April 26, 2020
Compared to other regions, northwestern Syria faces increased fear and distress. Several factors account for this, but after years of war, the main concern is the severe deterioration of the health system and the lack of a robust health authority, which has led to confine the management and supervision of the medical sector to humanitarian organizations that provide financing for hospitals and health centers.
At the time of the writing of this report, there were no records of infections by the novel COVID-19 virus in the northwest region. On April 26, the Ministry of Health of the Syrian Interim Government announced that after testing 230 samples of suspected COVID-19, all the results came out negative, which means there are no infections of the virus recorded to date. However, the Ministry stressed the need to undertake all the necessary measures to prevent the spread of the virus.
This report attempts to describe the current capabilities of the health system in the northwestern region of Syria, the preventive measures taken up to date, and the requirements to effectively address the COVID-19 pandemic.
- Medical infrastructure in northwestern Syria
The World Health Organization provided 300 diagnostic test kits for COVID-19 at the end of March. Throughout April, 206 samples were tested in a central laboratory located in Idlib, which was the only location with suspected cases of the novel coronavirus at that time. All the test results came out negative. However, current updates show that there are not enough tests for all the new suspected COVID-19 cases.
The Idlib Health Directorate provided records of its current medical capabilities and resources in the northwest:
- 600 doctors
- 3,065 beds
- 201 intensive care beds
- 95 respirators for adults
- 30 respirators for children
- 29 respirators for newborns
- 29 CPAP devices (continuous positive airway pressure)
- Ongoing construction for 28 quarantine rooms
This means that there are only:
- 4 doctors per every 10,000 citizens
- 1 hospital bed for every 1,363 citizens
- 1 intensive care bed for every 20,888 citizens
Further, Dr. Munther Hkalil, Director of Idlib Health referred to the severe weakness of the health capabilities in the region, as he stated: “The health sector in the northwest is suffering from a shortage of medical resources – from doctors, medical devices and equipment, to hospitals, dispensaries and medical centers. The support provided by international organizations is limited and insufficient, as it covers roughly 10% of the real needs in the region”.
- Preventive measures against the coronavirus
The Rescue Government has also taken several measures to prevent the spread of the COVID-19:
- Suspending the Friday prayer, in accordance with the decision issued on 2/4/2020.
- Banning large human gatherings, including popular markets or bazaars, bird-selling and other animal markets, and car and motorcycle markets, in accordance with the decision issued on 3/30/2020.
- Extending the suspension of activities in both private and public schools (including kindergartens); same as working through a distance education system, in accordance with the decision issues on 3/30/2020.
- Partial closure of the crossings.
Northwest Syria has witnessed an upsurge on activity from different types of organizations, youth groups, and women’s groups, which carry out community campaigns to inform and educate the population about the seriousness of the COVID-19, and the importance to treat seriously this new outbreak in order to contain the further spread of the pandemic. In addition, these actions have included guidelines to prevent HIV infections, which have been disseminated through the distribution of brochures, vehicles with amplifiers, murals, and seminars. Similarly, several organizations carried out joint sterilization campaigns in camps, markets, places of worship, schools and institutes, hospitals and medical centers, and through other public facilities.
These measures, however, result insufficient to effectively limiting the spread of the virus for several reasons:
- The overpopulation in northwestern Syria: about four million people live in the region, distributed in a limited geographical space. In addition, the population is spread in camps which were overcrowded by the recent military operation. As an example, in these camps every tent hosts more than two families. Further, some of the people who were unable to find housing settled in agricultural lands, which makes social isolation an extremely complex matter.
A woman actively involved in the fields of human rights and women’s affairs, spoke about the situation in the northwestern camps of Syria, and stated: “The overpopulation in the camps represents a real danger, where more than half a million civilians live in these camps, in a geographical area not exceeding ten square kilometers. And it is very difficult to apply quarantine in the region, not to mention the increasingly deteriorating economic situation, that is pushing people in the camps to go out for their daily work, so staying at home is not an option.”
- Weak response by humanitarian organizations: the response has been insufficient to address a humanitarian crisis of this dimension, and particularly, the needs of the internally displaced people (IDP) such as shelter, food, education, water, and sanitation. Some of the IDP are still homeless or are currently living in tents within agricultural lands and mountains.
(M.S) a construction worker from Maarat al-Numan, who was displaced at the beginning of this year to the Sarmada camps says: “We cannot stay in our tents, I go out every day from my tent looking for work, any work, and I cannot go back until the end of the day, maybe I work that day and maybe not. If I choose to stay in the tent, my children will not eat, we are faced with two options, the best of which is horrible, but we cannot wait for death in the camp.”
- Lack of commitment by the population to follow preventive measures: due to the difficult economic situation, people feel compelled to go out to work. There is not enough supply of preventive materials such as sanitizer and masks, and the low availability of such supplies has led to exorbitant prices that the common person cannot afford.
The nurse (CT) deals daily with dozens of people saying: “We have been trying to warn the people about the imperatives of prevention and what should be done; our role of raising awareness is not limited to advice, but also includes Sharia and the provision of sterile materials which are practically nonexistent in many of the Villages and towns. We try as much as possible, but unfortunately the response from the people is still weak.”
- Border closure measures: the measures taken to close the borders to other areas of control have exacerbated the economic crisis. As a result, there is a shortage of medicines since most of them came from areas controlled by the regime. In addition, there have been disruptions in the trade of agricultural crops with other regions due to road closure.
The Syrian civil platform monitors with great concern the possibility of an epidemic in the northwest regions, and calls on the international community and the United Nations to assist the medical organizations with the preparedness and response actions for COVID-19 through:
- Providing adequate quantities of COVID-19 diagnostic test kits to conduct testing for all suspected cases.
- Supporting the health sector in the Idlib Governorate with the necessary medical devices and tools to treat the COVID-19 outbreak.
- Delivering humanitarian aid to the camps, which are inhabited by tens of thousands of people that have stopped working due to the current conditions.
The Syrian Civil Platform also calls on the local authorities in the northwest to take effective measures to address the COVID-19 outbreak by stopping all institutional activity, including universities and other non-essential service institutions, to prevent the further spread of the virus in the region.