Badriya Al-Jasem (55 years old), a displaced Syrian woman from the countryside of the Ma’arrat Al-Nu’man city, isn’t only concerned about securing the necessities. COVID-19 has increased her worries and anxiety due to the absence of medical care in the camp, where she’s lived with her children since the death of her husband. What adds to her burdens is that she suffers from high blood pressure and diabetes, which puts her among the most vulnerable for contracting COVID-19.

The elderly in unofficial refugee camps in Reef Idlib are deprived of medical units for primary health care or quarantine centers, amid fears of the COVID-19 pandemic outbreak, upon detecting the first case in the camp on July 10, 2020. COVID-19 infection rate began to increase and reached 13 positive cases, according to the Syrian Interim Government’s Health Minister, who continually shares the infections updates. In contrast, the number of positive cases in the regime-controlled areas has reached 417, according to the Ministry of Health. The World Health Organization publishes the latest updates on the number of infections in Syria in general.

In this respect, the United Nations warned of a looming medical crisis in case of a mushrooming outbreak in northern Syria. This is mainly due to the severe medical insufficiency, lack of resuscitation devices, and the supplies needed to combat the prevalence of coronavirus. The international organization has set 385 million dollars of the additional requirements of 2020 to fight back the pandemic all over the country.

However, there are no signs that the UN warnings will be heeded.

Badriya suffers from diabetes and high blood pressure and is afraid of contracting Coronavirus. She says that her temperature always goes up because of the scorching weather, which stirs her fears due to the fresh hike in the number of new COVID infections.

Like most older people living in unofficial refugee camps, Badriya complains about the lack of medical units in the camp, and the medical examination centers are tens of kilometers away. What makes matters worse is the abject poverty that made her unable to undergo the necessary examinations or afford to buy preventive needs. 

Refugee Camps Lack Preventive Measures

One-third of the total Idlib population live in refugee camps. Which prompted Christian Renders, the field coordinator of Doctors Without Borders’ activities in northwestern Syria, to say that most of the recommendations to ensure people’s safety from Coronavirus and to slow down its prevalence are inapplicable in Idlib. “We ask people to follow proper hygiene practices and to wash their hands frequently, but how could this happen while they are living in dirt and poverty?” The field coordinator raises a big ethical question that may have no answer.

In an interview with the reporter, Dr. Ahmed al-Dibis, Director of the Syria programs in UOSSM, agrees with Renders, “It is impossible to apply any of the preventative measures in refugee camps. This is mainly due to the overcrowding and absence of preventive measures related to hygiene because of the scarcity of water, sewerage, and shared bathrooms that lack the minimum sanitary requirements. This being the case also in villages and cities as there is uncontrollable mass cohousing, and thousands of families are forced to be clustered around shared space in one or two rooms with one or more other families.”

The Union of Medical Care and Relief Organizations (UOSSM) is a coalition of humanitarian, non-governmental, and medical organizations, registered in Turkey, Britain, the United States, Canada, France, Germany, the Netherlands, and Switzerland.

Abu Ahmed (64 years old), a displaced old man from the southern Reef Idlib, lives in an unofficial refugee camp adjacent to the Turkish borders. He seems uninterested in our questions about COVID-19, after the first positive case in northern Syria has been announced. He is up to his ears, calculating the money he earned today from his work in one of the nearby farms. “We are no longer worried about Coronavirus or anything else; we basically do not have enough food. In all cases, we are almost dead. How could we protect ourselves with the soaring prices of masks, sterilizers, cleaning materials? With the dirty and shared bathrooms, or with clean water that never exists?” He asked the reporter.

Yacoub Mourad, a Syrian doctor who lives in the Turkish city of Reyhanli near the country’s borders, explained to the reporter that strengthening the immune system of the elderly requires eating a variety of healthy food, peace of mind, and avoiding stress or anxiety. The same thing applies after the infection. But none of that could be provided in the harsh living conditions in refugee camps or villages amid soaring prices and absence of inner calm due to the ongoing military operations and displacement.

Nursing Homes Entrapped by Fear

Mostafa al-Naser (63 years old) has lived in al-Salama nursing home in the city of Azaz in northern Reef Idlib for three years. He is a resident of Damascus. His family, wife, and three children were killed in the military operations in 2012. “I am terrified of the infection outbreak here. I no longer get out of the home or shake hands with people. I frequently wash my hands. I do not know when this pandemic will end, but I always ask myself what would happen to me if I contracted the virus and needed medical care?” said Mostafa.

The nursing home, established in 2013, consisted in a tent accommodating several people. In early 2018, it was transferred to a building that includes four rooms and its facilities, and accommodates between 18 to 25 people and six workers.

“I do not know when this pandemic will end, but I always ask myself what would happen to me if I contracted the virus and needed medical care?”

Ziad al-Najjar, the director of the nursing home, asserted that the administration had ensured the preventive measures because of Coronavirus, including sterilizing the home, distributing masks, banning socializing with people outside the home, and frequently washing clothes. He added that there are “mentally-disordered” residents who cannot be controlled regarding cleaning or socializing with people, and they suffer from the narrow space. He highlighted the fact that the home does not receive constant support from any entity, but rather relies on individual donations, and now bear the brunt of deficit and debt. “Nearby the home, there is the Blue Crescent Hospital, where we can immediately transfer those suspected to have been infected, but we have no idea what shall happen if the number of positive cases increased.” He replied when asked about the possibility of one of the residents getting infected. 

There are no typical nursing homes in northern Syria, but rather simple houses consisting of large buildings accommodating the elderly and people with special needs. They mainly rely on individual donations, and they are dispersed among Salqin, Azaz, Dana, and other cities. However, the areas between the countrysides of Halab and Idlib, which populated four million people, lack quarantine centers equipped to take care of the elderly in case they contracted Coronavirus.

Fear and Anxiety Loom Over Nursing Homes

The case is the same for the elderly and nursing homes in northern and northeastern Syria, particularly Hasakah and Raqqa, where the women’s authority affiliated to the Autonomous Administration is responsible for supervising nursing homes.

In the town of Rmelan, in the far east of Syria, people at the helm of Viyan (Amara) home care for women suffer from the COVID-19 perilous consequences and its mounting threat amid the scarcity of supplies and aid.

Inaugurated in March 2016, the home has a staff of four female workers who work in shifts 24 hours a day. The home’s capacity is only ten women.

“Even for female workers, there are preventive measures for daily entry, and as soon as they get to the home, they have to change their clothes, sterilize their hands, and wear masks. We also focus on their nutrition, so they eat healthy food, drink a lot of water, and eat fruits to strengthen their immune system in case of Coronavirus outbreak,” said Najah, one of the supervisors of the house.

The home has also set some measures to protect older women during their relatives’ visits, such as imposing physical distance, wearing masks, sterilizing hands, and maintaining a safe distance as a way to prevent contracting the virus.

“The most crucial challenges we face is that the elderly always remember their families, for example, one of them always wants to see her son, another one her daughter, and another one wants her siblings. Out of their desire to see their loved ones, we ask their families to pay a visit. Indeed, there are no words that could describe the feelings of the old women when they see their families.” said Najah.

Dr. Ahmed Al-Dabees, referred to the awareness campaigns launched by the “UOSSM” among the locals in the countrysides of Aleppo and Idlib, the distribution of quantities of masks, disinfectants, sterilizers and gloves in the camps, and targeting the most vulnerable cases, such as the elderly people and those with chronic illnesses, such as diabetes, cancer, asthma, or liver patients. But, due to the large numbers and numerous needs, the Union could only supply a small portion of the needs of 4 million civilians.

In light of these conditions in the camps, hundreds of thousands of displaced people preferred to finally leave and return to their destroyed villages near the military line of engagement and battles, as Abu-Muhammad did. Abu-Muhammad is a 60-year-old man who returned to his home in Taftanaz, in the countryside of Idlib. He told our reporter that after his return he does not fear the disease because he constantly ablutes to perform prayer, and at the same time confirms the absence of awareness campaigns to prevent this disease or any leaflets distributed to them, adding that he goes out to pray daily because the disease is not widespread. He asserted that, despite the danger and shelling, living in his city is better than living in camps, which lack prevention methods or health care, because during a certain period of time he was forced to live with 13 people in one room.

Bashir al-Khatib is in his seventies. We met him in Taftanaz, too. He said that he was trying to keep his distance from people who have the flu, from public places and small spaces where there are many people. He confirmed that there were no awareness campaigns about this illness, especially with the large population, and that there were no prevention supplies, like face masks or disinfectants, distributed.

In most of the cities in the north, bazaars still take place (a popular market that takes place on a specific day of each week) until this very moment and no serious decisions have yet been taken to cancel these gatherings.

Early Warning Unit, a local medical group operating in northern Syria, has published advice and guidance for the elderly to avoid being infected with COVID-19, like washing hands, avoiding large gatherings, and staying away from any ill person.

They stressed that medicines should be taken continuously, in case the person is suffering diabetes, closely monitoring blood sugar, asking for medical help if you are suffering from fever, cough or shortness of breath, and continuing to use inhalers for asthma patients. Cancer patients were advised by the unit to seek medical assistance in the event of fever, coughing or shortness of breath, and concluded that reliance on such procedures was necessary, because currently there is no vaccine or treatment for coronavirus.

Medical Facilities Are Out of Service

Medical facilities in northwestern Syria (Idlib, countryside of Aleppo) are very few, due to systematic targeting of the health sectors, following military campaigns by Russia and the Syrian regime at the beginning of this year, which caused about 70 percent of health facilities to be out of service, estimated at 75 medical points (health center or hospital), that have become totally or partially out of service, or after the regime imposed military control over them.

According to the UOSSM, this led to the collapse of the already failing health system. There are 200 intensive care beds, and 100 ventilators only for more than 4 million people, which is not enough to receive patients of COVID-19. Because these modest numbers of beds and ventilators are not enough for everyone; they are used for heart, liver and cancer, patients and war injuries.

The Ministry of Health of the “Temporary Syrian Government” has indicated that since the beginning of the COVID-19 testing last March, it has conducted about 3,000 tests on people suspected to be infected with the virus, through only one center, because there is only one device. 12 cases were confirmed positive by the time of writing this report on July 18.

Horrible Scenarios!

A predictive report obtained by the writer of this investigation, prepared by the Health Information Unit of the Department of Health in the north-west Syria region, in cooperation with a number of Syrian and international experts, on May 7, 2020, showed that the region was facing 3 scenarios.

Scenario 1: The number of injuries in the eighth week of the spread of the virus is expected to reach 16,384, of which 2458 cases will need medical care in hospitals, and the number of critical cases requiring intensive care and ventilators will be 819 during the eighth week.

Scenario 2: The number of cases in Week 8 is expected to rise to 185,364, including 9268 requiring intensive care and ventilators.

The third scenario focuses on the conditions of the most needy population, the newly displaced and the elderly, whose number is about 1.2 millions, and this scenario assumes that the cases will reach 240,000 in camps alone during the sixth week, of which 12,000 will require intensive care and ventilators.

Faced with these “frightening” predictions and limited capacity of the medical-sector, the elderly will be facing the epidemic without any protection or care, especially in the camps.

During the last military campaign of the Syrian regime and the Russian forces (beginning of 2020) approximately one million Syrians from the countrysides of Hama, Idlib and Aleppo emigrated to different regions in north-west Syria, bringing the total number of displaced persons, according to statistics of the United Nations Office for the Coordination of Humanitarian Affairs (OCHA), released in May 2020, to 1.4 million. The displaced live either in uninhabitable homes or in organized or random camps, mostly lacking all the basics of life, and this category is the most vulnerable toward COVID-19, because the random environment, the absence of hygiene, water for drinking and washing, and disinfectants make it an ideal environment for the spread of the virus, according to the Information Unit of the Department of Health in Idlib.

The UN’s deputy regional humanitarian coordinator, Mark Cutts, warned of a weak response towards this health crisis. via twitter, to the reduced number of international crossings on Syria’s northern border to provide aid to these areas, in the light of the recent Security Council meetings on ways to enter aid into north Syria.

The warning was also voiced by Dr. Mohamed Al-Issa, Health Officer of (SAMS) Office in Turkey (Syrian American Medical Society), saying that the health status before “Covid-19” was critical and that the medical needs of people with chronic illnesses were not fully covered. In the event of the epidemic, some medical facilities could stop offering basic health services to face the epidemic spread, and thus the Syrian north will face a new medical dilemma.

On the precautionary measures of SAMS, Al-Issa added that she conducted an online training for many medical staff to deal with Covid-19 and equipped three quarantine hospitals, and provided logistical support for medical facilities to deal with various outbreaks of disease, indicating that Syria’s medical sector is ranked second on a scale of 5. The country is far from a good global ranking.

Given the current situation, and with the inability of the UN and non-governmental organizations to supply these needs, Badreya will remain a captive of her fear, and hundreds of thousands of elderly people will remain in an unfair confrontation with a dangerous epidemic that may be devastating.

This report was carried out with the support and supervision of the Syrian Investigative Reporting for Accountability Journalism (SIRAJ). Colleague Roshin Habu-Qamishli participated in the collection of information from the North-East region.

This report was carried out with the support and supervision of the Syrian Investigative Reporting for Accountability Journalism (SIRAJ). Colleague Roshin Habu-Qamishli participated in the collection of information from the North-East region.