COVID-19 in Syria: The disaster waiting to happen

Translator: 

As Assad’s health minister smirks about the army “cleansing Syria of bacteria,” doctors in Damascus, Aleppo, and Idlib tell Al-Jumhuriya they are woefully ill-prepared to deal with a Coronavirus outbreak.

On Monday, the World Health Organization’s emergency director for the Middle East, Dr. Rick Brennan, declared the organization would begin testing for COVID-19, also known as Coronavirus, in opposition-held northwestern Syria later this week.

At least half of the medical facilities in Idlib Province have been bombed out of service in recent months by Assad regime and Russian aircraft. At the time of writing, none of the remaining hospitals has been provided with the equipment needed to detect the deadly new virus. By contrast, areas controlled by the regime were given these materials by the WHO some two weeks ago, though Damascus continues to claim there are no confirmed cases in the country thus far—a fact attributed by Health Minister Nizar Yaziji to the army “cleans[ing] a lot of the bacteria present on Syria’s territory.”

A doctor in opposition-held Idlib, meanwhile, who preferred not to be named, told Al-Jumhuriya there had been “several cases of lung infections in Idlib Governorate, some of them resulting in deaths, including most recently of a nine-year-old boy last week. However, the inability to conduct the required analyses made it impossible to confirm whether these were Coronavirus cases or not.” The source added that insufficient preparations for the virus have been made, and that the capabilities of the health sector in northern Syria have hugely declined as a result of its direct bombardment throughout the recent military campaign, as well as the immense volume of civilian displacement.

“The medical sector in northwest Syria is already facing grave challenges due to the military escalation, so to prepare to confront the Coronavirus, and the COVID-19 disease that arises from it, requires boosting the capabilities of staff already working under great pressure, as well as the capacities of hospital wards to receive cases of this kind,” says Dr. Bashir Taj al-Din, programs director at the Syrian American Medical Society (SAMS) office in Turkey.

Instead, there is a shortage of even basic medical supplies in Idlib Governorate and the northwest generally. As Taj al-Din tells Al-Jumhuriya, “There is a lack of protective equipment for health workers and hospital staff. Without this equipment, doctors and nurses may be in great danger. We also need an expansion of infrastructure in order to face the prospect of Coronavirus in northern Syria. Add to this the current inability to conduct lab diagnoses, which may delay timely interventions, meaning the only course of action currently available is to raise people’s awareness of preventative measures to reduce the likelihood of infection.”

On Sunday, the Idlib Health Directorate, operating in areas of Idlib Province outside regime control, announced it had equipped a dedicated laboratory for Coronavirus detection. It added that staff had completed training on detection, and that the lab would commence operations as soon as the needed materials arrived from the WHO. Until such time, it is not possible to confirm the existence of any cases in Idlib or western Aleppo Province.

As for regime-controlled territory, the cabinet has taken measures including suspending schools and universities, closing cafés, and limiting gatherings, including prayers in mosques, after a fatwa and statement from the Ministry of Religious Endowments. Despite these steps, and the news that six people in Pakistan who had traveled from Syria via Qatar tested positive for Coronavirus, the Assad regime has announced no confirmed cases so far.

From Damascus, a doctor who declined to be named told Al-Jumhuriya, “We as doctors have not seen an abnormal increase in pneumonia rates in large hospitals, and one of the most common symptoms of COVID-19 is pneumonia. On the other hand, the large decline in the number of doctors and in the health sector’s general capabilities may also be a reason no cases have yet been discovered.”

The doctor is concerned about the safety of medical staff, due to the lack of serious protection measures.

“The first thing that comes to mind is the very weak capabilities of our government facilities. With no significant ability to sterilize or perform isolation procedures according to the proper standards, there could be an outbreak of the disease if cases start arriving to the hospitals. Two hospitals in Damascus, al-Mujtahid and al-Mouwasat, have been designated to receive suspected cases. This is in theory; in practice no real preparations have been made.”

Other than that, things are relatively normal in the capital, according to the doctor, who added that the measures talked about in the media “are just window dressing; none of the serious standard procedures to confront a possible virus outbreak have been followed.”

In Aleppo, a medical source at the city’s largest hospital, the University Hospital, told Al-Jumhuriya there had been no noticeable increase in pulmonary infections in the city, suggesting the absence of a pandemic thus far. Despite several suspected cases, none had yet been confirmed. Nor do the city’s residents appear concerned about rumors of cases among Iranian and Iraqi militiamen in the area, as the latter are largely invisible in everyday life, their presence being concentrated in the surrounding countryside, most of which has been emptied of its population.

As for the northeast region, controlled by the Kurdish-led Syrian Democratic Forces, the de facto autonomous administration has taken several measures, including closing schools and border crossings, which now only admit entry to local residents, in an attempt to prevent the virus reaching the area by limiting interaction with the outside world.

That the Coronavirus has reached Syria certainly cannot be ruled out. As the doctor in Damascus said, it may well be that the substantial decline in the country’s health sector has kept it from being detected. An additional factor is the reckless irresponsibility displayed by the Assad regime’s cabinet vis-à-vis the necessity of taking serious measures and testing on a wide scale. It beggars belief that Syria, alone among all its neighbors, should be completely free of any Coronavirus cases, even if the available indicators suggest the situation has not reached epidemic levels yet.

The regime’s careless attitude was perhaps best expressed in the aforementioned remark by its health minister, Nizar Yaziji, who gave it to state TV last Tuesday when asked for comment on the Coronavirus situation. The full quote was, “God be praised, the Syrian Arab Army has cleansed a lot of the bacteria present on Syria’s territory.” Yaziji then thanked the army for this, and described the health sector as a “health army” in its turn. In other words, the health minister turned a legitimate question about a deadly global pandemic into an opportunity to repeat one of the most fascistic turns of phrase about the Syrian regime’s opponents, who were in fact previously compared to bacteria by the head of the same regime in the initial months of the revolution.

It remains very possible that a major catastrophe could occur in the event of an epidemic in Syria, to levels beyond the capabilities of any health sector in any part of the country to deal with. The war waged by the regime on so much of the country has destroyed a great portion of the health infrastructure, and displaced huge numbers of medical personnel, while neglect and severe funding shortfalls have brought about a terrible decline in the provision of medical services.