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Investigation Uncovers Link between Damascus Vegetables and Cholera and Cancer

The further investigation unveils the distressing reality that farmers in rural Damascus rely on polluted sewage water for irrigating crops, which are then sold in local markets.

A thorough investigation has brought to light the contamination of vegetables consumed by residents of Damascus. Samples taken from these vegetables were analyzed in both private and official laboratories, revealing alarming findings. The investigation further unveils the distressing reality that farmers in rural Damascus rely on polluted sewage water for irrigating crops, which are then sold in local markets.

On September 6, 2022, the Syrian Ministry of Health reported the first case of cholera in the city of Aleppo. This outbreak was directly linked to the consumption of vegetables that had been watered with contaminated sewage water, as well as the consumption of drinking water that had been tainted by sewage. According to a joint report by the World Health Organization and the United Nations Office for the Coordination of Humanitarian Affairs (OCHA), cholera rapidly spread across most governorates, resulting in the tragic loss of 100 lives throughout Syria.

The global status report on the disease, published by the World Health Organization, indicates that since the initial announcement of the cholera outbreak on August 25, 2022, a staggering 77,561 suspected cases of infection have been recorded in Syria up until February 11, 2023. Furthermore, the early warning program has identified a worrisome 99,902 suspected cases in northwestern Syria alone, up until July 22, 2023.

Regrettably, cholera is not the sole disease stemming from the utilization of wastewater. Medical studies have revealed that the presence of contaminated water and plants can lead to cancer and other conditions associated with paralysis and spinal cord issues.

The devastating impact of twelve years of war in Syria has left the nation grappling with economic and health challenges. Even prior to the declaration of the cholera outbreak, the country faced water shortages, a crumbling healthcare system, and inadequate awareness. Sadly, the risks persist, as evidenced by the findings of this investigation regarding the extent of contamination in the vegetables consumed by millions of Syrians, a direct consequence of the use of polluted sewage water.

The Food Source of Millions in Damascus: A Troubling Revelation

Damascus heavily relies on agricultural products from its surrounding countryside, particularly eastern and western Ghouta. According to the Ministry of Agriculture’s plan for the 2022-2033 season, the total area of irrigated crops in rural Damascus is 74,471 hectares. The winter season of 2023 saw 1,387 hectares cultivated with vegetables, as reported by the official news agency (SANA) based on information from a Ministry of Agriculture official.

During the summer season of 2021, approximately 3,518 hectares were cultivated, yielding an estimated 100,000 tons of vegetables, as disclosed by Eng. Irfan Ziyadah, the Director of Agriculture in Rural Damascus. However, with the country experiencing drought, declining water levels in wells, a scarcity of energy sources to power them, and the destruction of treatment plants, sewage water has become a primary source for irrigating crops, including vegetables, according to farmers in the towns of eastern and western Ghouta in rural Damascus.

To investigate the use of wastewater in watering vegetables and crops sold in markets, the Syria Indicator team visited farms owned by the 8th of March facility, which is under the authority of the Ministry of Agriculture. Due to a lack of energy sources and clean water specifically allocated for irrigation, farmers faced challenges in utilizing wells.

The facility spans an area of 7,460 dunums across three governorates: the countryside of Damascus, Quneitra, and As-Suwayda. Out of these, 3,599 dunams are located in the countryside of Damascus, and farmers cultivate these areas under contracts.

A farmer inspecting his crop in the countryside of Damascus. (Source: Syrian Arab News Agency / SANA)
A farmer inspecting his crop in the countryside of Damascus. (Source: Syrian Arab News Agency / SANA)

During the investigation, farmer Ahmed confirmed that he utilizes sewage water for irrigation. Since 2019, he has been cultivating two crops annually: summer crops such as cucumbers, zucchini, eggplant, and molokhia, as well as winter crops including beans and peas, which are sold in the markets of Damascus and its surrounding areas.

Hall Market in the Zablatani neighborhood of Damascus, where vegetables are sold and marketed. July 12, 2020. (Source: Syrian Arab News Agency / SANA)
Hall Market in the Zablatani neighborhood of Damascus, where vegetables are sold and marketed. July 12, 2020. (Source: Syrian Arab News Agency / SANA)

Ahmed cultivates 25 dunums of land in the countryside of Damascus, relying on polluted water from the branches of the Barada River. He explained, “We use the river’s water, and although we have a water well, we cannot operate it due to the lack of diesel, which is prohibitively expensive. With only 10 liters of diesel, what can we accomplish?”

This situation extends to privately owned farms in the countryside of Damascus, such as Darayya, Zibdin, Deir al-Asafir, and al-Malihah, as well as the farms associated with the 8th of March governmental facility. Samir, another farmer in Western Ghouta, informed the investigation team that he occasionally irrigates his 1,500-square-meter land with sewage water. In summer, he produces lettuce, cilantro, and parsley, while in winter, he cultivates beans, peas, spinach, and onions.

Both Ahmed and Samir believe that washing the vegetables they produce before consumption is sufficient to prevent any potential diseases among those who consume them.

These crops irrigated with sewage water are then sold in the markets of Damascus and its surrounding areas, becoming a staple for the region’s population of approximately five million people, according to 2014 estimates from the Central Bureau of Statistics, an official Syrian institution. The population relies on the vegetables and crops produced across various regions, which are supplied to the central “Zablatani” market in the capital for redistribution to secondary markets and vendors.

Leafy vegetables being marketed for local consumption in Hall Market in the Zablatani area of Damascus. (Zablatani Market – Facebook)

Uncovering the Truth: What Lies within the Vegetables?

Through visits to various areas in Eastern Ghouta, Syria Indicator has confirmed that some rely on sewage water, either partially or entirely. This alarming discovery prompted the sampling of crops, including “green radishes” from the Darayya region and “parsley and chard” from the farms of the 8th of March facility. These samples were analyzed in different centers, including government facilities.

A farmer harvesting his cauliflower crop in the Eastern Ghouta, countryside of Damascus. (Source: Syrian Arab News Agency / SANA)

Lead Contamination Reaches Alarming Levels: A Thousand Times the Permissible Limit

The findings of the analysis conducted by the investigation team have revealed an astonishing reality: lead (PB) concentrations in the examined vegetables exceeded the maximum permissible limit recommended by the Food and Agriculture Organization and the World Health Organization (FAO/WHO) for vegetables, surpassing it by approximately 1000 times for leafy vegetables and around 9 times for root vegetables, specifically green radishes. The recommended limit for lead in vegetables is 0.3 mg/kg.

To provide insights into the implications for health, the investigation team sought the expertise of Dr. Shem Suleiman, a specialist in food science, safety, and biotechnology. Dr. Suleiman analyzed the content and effects of the lead concentrations in the samples.

According to Dr. Suleiman’s evaluation, the analyzed parsley samples exhibited a lead concentration of approximately 300 mg/kg, while the chard samples recorded 250 mg/kg. In comparison, the lead concentration in the green radish samples was below 2.6 mg/kg. These concentrations of lead exceeded the recommended maximum limit for lead in vegetables by about 1000 times for leafy vegetables and approximately 9 times for root vegetables (green radishes). The limit set by the Food, Agriculture, and World Health Organization for lead in vegetables is 0.3 mg/kg.

Dr. Suleiman emphasized that lead is an environmental pollutant known for its high toxicity. It has the ability to form complex compounds with various biomolecules, impairing their functions and causing detrimental effects. Exposure to lead can adversely affect multiple systems in the human body, including the blood, nervous system, immune system, kidneys, skeletal system, muscular system, reproductive system, and cardiovascular system. Symptoms of lead exposure may manifest as poor muscle coordination, digestive issues, brain and kidney damage, hearing and vision impairment, and reproductive defects. Furthermore, Dr. Suleiman highlighted that early childhood and prenatal exposure to lead are associated with cognitive developmental delays, reduced learning abilities, and a range of other effects.

Alarming Cadmium Levels: Exceeding Recommendations by 20 to 45 Times

The investigation team’s analysis has unveiled a startling revelation regarding cadmium (CA) concentrations in the examined vegetables. The levels surpassed the maximum allowable limits recommended by the Food and Agriculture Organization and the World Health Organization (FAO/WHO) by approximately 45 times for leafy vegetables (such as parsley) and 20 times for Swiss chard. The recommended limit for cadmium in vegetables is 0.2 mg/kg.

Specifically, the parsley samples showed cadmium concentrations of 9 mg/kg, while the chard samples recorded 4 mg/kg. In contrast, the green radish samples maintained levels below the recommended maximum, with a cadmium concentration of 0.12 mg/kg. These concentrations exceeded the maximum allowable limits for cadmium in vegetables by approximately 45 times for leafy vegetables (parsley) and 20 times for Swiss chard, as defined by the FAO/WHO, which is 0.2 mg/kg.

Dr. Shem Suleiman emphasizes that high levels of cadmium pose a severe toxic risk to human health, particularly impacting the kidneys as the critical target organ. Cadmium has a slow excretion rate and accumulates in the kidneys over an extended period, resulting in prolonged renal weakness. Furthermore, elevated concentrations of cadmium can lead to serious effects on the liver, blood vessels, and the immune system.

Elevated Chromium Levels: 20 to 35 Times Higher Than Normal

The analysis also uncovered remarkably high concentrations of chromium metal (CR) in the examined vegetables. Chromium levels exceeded the maximum allowable limits for parsley and chard by approximately 35 times and 20 times, respectively, as defined by the FAO/WHO. The recommended limit for chromium in vegetables is 2.3 mg/kg.

According to the analysis results provided by Dr. Suleiman, the parsley samples exhibited chromium concentrations of 80 mg/kg, which decreased by almost half to 40 mg/kg in the chard samples.

While chromium is a necessary mineral in moderate amounts for vital physiological processes in the human body, excessive consumption through food can lead to hypoglycemia (low blood sugar) and gastrointestinal effects. Moreover, increased consumption of chromium can have adverse effects on the liver, kidneys, and nerves, potentially resulting in an irregular heartbeat.

Nickel Concentrations within Acceptable Limits

The analysis results indicated that nickel (NI) concentrations remained within the recommended limits set by the FAO/WHO for vegetables, averaging at 67.9 mg/kg. The parsley samples exhibited slightly higher concentrations, reaching 70 mg/kg, while the chard and green radish samples remained within the permissible range at 50 mg/kg.

Elevated Nitrite Levels Raise Concerns

The analysis revealed relatively high nitrite (NO2) concentrations in the parsley and green radish samples. The parsley samples reached 130 mg/kg, while the green radish samples recorded 115 mg/kg.

Dr. Suleiman highlights the significance of these findings, as there are no specific limits for nitrite concentrations in leafy green vegetables. Nitrite is primarily produced from nitrates after consuming contaminated vegetables. According to the Joint FAO/WHO Expert Committee on Food Additives (JECFA), the acceptable daily intake of nitrite is 0 – 0.07 mg per kg of body weight, equivalent to 4.2 mg per day for an average adult weighing 60 kg. Consuming 100 grams of parsley or raw green radish with an average nitrite concentration of 120 mg/kg would result in ingesting 12 mg of nitrite, significantly exceeding the permissible daily intake limit.

Dr. Suleiman further explains that increased dietary exposure to nitrates and nitrites, leading to the formation of nitrosamines, can induce toxicity in the form of methemoglobinemia and cause anemia. Moreover, large quantities of nitrosamines are known to be carcinogenic.


Ghouta vegetables are sold in central Damascus. (Syria Indicator – Exclusive)

of Contaminated Water: Cholera and Other Diseases

Dr. Bashar Shuaa, an expert in internal and infectious diseases, was consulted regarding the consequences of consuming contaminated water on public health. He confirmed that drinking water contaminated with pathogens and the subsequent consumption of contaminated vegetables can lead to various diseases, including cholera, diarrhea, hepatitis, E. coli infections, dysentery, and even infections affecting the brain, such as otitis media.

Dr. Shuaa pointed out the lack of statistics or studies in Syria concerning the incidence of cancers caused by consuming contaminated vegetables irrigated with sewage water. However, he referenced a 2022 study conducted after some farmers in the Syrian coastal region used sewage water for irrigation, which revealed a higher likelihood of hepatitis A infections among the affected population. Dr. Shuaa also recalled an alarming incident in 2009 when 46,000 cases of diarrhea were reported in the countryside of Damascus due to the use of contaminated water for irrigation. These examples emphasize that the issue of irrigating crops with polluted water is not limited to recent years but has been prevalent since the decline of water resources in the Barada River due to various factors.

Drying of one of the irrigation channels branching from the Barada River in the Eastern Ghouta. (Exclusive – Syria Indicator)

Dr. Shem Suleiman, a specialist in science, food safety, and biotechnology, examined the analysis results of the samples and expressed concern over the excessive presence of heavy metals, surpassing permissible limits in most cases. Dr. Suleiman highlighted the dangers posed by elevated levels of metals to human health, explaining that plants serve as the primary conduit for transferring heavy metals from contaminated soil to humans. Heavy metals tend to accumulate in the food chain due to their stability and non-biodegradable nature, ultimately affecting the functioning of vital organs within the human biological system.

Continuing her warning, Dr. Suleiman emphasized that the accumulation of these substances in the human body, coupled with excessive intake of certain heavy metals such as cadmium, lead, copper, and chromium, can result in severe detrimental effects. These effects encompass impairments in the bones, nerves, cardiovascular system, kidneys, and digestive system.

Confirmation from Official Authorities

To shed light on the role and awareness of official institutions regarding the issue of irrigation with sewage water and its associated risks, the investigation approached three key parties: the Directorate of Water Resources and the Directorate of Agriculture in Damascus and its countryside, both government-affiliated bodies, and the Peasants Union in Damascus and its countryside, an institution that assists and plans for farmers.

Ziyad Al-Khatib, the Director of Water Resources in Damascus and its countryside, provided an overview of the main water sources in the region. These include the Barada River and its branches, the Al-Awaj River and its branches, permanent and seasonal springs, licensed wells, and treated water from the sewage station in Adra. Al-Khatib emphasized that the water from the Barada River is currently reaching agricultural fields in areas such as Bala, Maliha, Irbin, Ain Tarma, Jisreen, Zibdin, and Kafr Batna. However, farmers have reported receiving the water in very limited quantities, which has led them to rely on sewage water.

Satellite image of Damascus and its countryside, with green areas visible to the east (Eastern Ghouta) where most vegetable crops are produced and sold in local markets. (Google Earth)(google earth)
Satellite image of Damascus and its countryside, with green areas visible to the east (Eastern Ghouta) where most vegetable crops are produced and sold in local markets. (Google Earth)

Regarding the utilization of treated water, Al-Khatib stated that it is directed towards the first carrier channel (pc1) to irrigate areas such as Hosh Nasri, Hosh al-Farah, Meda’a, and Zuraykiyah. This treated water is specifically used for wheat, barley, and fodder crops, with no allowance for the irrigation of vegetables and fruits. Al-Khatib acknowledged that there have been clear violations by certain authorities, which they aim to address.

Irfan Ziyadah, the Director of Agriculture in Rural Damascus, confirmed the farmers’ complaints regarding the scarcity of water and the lack of necessary energy sources to operate the wells. He mentioned the adoption of a cardboard card mechanism for this season to distribute agricultural diesel based on the agricultural plan, encompassing watering and cultivation requirements for all crops, including vegetables and fruit trees. This approach aims to ensure support for farmers and their access to the necessary resources.

On the other hand, Mr. Anas al-Masri, the head of the Peasants Union in Damascus and its countryside, stated that the allocated amount of fuel mentioned by the Director of Agriculture, which is around 10 liters per dunam (1000 square meters), is insufficient for operating wells and irrigating crops. Al-Masri highlighted the challenges faced by farmers due to the inadequate water supply from the Barada River, partly caused by encroachments from rural areas along the river, such as Douma. Consequently, it becomes difficult for water to reach areas like Maliha, Zibdin, and Deir Al-Asafir in its entirety. The authorities provide each farmer with only 10 liters of diesel per dunam, which is far from adequate considering the sandy nature of the soil in rural Damascus, which demands substantial water resources.

On the right, a photo showing vegetables being watered with sewage water in the Ghouta region. On the left, channels carrying sewage water over crops in the Haran Al-Awamid area, east of Damascus. (Source: B2B-SY)
On the right, a photo showing vegetables being watered with sewage water in the Ghouta region. On the left, channels carrying sewage water over crops in the Haran Al-Awamid area, east of Damascus. (Source: B2B-SY)

Al-Masri emphasized that the March 8 farms in Ghouta are the only lands irrigated with sewage water, accounting for no more than 10% of the total cultivated area. Irfan Ziyadah, the Director of Agriculture, justified this practice by explaining that it is primarily due to the lack of alternative water sources or scarcity of water in those specific areas. Additionally, the convenience of transferring sewage water channels to farmers’ lands, as they are nearby and accessible, plays a role. Despite attempts to raise awareness and implement strict measures to curb irrigation with contaminated water, there is still a lack of awareness among farmers regarding the dangers posed to the soil and crops. Polluted crops, especially raw vegetables, are significant sources of infection with diseases such as cholera.

There are concerns that Syria’s current situation may be an early example of a “drought war,” given the ongoing conflict combined with notable climate changes witnessed over the past two decades. The use of untreated sewage raises questions about the future. Is there an environmental approach or campaign that can help combat this health threat?.

Investigation: Suha Sharhan and Nihal Arab (pseudonyms) / Supervised by Ali Eid

Translated by: Nabil Nabo

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