SYRIA IN CONTEXT - CORONAVIRUS UPDATE #18
Dear friends and colleagues,
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 (with kind support from the Heinrich Böll Stiftung Middle East). Given the lack of independent and reliable coverage of the unfolding crisis, we think this is an urgent necessity.
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Thank you,
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.
We are a wholly subscriber-funded publication. If you have found this update useful, we encourage you to consider joining our growing community by subscribing.
WEEKLY COVID-19 UPDATE
COVID-19 cases are on the rise in all areas of Syria, especially in government-held governorates. Last week, Syria in Context reported that the government’s figures vastly understate the scale of the outbreak and estimated that there are likely at least 85,000 cases in Damascus alone. Official figures continue to lag far behind reality–– with 1,445 confirmed COVID-19 cases in Syria as of August 10. Of these, 1,255 were recorded in government-controlled areas, including 52 deaths and 364 recoveries, while 839 cases remain active. The northwest has conducted 4,087 Coronavirus tests, 46 of which have returned positive. In northeast Syria there are 144 cases so far, representing rapid spread in the region (here too it is believed that the true caseload outpaces official figures).
Meanwhile, news of a novel Russian vaccine has spread quickly among local Syrians desperate for relief from the crisis. However, thus far, the Russian vaccine had been tested on fewer than 100 people by the start of August with no evidence of appropriate trials having been conducted according to the Association of Clinical Trials Organizations in Russia.
Government-Controlled: Despite the real caseload estimated to be at least 85,000 cases as of early August, the Ministry of Health continues to release its own figures which are then repeated by the WHO. Almost 400 cases were registered in government-held areas of Syria last week. According to the Ministry of Health, there are 1,327 registered cases, of which 53 people died and 364 recovered; that leaves 839 cases active. Registered confirmed cases have recently increased from 19-23 cases every other day, to 50-70 cases per day without any acknowledged increase in testing capacity, suggesting that even with the limited government testing program, a greater proportion of tests are returning positive. 67 cases were registered on Monday across ten governorates, followed by another 72 on Tuesdays.
Despite the apparent rapid spread of the virus, the government and international response remain inadequate. During April and May, the UN’s COVID-19 response inside Syria built just four of 14 planned labs, reaching just 9% of their testing target. Just 0.1% of the planned PPE for humanitarian workers, including health workers, was distributed during this period. More recent figures are not available. There is a significant lack of PPE among medical personnel, as Syria in Context reported last week. Indeed, front-line medical workers and key civil servants have been heavily affected. Last week, doctors reported that 30 of their colleagues had died from COVID-19. Syria can ill afford a further loss of professionals in the medical sector, which had already suffered heavily throughout the war, which killed or displaced half of all doctors across the country.
Health facilities are accordingly overwhelmed with cases. In a voice note circulating via WhatsApp, an Aleppo doctor at a local hospital describes “people are lying on the floor, others are running around, everyone’s face is yellow; they drop on the floor and then are carried away hastily … the country is fucked.” Syrian actor Ahmad Rafiyee recounted to a local media outlet details of his visit to Al-Assad University Hospital when he suspected he had contracted COVID-19: “I saw dozens of people before me; all of them sick. There were people lying on the floor… Do you know how many death cases I witnessed in one day? 60!” He went on to describe how the hospitals are overwhelmed and they have no oxygen for those who need it. “There are no injections, no pills, no medicine, nothing to relieve the patient from this illness!” One Syrian tweeted that a physician friend of hers in Damascus saw “400 patients who all were infected with Corona” in 48 hours. “The situation is explosive, tragic, and horrifying, and no one can do anything.”
Last month, the Syrian government authorized several medical centers to carry out PCR tests and provide negative-result certificates to those who are wishing to leave the country at a cost of $100. In the past week, photos circulated online showing dozens of people queuing inside and outside those centers with no social distancing enforced. Locals quipped that the tests come with a “free case of Covid”. A new rule mandating masks on public transport and limiting the number of passengers was not widely obeyed, according to multiple images online showing overcrowded buses with limited mask usage. The government says that masks are affordable, costing only 100 SYP, which is belied by local reports of face covers selling for 1,000-2,000 SYP – a considerable sum in a country mired in economic crisis.
In the absence of state capacity and transparent communication, public skepticism and discontent towards the government has grown, while locals and local authorities have taken measures into their own hands, organizing their own response measures and even burials. Indeed, as cases spread beyond Damascus and its countryside during the past few weeks, other governorates and communities instated their own measures. 54 cases have been recorded in Sweida so far by the Ministry of Health; six of them died. The city of Basra Al-Sham has been doing its own fundraiser to support its hospital and, as of Saturday, August 8, it collected around 50 million SYP. The local committee in charge of the fundraiser has been publicly crediting those who donate and mentioning the amount of money they have provided. In Aleppo, the governorate allowed the burial of the dead during the night, which is uncommon in Syria and frowned upon by many Muslims. Latakia’s governor made wearing a facemask compulsory in all public establishments and ordered those establishments to set up reception stations at the doors to deal with citizens who do not have a mask.
Northwest: The NW now has 47 cases, and 32 recoveries. While total case numbers remain comparatively low, the nature of the crisis has dramatically transformed over the past two weeks as the COVID-19 outbreak in the region expanded from specific, traceable clusters attributable to a single patient-zero to community spread of unclear origin. Additionally, on Monday, two cases were reported in the Bab al-Salam IDP camps in northern Aleppo, home to the region’s most vulnerable civilian populations.
At the same time, Syria in Context has learned that the UN's preparedness response in the northwest is lagging behind its aims. The plan sets out the need for three testing labs, of which only one is currently available. Just eight of 30 planned community care centres, where cases would be treated to ensure they do not infect those they live within high-density IDP camps, are ready. Just five out of nine hospitals are ready, as are only 115 of 188 ICU beds. Total Covid-19 hospital beds available are 300, with 19 occupied to date. There are only 86 of 159 planned ventilators available, and as of the latest update to the UN's data, there are presently no additional ventilators in stock or in the procurement pipeline. Similarly, just 5,300 of the 12,000 testing kits needed for a six-month response have been distributed to the area with none in the pipeline. Only 100 of the required 1260 infection prevention kits have been received, with 400 more in the pipeline for delivery––the 1,260 kits are said to be 6 months supply, suggesting that fewer than two weeks’ worth of supplies were distributed with two months total available. A similar gap exists between the planned numbers of other critical PPE equipment––N95 and surgical masks, gowns, and goggles––needed for the plan, with tiny percentages of the required supplies having been distributed in the region and roughly 50% of needs for six months anywhere in the pipeline for most items. These figures suggest that the region could be quickly overwhelmed and that the WHO is struggling to procure and distribute critical supplies within the north-west. Notably, the logistics data has not been updated since July 17, a week after the first case reached Idlib.
Worryingly, contact testing in the region is also failing to keep up with the case contacts as they are announced. As of August 10, just 358 of the 618 contacts linked to known cases had been tested for the virus, despite 4,087 tests having been undertaken in total by August 11. Luckily, there are no serious cases yet reported, nor any deaths. Preventative measures have been implemented at Bab al-Salam IDP camp near Azaz after two cases were discovered there on Sunday. The camps are next to the crossing that was removed from the UNSC cross-border resolution last month, meaning it cannot be easily accessed with UN aid to fight the virus. Residents of the camp are told to quarantine at home for 14 days if they have symptoms, though this is difficult given the crowded living conditions.
Northeast: More than 100 COVID-19 cases were registered in northeastern Syria during the past week, with up to 20 new cases, including three medical staff in Qamishli, announced every day since August 5. The de-facto autonomous region, which was Corona-free for more than two months, now has 144 cases and seven dead.
Of particular concern were two reported outbreaks in IDP camps this week. Over the last week, two aid organizations have raised the alarm about 10 new corona cases, and two deaths, among the IDPs from Afrin who are sheltering in Al-Shahba city. The area is located in Aleppo and can only be reached from government-controlled Aleppo city. The Kurdish Red Crescent is providing some help on the ground and counts the cases among its total response numbers. According to the organization, the area lacks the healthcare capacity and supplies to tackle a large outbreak. Additionally, the first virus cases were reported in Al Hol camp, where women and children believed to have links to ISIS, or who were living within ISIS final strongholds, are housed. Last Thursday, the UN confirmed that three aid workers were reported to have tested positive in the camp before a case among the camp residents was confirmed on Monday by an INGO. Both areas are likely to see cases swell rapidly, due to the overcrowded conditions and poor sanitation in the camps.
In some rare good news, it was announced that new testing machines and testing kits reached NES during the last week––enough for 25,000 tests. NES has been critically short of tests and has suffered from difficulty coordinating testing after their aid response was upended in January. However, challenges remain and more aid is needed.
Neighbouring countries: In Turkey, 241,997 cases have been recorded, leading to 5,858 deaths and 224,970 recoveries. Turkey's official Covid-19 caseload continues to climb, with 1,193 new cases on August 10.
Despite denials from the Minister of Health last week, the outbreaks in multiple regions appear to be outpacing official figures. Additionally, the outbreaks in Ankara and the Syrian-Turkish-border areas of Gaziantep, Urfa and Diyarbakir - all heavily affected - were all confirmed by official figures to be facing significant growth in cases. Diyarbakır Medical Chamber President Dr. Elif Turan told DW that as of around August 1: "Our friends in the field give us different information. There are 300 new cases a day in Diyarbakır. Our friends in Urfa talk about 300-350 new cases daily. Only in Diyarbakır and Urfa.” He also said hospital space was limited. At the time, there were 265 cases in the two regions combined reported in official numbers. Mr Turan's claims were echoed by others.
On August 6, the Turkish minister of Health issued a statement saying: “Contrary to false allegations, not a single city is overflowing with patients or a hospital full to capacity due to COVID-19 in Turkey. Please give credence only to official statements by the Ministry of Health.” In a rare move, many Turks braved possible repercussions for public criticism via social media and responded angrily to his tweet. In Urfa and Ankara, photos of long lines for testing emerged online. In Gaziantep, locals protested that tests were not available at all due to demand and even phone lines set up to answer questions were overwhelmed. In Konya, dozens of people took to social media to complain that their loved ones had been turned away from hospitals, a fact that was echoed by doctors.
Turkey previously took control of the virus but economic concerns make a second lockdown period unlikely. The country has relatively high testing rates, recording daily 62,219 tests on August 10. With a previously relatively effective response now falling behind the outbreak, Turkey could be entering a dangerous phase of the epidemic, particularly in light of official denials.
Lebanon has recorded 7,121 COVID-19 cases, with 87 deaths and 2,377 recoveries. On Tuesday alone, the Ministry of Health announced registering 309 new cases and seven deaths. In Iran, 331,189 cases of COVID-19 have been recorded, with 18,800 deaths and 288,620 recoveries. Iraq has 153,599 cases, of whom 5,464 died and 109,790 recovered. In Jordan, there have been 1,268 cases of COVID-19, with eleven deaths and 1,187 recoveries.
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:
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 @SyriaContext or email us.
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