After more than a decade of brutal war, Syria is mired in poverty and disease. A nation that once boasted a middle-income economy and a relatively well-developed infrastructure can no longer feed its population, supply it with clean water, or keep preventable disease in check.

The Syrian conflict has been stagnant for years, reduced to skirmishing along largely frozen front lines. But there is no respite for Syrians. Amid an economic collapse unfolding since 2019, and on the heels of COVID-19, Syria now suffers another bout of deadly disease: since late summer, more than 60,000 suspected cases of cholera have been recorded across the country, even spreading into Lebanon.

Syria’s emergence as an exporter of deadly, waterborne disease is a tragic development, but not a surprising one. Much of the prewar infrastructure that used to supply Syrians with clean water and basic sanitation has been rendered inoperable by violent attacks, drought, energy shortages, or sabotage. As a result, Syrians are forced to turn to unsafe alternatives, such as polluted rivers, illegally drilled wells, and a booming industry of private water salesmen.1 With a health sector in tatters and millions living in overcrowded camps or other unsanitary dwellings, the country has turned into a perfect breeding ground for disease. “The cholera outbreak is a painful lesson that should lead to a change in the shape and the scale of the humanitarian response in Syria,” one aid professional said. “Treating symptoms is not enough.”2

As of now, more than two-thirds of Syria’s population requires humanitarian assistance, only half of all water and sanitation systems and hospitals still function, and the supply of drinking water has dropped by 40 percent as compared to before the war.3 Even surviving water purification facilities stand idle, whether due to electricity and fuel shortages or because the denial of water is being weaponized by armed actors. In some areas, water shortages are so extreme that civilians are forced to abandon basic hygiene, such as hand-washing, because they need the water for drinking.4 The situation is a blueprint for the production and export of waterborne disease.

Indeed, the rapid spread of cholera across Syria and into Lebanon—another economically devastated nation edging toward failed-state status—underlines that the crisis cannot be left to fester. Death rates may have slowed and global media attention may have waned, but Syria remains a live emergency that will not wait for the world to make up its mind about the war’s outcome.

This Century International report, which is part of “Networks of Change: Reviving Governance and Citizenship in the Middle East,” looks at the water crisis that is at the root of Syria’s cholera outbreak: a dramatic contraction of the water supply, coupled with a loss of purification and pumping capacity. It is a complex crisis for which many actors share the blame. But all Syrians—and the region as a whole—would benefit from seeing it addressed. Because as tragically broken as Syria is today, life there may still get immeasurably worse—and unless the deterioration of critical water infrastructure is reversed, it will.

The Cholera Outbreak

Historically, cholera likely originated in India’s Ganges Delta, whence it began to spread in the nineteenth century. Millions perished in repeated global pandemics, and cholera continues to claim tens of thousands of lives every year even today, mainly in South Asia and Africa. It is an extremely virulent bacterial disease that spreads via feces and water, typically as people drink contaminated water or eat food that was grown, made, or washed in it.5 Most of those infected never develop symptoms, but some will suffer an extreme form of watery diarrhea with a loss of fluid so brutal that, unless it is met with rapid treatment, 25–50 percent of victims die in a matter of hours.6

Fortunately, treatment is both simple and inexpensive—it is mainly a question of quickly rehydrating the patient, and vaccines are also available.7 The best defense against cholera, however, is public hygiene, clean water, and efficient sanitation. Where such conditions obtain, the disease will likely never appear and would only be able to spread with difficulty.

The best defense against cholera is public hygiene, clean water, and efficient sanitation.

In the first few decades after independence, Syria suffered regular small-scale cholera outbreaks. The worst year on record was 1993, with nearly 11,000 infections across all governorates. By 1997, however, the outbreaks had ended, due to improvements in the country’s water, sanitation, and health infrastructure. Cholera saw a brief surprise revival in 2008–9, with 390 cases registered in the northeastern governorates of Deir al-Zour and Raqqa, but in the subsequent thirteen years, nothing more was heard of the disease.8 By then, Syria was, for all of its problems, solidly established as a middle-income country with a robust infrastructure for water supply and purification—the kind of place that would not normally be troubled by cholera.

The Syrian civil war, which began in 2011, has had disastrous consequences for public health, sanitation, and water supplies, creating conditions in which waterborne disease thrives. Already in 2013–14, Syria saw the return of polio, triggering a brief panic as it spread to Iraq before being contained through a vaccination campaign.9

On September 10, 2022, the Damascus Health Ministry and a Kurdish-led breakaway region in northeastern Syria simultaneously announced that cholera had broken out.10 The first confirmed case had been registered on August 22.11 Both rival regimes insisted that they had things under control, but they were lying.12 Soon, the disease could be found in every Syrian governorate, and by mid-December the UN had registered more than 60,000 suspected cases of cholera in Syria. The number of officially confirmed deaths remained low, at around one hundred people or 0.2 percent of cases, which likely reflects early interventions and the availability of treatment.13 But cholera didn’t stop in Syria: by early October, neighboring Lebanon confirmed its first case in nearly thirty years. Cholera soon spread across all of that country, too, with nearly 5,400 suspected or confirmed cases and twenty-three known deaths as of December 20, 2022.14

“We Have No Other Choice”

Early in the outbreak, a Deir al-Zour hospital director told Agence France-Presse that the cholera cases he was receiving all had something in common: the patients were all drinking water sourced directly from the Euphrates River, without any filtering or purification. “We have suffered from diarrhea, vomiting and pain,” a badly affected forty-five-year-old patient told the news agency, “because we drink directly from the Euphrates River.” Writhing in agony, the man explained that, although he knew full well that river water was unsafe, “we have no other choice.”15

Reporting by the World Health Organization indicates that cholera is unevenly distributed across Syria, and that it has spread by different means in different areas. It is heavily concentrated in Syria’s northeast, where the outbreak began. In other Syrian governorates, the most common source of infection seems to be food grown with contaminated water, but the outbreak in the northeast is linked to people drinking untreated water, including from the Euphrates.16

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“Because of the combined effect of infrastructure breakdown and scarcity of water, an increasing proportion of the population nowadays depends on trucked water, provided often by private companies,” said Elias Abu Ata, an Amman-based spokesperson for the International Rescue Committee, an aid group. “Many of these companies are not regulated, use unprotected water sources, such as the Euphrates, and can be overly expensive,” he said. “It can cost $10–20 monthly for purchasing this unsafe water—which is not affordable to the majority of vulnerable Syrians, where 80 percent of the population live at or below the national poverty line.”17

One of the world’s great rivers, the Euphrates cuts a broad strip of lush, green farmland through Syria’s arid north and east, and serves as the main source of water for between 800,000 and 1.2 million Syrians.18 But it is horribly polluted. A UN report notes that in the northeastern Raqqa and Deir al-Zour governorates, “pretty much all the untreated raw sewage is discharged into the Euphrates River.”19

Of course, Syrians are well aware of the risks inherent in drinking contaminated water. But many have no alternatives, since water is in such short supply or simply too expensive.

The Birecik Dam on the Euphrates in southeastern Turkey is one of several that affects downstream flows.
The Birecik Dam on the Euphrates in southeastern Turkey is one of several that affects downstream flows. Source: Getty

For some, the situation is so dire that they must skip basic hygiene measures altogether in order to conserve enough water for drinking and cooking. In a recent survey, 82 percent of northeastern informants said a majority of people in their community lack money to buy soap, and 7 percent reported that most people around them avoid washing their hands so as to conserve water for drinking.20 When water is that scarce, effective hygiene and sanitation is simply impossible.

A Crumbling Water Infrastructure

It wasn’t always this way. Before the war, 98 percent of Syrian city dwellers and 92 percent of people in rural regions had reliable access to clean water.21 But Syria’s drinking water supply fell by 40 percent in the war’s first decade, and half of all water and sanitation systems no longer function properly.22

According to UN data collected in 2022, 52 percent of Syrians now lack access to piped water and must instead tap into unsafe alternatives, such as water from nearby rivers.23 It is a rapidly increasing problem, as Syria’s water infrastructure has begun to crumble more quickly over the past few years. In the UN’s 2021 survey, the figure was 47 percent, and a year before that, 37 percent.24

There are many drivers of this spiraling breakdown, but they can, for the sake of simplicity, be grouped into four clusters. First, there is the impact of the conflict itself, including deliberate attacks on key infrastructure. Second, water supply factors are at play that relate to climate change, diversion at upstream Euphrates dams, drought, and decades of state mismanagement and overuse. Third, Syria’s accelerating energy crisis has begun to shut down critical infrastructure. Fourth, conflict actors deliberately deprive civilians of water as a political pressure tactic.

The following sections briefly describe all four of these clusters of causes.

The Impact of Conflict

The Syrian war has seen repeated, deliberate attacks on civilian water infrastructure. Many of these attacks were carried out by Russian or Syrian government forces, which have also repeatedly bombed health clinics and hospitals.25 In 2019, according to UNICEF, 46 attacks were recorded on water facilities across Syria.26 In all, the organization says nearly two-thirds of Syria’s water treatment plants, half of the pumping stations, and a third of all water towers have suffered damage during the conflict.27

Some 52 percent of Syrians now lack access to piped water and must instead tap into unsafe alternatives, such as nearby rivers.

Fighting has declined considerably since 2017–18, notwithstanding brutal bouts of violence in 2019–20. But even though it is now rarer for water facilities to be damaged in fighting, the destruction inflicted in earlier years has often not been repaired.

Nonviolent consequences of the conflict matter, too, such as brain drain and the depletion of public sector capacity. For example, the state utilities that run Syria’s water infrastructure are reported to have lost 30 to 40 percent of their technical staff during the war, as employees either left the country or retired without being replaced.28

Climate Change, Drought, and Dams

Syria has suffered a crippling drought in recent years.29 Droughts are nothing new in the region, but “due to climate change these appear to be getting more intense and more frequent,” said Peter Schwartzstein, a Middle East-focused environmental journalist and global fellow at the Wilson Center.30 Changing weather patterns would not matter nearly as much, however, if Syria’s agricultural sector hadn’t been so mismanaged and if the war hadn’t depleted its ability to cope with crisis. “The state built an agricultural system that sapped the land of resources and that required more water than this very dry region could provide in the long run,” Schwartzstein said. “The war has shattered farmers’ and rural communities’ capacity to adapt. In other words, climate change is arguably just the blow that toppled an already precarious house of cards.”31

There is also the related issue of river management. The thorny issue of how to share the Euphrates has created tensions between Turkey, Syria, and Iraq for decades. Against a backdrop of drought, scarcity, and conflict, it is again a hot topic. According to a 1987 agreement, Turkey is bound to keep the Euphrates flowing through its dams to Syria at a yearly average of at least five hundred cubic meters per second. These days, that rarely happens. In the period 2014–20, Syria only once received its full share of water, in 2019. Although data is still missing for 2021 and 2022, informal estimates indicate that the flow fell short in these years, too.32

Turkey admits that water isn’t coming through as promised, but blames the drought. The Kurdish rulers of northeastern Syria disagree, insisting that Ankara is deliberately trying to foment a crisis by depriving their areas of water.33 Even if Turkey is withholding water, however, it could be for more mundane reasons. Wim Zwijnenburg, a researcher with the Dutch conflict research group PAX, who has published extensively on Syria’s water crisis, noted that Turkey’s own reservoirs have also held less water since 2019, for weather-related reasons. “It would make sense that Turkey would retain more water for domestic use, which would explain the lower levels of water influx into the Euphrates,” he said.34

The low water levels of the Euphrates have troublesome knock-on effects. For example, less water can mean higher concentrations of bacteria, raising the risk of disease.35 It also undermines the functioning of existing infrastructure. For example, pumps may not work if the water drops below a certain level, or they can be left sitting on dry land when the river shrinks or shifts. According to the UN, about a third of the northeastern region’s approximately two hundred pumping stations, which supply water to 5.5 million people, are “significantly affected” by the low water levels.36

Last but not least, the reduced flow of river water hobbles power generation at Syria’s hydroelectric dams, adding to an already severe energy crisis—which feeds back into the water shortages.

No Energy, No Water

For the past few years, Syria has been in the throes of a serious energy crisis, causing routine electricity cuts and sky-high fuel prices. Consumption of state-supplied electricity has slipped to just 15 percent of what it was before 2011.37 Some 73 percent of Syrian households report getting less than eight hours of electricity per day, and 15 percent receive less than three hours.38 Almost half of all Syrian households now name electricity as one of their top two unmet needs, after food.39

There are many reasons for these shortages, including the effects of war, damage to oil and gas facilities, mismanagement, corruption, and—as noted—diminished hydroelectric power from the Euphrates due to low water levels. (Three dams on the Euphrates supplied nearly 14 percent of Syria’s electricity in 2013, but most power plants ran on gas and in some cases fuel oil.)40 The United States and the European Union also impose sanctions to prevent the Syrian state from buying fuel and repairing its electric power generation infrastructure. Last but not least, the Syrian currency has lost 90 percent of its value since late 2019, mainly because of a financial crisis in Lebanon but also due to tightened U.S. sanctions and other problems. It has made the import of dollar-priced oil products unsustainably expensive, undercutting the use of diesel-powered generators as an alternative to the failing electric grid.41

The resulting energy crisis has had a heavy impact on Syria’s water supply. Water pumps are, in essence, just big pieces of machinery, and, like other machines, they run on electricity or diesel. Now, however, the electricity supply is spotty at best, and generator fuel has grown exorbitantly expensive.42

The UN Office for the Coordination of Humanitarian Affairs has concluded that the energy crisis is “the root cause” for the failure of Syria’s water supply systems.

“The water sector relies on electricity and fuel for pumping and distribution of water from its source,” the Norwegian Refugee Council, an Oslo-based aid group active across all areas of Syria, said in a statement. “Households need sustainable energy sources to store water tanks and water supply in public networks need to match the hours of electricity supply.”43

Humanitarian data clearly shows the impact of the energy crisis on water provision. According to the United Nations Development Programme, Syria produced 1.7 billion cubic meters of water in 2010, which had slipped to 1.0 billion by 2019, after years of war. When the energy crisis set in, water supplies dwindled even further: by 2022, yearly production had nearly halved to 600 million cubic meters, even though Syria had seen little fighting for most of that time.44

In 2022, the UN’s aid coordination body, the Office for the Coordination of Humanitarian Affairs (OCHA), concluded that the energy crisis was “the root cause” for the failure of Syria’s water supply systems.45

Moreover, the lack of power affects not only the quantity of water provided, but also its quality. To make the most of their limited operating hours, many Syrian water facilities now bypass the slow process of purification and quality control, since they want to pump as much water to consumers as time allows.46 Unsafe water is, after all, better than no water at all.

The Weaponization of Water

Syrians have repeatedly been denied access to water as a tool of pressure or as means of collective punishment. As usual, the regime of Bashar al-Assad is among the culprits, but the most infamous instance of water being weaponized—which also happens to be highly relevant to the cholera outbreak—is linked to another government.

Located near Ras al-Ein, close to the Turkish border, the Alouk water station is one of northeastern Syria’s most critical water facilities. Its pipes reach some 460,000 people, while an additional half-million Syrians in off-grid communities rely on water trucked from Alouk by private salesmen and aid organizations. The station also feeds many public services, including thirty of the region’s thirty-seven health care facilities.47 In autumn 2019, Kurdish forces were driven out of Ras al-Ein by Turkey and its Arab rebel allies, creating a front line between Alouk and most of the people who depend on its water. Since then, the pumps have repeatedly been shut off or had their output reduced. Monitoring by humanitarian groups shows that Alouk has been entirely offline about a third of the time since it was seized by Turkey, and that it operated well below half capacity for most of the remaining time.48

UN agencies and humanitarian groups have long warned that the Alouk closures create public health hazards.49 In July 2021, three senior UN aid officials said that “families are resorting to potentially unsafe sources of water or limiting consumption, which may contribute to growth in a range of potentially fatal water-borne diseases.”50 Turkish diplomats dismissed the criticism, responding that the pumps could run if it weren’t for the fact that Kurdish groups had restricted Ras al-Ein’s power supply.51 While the electricity issue may have been a genuine problem in the past, the Ras al-Ein area has “been connected now with the Turkish electricity grid, so that should currently not be an issue anymore,” said Zwijnenburg, the Dutch water researcher. He added, however, that “the truth around this is hard to independently verify.”52 A 2021 report from the U.S. State Department also notes that the Turkish claims are disputed by the UN and aid groups working in the area.53

In August 2021, Russian-Turkish talks appear to have led to some improvements in the supply from Alouk—but not for long.54 Last May, Turkish president Recep Tayyip Erdogan began to threaten another invasion of Kurdish-held areas.55 Over the summer, Kurdish leaders accused Turkey of throttling the Euphrates as a “special means of war.”56 Finally, on August 9—right before the cholera outbreak—the Alouk Station was once again taken offline, depriving nearly a million people of clean water.57 Except for a few short blips of activity, it has yet to resume operations.58

Responding to the Cholera Outbreak

The international response to Syria’s cholera outbreak has played out as one would expect: UN agencies and humanitarian groups sounded the alarm and began to ship in supplies. In late November, UN trucks carrying two million cholera vaccines arrived in Damascus, to feed a vaccination campaign for the worst-affected northeastern governorates.59 At the same time, a parallel campaign brought vaccines to Lebanon.60 By mid-December, some 577,000 Syrians and more than 621,000 people in Lebanon had received the vaccine.61

Rebel-controlled regions in Syria are less likely to benefit from supplies channeled through Assad’s Health Ministry, but local and international aid groups do what they can, working across the Turkish border.62 In jihadist-ruled Idlib, for example, COVID-19 isolation units have been repurposed as cholera treatment centers.63 Although Russia had threatened to use its Security Council veto to block independent UN access to areas of Syria outside of Assad’s control, including Idlib, the aid programs were granted a six-month extension on January 9.64

A girl carrying jerry cans of water walks past a pile of debris on a street in Aleppo in 2012. Access to water has only worsened as Syria’s war grinds on.
A girl carrying jerry cans of water walks past a pile of debris on a street in Aleppo in 2012. Access to water has only worsened as Syria’s war grinds on. Source: OCHA

For all of the commendable aid activity now underway, the fact remains that the best time to treat any disease is before the outbreak. Even if cholera can be contained, Syria and its neighbors will remain at risk of infectious waterborne disease. Instead of merely scrambling resources for each new crisis, the nations that donate to Syrian aid efforts—mainly the United States, Europe, and a handful of their allies—should seek to stem the decline of Syria’s clean water supply.

Unfortunately, improving water security in Syria is no easy task. The country is ruled by not one but several authoritarian regimes. The water infrastructure straddles contested front lines and suffers both from political jostling and from the kind of neglect and buck-passing that comes from being under no one’s sole control. To expect a comprehensive solution to Syria’s water woes would be foolish, especially since the United States, Europe, and like-minded nations have so little leverage over the main actors involved. But that is no excuse for inaction: even intractable problems that remain unripe for resolution can be constructively managed and mitigated.

“The international donor community needs to consider a serious shift to early recovery programming in Syria, addressing the root problems hindering access to safe water sources,” Norwegian Refugee Council said. “This means changes in funding and engagement policies, assessment of the negative impact of coercive measures on the living conditions of the general population in Syria and a serious investment in improving critical infrastructure.”65

Some commendable work along those lines is, in fact, already being done.

For example, twenty small emergency desalination plants that are capable of making salty ground water fit for drinking—albeit at the risk of depleting it—have been built in northeastern Syria since 2021. According to the Syria Report, a newsletter that tracks the country’s economy and politics, four of these plants were built by an Iranian contractor on commission from the Ministry of Water Resources, while sixteen were constructed by UNICEF and the Syrian Arab Red Crescent. Fifteen of the plants are currently online, adding to the northeast’s water supply at a critical moment.66 Investments of this kind won’t solve Syria’s water crisis, but they do help.

Other projects remain on the drawing board, awaiting funding or permits. As noted by Century International’s Sam Heller, the International Committee of the Red Cross has appealed for funds to repair seven large water systems that serve Syria’s main cities, described as “too big to fail.”67 Together, they account for four-fifths of the total water supply for some 9.5 million people—but six of the seven systems were damaged during the war and all have degraded because of a lack of maintenance, even before the energy crisis struck.68 According to the UN, the lack of spare parts and skilled staff has put these systems “on a trajectory towards complete failure.”69 Moving early to prevent such a disaster is not just the moral thing to do—it is also a prudent, cost-efficient policy for donor nations that will otherwise need to deal with a far worse emergency down the line.

Then there is the thorny issue of sanctions. While many Syria sanctions are aimed at specific war criminals or military units, the United States, the EU, and their allies also impose broad restrictions that seem designed to harm the Syrian economy as a whole. For example, sanctions that seek to ban Syrian fuel imports and block power sector reconstruction clearly exacerbate the energy crisis, which, in turn, prevents Syrians from accessing clean water.70

It is time to stop thinking about Syria’s broken, balkanized governance as a transient condition.

U.S. and European officials appear unwilling to tamper with existing sanctions, for fear that it would be seen as a reward to war criminals and could break up common positions. But in a situation where more than two in three Syrians rely on humanitarian assistance, and with fuel and electricity shortages now so severe that some Syrians wonder if they will survive the winter, a strategy that deliberately seeks to intensify the energy crunch is both ethically and politically questionable.71 If sanctioning states want to maintain these damaging, broad-stroke economic restrictions, they should at least put more of an effort into ensuring that critical infrastructure, including for water and sanitation, will be insulated from harm.72

There is of course much more that could be done. For example, the UN could be mobilized to help institutionalize today’s informal economic collaboration between rival Syrian actors, facilitating cross-frontline contacts to maintain, supply, and operate the water and sanitation infrastructure needed by all.73

It also remains critically important to ensure continued UN access to rebel-held areas like Idlib, where the health, water, and sanitation infrastructure is wholly dependent on outside assistance. Russia has repeatedly threatened to curtail that access, using the lives of vulnerable Syrian civilians as a bargaining chip and turning what should be a straightforward humanitarian operation into a political dispute.74 Similarly, the weaponization of water by the Turkish and Syrian governments—and perhaps other actors—remains a major problem, even as the conflict’s overall intensity has declined. Turkey’s three-year chokehold on the Alouk water station—which its U.S. and European allies have yet to publicly protest—clearly demonstrates the deleterious effects of such tactics on public health and disease prevention.

Ultimately, however, many of the policy questions raised by Syria’s cholera outbreak and the underlying water crisis boil down to the same thing: it is time to stop thinking about Syria’s broken, balkanized governance as a transient condition. It is not: it is the new normal. After eleven years, the war has arrived at a dead end in which Assad’s brutal, parasitic regime remains as well-entrenched as ever, only locked in tension with rebel regions that can neither break away nor mount a credible challenge to his rule. Worsening socioeconomic malaise seems certain, and a relapse into apocalyptic violence remains a risk. In contrast, a unifying, healing political solution seems so improbable that it verges on the hallucinatory.

Outside actors who aspire to do good in Syria should deal with this sad state of affairs as it is, not as they would like it to be. They may—and indeed, should—stay true to the vision of a freer, better Syria, but their practical efforts need to be refocused on practical problems, to stem or at least slow Syria’s socioeconomic and humanitarian backsliding. Among these problems, the water crisis looms large—because unless serious action is taken to reverse the degradation of Syria’s clean water supply, the thirst, hunger, and deadly disease that it has already produced will spiral out of control.

This report is part of “Networks of Change: Reviving Governance and Citizenship in the Middle East,” a Century International project supported by the Carnegie Corporation of New York and the Open Society Foundations.

Header Image: Children stand in the entryway of their tent shelter, in the Bab al-Salame camp for internally displaced persons, near the border with Turkey, in Aleppo Governorate in 2014. Source: OCHA


  1. Oula Mashfji, “Inside Syria’s Water Crisis: A Cholera Outbreak in the Making,” Norwegian Refugee Council, December 29, 2022,
  2. Statement provided to the author for the purpose of this report by an official at the Norwegian Refugee Council, January 2023.
  3. Adnan Hezam, International Committee of the Red Cross, interview with the author via online messaging service/email, September 2022.
  4. “Brief: Northeast Syria: Cholera Outbreak,” REACH, Impact Document Repository, September 2022, 8,
  5. “Cholera,” World Health Organization (WHO), March 30, 2022,
  6. REACH, “Cholera Outbreak,” 1.
  7. WHO, “Cholera.”
  8. WHO, “Epidemic Preparedness and Response Plan For Cholera in Syria,” November 1, 2015, 3,
  9. At the time, some doubted that polio had been eradicated. See Danya Chudacoff and Louise Redvers, “Has Syria Really Beaten Polio?,” The New Humanitarian, February 2, 2015,
  10. Health Announces the Registration of Fifteen Cases of Cholera in Aleppo” (in Arabic), SANA, September 10, 2022,; “The Health Authority Confirms: The Situation Is under Control and the Authority Has Taken the Necessary Measures” (in Arabic), Hawar News, September 10, 2022,
  11. “Syrian Arab Republic: WHO Syria Situation Report #11: Cholera Outbreak: W43 (23-29 October 2022),” WHO, November 2, 2022,
  12. Hawar News, “The Health Authority Confirms”; Shaza Qreima, “Health Minister: Epidemiological Situation of Cholera Is Completely under Control,” SANA, September 17, 2022,
  13. “Whole of Syria Cholera Outbreak Situation Report no. 10,” Office for the Coordination of Humanitarian Affairs (OCHA) and WHO, December 18, 2022, 1,
  14. “UNICEF Syria Cholera Response Situation Report for 04 October 2022,” UNICEF, October 4, 2022,; OCHA, “Whole of Syria: Cholera Outbreak Situation Report No. 3,” October 14, 2022,; Kareem Chehayeb, “Lebanon Announces First Cholera Case in Almost 30 Years,” Associated Press, October 6, 2022,; “WHO warns of deadly cholera outbreak in Lebanon as cases increase,” WHO, October 31, 2022,; “UNICEF Lebanon Humanitarian Situation Report No. 9 (Cholera),” UNICEF, December 20, 2022,
  15. Delil Souleiman, “‘Drink It Anyway’: Syria Water Woes Peak in Cholera Outbreak,” AFP via France24, September 22, 2022,
  16. “Syrian Arab Republic: WHO Syria Situation Report #11: Cholera Outbreak: W43 (23-29 October 2022),” November 2, 2022,
  17. Elias Abu Ata, International Rescue Committee, interview with the author via email, September 2022.
  18. Ibid.
  19. “Syria: Humanitarian Needs Overview,” OCHA, February 2022, 84,
  20. REACH, “Cholera Outbreak,” 8.
  21. International Committee of the Red Cross (ICRC), “Syria Water Crisis: Up to 40% Less Drinking Water after 10 Years of War,” October 1, 2021,,water%20than%20a%20decade%20ago.
  22. Hezam, interview.
  23. “Syria: Humanitarian Needs Overview,” OCHA, December 2022, 27,
  24. OCHA, “Syria: Humanitarian Needs Overview,” February 2022, 9.
  25. Aron Lund, “The UN Made a List of Hospitals in Syria. Now They’re Being Bombed,” The Century Foundation, June 13, 2019,
  26. “UNICEF Executive Director Henrietta Fore’s Remarks at the Security Council Briefing on the Humanitarian Situation in Syria,” UNICEF, March 29, 2021,
  27. Antwan Chnkdji and Maher Ghafari, “Clean Water and Good Sanitation Bringing Wellbeing to Neighbourhoods in Aleppo,” UNICEF, July 28, 2022,
  28. ICRC, “Syria Water Crisis.”
  29. Amberin Zaman, “Camels Weep as Their Young Perish in Syria’s Killer Drought,” Al-Monitor, November 12, 2021,
  30. Peter Schwartzstein, interview with the author via online messaging service, September 2022.
  31. Ibid.
  32. “Chart: Average Flow Rate of the Euphrates in Syria (2001–2020),” Syria Report, November 8, 2022,
  33. Ibid., Delil Souleiman and Alice Hackman, “‘Desert:’ Drying Euphrates Threatens Disaster in Syria,” AFP/Yahoo News, August 30, 2021,
  34. Wim Zwijnenburg, PAX, email to the author, December 2022. During the exceptionally dry summer of 2021, Turkish-backed Syrian rebels built several dams on the Khabour, a Euphrates tributary. It’s unclear if they were trying to starve Kurdish-held Syria of water or simply feed their own fields—but whatever the reason, the results were grim for Syrians living downstream. A reporter who visited the Kurdish-controlled area in spring 2022 found the Khabour reduced to “puddles of murky water.” Wim Zwijnenburg, “Killing the Khabur: How Turkish-Backed Armed Groups Blocked Northeast Syria’s Water Lifeline,” PAX, November 3, 2021,; Jane Arraf, “Conflict and Climate Change Ravage Syria’s Agricultural Heartland,” New York Times, February 19, 2022,
  35. REACH, “Cholera Outbreak,” 3.
  36. OCHA, “Syria: Humanitarian Needs Overview,” February 2022, 20
  37. OCHA, “Syria: Humanitarian Needs Overview,” December 2022, 25.
  38. Ibid., 88.
  39. Ibid., 25, 37. On Syria’s deteriorating food security, see Sam Heller, “Syrians Are Going Hungry. Will the West Act?,” The Century Foundation, June 7, 2021,
  40. David Butter, “Syria’s Economy: Picking up the Pieces,” Chatham House, June 2015, 22,
  41. Syria was previously an oil-exporting country, but the depletion of reserves, infrastructural damage incurred during the conflict, and the loss of major oil fields have made the economy dependent on imported oil products. See Aron Lund, “The Blame Game over Syria’s Winter Fuel Crisis,” The New Humanitarian, March 5, 2019,; Heller, “Syrians Are Going Hungry”; Sam Heller, “Russia’s War in Ukraine Will Also Hurt Syria,” The Century Foundation, April 5, 2022,
  42. The energy crisis also harms the water supply of communities that use local wells, unconnected to Syria’s national infrastructure—because they, too, need electricity or generator fuel to run their pumps. To extract a town’s daily requirement of groundwater and pump it out through kilometers of pipes may require several hours of uninterrupted power, at a time when many communities have unreliable on-off electricity, at best. And when Syrians react by improvising other means of storing and transporting water, it raises the risk of contamination. See “Access to Electricity and Humanitarian Needs in Syria,” United Nations Development Programme (UNDP), July 21, 2022, 4,; Mashfji, “Inside Syria’s Water Crisis.”
  43. Statement provided to the author for the purpose of this report by an official at the Norwegian Refugee Council, January 2023.
  44. UNDP, “Access to Electricity and Humanitarian Needs in Syria,” 4.
  45. OCHA, “Syria: Humanitarian Needs Overview,” February 2022, 84.
  46. Ibid., 20.
  47. “Syria: Alouk Water Station—Flash Update: Disruption to Alouk Water Station,” OCHA, July 1, 2021,
  48. “Alouk Station and Himme Reservoir–Daily Status,” WASH Working Group–North East Syria, December 11, 2022,
  49. OCHA, “Alouk Water Station.”
  50. “Up to 1 Million People at Risk Due to Severe Interruptions to Alouk Water Station,” joint statement by UN Resident Coordinator and Humanitarian Coordinator for Syria Imran Riza, UN Regional Humanitarian Coordinator for the Syria Crisis Muhannad Hadi, and UNICEF Regional Director for the Middle East and North Africa Ted Chaiba, July 15, 2021,
  51. “Turkey Urges Unbiased Un Stance after Syria Water Station Statement,” Daily Sabah, July 16, 2021,
  52. Zwijnenburg, email.
  53. “Syria: Country Report on Human Rights Practices 2021,” U.S. State Department, (section G), available via
  54. Ashraf Moussa, “A Turkish-Russian Agreement to Solve the Problem of Water and Electricity in Northern Syria” (in Arabic), Anadolu, August 8, 2021,الدولالعربية/اتفاقتركيروسيلحلمشكلةالمياهوالكهرباءشماليسوريا/2328262; WASH Working Group–North East Syria, “Alouk Station.”
  55. Aron Lund, “Syria in the Shadow of the Ukraine War: Turkish Sabre-Rattling and Russian Bargaining,” Swedish Defence Research Agency (FOI) Memo 7984, November 25, 2022,; Sam Heller, “Turkey’s Russian Red Light in Syria,” War on the Rocks, December 30, 2022,
  56. ”Hind Al-Ali: The Decrease in the Level of the Euphrates River Will Cause a Humanitarian Catastrophe, and the Authorities of Damascus and Baghdad Must Take Action” (in Arabic), Executive Council of Northern and Eastern Syria, Autonomous Administration of Northern and Eastern Syria, June 11, 2022,
  57. REACH, “Cholera Outbreak,” 1.
  58. WASH Working Group–North East Syria, “Alouk Station.”
  59. “Two Million Doses of Oral Cholera Vaccines Arrive in Syria,” WHO and UNICEF, November 29, 2022,,in%20Damascus%2C%20Syria%2C%20today
  60. “An Additional 900 000 Doses of Cholera Vaccines Arrive in Lebanon,” WHO, December 15, 2022,
  61. OCHA and WHO, “Whole of Syria Cholera Outbreak Situation Report no. 10,” 4; UNICEF, “ Lebanon Humanitarian Situation Report No. 9 (Cholera),” December 20, 2022.
  62. Maya Gebeily and Khalil Ashawi, “Aid Workers in Syria Fear Cholera Spread If Cross-Border Support Halted,” Reuters, January 6, 2023,
  63. Muhammad Al Hosse, “Cholera Worries Grow in Syria’s Idlib,” New Humanitarian, September 29, 2022,
  64. Aron Lund, “Is Russia about to Block a Key Aid Route into Northwest Syria?,” New Humanitarian, June 27, 2022,; “Adopting Resolution 2672 (2023), Security Council Renews Cross-Border Aid Operations into North-West Syria for Six Months, Requests Special Report on Humanitarian Needs,” UN, SC/15168, January 9, 2023,
  65. Statement provided to the author by an official at the Norwegian Refugee Council, January 2023. On early recovery aid, see Sam Heller, “‘Early Recovery’ Aid Can Provide Vital Relief to Syrians—If Donors Follow Through,” The Century Foundation, December 16, 2021,
  66. “Government Activates Emergency Water Plant Amid Water Crisis and Cholera Outbreak,” Syria Report, September 13, 2022,
  67. Heller, “Early Recovery Aid.”
  68. The sole undamaged system is that which serves the Syrian coast. UNDP, “Access to Electricity and Humanitarian Needs in Syria,” 3.
  69. OCHA, “Syria: Humanitarian Needs Overview,” February 2022.
  70. Lund, “The Blame Game over Syria’s Winter Fuel Crisis.”
  71. OCHA, “Syria: Humanitarian Needs Overview,” 27. “Syrians Brace for Long, Cold Winter as Fuel Crisis Bites,” Reuters, December 8, 2022,
  72. U.S. and European sanctions explicitly exempt things like food, medicine, and humanitarian activities, but a combination of inscrutable rules and bank and business overcompliance has prevented these carve-outs from working as intended. A recent UN Security Council endorsement of exemptions across all global sanctions regimes and U.S. government decisions to the same effect represent positive steps in the right direction, but Syria’s water sector may still merit special attention. For example, specific licenses could be issued to green-light repairs and supplies to pumping and treatment facilities and their associated power and distribution infrastructure. Sanctioning governments could also take it upon themselves to dispatch targeted aid to compensate for any harm still inflicted. See Aron Lund, “Briefing: Just How ‘Smart’ Are Sanctions on Syria?,” New Humanitarian, April 25, 2019,; UN Security Council resolution 2664, December 9, 2022,; “Treasury Implements Historic Humanitarian Sanctions Exceptions,” U.S. Department of the Treasury, December 20, 2022,
  73. Although not related to water or infrastructure, similar ideas were suggested in a recent Clingendael report by Malik al-Abdeh and Lars Hauch; “A New Conflict Management Strategy for Syria,” Clingendael, July 2022,
  74. Lund, “Is Russia about to Block a Key Aid Route?”