Northern Syria’s most severe COVID-19 outbreak overwhelms health system

MSF is scaling up operations to meet the needs

A patient receives care in the COVID-19 ward of Raqqa National Hospital, in Northeastern Syria, in June 2021. MSF has now moved it's COVID-19 program from Raqqa National Hospital to the Raqqa COVID-19 centre.
Syria 2021 © Florent Vergnes
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NORTHERN SYRIA/NEW YORK, OCTOBER 13, 2021—Northern Syria is experiencing its most severe wave of COVID-19 as the needs rapidly outpace already limited oxygen supplies and health facilities begin to run out of testing kits, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) said today. Support and protection for health care workers, provision of testing kits and oxygen, increased bed capacity in hospitals, and the expansion of vaccination coverage are urgently needed to prevent health care facilities in northwestern and northeastern Syria from totally collapsing under the weight of this new outbreak.

“We are directly witnessing the extent of this outbreak in the facilities we manage and support,” said Francisco Otero y Villar, MSF’s head of mission for Syria. “People in desperate need of oxygen or intensive care are stuck in queues because no beds or ventilators are available. [This] is leading to a higher mortality rate compared with previous [COVID-19] waves.”

In northwestern Syria, the number of confirmed cases of COVID-19 almost doubled in September, reaching nearly 73,000 cases compared to 39,000 recorded by the end of August. “The peak reached in this wave so far has been as high as 1,500 cases per day, while [previous waves] never exceeded 600 cases per day,” said Villar. “In Afrin [in Aleppo governorate in northwestern Syria], 44 percent of the patients currently admitted to a center supported by MSF are between 16 and 40 years old, indicating that even people who were previously thought to be relatively safe from severe illness caused by the virus are being seriously impacted.”

Only 16 out of 33 COVID-19 treatment centers are currently functioning in the northwest, a region home to about four million people. Severely limited health infrastructure as well as supply issues resulting in inadequate COVID-19 testing and screening make it impossible to assess the real extent of the spread of the virus and implement an adequate response. Efforts to contain the virus are hindered by poor access to health care and low COVID-19 vaccination rates—only 3 percent of the total population is fully vaccinated due in part to people’s hesitancy to get vaccinated and a slow vaccine rollout.

MSF is scaling up its operations based on the increasing needs. In August, MSF reopened two COVID-19 isolation centers in Idlib governorate, and we are now in the process of expanding their capacity. We also renewed our support to two community treatment centers in Afrin and Al-Bab, and we continue to support a treatment center for respiratory illnesses in Afrin. In displacement camps—where more than 13 percent of people with confirmed COVID-19 live—MSF runs mobile clinics to conduct COVID-19 testing and distribute prevention kits for displaced people.

MSF has also witnessed a worrying increase of COVID-19 cases in northeastern Syria over the last few weeks. In the last week of September, an average of 342 people tested positive each day—the highest daily number since the pandemic began. The number of cases started to decrease in the first week of October, but the only laboratory able to perform PCR tests to diagnose COVID-19 in the region is running low on materials and faces the possibility of having to stop testing in the coming weeks if numbers do not continue to decline. Oxygen supply is also under serious strain, with the COVID-19 treatment facility in Hassakeh forced to source oxygen cylinders from Qamishli, Raqqa, and Tabqa cities to meet the needs.

“In response to this new COVID-19 wave, MSF is partnering with a local organization to care for people with suspected or confirmed COVID-19 in treatment centers in Hassakeh and Raqqa city,” said Hanna Majanen, MSF emergency medical manager for Syria. “But our ability to source oxygen is stretched, and we are worried that if the number of positive cases increases again or stays steady at such high rates, we will be unable to meet the [needs of] all patients."

Even prior to the pandemic, the health system in northern Syria was struggling to respond to basic medical needs and relied on humanitarian aid. Now health care facilities and humanitarian actors are unable to cope with the new wave of COVID-19. Urgent assistance is needed in order to adequately respond to this new COVID-19 outbreak and reduce its impact on the people living in northern Syria.