SYRIA IN CONTEXT - CORONAVIRUS UPDATE #8

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In recent weeks, Syria in Context has been making our COVID-19 coverage available as a free supplement in English, as well as in Arabic. Given the lack of independent and reliable coverage of the unfolding crisis, we think this is an urgent necessity.

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Emma, Tobias and Asser


Syria in Context will continue to cover the impact and response to COVID-19 in Syria throughout the coming weeks. You can find previous updates on our website.

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SPOTLIGHT: COVID-19 UPDATE

As of early Tuesday, the Ministry of Health (MoH) in Syria had reported 44 COVID-19 cases - with 27 recoveries and 3 deaths. Two additional cases have been reported in Syria’s northeast which are not recognized by the MoH. It is also unclear whether the MoH numbers include a third case from the northeast which doesn’t appear in their data disaggregated by location. According to local sources, on Tuesday afternoon, an unconfirmed number of Turkish soldiers in northern Aleppo tested positive for COVID-19 and were taken to Turkey for treatment. 

Government-controlled areas: The government’s Ministry of Health reports 44 COVID-19 cases, with 27 recoveries and 3 deaths. Around 2,000 tests had been done in the central lab in Damascus by the end of April. Testing began at Tishreen University Hospital, Latakia, on April 25 - the first of three additional labs currently being created. 3,325 people have been quarantined since February 5, with 771 remaining in quarantine as of May 5. The MoH statement indicates that Syria may have been quarantining possible COVID-19 patients in Syria more than six weeks before their first confirmed case in the country and nearly three weeks before rumours of the virus spreading were circulating in the local and international press, at which time the government of Syria was categorically denying the virus was present in the country. The admission may begin to lay the groundwork for increased transparency from the government, who have obfuscated case details to date.

On Monday, President Bashar al-Assad addressed the COVID-19 taskforce in Damascus, stating that the low official numbers of cases in Syria do not mean the country is out of danger. He also warned that numbers may explode again soon, or later on and that Syrians should not act as if the virus was behind them or disregard its seriousness. In the speech, he stated that restrictions were being lifted due to the economic situation in the country and used the opportunity to reprimand business people and political foes. On Monday, it was announced that Friday prayers will be allowed to commence from Friday 8 May. This follows decisions last week to allow shops and markets, as well as dentists and barbers, to resume operations. Civil records offices and other public-facing public institutions also resumed some operations last week. 

Last week, the first repatriation flight of Syrians from Armenia landed in Damascus, bringing people. A second flight from the UAE arrived on Sunday. The Civil Aviation Authority claims 10,000 others are on lists requesting return. Those returned must quarantine in official centres for 14 days on arrival, meaning the rate of repatriation will be dictated by quarantine centre capacity and will prioritize women, children, the ill, and those whose residency will expire. A flight is scheduled to return from Moscow this weekend. 

Northwest: Northwest Syria had completed 290 tests by May 1. Of these, 25 are still awaiting results while the remainder returned negative for the virus. As of April 27, the north-west is behind the rest of Syria in the implementation of mitigation measures and on preparedness. While it remained the only area without confirmed Syrian cases, on Tuesday afternoon, an unconfirmed number of Turkish soldiers in northern Aleppo reportedly tested positive for COVID-19 and were taken to Turkey for treatment. It is not yet known if they had contact with people in the province or when they were believed to have developed symptoms. A rigorous test and trace campaign will be needed to ensure any potential outbreak is contained. 

The focus in the northwest remains on preparedness, with an emphasis on building capacity within health services themselves and on education and training of key staff members, individuals, and organizations. On Friday, the Syrian Medical Association for Syrian Expatriates (SEMA) opened an isolation centre in Kafr Khareim, in the Idlib countryside. The hospital with its 40 sick and four ICU beds will receive confirmed COVID-19 cases. Idlib had no available ICU beds with ventilators at the beginning of the virus response, and only a handful have been allocated for future cases since. Available facilities remain perilously inadequate and the province would still be unable to manage an outbreak of even a moderate scale.

While there is no curfew in the northwest, movement restrictions across borders and between areas remain in place. Some restrictions on social gatherings and social distancing are also being encouraged by local authorities. However, footage of protests and crowded markets suggests social distancing and stay home orders are not widely enforceable as crowded camps and economic hardship make compliance difficult. That said, the impact of the economic pressures caused by the falling Syrian pound and the COVID-19 mitigation measures, as well as reduction and redirection of aid, is beginning to cause serious issues. The UN reports that three in ten pregnant or lactating women are now acutely malnourished, compared to 1 in 20 in the first half of 2019. 

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Northeast: The northeast has three confirmed COVID-19 cases, one tested in Damascus and two tested and confirmed by the local Autonomous Administration. The Damascus case may or may not be recorded in the official Ministry of Health figures, it remains unclear from the data provided. 80 isolation beds of a planned 580 beds are now available, while no spare ICU beds with ventilators were available as of April 17.

Two new cases in the northeast were announced on April 30 and are believed to be family members of the case reported on April 16, a man who had tested positive and died two weeks ago. The new cases were a woman at Qamishli National Hospital and her husband from Al-Hasakah City. Late last week, restrictions on the Al-Amran neighbourhood of Al-Hasakeh City were implemented in response to the positive tests. The newly confirmed virus cases led local authorities in NES to continue movement and curfew restrictions after they came up for review at the end of last week. All social and public gatherings and events continue to be banned, including religious events. 

Despite the Coronavirus.affected family living in government-controlled areas of the northeast, testing was carried out among the surrounding population using the AANES’s newly acquired PCR machines. As of April 24, in the region, 50 samples had been transferred from NES to Damascus for testing and 18 tests were done on the local PCR machines from an unknown number of samples, while 26 had been transferred to Idlib for testing by April 21. During the last week, the Syrian government condemned the AANES for preventing the testing of some potential NES cases, with the local authorities in NES having previously outlined diagnostic criteria for testing that prioritized those who had travelled to Damascus. The establishment of Rapid Response Teams (RRTs) from the local authorities in the northeast may help to overcome the testing gaps and disputes after RRTs overseen by Damascus had faced extensive restrictions on their movement and security permissions which are inhibiting their ability to test and to contact trace and feedback on test outcomes. 

Actors in NES report that information about tests carried out in Damascus is still not being reported back in a systematic manner that aligns with good case management practices. Indeed, the April 16 case was reported to NES actors by WHO regional offices and not through the weekly Damascus-NES coordination meetings. Coordination between Damascus and NES is also impacting the delivery of goods, with the recent shipment of 20 tonnes of aid being dispatched to medical centres across the north-east without close coordination. At the end of last week, local NES sources advised residents north of Raqqa not to use food aid assistance given by Russia as the goods were out of date.

Neighbouring countries: Turkey is the worst affected of Syria’s neighbours with 127,659 cases, 3,461 deaths, and 68,166 recoveries (Turkey only records those who test positive, not those who present with clinical symptoms conducive to COVID-19.) Turkey is home to around 3.5 million Syrian refugees who live across the country in a range of circumstances and are subject to the same measures as their host communities. Almost half of Syrians in the country depend on aid deliveries via the Red Crescent each month while as of March 16, most NGO’s working among refugees had temporarily stopped working. 

Last week, the Istanbul Mayor said the city’s death rate was 30-35% higher than the same time last year, suggesting there are fairly high numbers of un-tested cases as well as second-order effects of the pandemics leading to excess deaths. Other countries with significant COVID-19 outbreaks have reported similar phenomena. In fact, Turkey does have a comparatively low death-rate, which doctors credit their treatment protocol. According to Dr. Sema Turan, a member of the Turkish government's coronavirus advisory board, all positive cases are given the controversial anti-malarial-drug hydroxychloroquine and a second antiviral drug to those with breathing difficulties. They have not been conducting clinical trials but believe this to be the reason for their seemingly low levels of ICU occupancy and death considering the high caseload. Three specialist COVID-19 hospitals have been built in Istanbul with 2,100 beds for virus patients.

Containment measures will remain in place in Turkey for at least another month. Currently, under 25-year-olds and over 65-year-olds are under week curfew during the week, with everyone under weekend curfew. Restrictions on travel between provinces have been in place since late March. These restrictions include the closing of the Turkish-Syrian border which in the past has been opened during Ramadan and Eid whereas today, even urgent medical cases from Syria require additional permissions in order to cross. 

Lebanon has begun a phased lifting of severe COVID-19 mitigation measures, having recorded only 741 cases, 25 deaths, and 206 people who have recovered to date. The impact of lockdown measures has been severe on all residents who also have to cope with a collapsing economic and social order. As of last week, protests against authorities and banks have ramped up again and will likely continue. The impact on refugees in the country has also been severe, with measures depriving them of economic opportunities and the spiralling cost of goods making it hard to meet basic needs. 

Iraq, too, has kept its early COVID-19 outbreak under control, counting 2,346 cases, with 1,544 recoveries and 98 deaths to date. Jordan has just 465 cases, with 9 deaths and 370 recoveries. In the last week, Jordan reported that a driver at the Nassib crossing to Syria had come down with the Coronavirus.  

Key Reads:


Syria in Context will continue to cover the impact and response to COVID-19 in Syria throughout the coming weeks. You can find previous updates on our website.

We are a wholly subscriber-funded publication. If you have found this update useful, we encourage you to consider joining our growing community:

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SYRIA IN CONTEXT is a subscription newsletter edited by Emma Beals and Tobias Schneider and written with Asser Khattab. You can follow us on twitter @SyriaInContext or email us at SyriaInContext@gmail.com .

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