Weaponizing water as an instrument of war in Syria: Impact on diarrhoeal disease in Idlib and Aleppo governorates, 2011–2019

Abstract

Investigate the weaponization of water during the Syrian conflict and the correlation of attacks on water, sanitation, and hygiene (WASH) infrastructure in Idlib and Aleppo governorates with trends in waterborne diseases reported by Early Warning and Response surveillance systems. Methods: We reviewed literature and databases to obtain information on attacks on WASH in Aleppo and Idlib governorates between 2011 and 2019. We plotted weekly trends in waterborne diseases from two surveillance systems operational in Aleppo and Idlib governorates between 2015 and early 2020. Results: The literature review noted several attacks on water and related infrastructure in both governorates, suggesting that WASH infrastructure was weaponized by state and non-state actors. Most interference with WASH in the Aleppo governorate occurred before 2019 and in the Idlib governorate in the summer of 2020. Other acute diarrhea represented >90% of cases of diarrhea; children under 5 years contributed 50% of cases. There was substantial evidence (p < 0.001) of an overall upward trend in cases of diarrheal disease. Conclusions: Though no direct correlation can be drawn between the weaponization of WASH and the burden of waterborne infections due to multiple confounders, this research introduces important concepts on attacks on WASH and their potential impacts on waterborne diseases.

Water disruption and waterborne communicable diseases in northeast Syria: a spatiotemporal analysis

“…Similar events and ndings were reported by Abbara et al in their investigation into the weaponization of water in northwest Syria in Aleppo and Idlib governorates, with the majority of events occurring in the main cities (Abbara et al, 2021).…”

“…That 80% of disease reports were "other acute diarrhoea" deserves some attention to ensure accurate reporting of the case de nitions for acute bloody and acute watery diarrhoea by health workers. An overall upwards trend of WBDs, with seasonal peaks in the late summer, was observed throughout the whole region, corresponding to trends reported in northwest Syria (Abbara et al, 2021). However, considerable variability in trends and median weekly levels of WBDs were observed in different districts.…”

“…A recent paper by Abbara et al identi ed several attacks on water and water infrastructure in northwest Syria with an overall upwards trend of diarrhoeal diseases during this period. (Abbara et al, 2021). Attacks and disruptions such as these can have repeated impacts on the risk of waterborne disease outbreaks; we have summarised the potential pathways to impact in Fig.…”

Crop Cultivation at Wartime – Plight and Resilience of Tigray’s Agrarian Society (North Ethiopia)

“…Water is another valuable natural resource that has also been weaponised in conflicts, especially in drier environments. In Syria, all major parties have weaponised water in order to control or to inflict damage on their opponents (Abbara et al 2021). For example, ISIS (Islamic State) is responsible for the deliberate contamination of drinking water to expand their control over the populations, the government of Syria bombed eight water facilities over the summer of 2019 and the Free Syrian Army captured and controlled a spring in 2014 to control the water provision of Damascus with the goal of having leverage in negotiations.…”

The health of internally displaced people in Syria: are current systems fit for purpose?

“…Given the vast humanitarian needs for most of Syria's population, (whether they are IDPs or host communities), some in the health and humanitarian sector challenge the utility of defining and exploring IDPs as a unified group, particularly given their heterogeneity. However, to counter this, it is noted that IDPs may face additional vulnerabilities over and above those experienced by other vulnerable populations in Syria related to the reasons for forced displacement, ongoing violence and insecurity, inadequate living conditions, poor WASH (water, sanitation and hygiene ( Abbara et al., 2021 )) as well as other risks including that of communicable diseases outbreaks and SGBV (Sexual and Gender Based Violence ( Cantor et al., 2021 ).) This does not detract from the vulnerabilities faced by the majority of the Syrian population of whom more than 80% live below the poverty line and more than 12.4 million people are food insecure (an increase from 7.9 million in 2020 ( CCCM Cluster 2022 )).…”