COVID-19 outbreak in northwestern Syria threatens displaced people and health workers  

An MSF nurse talks with a young boy, who brought one of his relatives to MSF's mobile clinic for a consultation at a camp for displaced people in Northwest Syria.
Syria 2020 © Omar Haj Kadour/MSF
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Since the first case of COVID-19 was confirmed in northwestern Syria on July 9, an additional 18 people have tested positive in the area—more than half of whom are health care workers from the few remaining functional hospitals. Doctors Without Borders/Médecins Sans Frontières (MSF) is concerned that the outbreak threatens to overwhelm a regional health system that is barely functioning after more than nine years of war.

“The fact that the first confirmed COVID-19 cases come from the medical community is worrying,” said Cristian Reynders, field coordinator for MSF in northwestern Syria. “Just a few doctors temporarily put out of work and staying in isolation can make a huge difference when it comes to the access to health [care]. Prior to the outbreak, human resources were [already] very limited in the health sector: Many doctors have fled the war in Syria, and hospitals often have to share medical personnel to remain open and function.”

Two hospitals temporarily closed their doors after medics who had visited the hospitals tested positive for COVID-19. All medical personnel were asked to either self-isolate at home or to stay in quarantine, the hospitals said.

However, services were already reduced in some other hospitals in northwestern Syria. At the beginning of the outbreak, local health authorities asked hospitals to temporarily suspend all services in outpatient departments (OPDs) and non-essential surgeries. “There have been occasions when some OPDs have already been closed for weeks in response to alerts or fears about COVID-19,” said Reynders. “Of course it is important to take precautionary measures, but this is a region that does not have the luxury of extra medical capacity to take [on] the burden of such measures. The fact that essential services have been temporarily closed or reduced and that we are facing even more human resources shortages than before the pandemic is extremely worrying.”

The infected medics were working in several health facilities in Azaz district, in Aleppo governorate, and Sarmada and Ad-Dana districts, in Idlib governorate, so it is likely that the virus may have spread from what was thought to be a localized cluster of cases to a much larger area.

Doctors following the positive cases say testing and contact tracing is underway to attempt to isolate and prevent further spread of the virus. This is particularly important in northwestern Syria, where at least 2.7 million people are displaced, most of whom are living in overcrowded camps or makeshift shelters. Water and sanitation conditions here are dire, and physical distancing is impossible.

“There is a real issue of testing capacity in northwestern Syria,” said Reynders. “Very few tests [are] available, and the accelerated testing [because of] these confirmed cases is fast depleting the available test kits. If these run out, there is a chance of fast spread in the camps that will be impossible to track and halt. And [this] poses alarming consequences for the most vulnerable people—the elderly and people with [chronic] diseases—who must be prioritized for the distribution of hygiene kits and other measures to protect them against the virus.”