AMMAN: The three remaining medical professionals in the blockaded town of Madaya suspect an outbreak of meningitis, with 14 reported cases over the past two weeks, but say they cannot confirm the diagnosis because “we don’t have the tools to diagnose and treat patients.”

Symptoms of hallucination, fever, memory and hearing loss began showing up in two young patients early in August. Days later, the patients were evacuated by the regime for treatment, but their diagnosis has not been made public.

“Until now, the regime hasn’t officially disclosed their diagnosis,” said Mohamed Darwish, a dentist and Madaya's most experienced medical professional who works at the only hospital in the town, the Madaya Field Hospital.

Syrian state media has not commented on the possible outbreak, but a team of four doctors from the regime-affiliated Syrian Arab Red Crescent was allowed in on Sunday to examine quarantined patients.

The SARC doctors did not share their conclusions with Darwish, the dentist said. But a local councilman in Madaya, Hussam Madaya, who accompanied the SARC delegation said “they promised us they would either evacuate patients or send medical supplies for treatment, but didn’t give us a set date.”

Right now, the evacuation of patients from Madaya is tied to a ceasefire known as the Four Towns agreement, signed in September 2015. It stipulates parallel evacuations and aid deliveries for four encircled towns: two in Outer Damascus and two in Idlib province. Madaya and Zabadani are encircled by the regime and Fuaa and Kafariya are encircled by rebels in northern Syria.

When the two suspected meningitis cases and 16 others were evacuated from Madaya on August 19, a total 18 other patients from Fuaa and Kafariya were allowed out on the same day. Syria Direct contacted a citizen journalist inside the rebel-encircled town of Fuaa on Monday, who said he knew of no ongoing negotiations to evacuate any other emergency cases from his town.

Red Crescent delegation visiting Madaya. Photo courtesy of Syrian Civil Defense, Rif Damashq.

The SARC team suggested that an evacuation or medical delivery could happen outside the scope of the Four Towns agreement, said councilman Madaya on Monday, but it is not clear how binding that promise will be.

On Tuesday, Darwish, citing rebel sources close to Fuaa, told Syria Direct that “efforts to evacuate patients from Madaya will be suspended” because any action will require concurrent evacuations, and therefore time to negotiate, from Fuaa.

‘We’re facing an epidemic’

Madaya’s remaining 40,000 residents fear an epidemic that Darwish says is already in the town.

“We’re afraid that some people may have a mental breakdown out of fear,” he said, adding that paranoia is developing among residents, who are rushing to the field hospital with any of the signs of meningitis.

“In reality, we’re facing an epidemic that is sweeping the city,” he said.

Darwish’s two-kilometer walk to work at the field hospital now takes more than an hour and a half, he says, because “hysterical” residents stop him along the way to solicit medical advice.

“They ask, ‘what are the symptoms of meningitis? I have those symptoms—do I have it?”

Darwish and his medical team attribute the appearance of meningitis to malnutrition of residents, weakened immune systems and high summer temperatures.

Bacterial meningitis is deadlier than the viral and fungal variations. It is transmitted through close and prolonged contact with an infected person, according to a 2015 fact sheet published by the World Health Organization. The bacterial strand is highly infectious, affecting the brain and spinal cord. Left untreated, meningitis can cause brain damage, epilepsy, deafness or death.

The field hospital staff has examined at least 20 patients who may have contracted the bacteria. Even if the diagnosis is accurate, “we don’t have the tools or medicine to treat them,” Darwish said. Madaya’s most experienced medical professionals include Darwish, the dentist, a veterinarian and a former medical student.

One of the two young patients who was evacuated last month reportedly transmitted the bacteria to his family members, who are now at the field hospital. As of Tuesday, “the family’s situation has gotten worse,” said Darwish. “They are hallucinating and in an agitated state.”

The family members subsequently infected eight members of the field hospital’s medical staff, including five nurses, said Darwish on Tuesday.

Last Friday, Madaya’s Medical Authority, consisting of Darwish and two of his colleagues, issued a statement declaring the town to be “a meningitis-infected area after an entire family and a medical staffer were infected.”

New cases “are rapidly appearing every day,” according to the statement.