In rebel-held northwest Syria, where a year of sustained attacks on hospitals has crippled the health care infrastructure, doctors warn that a looming coronavirus outbreak would be devastating to the large numbers of Syrians living in makeshift homes and squalid, overcrowded camps along the Turkish border.
Although no cases of COVID-19 have been reported in the country, health care workers reached by Al-Monitor on WhatsApp are gearing up for what they say is a likely catastrophe in war-torn Idlib province, the last swath of the country still in the hands of the opposition after nine years of war.
“I’m scared,” said Dr. Wassim Zakaria, 36, an internal medicine specialist who works in Idlib city. “Our inability to provide is the most difficult type of torture.”
Zakaria, who has diabetes, worries he and other health care workers could be among the disease’s first victims. Hospitals in Idlib, already overwhelmed and under-resourced, face a critical shortage of personal protective equipment — including masks, gowns and gloves — that could leave doctors like himself exposed to the virus.
“I am afraid that I will be infected and my three children will lose me,” Zakaria said.
The Idlib Health Directorate, the de facto health care authority in the region, says preparations are underway with the World Health Organization and local nongovernmental organizations to designate a total of 60 beds in three hospitals in the cities of Salqin, al-Bab and Darat Izza for coronavirus patients in need of advanced care.
Within the month, authorities plan to convert schools and other facilities into 28 community-based isolation centers for patients whose coronavirus symptoms are less severe, said Dr. Abdul Hakim Ramadan, public health coordinator at the Idlib Health Directorate.
The Syrian government insists that regime-held areas are virus free. But health officials in Pakistan have said that at least eight of their own cases were linked to patients traveling from Syria.
The thousands of regime-allied fighters sent to Syria from Iran — the epicenter of the coronavirus outbreak in the region — also increase the likelihood of transmission in the country.
The current process for testing suspected cases in northwest Syria involves sending samples to two state-run labs in Turkey. According to WHO spokesperson Hendinn Halldorsson, the first three samples collected in Syria’s northwest and analyzed in Turkey turned out to be negative.
Meanwhile, local health authorities in Idlib are preparing to conduct their own testing. Some 300 tests are on their way from Turkey and will be followed by bigger shipments, Halldorsson told Al-Monitor in an email. A lab in Idlib city will serve as the main testing site once they arrive.
Further complicating things, should the coronavirus reach northwest Syria, is a shortage of intensive care units. Across the 299 functioning health facilities in Idlib and Aleppo provinces, there are just 153 ventilators and 148 intensive care unit beds, according to WHO.
Zaher Sahloul, president of MedGlobal, a Chicago-based medical nonprofit providing emergency medical care worldwide, worries that won’t be enough to meet the demand. He points to the nightmarish scenario unfolding in Italy, where doctors are making wartime-like triage decisions about who will receive care.
“We’re talking about developed countries with large numbers of hospitals, intensive care units and ventilators,” said Sahloul. "So imagine the situation in northwest Idlib, where 67 hospitals were bombed in the last few months by the Russians and Syrian regime.”
Over the course of the nearly decade-long conflict, both the Syrian government and Russian warplanes have systematically bombed hospitals in what experts say is an attempt to render entire areas unlivable by depriving the population of basic health care.
This latest military campaign in Idlib is no different. Since April 2019, when the government began its offensive, there have been 95 direct attacks on medical facilities in the northwest, according to the Syrian American Medical Society, a nonprofit organization that supports health care workers in Syria.
“The spread of coronavirus in Syria would be devastating due to its weakened health systems and inadequate numbers of medical personnel due to years of war,” said Dr. Mohammad Isa, a Gaziantep, Turkey-based member of the COVID-19 response team at the medical society.
Since December, nearly a million civilians — a majority of them women and children — have fled the Russian-backed bombing campaign on Idlib province. Many have ended up in displacement camps and makeshift shelters along the locked Turkish border, where doctors say overcrowding and lack of running water will make safe hygiene practices and social distancing difficult to enforce in the event of a coronavirus outbreak.
“The close proximity of families in camps, poor hygiene and sanitation conditions will cause the coronavirus to spread quickly,” said Isa. “We’re talking about five to 10 living people in one tent.”
Health authorities and organizations including the White Helmets rescue workers have begun disinfecting surfaces in schools, hospitals and other public places. An awareness campaign is also underway to distribute brochures and posters advertising safe hygiene practices and other prevention measures.
But for many Syrians in Idlib, there’s a certain amount of indifference. They’ve already endured a seemingly endless cycle of starvation, displacement and violence — the coronavirus is just the latest hazard.
Erwa al-Abdullah and his family are crammed into a dark, cold basement in the Syrian border town of Harem, which they rented after fleeing the village of Jabala in southern Idlib last month. As Abdullah explained over WhatsApp, COVID-19 is nothing to get worked up about: In his view, he’s more likely to die from one of the regime’s barrel bombs than he is from the novel virus.
“I am not afraid of death as much as I am afraid of living,” he said.