August 11, 2020 | The Washington Post

The pandemic hasn’t hit Syria hard yet. When it does, it’ll be a disaster.

Infections are rising in a country that’s unprepared for the coronavirus.
August 11, 2020 | The Washington Post

The pandemic hasn’t hit Syria hard yet. When it does, it’ll be a disaster.

Infections are rising in a country that’s unprepared for the coronavirus.

Syria has barely suffered from covid-19, according to official data from the country’s Health Ministry. Testing has confirmed 1,255 infections, of which 52 were fatal, as of Monday. The country’s caseload, both total and per capita, hovers near the bottom of global rankings. Until mid-July, Syria reported fewer confirmed cases than Taiwan, the benchmark for effective management of the pandemic.

There is ample reason to distrust the numbers published by Bashar al-Assad’s regime, yet health authorities in areas outside of Assad’s control have reported similarly low figures. In northeast Syria, where U.S.-aligned Kurdish forces govern an estimated population of 3 million, there have been only 34 cases and a single fatality. In the northwest, where roughly 4 million Syrians live under the control of Turkish proxies and Islamist militias, there were no confirmed cases until July 9; the current figure is 40.

All of these numbers are likely to be understatements, perhaps by an order of magnitude or more, yet it’s clear that there was no major outbreak in Syria during the first months of the pandemic. Still, the fuse of a covid explosion in the country may already be lit.

Low as it may be, the official caseload has tripled since the beginning of July. On social media, Syrians are sharing obituaries for relatives and friends lost to the virus. A medical worker told NPR that hospitals are being overwhelmed while staff lack personal protective equipment. He said the regime warns doctors not to share information and intelligence officers watch the hospitals. “We are all scared, all the time,” he said, referring to hospital staff.

Yet prominent Syrian physicians and front line doctors have begun to speak up. Nabog al-Awa, the dean of the medical faculty at the University of Damascus, said 100 coronavirus patients are arriving at hospitals daily, but the number of new infections is far higher, since only the sickest go to hospitals. A mortuary official reported that 40 patients die of covid-19 each day in Damascus alone.

Ahmed Habas, a physician serving as deputy director of health for Damascus, posted calculations on his Facebook page indicating there have been 112,500 infections in the capital and surrounding areas. He later took down the post, explaining that he did not want to spread fear or spur criticism of the Ministry of Health.

Shagaf Faour, a physician working in the covid ward at the Mujtahed public hospital in Damascus, posted a video on YouTube in which she describes doctors working for 24 hours consecutively using a single gown and mask. “At the hospitals we are begging for ventilators for patients, even for one of my relatives I couldn’t find a place. The situation is horrific,” Faour says.

Zaher Sahloul, a Syrian American pulmonologist and president of the U.S.-based charity MedGlobal, has been tracking the impact of the pandemic on Syrian health-care workers. His efforts include counting obituaries for Damascus physicians, at least 29 of whom have died from coronavirus so far. Sahloul told me by phone that “fatalities among health-care workers are a leading indicator of widespread communal infection.”

In March, a paper from the London School of Economics estimated that Syria has the capacity to treat only 6,500 active cases of covid-19 because the country has so few intensive care unit beds with ventilators. In April, the scholar Elizabeth Tsurkov assessed that a lack of qualified medical personnel may be an even greater bottleneck. Since the outbreak of war in 2011, an estimated 70 percent of health care workers have fled the country, while Russia and the Assad regime have carried out 537 verified attacks on health-care facilities, according to Physicians for Human Rights.

The World Health Organization has shown it is not prepared to challenge the regime’s efforts to conceal information. Annie Sparrow, a physician and professor of medicine, has chronicled the extent of the WHO’s deference to the regime, which ranges from purchasing medical supplies for Assad’s Defense Ministry and remaining silent about the stripping of critical supplies from aid deliveries for civilians in rebel-held territory to partnering with organizations under the control of Assad’s cousin Rami Makhlouf, whom the United States and European Union sanctioned for his corruption and support of the regime.

During the pandemic, the WHO office in Syria has dutifully retweeted notices with the latest official caseload and fatality figures. The WHO serves as one of two organizational co-authors of the United Nations’ weekly updates on covid-19 in Syria, yet these lengthy documents do not relay firsthand accounts from local physicians.

The WHO also amplifies public health risks by neglecting the areas outside of Assad’s control, despite their population of 7 million, compared to 10 million or so governed by the regime. The WHO began delivering coronavirus-related supplies to Damascus in February, including five polymerase chain reaction (PCR) machines necessary for coronavirus tests. Authorities in northwest and northeast Syria received no PCR machines from the WHO, but eventually procured them from other sources.

The WHO justified its disparate treatment in political terms, not humanitarian ones. “The northwest is not a country,” a spokesman said. The northwest has far less testing capacity than the regime thanks to this lack of support. The Health Ministry had conducted 12,416 tests as of July 24, compared to 3,704 in the northwest as of last Friday.

This deficiency is of particular concern, because the northwest is home to 2.7 million internally displaced people — half of them children — many of whom live crowded together in camps. “You want us to wash our hands?” one aid worker asked a New York Times reporter. “Some people can’t wash their kids for a week.”

In March, when coronavirus began to spread rapidly in the Middle East, aid organizations in northwest Syria braced for disaster. “Social distance is a fantasy in a camp,” warned the country director for Mercy Corps. “The disease could spread like wildfire.” That did not happen, for reasons that remain speculative at best, such as the country’s relatively young population.

But then, on July 9, a physician in the northwest tested positive for the virus, followed by two more on July 11. The outbreak had clearly infiltrated the region’s overtaxed hospitals. There is a single lab in the region that runs covid tests, but only a few dozen per day. It has now confirmed 40 cases, yet the virus could be racing ahead undetected — or it could stall as inexplicably as it did in March.

While flattening the curve may be nearly impossible in the northwest, Assad’s government is choosing to maintain a relaxed posture. In May, it lifted lockdown measures including school closures, travel restrictions and curfews. Last week, authorities suspended Friday prayers at mosques in Damascus, but is hesitant to impose restrictions amid a severe economic downturn. The price of food has doubled over the last six months, while the Syrian pound has lost two-thirds of its value.

If and when the public health crisis escalates, foreign assistance will be essential to any mitigation effort. Increasing aid to areas outside of Assad’s control will be difficult, since Russia has wielded its veto at the U.N. Security Council to force the closure of border crossings that were once key conduits for assistance. Via U.N. agencies, the United States and other donors can send more aid to areas under Assad’s control, yet the regime’s manipulation of aid is so extensive that it may serve little purpose beyond protecting favored communities while alleviating Assad’s financial distress. Moscow and Damascus routinely call for the lifting of U.S. and E.U. sanctions, yet the sanctions already include comprehensive exemptions for humanitarian trade and assistance.

Ultimately, millions of Syrians may have to draw on nothing more than grit to survive yet another catastrophe.

David Adesnik is research director and a senior fellow at the Foundation for Defense of Democracies. Follow David on Twitter @adesnik.

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COVID-19 International Organizations Sanctions and Illicit Finance Syria