War prepared Syria to deal with epidemic outbreaks

Challenges remain, not least a Syrian regime with a record of using medical goods as negotiating tools.
Sunday 29/03/2020
A member of the Syrian “White Helmets” disinfects a tent in the Kafr Lusin camp for the displaced by the border with Turkey, in Syria’s province of Idlib, as part of efforts to prevent the spread of coronavirus, March 24. (AFP)
Trying to cope. A member of the Syrian “White Helmets” disinfects a tent in the Kafr Lusin camp for the displaced by the border with Turkey, in Syria’s province of Idlib, as part of efforts to prevent the spread of coronavirus, March 24. (AFP)

Syria’s medical facilities and infrastructure lie in tatters after nine years of brutal conflict and its once-admired pharmaceutical industry, centred on Aleppo and Damascus, remains largely in ruins. However, Syria may be better prepared for a coronavirus outbreak than many might expect.

Because of the multi-year, countrywide emergency health responses during the war, Syria may be better prepared than many other countries for what’s coming. Years of displacement and endless rounds of localised disease outbreaks turned Syria’s hodgepodge of medical services and the NGOs that operate there into emergency health experts.

Over the years, the World Health Organisation (WHO) acquired vast expertise in detecting and treating viral and other outbreaks in Syria. To deal with poor sanitation, irregular access to water, low vaccination rates and malnutrition, the WHO works with about 1,700 medical facilities around the country. In many of those clinics and field hospitals, identifying and treating contagious diseases is an everyday experience.

For example, a polio outbreak identified in Deir ez-Zor province in 2017 saw swift intervention. “In response, WHO and partners meticulously tracked the outbreak, engaged all parties in affected areas and organised mass polio vaccination campaigns,” an article published by WHO stated. Medical agencies vaccinated 2.6 million children around the country.

Last year, outbreaks of typhoid, hepatitis A and measles in various parts of the country were quickly identified and contained.

In 2018, the WHO set up eight mobile medical clinics, provided 36 ambulances and deployed 75 medical teams to some of the worst-affected parts of the country. The same year, it trained close to 31,000 people — mostly Syrians — in health issues and handed out almost 2,000 tonnes of health and medical supplies.

Now, as the first traces of the COVID-19 pandemic are reported in Syria, the regime of President Bashar Assad has been forced to act. State media said Syria’s cabinet of ministers “adopted the plan of the Health Ministry and other ministries for the next six months to confront the coronavirus, which involves expanding quarantine and isolation centres, forming 19 emergency teams for epidemical detection and setting up addition labs for diagnosing the virus in Damascus, Latakia and Aleppo in cooperation with the World Health Organisation.”

Despite this ability to respond quickly to medical emergencies, there are challenges unique to Syria. Among them, a regime with a record of using medical goods as negotiating tools to secure its demands.

For international health workers, it’s groups of people sheltering in densely populated camps who are a worry. “WHO is extremely concerned about the impact COVID-19 may have in the north-west,” WHO spokesman Hedinn Halldorsson told Agence France-Presse. “Displaced people live under conditions that make them vulnerable to respiratory infections.”

The 2017 polio outbreak in Deir ez-Zor paralysed 17 children before they could be helped. A hepatitis A outbreak in internally displaced persons camps at 17 locations in western Aleppo province affected more than 600 children.

Outbreak rates for contagious respiratory diseases, such as tuberculosis (TB), are practically unknown in part because there’s just one TB control centre in the entire country but also because Syrian officials have been supplying international health agencies with figures so low as to be barely believable.

While rebel-held areas in north-western Syria have relied on Turkish medical teams and the WHO, which collaborated to begin COVID-19 testing there, millions of people in Kurdish areas of the north-east are reliant on the whim of authorities in Damascus to test suspected cases.

On March 25, authorities in Damascus implemented a 6pm-6am curfew “with all commercial activities and shops to be closed completely during curfew times,” state-run news agency SANA reported. Ahead of the curfew, food and essentials in stores in government-controlled areas quickly disappeared from shelves.

While a hospital in Zabadani in the Damascus suburbs was opened as a dedicated medical “isolation centre” to help deal with coronavirus victims, care for medical professionals and workers does not seem to be front and centre in the regime’s thinking: Assad’s decree Number 86 ordered factories producing cleaning material and hand sanitiser to “operate at maximum capacity, 24 hours a day.”

Just how Syria comes through the impending tsunami of coronavirus cases is anyone’s guess. Although approximately 1,000 health-care professionals have been deployed to Idlib province, bombed and starved by the Syrian regime and its Russian backers for months, it’s Syrians in regime-controlled areas who may find themselves worse off when coronavirus hits.