Damascus, Mamdouh, a young man from Damascus, did not know he would have to undergo a procedure to break up crystallized stones in his right kidney. According to doctor reports, the kidney stones were caused by contaminated drinking water that needs chlorine treatment and sterilization to be fit for human consumption.
Mamdouh, 25, said before undergoing an endoscopy procedure for the kidney stones at the beginning of the year: “Doctors asked me to drink only sterilized water because my health does not allow me to drink from the government water network. They said that the kidney stones could return after three months and my condition would deteriorate.”
Mamdouh’s condition resembles that of 26-year-old Ola, who suffers from Hepatitis A, which recently spread across several areas in Rif Dimashq (Damascus countryside) due to contaminated drinking water. In a statement published in the local media on July 26, 2014, the Syrian Red Crescent Organization said that “contaminated water has caused widespread diarrhea, hepatitis, and skin disease.”
Tens of thousands of Syrians drink contaminated water mixed with sewage water, as the networks could not withstand the surrounding military confrontations, which caused breakage and leaks. This is not to mention the type of pipes that violate international standards and lack maintenance, according to this investigation, which covered the status of water and networks in Rif Dimashq and the city, the lifeline for at least 2 million residents living there.
This investigation found that 74% of water sources are contaminated in Damascus and its countryside after the main water refinery station in Adra, Rif Dimashq, and water analysis equipment were destroyed during the war. Water networks were also destroyed in more than 20 villages and towns, where drinking water was mixed with sewage. This is in addition to lack of sterilization and maintenance equipment blocked by international sanctions, which led to the spread of Hepatitis A and severe diarrhea.
Contaminated and “calcified water” also causes kidney stones because of insufficient treatment with chlorine. Chlorine shortages – due to international sanctions on Syria – come with failure to adhere to the required standards in the treatment and sterilization process conducted by employees at the government-run Drinking Water Institution. Husam Huraideen, the institution’s director, acknowledged that “the human factor and negligence contributes to lack of sterilization in rural areas.”
Further aggravating the problem is the destruction of the main water laboratory in Harasta and two water treatment stations in Adra and Daraya. The raging conflict in Syria since March 2011 also obstructed technical teams from reaching some areas to sterilize the water.
This reporter took water samples from Rif Dimashq, including Jaramana, Sahnaya, and Dahiyet Qadsaya for a lab analysis, which showed drinking water was contaminated with the E-coli bacteria in two of three sources. These samples, therefore, are considered “infected with germs, chemically unacceptable, and do not adhere to water standard specifications,” according to water specialist Abdul Qader J., who participated in several Syrian official committees that studied water contamination cases. Infected water – as well as lack of hygiene due to the crisis – is a main cause for the spread of communicable diseases, including acute diarrhea, Leishmaniasis, and hepatitis, according to Burhan Asfour, director of the Communicable Diseases Department in the governorate of Rif Dimashq.
The sample test results match others conducted by official Syrian institutions, but they were not announced.
However, this reporter obtained copies showing that Rif Dimashq governorate, the Health Directorate, and Water Institution conducted tests in November and December 2013 in Al-Mlaiha, Adra, and Sahnaya, in addition to another analysis on August 6, 2014. Of 27 drinking water samples tested for bacterial levels from the countryside towns, 21 samples were found “unacceptable” from areas where hepatitis was widespread.
An official epidemiological bulletin issued by the Health Ministry said that more than 276,000 cases of acute diarrhea were recorded between 2012 and the first half of 2013. According to the ministry, this official number is “less than the actual rate.” A ministry medical source believes that private sector hospitals registered nearly the same number of cases.
The recorded cases suffering from these diseases constitute nearly 200,000 more than the two years preceding the crisis in Syria in 2009 and 2010.
According to these numbers, Rif Dimashq came in second after Al-Hasakah in terms of acute diarrhea and third after Tartous and Latakia, respectively, in cases of hepatitis in the first quarter of 2013.
Dr. Haitham Mohammad, a physician specialized in kidney disease, wrote a special report upon this journalist’s request on diseases caused by contaminated water, stages of kidney stone formations and causes for their growth, and whether water is a factor in this regard. He said in his report: “Hard, calcified and contaminated water is a cause for Hepatitis A and acute diarrhea; it also forms different types of kidney stones.” Dr. Mohammad, a specialized surgeon at the government kidney hospital, attributed his reference to Campbell, an international medical source on kidney disease and surgery.
Chemist Intissar Mardini, an expert in drinking water at the Ministry of Water Resources, acknowledged that “there is no water supervision to deteremine whether water it is fit for human consumption in heated areas, including Rif Dimashq.”
She added: “Although the Public Institution of Drinking Water in Damascus sterilizes some water sources with chlorine, it cannot reach many important water sources in Rif Dimashq. Making matters worse is the destruction of the main laboratory in Harasta and water treatment plant in Adra.”
Due to shortage of sterilization material, namely chlorine, these materials have fallen under aid to Syria from organizations such as the International Committee of the Red Cross and Syrian Red Crescent. They are distributed to water pumping stations in Damascus and its countryside for sterilization, but the amount is not enough and there is no guarantee that they would be used in all areas due to the war, according to the Ministry of Water Resources.
Syria previously produced liquid chlorine in the city of Aleppo, but the only factory in Syria stopped operations because of intermittent confrontations in its area. Consequently, international organizations supply an insufficient amount of tablets for use.
According to Mohammad Al-Shayyah, drinking water director at the Housing Corporation, a cylinder of liquid chlorine costs 25,000 Syrian pounds ($156), while it is sold in the black market at 125,000 pounds ($780). Each cylinder is enough to purify Damascus’s water for one week.
A 2012 World Bank report on water in Syria stated that a high percentage of the population drank water from public pipes, or the government water network. The study indicated that 87 percent of residents in Syria’s rural areas depended on water sources that suffered from “a regression in the water system, damaged networks, and malfunctions, which led to cases of contamination.”
International organizations sounded the alarm at the state of Syria’s drinking water networks, particularly in Rif Dimashq, and called for moving quickly to address the implications of the water crisis if contamination continued. UNICEF estimated $80 million is needed to implement its plan to secure water safety in 2014 and continue to provide sterilization material to deliver safe water for citizens.
Elizabeth Hoff, World Health Organization (WHO) representative in Syria, said: “What concerns us most is the collapse of water and sanitation networks and rise of water-borne diseases. There are reported cases of Hepatitis A, which could cause epidemics in Aleppo, Idlib, and crowded shelters for displaced people in the capital.”
In early May 2014, Damascus Health Directorate released laboratory test results showing that the bacterial levels in 21 out of 27 water samples from different areas of Damascus and its countryside were unacceptable.
Another report by the Executive Bureau of Rif Dimashq Governorate covering the last two months of 2013 indicated that contaminated drinking water reached several areas, according to samples analyzed by the Epidemiological Investigation Division at the Health Directorate following the spread of Hepatitis A last year. The tests were conducted on 23 water samples taken from areas where the disease had spread, including Sahnaya, Adra Al-Ummaliah, and Al-Mulaiha. The results showed that the bacterial levels in only six out of 23 samples were acceptable, while 17 were unacceptable, meaning that 26% of the samples were acceptable and 74% were contaminated. This means that 74% of the population in these areas drinks contaminated water.
A previous similar study by the Health Ministry in 2012 of 31 water samples that were tested from different areas in Rif Dimashq showed bacteria levels in 17 samples were unacceptable (55%) while the rest was acceptable.
The studies in 2012, 2013, and 2014 show a 25% annual increase in unacceptable bacterial levels in water samples.
A copy of a WHO report published in July 2013 and obtained by this reporter links between Hepatitis A and water contamination. It said that “unsafe water” causes this disease, with 90 percent of its victims being children under 10 years old. The report noted that “Hepatitis A is a viral liver disease that can cause mild to severe illness and spreads by ingesting contaminated water and food.”
The report also showed that Hepatitis A is “caused by unsafe water and inadequate sanitation” adding that there are an estimated 1.4 million cases of Hepatitis A worldwide. It said that “unlike Hepatitis B and C, Hepatitis A infection does not cause chronic liver disease and is rarely fatal, but it can cause debilitating symptoms and fulminant hepatitis (acute liver failure), which is associated with high mortality.”
Husam Huraideen, director of the Drinking Water Institution in Damascus, said that the war exposed past negligence by failing to renew the water networks in Rif Dimashq. He added that “most of them are old and made of asbestos, which is unacceptable worldwide, violates standard specifications, harmful to drinking water, and may sometimes cause cancer.”
Dr. Adel Awad said in a study conducted for Tishreen University’s Environmental Engineering Division in 2009: “Asbestos and amianthus in the first group are known to cause cancer in human beings upon inhalation. The International Agency for Cancer Research linked pancreatic and stomach cancer to concentrations of asbestos in drinking water.”
The effect of this substance is reduced when using water sterilization materials, but international sanctions have prevented the sterilization process, leading to an increased risk of cancer and other diseases, according to Huraideen.
He said that all countries use “Font” pipe networks for the main lines and polyethylene for the branch lines.
He added: “Due to the crisis in Syria, work has stopped on most projects that were previously contracted. In addition, contractors did not submit entries for projects that were announced last year.”
According to a Rif Dimashq Governorate report on maintenance of water networks in 2013, the replaced water pipelines in several areas showed the following rates: Al-Dumair, 38%; Jairood, 35%; Hosh Arab, 51%; Jebaideen, 20%; Al-Qutaifa, 36%; Al-Nabak, 72%; and Shebaa, 35%. This means that less than 50% of the overall water pipelines across Rif Dimashq were replaced.
The WHO’s early warning system that covers 14 Syrian governorates warned of disease outbreaks and showed a significant increase in cases of acute watery diarrhea, which increased by 172% from 243 cases in the first week of January 2013 to 660 in the second week of May 2013. Hepatitis A increased by 219% from 48 cases to 153 during the same time period.
Family physician Dr. Hisham al-Khatib said that diseases caused by drinking contaminated water, which is contaminated by human and animal feces, causes diarrhea, cholera, dysentery, typhoid, and hepatitis.
Dr. Jawad Mahjour, director of the Department of Communicable Diseases at the WHO’s Eastern Mediterranean Regional Office, said in June 2014: “We are anticipating a number of public health risks from water-borne diseases, specifically hepatitis, typhoid, and cholera.”
Conditions are expected to deteriorate, according to official statistics that predict the number of acute diarrhea cases to rise to 133,000 by the end of 2014, or an average of 32,000 cases every three months; Hepatitis A is expected to increase to 2,600 cases, or an average of 670 cases every three months, according to the WHO regional office.
This investigation was conducted with support from Arab Reporters for Investigative Journalism, ARIJ: www.arij.net