For weeks through March, the Syrian regime of President Bashar al-Assad vehemently denied the faintest signs of coronavirus spread in the country.
It continued doing so while the whole region was being overwhelmed by the pandemic, with contestant flow of people between Syria and disease hotspots like Iran and Turkey.
And while the regime was in blunt denial, watchdogs like London-based Syrian Observatory for Human Rights reported full-swing COVID-19 outbreaks in Latakia, Homs, Tartus, and Damascus. It even reportedly issued an order strictly forbidding medics from even talking about the disease. And nations like Pakistan were detecting new cases among people with travel history in Syria.
The silence was eventually broken only on March 22, when the Syrian healthcare ministry for the first time reported a COVID-19 case.
In this global pandemic, Syria, which is ripped apart and devastated by its nine-year multisided war that has claimed at least 380,000 lives, is almost defenseless. Its basic healthcare infrastructure is bombed into ashes, it has almost no equipment and very limited capacity of intensive care beds. Much of its impoverished population lives in severely overpopulated displacement camps, the perfect growth medium for the virus.
Nearly all observers and watchdogs, including the World Health Organization, have no doubt about the fact that the embattled country might be facing a devastating COVID-19 outbreak — and that this can be happening right now.
Tip of the iceberg
Even before admitting its first officially confirmed COVID-19 case, the Syrian government went on full lockdown starting from March 14. It delayed upcoming parliamentary elections, banned all gatherings and public events, all non-essential businesses and institutions, and all traffic between provinces.
Starting from March 25, it has also introduced a curfew from 6 p.m. to 6 a.m. all across the provinces it controls. It even suspended conscription to the regime army amid ongoing wartime, which says a lot about the danger the country could be facing.
As of Apr. 8, Syria reports only 19 cases and 3 deaths. These figures contrast sharply with the situation in neighboring countries: over 34,000 cases in Turkey, 575 cases in Lebanon, over 1,000 in Iraq, and over 64,000 in Iran — the regime’s ally which sends thousands of militia fighters to fight in Syria.
Few have any doubts regarding the fact that the true number of cases in Syria is much higher.
“Judging from other places, this is the tip of the iceberg,” the United Nations emergency relief coordinator Mark Lowcock stated on March 30.
Nonetheless, the country’s shattered healthcare grid is not even close to being ready to tackle an influx of critically ill. According to the World Health Organization, only 64 percent of Syrian hospitals are functioning, and even working clinics have a severe shortage of trained staff.
“Health infrastructure and basic services have all been decimated over much of the country … and Syrians are very likely to be some of the most vulnerable to the spread of the virus globally,” as Rachel Sider, an adviser with non-government organization Norwegian Refugee Council, told the Reuters on March 23.
“What’s very clear is they’re nowhere near ready for an outbreak.”
Numerous watchdogs also come to unpromising conclusions regarding Syria’s prospects in the endemic.
Upon estimates by the London School of Economics and Political Science (LSE), the country’s healthcare system can provide adequate treatment to no more than 6,500 COVID-19 patients.
“Once the number of cases passes this estimated threshold of 6,500, also known as the maximum capacity threshold, the healthcare system is likely to collapse, with rationing decisions needing to be made,” as LSE’s research paper reads.
There are only up to 325 intensive care unit beds with ventilators available in the whole country, according to the study.
“There is an overall lack of sufficient public awareness, a significant lack of resources, and continued deterioration of humanitarian and socio-economic conditions across Syria, making the country acutely at risk of an uncontainable COVID-19 outbreak,” the researchers say.
On March 30, the UN again called for “complete, immediate nationwide ceasefire,” adding that Syria is at “high risk” of being unable to contain the pandemic.
Syrians wearing face masks walk in front of posters informing about the novel coronavirus, in the capital Damascus on April 1, 2020. (AFP)
Contagion in Idlib
The northwestern province of Idlib, the last stronghold still held by the Syrian opposition, is very likely to become the worst hotspot.
Out of nearly 3 million people trapped in the enclave blocked by Turkey, government forces, and Russia, nearly 1 million live as internally displaced persons in tent camps and unofficial settlements lacking very basic sanitation and health capabilities.
One of such settlements, Deir Hassan camp in Idlib, hosts more than 164,000 people, according to Doctors Without Borders (MSF), an international medical organization present in northern Syria.
Many families in such camps live in overcrowded, fragile tents and huts, while new displaced persons arrive all the time in huge numbers that cannot be accommodated by the settlement.
“The water and sanitation facilities are inadequate for such large numbers of people, raising the risk of water-borne diseases,” as the organization noted on March 30.
“So far, upper respiratory infections have been the main condition seen by MSF mobile clinics.”
The organization also noted that in north-west Syria the situation could become “critical.”
“The disease would spread very quickly, especially in camp settings,” the statement reads.
“Hospitals and health centers would become overwhelmed with a massive influx of COVID-19 patients that would be in need of hospitalization, while these same facilities are still handling casualties from the fighting — as well as responding to other medical needs.”
So far, no cases were reported from the devastated enclave, although the World Health Organization in late March shipped 300 coronavirus test kits to Idlib and promised to supply more 2,000 as soon as possible.
Nonetheless, the outbreak in Idlib can be just a matter of time, and the probability of that is very high, as many watchdogs believe.
“Conditions in Idlib are ripe for a spread of the disease,” as International Rescue Committee, a global humanitarian organization, stated on March 23.
“A lack of food, clean water and exposure to cold weather has already left hundreds of thousands of people in poor health, making them even more vulnerable to a disease that can spread as quickly as COVID-19.”
“Although there have so far been no confirmed cases in Idlib, it is not yet clear where testing will be carried out, and it is possible that the disease is already making its way through the population.”
And if the worst-case scenario becomes the likely case, Syria, in general, could let “to one of the most severe outbreaks in the world,” the organization added.
