[Congressional Record Volume 162, Number 36 (Monday, March 7, 2016)]
[Extensions of Remarks]
[Pages E282-E283]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




  THE GROWING THREAT OF CHOLERA AND OTHER DISEASES IN THE MIDDLE EAST

                                 ______
                                 

                       HON. CHRISTOPHER H. SMITH

                             of new jersey

                    in the house of representatives

                         Monday, March 7, 2016

  Mr. SMITH of New Jersey. Mr. Speaker, during the last several years, 
conflicts in the Middle East have cost the lives of hundreds of 
thousands of people, primarily in Syria, Iraq, and Yemen. As a result 
of conflicts in these countries, as well as the influx of refugees from 
conflict zones into surrounding countries such as Turkey, Jordan, and 
Lebanon, many of those who die are the victim of disease.
   Almost 17 million people in the region are in need of humanitarian 
assistance, including roughly four million refugees who have fled their 
countries and an additional 13 million people who have left their homes 
but are internally displaced within their countries.
   A hearing I convened last week examined the scope of the cholera and 
other disease threats to determine what can and should be done to 
control it and minimize their spread beyond the Middle East.
   The World Health Organization reported the spread of a cholera 
epidemic that first began in Iraq in 2007 that crossed over into Iran, 
Syria and is considered the region's greatest, although not only, 
health threat. These threats are worsened by the targeting of health 
workers in Syria and an Islamic State that has no experience and little 
interest in providing social services. Thus, cholera and other diseases 
are untreated, often unreported and pose a significant health threat in 
the region due to poor sanitation and overcrowding in areas such as 
refugee camps.
   Cholera is an acute diarrheal disease that can cause death within 
hours if left untreated. Roughly 80% of those who contract the disease 
do not develop symptoms, leaving some uncertainty about precisely how 
many people contract the disease annually. Scientists estimate that 
between 1.4 and 4.3 million people contract cholera annually, of whom 
28,000 to 142,000 die. Cholera bacteria are present in the feces of 
infected people for one to ten days after infection and can be spread 
to others if they ingest food or water that is contaminated with their 
fecal matter. The spread of cholera is mostly facilitated by inadequate 
water and sanitation management and outbreaks are common in areas where 
basic infrastructure is unavailable, such as urban slums and camps for 
internally displaced persons and refugees.
   As devastating as this cholera epidemic has been and can be going 
forward, we must also remember the MERS epidemic of three years ago. 
The Middle East Respiratory Syndrome, or MERS, is a respiratory 
illness. It is caused by a virus called Middle East Respiratory 
Syndrome Coronavirus, or MERS-CoV. This virus was first reported in 
2012 in Saudi Arabia. It is different from any other coronaviruses that 
have been found in people before.
   MERS-CoV, like other coronaviruses, is thought to spread from an 
infected person's respiratory secretions, such as through coughing. 
However, the precise ways the virus spreads are not currently well 
understood. MERS-CoV has spread from ill people to others through close 
contact, such as caring for or living with an infected person. Infected 
people have spread MERS-CoV to others even in healthcare settings, such 
as hospitals. This transmission pattern is more likely when medical 
facilities and health workers are in short supply.
   The conflicts and political crises in the Middle East have brought 
anguish, suffering, and severe declines in health to people throughout 
the region. The most catastrophic case by far is Syria, where more than 
a million people have experienced traumatic injuries, once-rare 
infectious diseases have returned, chronic disease goes untreated, and 
the health system has collapsed. In Yemen, Libya, Gaza, and Iraq 
violence has limited access to health care and grievously harmed the 
population.
   According to Physicians for Human Rights last summer, at least 633 
medical personnel had been killed and more than 270 illegal attacks on 
202 separate medical facilities had taken place since March 2011 in 
Syria. Of the attacks on medical facilities, at least 51, or 19 
percent, reportedly were carried out with barrel bombs. Almost all the 
assaults were inflicted by the regime of President Bashar al-Assad.
   In the Middle East, threats against as well as arrests and 
intimidation of health workers extends beyond armed conflict to 
situations of political volatility, as evident in Bahrain, Egypt, and 
Turkey. In most of these cases, doctors and nurses who treat victims of 
violence are, by the very act of providing treatment, deemed guilty of 
anti-government activities. In Bahrain, almost 100 doctors and nurses 
were arrested and 48 originally charged with felonies for having 
offered medical care to wounded people in the wake of the 2011 Arab 
Spring uprising,
   Cholera can be treated and its spread can be prevented, but diseases 
such as MERS pose a danger of spreading beyond the region. However, 
beyond the global health implications, we must consider the compounded 
suffering of people in the Middle East. Not only are they often in 
threat of violence through no fault of their own but they face 
preventable, treatable diseases that have gotten out of control due to 
conflicts.
   Our panel at the hearing included health experts who helped us think 
through the health challenges our government faces in considering how 
to provide the most effective assistance to people in the Middle East. 
The two keys to success are: remain vigilant and sustain commitment. 
The hearing last week was intended to demonstrate our vigilance and 
commitment to addressing this situation.

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