National Newswatch

Years of destruction brought upon industrial infrastructure in Syria are likely to have consequences beyond the economic cost of reconstruction. Attacks on water and oil facilities in particular present both direct and indirect risks for the public health of Syrians. These risks may prove to outlast the conflict itself, and thus constitute important threat multipliers that need to be understood if the potential for future renewed unrest is to be reduced.

In the first days of 2017, about 1,300 people fled Syria’s Barada Valley following a government assault on rebel-held territory bolstered by Hezbollah fighters and Russian aircraft. Due to the presence of Jabhat Fateh al-Sham (formerly known as Jabhat al-Nusra), the region is not part of the ceasefire that went into effect on Friday December 30th.

However, the consequences of the ongoing operations are far from limited to the inhabitants of the Barada Valley. In January, the valley’s Ain al-Fijeh water processing facility was destroyed in airstrikes. Water sources have allegedly been contaminated with diesel fuel, although it remains uncertain which party involved in the fighting was responsible for the contamination. The valley region serves as the primary source of water for Damascus and its surrounding region. Due to the assault, over 5.5 million people in and around the capital have been facing a severe water shortage since December 22nd.

While the United Nations (UN) has been working with water authorities in Damascus to implement an emergency plan to meet 30 percent of the city’s water demand, the restoration of the area’s water supply should not be regarded as the end goal. Indeed, water shortages give rise to public health issues, which are likely to persist in the affected area in the long-term. A number of communicable diseases are associated with sanitation facilities that do not meet the minimum requirements for clean water, or with water shortages so severe that people resort to drinking rainwater and other unfiltered sources. Cholera is the most notable example of a waterborne disease that is at a higher risk of transmission during and following humanitarian crises, and that, if left untreated, can kill within hours. According to the World Health Organisation (WHO), areas with a high concentration of internally displaced persons (IDPs) or refugees are particularly at risk should the bacteria of a communicable disease be introduced as a result of infrastructural damage. With 1.4 of Syria’s nearly 6.6 million IDPs concentrated in the Damascus area, the developments in the Barada Valley could present a serious public health issue.

The level of vulnerability is reminiscent of the situations faced by Haiti in 2010 and 2016, by Sierra Leone in 2012 and by Ethiopia last year, when the lack of adequate water and sanitation facilities led to the sudden spread of communicable diseases. And, as in these three cases, the single most important condition that could prevent the occurrence of disease from evolving into a full-fledged public health emergency is lacking in Syria too: a functioning healthcare system. Nearly two-thirds of healthcare workers have left the country since the start of the crisis, and hospitals were targeted in airstrikes more than 100 times in 2016. Meanwhile, the potential for international organisations and NGOs such as Doctors Without Borders, to access the most deprived areas remains highly limited due to the insecurity and a lack of authorisations. As a result, access to medical care and supplies is “appallingly insufficient”. It is safe to say that Syria’s healthcare system has gone from crumbling to depleted over the course of the conflict—this, in itself, presents an important risk multiplier for the regions faced with poor access to (clean) water.

And the water shortage around the Barada Valley is but one of many other public health concerns in Syria. Attacks on industrial infrastructure have been commonplace and in the wider regional fight against the Islamic State (IS). In that sense, the destruction of the Ain al-Fijeh water spring is actually somewhat of a novelty; previous attacks have tended to target oil facilities. The first US airstrike against oil installations held by IS took place on 24 September 2014 in the Deir al-Zor region. To date, the US military claims to have damaged or destroyed over 2,600 targets related to oil infrastructure in Syria and Iraq. Russia has also confirmed targeting oil tankers, refineries and pumping stations in their airstrikes, which began in September 2015. Last October, IS fighters set alight nineteen oil wells in Iraq’s Qayyarah region—they burned for months.

The health effects of such attacks are multifaceted and severe, creating both acute and long-term risks. Burning oil releases soot and hazardous gases, notably sulphur dioxide, nitrogen dioxide, carbon monoxide and lead.  In the short run, sulphur dioxide is known to irritate nose and throat; nitrogen dioxide can cause respiratory problems; carbon monoxide is linked to headaches, nausea and dizziness; and lead poisoning can affect brain, kidneys, liver and bones, to which children are particularly at risk. When an oil well burns, these harmful substances produce toxic clouds that can affect populations far from the site of the original attack. During the battle to retake Mosul in Iraq from IS, a stockpile of sulphur dioxide caught fire at the Mishraq Sulphate Factory south of the city, and created a toxic cloud that spread for dozens of kilometres. The WHO treated over 1,000 cases of suffocation in the affected areas.

The harmful effect of each substance is amplified when combined with other chemicals, and once inhaled, they are absorbed by fat tissue, which means that they are stored in the body and remain for a long time. Prolonged exposure is correlated with chronic respiratory disorders, lung damage, heart complications, cancer, reproductive problems and damage to the immune system. While it must be mentioned that research on the long-term health effects from exposure to oil well fires is not definitive, there is serious concern that problems associated with for example lead poisoning are especially risky for impoverished people and when left untreated. In the case of Syria, this is not only relevant for reasons related to the current state of the country’s healthcare system as discussed above; the population has also become severely impoverished. The World Food Programme (WFP) estimates that four out of five people in Syria today are living in poverty.

It is important to note that the possible health risks set out above are potentially interconnected. War tactics in one area can have a range of unforeseen public health effects both in the targeted area and elsewhere. For example, as oil wells continue burning, they do not only produce the toxic gases for which they are most well-known, but may also pollute groundwater sources used for drinking. In this way, airstrikes on oil facilities could indirectly contribute to the risk of communicable waterborne diseases as well.

This example further serves as an illustration of the links between damage to industrial infrastructure, health, and environmental factors. While the most acute risks created by the destruction of industrial targets in war are directly related to public health, there are also numerous ways in which they may continue to present indirect health challenges on the long run through environmental consequences. Similar to how a burning oil well may contaminate a groundwater source, it is likely to degrade land that serves agricultural purposes. Not only would this feed back into health concerns through foodborne diseases, the degradation of agricultural land is also known to lead to a host of environmental challenges, with potential indirect impacts on public health. Droughts and desertification, crop failure and food shortages are among the most prominent risks. These, in turn, could provide a renewed source of conflict and strife, thus limiting the prospects of sustainable peace and reconstruction. The links between environmental degradation and unrest are well-documented, including, for example, in the case of Darfur, where the UN Environmental Programme (UNEP) assesses that “eroding environmental services” are among the root causes of persistent conflict. Indeed, there is an argument to be made that even the origins of the Syrian conflict are partly found in worsening environmental conditions in the years leading up to the 2011 protests.

Importantly, as is characteristic of both public health and environmental issues, their risks are not limited to conflict-stricken areas only. With over 4.8 million refugees in Syria’s neighbourhood alone, the potential impacts described above are likely to be felt beyond the country’s borders too. Refugee settlements that were meant to be temporary often end up being in use for longer periods of time, and may expand considerably. Big camps tend to have larger environmental impacts than several more dispersed smaller ones. Deforestation, soil erosion or the depletion and pollution of water resources are cited by the UN High Commissioner for Refugees (UNHCR) as common problems in and around major refugee camps. Naturally, these issues may have a negative impact on the health of refugees in the same way that they may affect civilians within Syria. In Lebanon, humanitarian agencies have attributed the outbreak of a diarrheal disease in Syrian refugee camps in 2014 to the poor quality of water. This water contained bacteriological levels ten times higher than guidelines prescribed by the WHO.

With peace talks on Syria underway in Kazakhstan, it is important to be aware of the public health risks faced by the Syrian population—both acute and long-term, direct and indirect, inside and beyond the country’s borders. A failure to address these risks efficiently as soon as possible would be to underestimate their potential as threat multipliers to civilian suffering, to the sustainable reconstruction of livelihoods and, ultimately, to durable peace.

Aminata M. Kone is a Middle East and North Africa Analyst with the Initiative for the Future of Global Risk (IFGR).  Having obtained a joint Bachelors degree in International Relations and French from the University of Sussex in the UK, Aminata currently pursues a Master in International Security at Sciences Po Paris, with a special focus on energy issues. Fluent in Dutch, English and French and conversational Arabic (MSA) Aminata has worked on a diverse range of issues related to the MENA region through research placements as well as in the public sector.  The Initiative for the Future of Global Risk (IFGR) provides a platform for unconventional approaches to existing and emerging areas of risk.

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