Syria Insight: Fears of Covid-19 outbreak in northern Syria
Since August, northeast Syria has witnessed a 1,000 percent increase in Covid-19 cases, according to the International Rescue Committee (IRC).
The surge has been compounded by shortages in vital medical equipment and doctors, along with difficulties brought about by war and border closures.
"After nearly 10 years of war, the health system in the northeast was already incredibly weak – and the pandemic is going to push it beyond breaking point," Dr. Mohammed Abdalgadir, the IRC Medical Coordinator for Northeast Syria, told The New Arab.
Health workers in the autonomous region say they are alarmed by the scale of the outbreak and the lack of resources at their disposal.
There are just 13 ventilators and 28 ICU beds - vital for supporting critical cases - for a population of 2.2 million.
"There are not enough doctors, nurses or other health professionals. Only one district meets the emergency threshold of at least 22 health workers per 10,000 people, and there is also only one fully functioning hospital in the region," told Dr. Abdalgadir said.
"The other 15 all lack equipment, staff and medicines. Although the IRC and other health agencies are working to procure more equipment and to train more staff, it is a race against time, as the disease is already spreading extremely quickly."
Another hinderance is the lack of testing kits with just two PCR machines operation for the whole region, limiting medical workers to only 1,500 tests.
In May, The New Arab reported that northeast Syria had one of the world's lowest testing rates in the world, with just 59 tests per million people.
Although the situation has improved since then, Dr. Abdalgadir warned that a lack of trained staff needed to bring new ICR units online, have limited the region to a maximum of 60 tests per day.
Among those tested for Covid-19 in northeast Syria, 40 percent were confirmed to have the disease.
"[This] strongly suggests that it is far more widely spread in the region than what has been detected or confirmed so far - and this is mainly due to the low capacity of testing and surveillance that is possible in northeast Syria," he said.
Among the potential hot spots health workers are most concerned about are the region's densely populated camps, where a lack of sanitation facilities and limited food options could make IDPs particularly vulnerable to this disease and others.
The largest camp in northeast Syria is Al-Hol, which hosts 65,000 people - a population density more than three times greater than New York City.
Medical workers have feared an outbreak there since the start of the epidemic due to the density of the camp's population, Dr. Abdalgadir said.
"People live in tents that are just one metre apart, and many have multiple occupants, so it is practically impossible for people to practice physical distancing there," he said.
There is extremely poor sanitation across the camp and many people already have chronic diseases such as diabetes, hypertension and asthma, he said, which would make them hugely vulnerable to Covid-19.
The first Covid-19 case in Al-Hol was reported last week. Although the patient has been isolated from other residents and is in a stable condition, it sparked concerns about a wider outbreak.
"If the disease is not contained and a widespread outbreak occurs it is going to have devastating consequences. This isolation centre is not equipped to look after large numbers of people," Dr. Abdalgadir said.
"There is not enough PPE, there is not enough space between each bed, there are only 10 oxygen cylinders for 80 beds and there are not enough staff."
|If the disease is not contained and a widespread outbreak occurs it is going to have devastating consequences
- Dr. Mohammed Abdalgadir, the IRC Medical Coordinator for Northeast Syria
The Covid-19 outbreak has also highlighted the urgent need for more medical resources for workers at Al-Hol and other parts of Northeast Syria.
In August, eight children - suffering from dehydration, heart failure or low blood sugar levels - died in the space of five days due to a lack of access to medical treatment, Dr. Mohammed said.
"Four of the children had malnutrition as an underlying complication and all but one could have been saved if they had been able to access treatment," he said.
Three of the children died in the annex for foreign women and their families, where healthcare is limited, he said.
"With not enough staff, not enough equipment, not enough facilities and a population who are already in poor health, an outbreak of Covid-19 in Al-Hol is going to have catastrophic consequences," he said.
"[But] limited access to health care and other services is also a serious concern in Al-Hol."
With winter approaching, the situation looks perilous for residents in Al-Hol and the Syrians across the northeast.
"In the winter, there are always many more respiratory infections and with people already in poor health in northeast Syria, they are always susceptible to these," he said.
"They are already at-risk of COVID and our health teams are already concerned that there is no capacity to test all suspected cases, so unless it is possible to scale-up the health response, the situation is only going to deteriorate."
He said one step the UN Security Council could take it to re-authorise UN use of the Yarubiyah border crossing with Iraq, so that the required medical supplies and equipment can be brought in.
"There are critical shortages of medicines for chronic diseases, on top of the lack of equipment to cope with COVID-19. Cross-line deliveries are not enough to meet the needs of everyone in need in northeast Syria, and NGOs do not have the ability to fill the gaps without additional support," he said.
Idlib and Aleppo
In opposition northwest Syria, the situation appears equally bleak with a shortage of vital medical equipment and workers.
The first Covid-19 case in this region was reported at Bab Al-Hawa hospital in July. Since then the numbers have steadily increased, sparking alarm among aid workers.
There have now been a total of 89 cases – 51 in Aleppo and 38 in Idlib - with 61 people recovering and two passing away from the disease, according to aid workers.
A spike in cases was seen on Wednesday when nine new cases were reported, the biggest increase in a single day in northwest Syria since the outbreak began.
Refugee camps are packed and lack the necessary hygiene items and medical equipment needed to fend off the disease for long.
"People are facing a lack of support in general, particularly with water and hygiene products. Aid groups are facing difficulties with people not abiding by social distancing measures and humanitarian workers are facing even more risks in their line of work these days," one Syrian aid worker told The New Arab, who did not wish to be named for security reasons.
"The attempts of humanitarian organisations to implement social distancing measures have been made difficult as there is no commitment from the people."
|Even if there were enough ventilators and other necessary equipment secured, the shortage of staff will require more trainings in order to be prepared for the worse
- Amany Qaddour, Regional Director of Syria Relief & Development (SRD)
The difficulties in implementing social distancing measures in Aleppo and Idlib, where hundreds of thousands of people live in makeshift shelters or densely-packed camps, could make the northwest a fertile environment for the spread of disease, the aid worker said.
"Many humanitarian organisations are providing awareness sessions about Covid-19 and how to prevent. Many quarantine centres have also opened, with collaboration between some humanitarian organisations and the health directorate, but it is still not enough," the worker said.
"There is no commitment from people towards the preventive measures, especially in the camps, which are considered the most dangerous spots due to the density of the population there and the lack of the minimum necessities of life."
Regional Director of Syria Relief & Development (SRD), Amany Qaddour, said that although thousands of Covid-19 tests have been conducted in northwest Syria, medical workers suspect there are many more cases under the radar.
"There is of course concern around the increase in cases, with planning around a potential peak in October, so this may only cause more alarm," Qaddour told The New Arab.
A Covid-19 task force has been activated that is focused on eight pillars, including Infection Prevention and Control (IPC), led by SRD, Case Management (CM) and Risk Communication & Community Engagement (RCCE) to keep communities informed on the situation.
"Points of entry are being tracked, referral systems for Covid-19 are activated, and support to hospitals for receiving cases," Qaddour said.
Medical workers in the field also lack ICUs and personal protective equipment (PPE) needed to deal with the crisis, which could see the death toll rise when cases increase.
"Even if there were enough ventilators and other necessary equipment secured, the shortage of staff will require more trainings in order to be prepared for the worse," Qaddour added.
Syria Insight is a regular feature from The New Arab. To get Syria Insight in your inbox each edition, sign up here.
Paul McLoughlin is a news editor at The New Arab.
Follow him on Twitter: @PaullMcLoughlin