Battered by years of warfare, the country's health infrastructure is barely prepared to cope with daily incidences — let alone a viral pandemic like COVID-19.
People have been told to wash their hands. But water supply has been one of the primary casualties in the near decade-long war. Advice to practice "social distancing" is impossible in the overcrowded camps which millions of Syrians call home. With a countrywide shortage of key medical equipment and health professionals, all sides brace themselves to face a viral outbreak that cares not for Syria’s political faultlines.
The top UN envoy for Syria on Tuesday issued a plea for a nationwide ceasefire to allow for a better response to the threat of the novel coronavirus.
Void of foot traffic, businesses and mosques in Damascus lay quiet as the Syrian government announced a two-week curfew, that saw the historic Umayyad Mosque close its doors for the first time in centuries.
Loyalist strongholds are less pulverized than other areas, comparatively safe from the bombs that have pummeled the country for years. In the remaining rebel areas, health infrastructure has been repeatedly targeted.
All of Syria's neighbors have reported cases of COVID-19 in at least the double digits — but the government in Damascus has so far reported just five. Fears are high that the virus could spread rapidly among the war-battered country's vulnerable, and that efforts to contain it could prove too little, too late.
Assad's Syria
Just 57 public hospitals remain fully functioning in Assad's Syria, and only one laboratory in rural Damascus is nationally designated to test for COVID-19. To meet staff shortfalls, the Syrian government has drafted medical students who have yet to complete their studies to support the response to the pandemic.
Syria plans to open a second laboratory in Aleppo, a local health official said in an interview with al-Watan newspaper, owned by Syrian aristocrat Rami Makhlouf.
A January report by the World Health Organization estimated that if Syria were to increase its testing capability to seven facilities, it could test up to 200 samples per day.
Assad's forces today hold more than 70 percent of Syrian soil following Russian-backed victories against rebels since 2015.
Rudaw English spoke to a doctor working in a Damascus hospital, who asked that her name not be published for fear of repercussions.
She says keeping to her daily routine — make coffee, go to work, come home and care for her family — has kept her stable. But she is worried.
"I'm not optimistic at all, I come home scared. I think the corona arrived late to Syria because it's not as open to foreigners as other countries," the doctor in Damascus told Rudaw English.
"Now they are announcing the opening of quarantines [centers] which I think is very late," she said, "but our hospital is not prepared to accept corona cases, so of course, we have fear. There is a shortage in sterilizers, so we tell patients with simple complaints not to come in. You tell people to stay at home but no one listens because people have not been educated."
A January report by the WHO in Syria found that the majority of patients coming into hospitals throughout Syria presented with "influenza-like illnesses" accounting for 63.2% of patients in the month before Syria began testing for COVID-19.
Though the government's response came late, the warning signs began early.
Chinese authorities placed Wuhan under lockdown on January 23, when recorded infections began to spike exponentially.
Public panic did not reach Syria until late February, when hoarding caused the price of face masks to spiked by 600%. Though the government assured citizens that it was taking necessary precautions, flights to virus-slammed Tehran out of Damascus International Airport remained in service until the airport closed March 17, when the government ordered a two-week curfew.
The Rebel North
Nine years of war have battered healthcare facilities across Syria, and hostilities continue to devastate civilian infrastructure in the rebel-held northwest.
World Health Organization (WHO) officials have documented 494 attacks on hospitals and other medical facilities across Syria which have killed hundreds of patients and health workers since 2016.
The results of six suspected cases of COVID-19 came back negative on Wednesday, Idlib health officials told Rudaw English. The testing kits were sent by the World Health Organization and tested in a laboratory in Turkey.
Dr. Samih Kaddour, who works in Akrabat Hospital in Idlib, says that the signs of outbreak having yet to take hold in the rebel enclave is something in the back of their minds. "People have much bigger problems to worry about than washing their hands," he told Rudaw English. Close to Turkey's border, the hospital and its vicinity is safer from Russian airstrikes – but at any time, ambulances can rush in with trauma victims from nearby bombardments.
"People say if they stay quarantined in the house, then who will feed the kids?" says Dr. Kaddour.
Many of the doctors working in the besieged rebel enclave live in Turkey and commute cross-border to go to work. Dr. Kaddour says he now faces a grueling choice: stay quarantined to keep his family safe, or risk contracting the infection to continue doing life-saving work.
Detainees 'particularly vulnerable'
Human rights groups warned Tuesday of a "catastrophe" if the novel coronavirus hits the Syrian regime's overcrowded and squalid prisons. The tens of thousands of prisoners are routinely packed into small overcrowded cells in conditions especially ripe for the spread of disease and denied adequate food, medical care and ventilation, rights groups say.
"If the novel coronavirus spreads in security branches or prisons... this will lead to a major humanitarian catastrophe," said Diana Semaan, Syria researcher at Amnesty International.
"Over the past nine years, we have found that security forces and the heads of the security branches do not provide any kind of medical care for even illnesses considered simple to treat compared to the coronavirus," she said.
"One case of coronavirus in detention facilities can and will be catastrophic," HRW's Sara Kayyali told AFP.
Human rights groups have for years documented how prisoners have died not just from executions, but also from illness and poor living conditions.
"If coronavirus hits the prisons we are likely to see an exponential increase" in such deaths, Kayyali said.
Syrian activist groups on Monday pressed the government for action, calling for the release of political prisoners and halt to new arrests.
A statement signed by 43 non-government groups, many of which are based outside of Syria, also called on the government to open detention facilities to the World Health Organization and the International Committee of the Red Cross (ICRC).
UN envoy to Syria Geir Pedersen on Tuesday made a similar call, urging "large scale releases of detainees" and appealing for "immediate access for relevant humanitarian organizations to all detention facilities, and urgent steps to ensure adequate medical care and protective measures in all places of detention".
The issue of detainees remains one of the major obstacles to diplomacy between the Syrian regime and opposition. Research by Amnesty International estimates that tens of thousands of Syrians have "disappeared" in the custody of the Syrian police state. Some are reportedly still held incommunicado from their family members, even after taking "reconciliation" oaths that they expected would wipe their names from government blacklists.
A spokesperson for the ICRC said the Red Crescent is discussing the issue of detainees with relevant actors and is ready to provide assistance if it is allowed access.
The Kurdish enclave
Though less battered than Idlib, the situation in the Kurdish-held northeast is, home to massive displacement camps hosting hundreds of thousands of people. While the Kurdish self-administration in northeastern Syria has yet to detect any official COVID-19 cases, measures needed to respond in case of an outbreak are scarce. Authorities instituted a 15-day lockdown beginning Monday.
Officials told Rudaw English that the Rojava region does not currently have the necessary testing kits to detect COVID-19, and instead must send smear samples across the length and breadth of the country for testing to the capital Damascus.
"The World Health Organization is taking coronavirus tests to the regime's main laboratory in Damascus, where the results will come out," spokesperson for the self administration's health department Jawan Mustafa said. "The WHO is not acting as a mediator between us and the regime, but it is their job to conduct the tests and announce the results there, in Damascus."
With only nine quarantine centers hurriedly being prepared to house suspected COVID-19, aid workers fear there are not enough beds to house patients in the event of an outbreak.
The Kurdish-controlled northeast is less damaged by war than other parts of Syria. But unlike Syria's rebel-held northwest, where UN aid enters via Turkey, the northeast is deprived of cross-border channels for UN medical assistance.
Rojava has in recent months become increasingly reliant on Damascus for aid after Russia blocked proposals to renew the mandate for humanitarian to be routed through the border with Iraq, insisting that aid be come through Damascus, where it can be controlled and conditioned by the Syrian government.
Aid groups say the move has effectively left the region under a blockade that "could lead to one of the most severe outbreaks in the world."
"With the UN no longer able to provide medical supplies from across the border, the ability of many humanitarian organizations to meet the healthcare needs of those in camps such as al-Hol has already been compromised," the International Rescue Committee said in a press release.
Camps for displaced refugees remain the gravest concern, especially in massive displacement camps such as al-Hol, home to some 100,000 people including families still loyal to the deterritorialized Islamic State.
Kurdish security that controls al-Hol have struggled to contain riots in the camp, where residents wait in limbo to be brought to justice.
Aid workers said that they have had to limit entries into the camps to emergency circumstances only.
In its last report, dated January, out of 43,000 medical consultations the WHO recorded in al-Hol camp, more than one in five patients were referred to its early warning alert and response system.
According to Kurdish authorities, no one in al-Hol has been tested for COVID-19.
While the Kurdish-administered northeast still has yet to declare a single infection of the novel coronavirus, the enclave is also under pressure from an offensive by rebel forces supported by Turkey.
UN agencies have repeatedly warned that the Allouk water station near Sari Kani (Ras al-Ain), a border town now controlled by Turkish proxies, has repeatedly been cut off as a result of the conflict, depriving around 460,000 people of water at a time when hand-washing is of critical importance.
"The interruption of water supply during the current efforts to curb the spread of the coronavirus disease puts children and families at unacceptable risk," UNICEF's Fran Equiza said in a statement. "Water and water facilities must not be used for military or political gains - when they do, children are the first and most to suffer.”
Additional reporting by Asmaa al-Omar and Yasmine Mosimann
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