"The consequences of an uncontrolled COVID-19 outbreak in northwest Syria are almost too terrible to contemplate."
A new battleground in the nine-year conflict in Syria opened last week with confirmation of the first case of COVID-19 in war-torn Idlib Province. On July 9th, a doctor at the Bab al-Hawa Hospital, situated at a crucial border crossing with Turkey, tested positive for the virus. By July 12th there were three additional cases confirmed; two more doctors and a nurse. We are likely to see more in the coming days.
The consequences of an uncontrolled COVID-19 outbreak in northwest Syria are almost too terrible to contemplate, with around 2.3 million of the four million population in the opposition-controlled area displaced from their homes, living in overcrowded temporary shelter and all dependent on aid.
The already appalling conditions were worsened this year due to the final collapse of the Syrian Pound which has lost its value, and the subsequent economic consequences of the global pandemic. In addition, the number of displaced fleeing conflict increased at the end of 2019 by one million people due to an aggressive military push by the Syrian Government which reduced opposition-held territory by a third. A tenuous ceasefire reached by Turkey and Russia in March is holding for now.
The controls that Ireland and countries around the globe have enacted in the past months to stem the spread of COVID-19 are neither practical or possible in the refugee or displaced camp context. Although GOAL staff in Syria have now reached over 800,000 people with information on controlling the spread of the virus, it is unrealistic to expect people who live in such conditions to be able to wash their hands as often as is necessary given the lack of running water, to wear masks or sanitize, and to socially distance while living six or seven to a tent while a similarly full tent is inches on either side.
Even “Stay in Your Tent” messaging is impractical when the vast majority live hand to mouth. Not leaving the tent would mean not securing an evening meal, often the only daily sustenance. Such a day-to-day existence means that the stocking of supplies that allows for cocooning or self-isolation is simply not an option. Even if a family had the means to stockpile, there is no refrigeration, while mid-summer temperatures are hitting forty degrees centigrade.
Within such circumstances, a COVID-19 outbreak would be disastrous. The first four cases have all been medical personnel at two hospitals that have been forced to close as a result. In North West Syria, hospitals are few and far between, while medical personnel are at a premium. Hundreds of hospitals or make-do medical facilities have been deliberately targeted in Idlib during the conflict, and by mid-2019, 900 Syrian medical personnel were reported killed. This despicable death toll has risen in the interim, given that 85 medical facilities in Idlib have been deliberately targeted this year alone.
According to the Union of Medical Care and Relief Organizations, there are 300 ICU beds in Idlib and only a handful of ventilators, already in use. Meanwhile there is only one COVID-19 testing machine. If the medical infrastructure in some of the world’s most advanced countries has been overwhelmed by the pandemic, how could the shattered and threadbare health system in Idlib cope? The answer is it can’t, certainly without a massive intervention by the WHO.
Two of the four positive COVID-19 cases confirmed in Idlib in recent days are a doctor and nurse at Bab al-Hawa Hospital at Bab al-Hawa border crossing, one of two access points for aid between Turkey and North West Syria. While Bab al-Hawa connects Turkey with opposition-held Idlib province, the other cross at Bab al-Salaam allows access between Turkey and opposition-held northern Aleppo province.
For the past week, the United Nations Security Council has been debating shutting down both these border points to humanitarian aid from Turkey into areas controlled by the opposition. Russia and China, permanent members of the Security Council, favoured the closure while the other 13 Security Council members want to keep them open.
On Saturday (July 11th) a last minute compromise was reached in which humanitarian access through Bab al-Hawa will continue, but not through Bab al-Salaam. This will potentially seriously limit the amount of vital food and medical aid that can get through. The position will be clearer in the weeks ahead.
The original United Nations Security Council Resolution (2165) permitted cross-border humanitarian aid at four humanitarian crossing points – the Turkish ones as well as one each from Iraq and Jordan into Syria. Under Russian pressure, the Council removed the Iraq and Jordanian gateways last January (Resolution 2504) and have now further compromised access by removing Bab al-Salaam. The German and Belgian delegates noted that the compromise was based on the logic that one humanitarian access point was better than none.
GOAL uses both Bab al-Hawa and Bab al-Salaam crossing points to deliver humanitarian aid to the 1.1 million displaced Syrians we support in the opposition-held parts of Idlib and northern Aleppo provinces, and will continue to do so.
That GOAL continues to do so is now even more critical, as the humanitarian outlook for those millions is more precarious than ever given the looming threat of COVID-19, the collapse of the economy both locally and globally, and the ongoing Syrian conflict which is now in its tenth year. The world cannot forget this devastated population which more than ever needs our support.