SPOTLIGHT: CORONAVIRUS UPDATE
Despite the rapid spread of the Covid-19 pandemic across the region, the Syrian Ministry of Health continues to insist that no cases have been registered in the country - as of now. Last week, Syria in Context reported that Pakistan had detected multiple infected men who had travelled to the country separately from Syria. Considering the continued unmonitored entry of militiamen and civilians from Iran, Iraq and Lebanon - all of which have reported community spread of the virus - this claim seems increasingly untenable. This week, research conducted by Syria in Context indicates that there are individuals presenting symptoms consistent with Covid-19 who have not been tested within government-controlled areas of the country.
The World Health Organization (WHO) assesses the risk to Syria as “very high” due to the high numbers of vulnerable peoples (incl. displaced people and refugees), large scale population movements for religious pilgrimage and such, as well as the fraught state of the Syrian health care sector whose response preparedness and response capacity, is considered to require “technical and operational support”. According to its spokesperson, the system “may not have the ability to detect a pandemic.”
This interpretation is further supported by interviews with doctors and nurses working Damascus According to them, the lack of officially confirmed and registered cases thus far may be less a product of government conceit, than due to a lack of testing, reporting that tests for Covid-19 only became available in Syria from March 13, when the WHO provided the Syrian Ministry of Health with testing kits. While Syrian state media continues to attempt to project calm, claiming that all 103 tests conducted thus far have returned negative, interviews with those on the frontlines of the impending health crisis paint a more disconcerting picture: In interviews, five medical professionals working in Damascus reported personally witnessing patients who displayed symptoms consistent with Covid-19 infection, at least one of whom has since died. According to the doctors, none of these cases were tested. Interviews with two doctors working at Tishreen Military Hospital in Damascus further corroborate controversial claims made by Syrian opposition activists that the virus had been imported to Syria by Shia militiamen under Iranian control. The two doctors report that multiple foreign fighters had been treated at the secure medical facility for what appeared to be Covid-19.
Official claims about the absence of cases are met with incredulity even among government supporters and fighters in loyalist ranks. As ordinary people rush to protect themselves, the supply of basics such as masks and rubbing alcohol dwindles across the country, leading to price hikes and shortages (despite the Syrian government’s announcement of accelerating domestic production). Indeed, the state of the Syrian healthcare sector (and broader economy) is such that patients in public hospitals are regularly forced to self-purchase tests, drugs or medical equipment, including basics such as gauze or intubation tubes. In regime-held areas, the system further suffers from immense corruption, years of brain-drain as well as financing shortages for basic investments. Human rights activists from Human Rights Watch on Monday further raised the issue of the tens of thousands of detainees in Syrian prisons who are being denied “adequate food, medical care, sanitation supplies, ventilation, and space”, leading to a potentially catastrophic situation. In opposition-held areas, the few surviving medical facilities and professionals continue to be the targets of a merciless campaign of military targeting that has destroyed dozens of hospitals and primary care units in recent months. As the Syrian economy continues to contract and violence escalates, fewer and fewer families will be able to access even nominally public care.
In light of the looming epidemic (and despite the lack of reported cases), the Syrian government has moved to institute the first measures to restrict public life and slow the spread of the virus through the country. On March 14, the cabinet announced the closing of schools, universities, mosques and a number of public offices, as well as the cancellation of cultural and public events. In essential areas, directors are asked to develop work plans that would reduce the effective workforce to 40% of normal staffing without affecting the delivery of services. Media affiliated with the Shia militias operating in loyalist areas also reported the closure of the holy shrines of Sayeda Zeinab and Sayeda Ruqaya in Damascus following a decision by the local representative of Iran’s Supreme Leader Ali Khamenei (Iran had also only closed its own holy sites this week). However, these steps only led families to take their children to public gardens and places to try and escape their cramped living quarters. The announcements also did nothing to reduce crowding and long, tightly-packed lines at distribution points for subsidized goods such as food. It also did not alleviate the pressure on Damascus’ public transit system which has been overburdened due to fuel shortages throughout the country.
Syrian opposition authorities have taken similar measures, cancelling school and delaying exams throughout Idlib and northern Aleppo. The Syrian Interim Government’s Ministry of Health also reported having set up monitoring stations at border points as well as internal crossing to opposition-held territory. It also opened three quarantine centers in Salqin, Darat Izza and Al-Bab, each equipped with 20 beds. However, humanitarians lament these measures as wholly inadequate. While local officials and health workers were being trained and tests were made available (testing is scheduled to start later this week), the system would be unable to bear the stress of an outbreak and the corresponding influx of critical care patients. According to SAMS, the Idlib health directorate - the principal public health body for millions of destitute civilians in northwest Syria - does not have the ability to isolate infected patients in its hospitals. In the camps, some of which have almost doubled in size following fighting in recent weeks, basic hygiene and social distancing practices are made impossible by lack of running water, soap and cramped living spaces. The situation is further complicated by the political situation, leaving the response in the northwest to be coordinated via Turkey as part of the cross-border effort in consultation with the Turkish Ministry of Health (which would process testing kits) and the World Health Organisation. The end of cross-border aid from Iraq (reported previously in Syria in Context) means the response across the northeast will be coordinated via Damascus, leading to considerable trepidation among local authorities. The local Autonomous Administration further decided to close non-essential government departments, after it had already blocked the area to European passport holders two weeks ago.
The situation is marginally better across the border, where refugee communities could be supported via local public health systems, as well as a more coordinated and effective international response. Among these, refugees in Lebanon are once again considered the most vulnerable to external shocks due to their precarious economic and legal situation across the country. On Monday, the government of Hassan Diab declared a national emergency as the official case count in the country rose to 120. Unregistered, with hundreds of thousands living dire conditions in dispersed locations, the more than one million Syrian refugees in Lebanon could not only be refused access to Lebanese health services but also be vulnerable to xenophobic backlash and economic fallout as the pandemic coincides with an economic and political crisis in the country. On Tuesday, the governor of the Beqaa issued the first decree, instructing local authorities to extend the monitoring, disinfecting and restrictive government measures on public gatherings into the refugee settlement.
Our colleague Elizabeth Tsurkov contributed research to this report. Read her latest on the deteriorating state of the government-held areas of Syria.
FURTHER:
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The New Humanitarian will host an online expert discussion on the potential impact of Covid-19 on crisis zones this Thursday: “How will COVID-19 impact crisis zones?” [Link to register] (EN, The New Humanitarian, March 19, 2020)
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Carnegie Middle East Center compiles expert opinions on the regional response to Covid-19: “What Have the Reactions to the Coronavirus Outbreak in the Middle East Shown?”(EN, Carnegie MEC, March 12, 2020)
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Jan Egeland, Secretary-General of the Norwegian Refugee Council, issued an urgent plea on behalf of the organization warning that “Coronavirus will decimate refugee communities if we don’t act now” (EN, NRC, March 16, 2020)
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Tom Allinson and Mehyeddin Hussein report for Deutsche Welle on the potential impact of coronavirus on the displaced: “How are Middle East refugee camps prepared?” (EN, DW, March 11, 2020)
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Aymenn Jawad translates the Islamic State’s guidance on Covid-19: “Islamic State Advice on Coronavirus Pandemic” (EN, Aymenn Jawad, March 12, 2020)
Syria in Context will continue to cover the impact and response to Covid-19 in Syria throughout the coming weeks.
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