WASH cholera prevention and response activities in high cholera risk areas in Baalbeck-Hermel and South of Lebanon. Action Against Hunger (ACF) will roll out a lifesaving cholera response to reduce transmission of the disease in affected areas and minimize the risk of introduction of the outbreak in other high-risk areas. ACF will provide assistance to all populations regardless of status, intervene in all types of settings (urban areas, ITS, CS, or rural areas) and tailor its response based on WASH needs. ACF will cover the following geographical areas: 
-	Baalbeck (including Aarsal, Qaa, Deir el Ahmar and Labwe clusters), 
-	Hermel, and 
-	Saida (Clusters 6, 7, and 8). 

Specifically, ACF will implement 
1) Case-area targeted intervention approach (CATI) or case-cluster targeted intervention approach (CATI), and 
2) Preventive measures to ensure water safety in high-risk areas through different modalities.

The CATI approach is to provide affected populations with enough water, sanitation services, and hygiene items for a minimum period of 2 weeks to face a cholera outbreak. As a first step, ACF will ensure access to safe chlorinated water for two weeks for at-risk populations where a confirmed or suspected cholera case is identified. In ITS and CS, all households (HH) will be targeted. In Lebanese host communities, all HHs between a 50 to 100 meters radius from the affected HH that do not have access to safe water will be targeted (estimated: 20 - 30 HH).

ACF will also provide desludging services to cholera affected or suspected households and its surrounding areas. The desludging services will only be used for decentralized systems that are not connected to the public wastewater systems, mainly in ITSs and Collective Shelters, but also in Lebanese communities using septic tanks (decentralized systems). Most ITSs in Lebanon are already covered by WASH partners working with UNICEF, however in the eventuality that a particular ITS is not covered (as it is the case in South), ACF will provide desludging services for the whole ITS for 2 weeks. 

ACF’s field officers will carry out Risk Communication and Community Engagement (RCCE) activities, by providing awareness sessions on the prevention and treatment of Cholera. The sessions will target households with confirmed or suspected cases, as well as surrounding households. Community-based awareness sessions provided by ACF’s field officers will be complemented by the provision of a hygiene kit (HK) with items designed to help prevent and treat Cholera.
ACF will disinfect main areas of cholera hotspots (latrines, excreta and vomits, garbage dumping sites). The disinfection will be conducted outdoors in the surrounding areas where cholera cases are detected, with a 2% chlorine solution. 

Beyond the CATI approach, ACF will work closely with public institutions to ensure water delivered through the public network is chlorinated and safe to drink. ACF will coordinate with UNICEF to support Water Establishments and municipalities with the provision of chlorine to sterilize water and the reduce risk of waterborne diseases, wherever not already supported by UNICEF. ACF will also support public institutions, such as schools and public health centers (PHC) to increase water safety delivered to students and patients, manly through: maintenance of water filters, provision of clean water tanks, and chlorine donation. Finally, ACF will also train private water truckers, in Coordination with LRC, on cleaning and disinfection of storage and distribution water tanks, as well as chlorination.   

ACF will also target high-risk and hard-to-reach areas in Qaa-Hermel with water treatment systems both at household and community level. The presence of high levels of water contamination in the wells around Qaa-Hermel (around 70% of the agricultural wells are bacteriologically contaminated) and the lack of minimal sanitation conditions in some of the sites, are the perfect combination for a cholera outbreak in the area.