In Damascus, protective medical equipment is so hard to find that healthcare workers like Zeinab have for weeks been using local tailors to stitch crude face masks.
“The doctors are now the same as the public,” she said by phone from the Syrian capital. “We don’t have anything more than any other citizen.”
In opposition-controlled Idlib city, 300km to the north, Dr Mohamad Abrash said he has watched in dismay as people have continued to roam the streets, enjoying the calm of a shaky ceasefire despite the creeping threat of coronavirus.
“We don’t have enough medical [or] ICU [intensive care] doctors,” said the battle-hardened general surgeon who usually patches up bodies torn apart by shrapnel.
As medics on different sides of Syria’s front lines, Dr Abash, 58, and Zeinab, 50 — who asked that her real name not be used — have both survived nearly a decade of civil war but now face a new kind of enemy.
So far there has been only 19 confirmed cases of coronavirus in Syria and two deaths. But with testing virtually non-existent, many suspect it is already far more widespread.
“Judging from other places, that is the tip of the iceberg,” Mark Lowcock, the UN’s emergency relief co-ordinator, told the UN Security Council at the end of March.
Damascenes have for weeks muttered about a spate of pneumonia. In the restive southern province of Suwayda, local journalists have reported of pneumonia patients strangely buried and funeral rites conducted inside ambulances.
Last month 39 aid organisations asked the WHO for more support, questioning the transparency of the government’s reporting on the extent of coronavirus in Syria and warning of potentially “horrific repercussions” for the population.
Around the world, the pandemic risks pushing even the most sophisticated healthcare systems to the brink of collapse. In Syria, the health system is already in pieces.
Throughout the war, medics have been relentlessly targeted. US-based Physicians for Human Rights has documented 923 medical personnel killed since 2011, and the WHO says up to 70 per cent of medical staff have left the country.
After 600 attacks on health facilities since the conflict began only half of Syria’s public hospitals and health centers are fully functional, according to WHO data. A study by the London School of Economics says there are just 325 intensive-care unit beds to serve a population of around 17m.
The country is also divided, in effect, into four administrative zones. President Bashar al-Assad’s government runs central, south and coastal areas. The north-eastern provinces are managed by a western-backed, Kurdish-led administration, which is not fighting Damascus but wants autonomy. What is left of Syria’s opposition governs north-western Idlib province, now dominated by jihadi factions. And neighbouring Turkey has taken over a swath of Syrian land along its frontier.
Syria’s international borders have officially been shut and its cities locked down, but the common threat of coronavirus has not fostered any greater co-operation between the regions, according to the LSE study.
Damascus did not stop flights to and from badly hit Iran until the beginning of March but it did put some Syrian passengers into a makeshift quarantine centre on arrival.
One passenger who was quarantined after returning from Iran said the facility was unhygienic and that he was detained against his will. “The toilets need a toilet,” he said, adding that he was not tested for Covid-19 despite asking to be screened.
The availability of tests has now improved in Damascus, where the WHO say they have provided testing kits to laboratories, batches of personal protective equipment, respiratory machines and additional intensive care beds.
In the north-western region of the country, which includes Idlib province, only 20 tests have been analysed so far: 18 were negative and two sets of results are still pending, according to the WHO.
The UN has said it is working to support health providers across the country. Munzer Khalil, director of Idlib’s health directorate, this week attacked the UN’s commitment as “still mere words on paper”.
In the north-eastern city of Raqqa a laboratory technician who asked not to be identified said testing kits arrived only last week. Before the outbreak, Syrian laboratories had collaborated across territorial divides but, with the porous borders between the regions now sealed, co-operation had stopped, the technician said.
The slow rate of testing has alarmed international aid agencies, who warn that northern Syria’s town-sized camps crammed with displaced people could become breeding grounds for the virus. The International Rescue Committee has warned that in the sprawling al-Hol camp, home to 68,000 people, the virus could spread even faster than it did on the Diamond Princess cruise ship, where more than 700 of the 3,711 passengers on board in February contracted Covid-19.
The lack of resources has left Syrian doctors who are more accustomed to treating battlefield injuries than respiratory diseases facing difficult choices.
“I am not afraid for myself,” said Dr Aisha Idris, a gynaecologist in Turkish-controlled Afrin city, “we have always been besieged, bombed.” But she was frightened of exposing her three young children to Covid-19 or of being forced into quarantine away from them. “I am afraid I will be deprived of their hugs if I get the virus,” she said.
Despite the risks, many of the frontline medical staff interviewed across Syria said they felt compelled to continue their work. In Idlib, Dr Abrash said he would adapt his skills to new roles to fight the virus. Surgeons like him “will do disinfection, we will do triage”, he said. “We can help.”
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