
The Committee on Economic, Social and Cultural Rights (CESCR) notes that during armed conflicts, emergency situations and natural disasters, the right to water embraces those obligations by which States parties are bound under international humanitarian law.20 This includes protection of objects indispensable for the survival of the civilian population, including drinking water installations and supplies and irrigation works, protection of the natural environment against widespread, long-term, and severe damage, and ensuring that civilians, internees, and prisoners have access to adequate water.
As for Syrian legislation, the current 2012 Syrian Constitution does not have any articles that specifically address water and food security or the state’s responsibility to secure and protect them. However, it does mention the state’s duty to safeguard the health of its citizens;
“1. The state shall guarantee every citizen and his family in cases of emergency, sickness, disability, orphan-hood, and old age;
- The state shall protect the health of citizens and provide them with the means of prevention, treatment, and medication.” (Article 22).
“Education, health, and social services shall be the basic pillars for building society, and the state shall work on achieving balanced development among all regions of the Syrian Arab Republic.” (Article 25).