How is Idlib prepared to confront Coronavirus amid absence of social distancing and adequate health care system?

Children putting on face masks during an activity to promote awareness of the dangers of the "Coronavirus” in Atmeh camps - 16 March 2020 (Enab Baladi)

Children putting on face masks during an activity to promote awareness of the dangers of the "Coronavirus” in Atmeh camps - 16 March 2020 (Enab Baladi)


Adnan al-Imam, a displaced person residing in the town of al-Dana, north of Idlib, heard of a “Coronavirus” disease (COVID-19) from one of his friends. Even though al-Imam is not convinced of the deadly danger of the Coronavirus to the region, he refrained from performing Friday prayer in the mosque. Al-Imam told Enab Baladi “ no need to fear the virus, we have gone through worse situations; we have been subjected to bombardment, forced displacement, and migration. But if Coronavirus spreads, there will be a large-scale humanitarian disaster.” 

Al-Imam is one of the hundreds of thousands of people who have been driven to flee their homes and head north to the crowded border cities, by the military campaign of the Syrian regime forces and its ally Russia.

More than three million people in the opposition-held province of Idlib hardly received the news of the ceasefire agreement signed between Russia and Turkey on 5 March. Then, warnings and campaigns to combat the emerging Coronavirus (COVID-19) crisis filled the air.

The first coronavirus cases were observed at the end of December 2019 in China and quickly spread globally, causing panic and pandemonium even in the most advanced countries in the fields of health and technology.  However, that was not the case in Syria, which has now entered the ninth year of the war. Although no cases of the Coronavirus have been reported in Syria, global health officials and local doctors warned that the virus could actually spread, without being discovered, amid an apparent lack of adequate preparation to counter the virus.

No way for physical distancing

The latest military campaign in northwestern Syria waged since December 2019, has caused the most massive wave of displacement during years of conflict and put northern Syria’s most significant humanitarian lifeline at risk.

Over a million people were forced to leave the southern countryside of Idlib and crowded north on the Syrian- Turkish border, in formal and informal IDP camps, in cities, villages, and towns that are already crammed with uprooted people.

Finding shelter was the biggest challenge uprooted people faced in their new areas of displacement, as they had to share tents with other families and shelter themselves in unfinished or non-residential buildings, such as schools and mosques. Others were forced to sleep in the open air.

The absence of health housing, as described by the medical coordinator of “the ATAA Humanitarian Relief Association” al-Tayyip Aref Abu Karsh, increases the risk and the prevalence of the virus “very quickly and uncontrollably.”

Abu Karsh, in an interview with Enab Baladi, indicated that the IDP camps suffer from a lack of sanitation facilities and that people always intermix with each other widely.

According to the data released by the Syrian Response Coordinators Group (SRCG), only 0.51 percent of the IDPs returned to their areas after the ceasefire. The Syrian regime forces and its backer Russia have violated the latest ceasefire agreement between Turkey and Russia 45 times until 21 March after it was implemented, which means that there are no guarantees for the return of the rest.

Speaking to Enab Baladi, the director of the emergency team at Violet Organization, Mamoun Kharbout considers the camps, and accommodation centers as “the weakest link,” They include large groups of displaced people who share the same service facilities such as bathrooms and kitchens, amid poor levels of health care and hygiene.

Overcrowding in camps impedes following the health and safety rules recommended by health care organizations to avoid the hazards of the virus spreading, such as people have to keep a distance of at least one meter, wash their hands with soap and water frequently, and sterilize housings and used items.

However, relief organizations worked to raise awareness about COVID-19, its risks, means of protection and prevention, considering that the first line of defense against the coronavirus infection is personal protective measures because the health system lacks support, suffers a shortage of medical supplies and has been systematically targeted by the Syrian regime and its ally Russia.

Health facilities are in unsecured conditions in northern Syria

The province of Idlib has lost 76 health facilities as a result of the massive bombardment and the systematic target by the Syrian regime forces and Russia. Idlib also registered a loss of medical staff and health workers due to the killing and displacement, the head of the drug control department in the Idlib health directorate, Mustafa al-Sayyid al-Dagheem told Enab Baladi.

The Idlib health directorate, in coordination with the World Health Organization (WHO) and other partner organizations, has formed a team to set up three hospitals to receive cases of the Coronavirus within 15 days. They also establish isolation centers of suspicious cases, but “these centers would not be sufficient to accommodate the expected numbers if the Coronavirus cases broke out in the area.”

There are only 200 intensive care beds in the health centers in Idlib, according to al-Dagheem’s estimate, while Dr. Muhammad Shaham Makki estimated that the region would need more than 50 thousand intensive care beds if the virus spreads in the area.

Makki, a specialist in laboratory medicine, received specialized training to deal with the Coronavirus in Turkey. The health directorate prepared a laboratory for epidemiology to detect the virus. Still, several Coronavirus test kits were not yet available in the region, and therefore it is not possible to confirm if there are Coronavirus cases or not.

The WHO provided the Syrian regime-controlled areas with the Coronavirus test kits last February while the opposition-controlled areas, which are not officially recognized as a state, need more time to obtain them.

Al-Dagheem believes that there are Coronavirus cases in the areas under the control of the Syrian regime because its borders are open to neighboring countries where the disease has spread. Besides, al-Dagheem perceived the lack of “transparency” in the authorities of the Syrian regime; they do not announce that there are Coronavirus cases across the country.

The head of the drug control department in the Idlib health directorate considers the closure of the border crossings as one of the preventive measures that must be adopted. He said that he confirmed that the closure of border crossings came into effect; it banned entry to travelers from the “Abu al-Zindan” crossing with the Syrian regime-held areas, and the “Bab al-Salama” and “Bab al-Hawa” crossings with Turkey, but an exception has been made for entering trucks. Not to mention that the cargoes and truck drivers will be checked when crossing the border.

An ounce of prevention is worth a pound of cure

The Idlib health directorate began awareness-raising campaigns on the fight against Coronavirus, conducted in conjunction with several organizations; “brochures” about Coronavirus are printed, and education is provided by community health workers on prevention and isolation methods in camps, gathering places and markets.

Ataa Humanitarian Relief Association directed its mobile clinics and medical teams to camp areas to distribute face masks and sterilization materials. At the same time, Violet Organization trained 40 paramedics in dealing with suspected cases and practical scenarios to respond to these cases.

Health care teams have disinfected, and sterilized accommodation centers, schools, mosques, and gathering places, the director of the emergency team at Violet Organization, Mamoun Kharbout, told Enab Baladi.

However, citizens, including Ibrahim Darwish in the Deir Hassan camp, do not think that these Coronavirus awareness campaigns are feasible, because most of the displaced people in the camp are too “simple,” as described by Darwish. They cannot follow the required precautions, such as washing hands and buying face masks. Darwish described to Enab Baladi that the IDPs “only hope for the best to come, letting God have His way in their lives.”

For his part, al-Dagheem stressed that social distancing and continuous sterilization are the keys to combating the virus, and the only obstacles to the growing number of deaths.

Al-Dagheem said that the people of the region should stay home and stop going out to markets, schools, universities and mosques without utmost necessity, and those who go out should take appropriate prevention measures; such as washing hands with water, soap, and using alcohol-based hand sanitizers which contain between 70 percent to 80 percent alcohol, and avoid close contact with people expected to be infected.

Al-Dagheem believes that practicing social distancing and staying at home (self-quarantine) are the only ways to stem Coronavirus spread, referring to the difficulties experienced by developed European countries in containing the infected cases at their hospital. He called on the people of the region to cooperate to confront Corona effectively.



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