Valdai Club

The impact of the COVID-19 pandemic across the globe is enormous. For countries that have already seen long term conflict and crises, such as Syria, the stakes are very high. With limited capacity to detect, manage and follow-up cases of sickness throughout its territory, the risk of transmission is considerable, writes Philip Spoerri, Head of the International Committee of the Red Cross Delegation in Syria.

To help mitigate the danger from COVID-19, my organization works closely with the public authorities and the Syrian Arab Red Crescent Society (SARC), responding to this additional health emergency, principally by helping to contain and deal with infections in vulnerable communities such as the displaced and detained.

Challenges to healthcare and multiple needs

After weeks of heightened alert and the introduction of the first measures to curb the spread of the pandemic, Syria had its first officially confirmed case of the virus on 22 March, followed by the first COVID-19 death on 29 March. Over the second half of March, measures restricting assembly and movement were successively tightened, and by early April, the country was put under a partial lockdown. To date, the number of COVID-19 has cases reached a total of 47, with three fatalities, 29 recovered, and 15 active cases.
 
The global COVID-19 pandemic reached Syria at a time when the country entered the tenth year of destructive conflict that has put a once strong healthcare system in a precarious state. Half of all health facilities are now out of service or partially functioning. Even before the pandemic, the healthcare system was struggling to cope with the growing needs among civilians, which has already led to a rapid increase in communicable and non-communicable diseases. Massive displacement has led to a degradation in access to healthcare and essential services across the country. Active hostilities, where continued, caused serious reduction of health services, forcing people who are wounded and sick to travel further and increases vulnerability.

It is not only healthcare, but all other aspects of people’s lives that are heavily affected by the conflict. With some 11 million people displaced, 1.8 million newly displaced, and about half a million returnees over the last year, and with approximately 150’000 housing units damaged or destroyed in urban centers, a significant part of the population faces chronic challenges with regard to their basic living conditions. In parts of the country, areas are weapon-contaminated, essential infrastructure has been damaged or destroyed, and key services are unavailable or insufficient. The situation is exacerbated by the loss of skilled staff and the impact of sanctions.

Some areas still witness regular, albeit currently lower level hostilities, such as in and around Idlib, where a million people have been displaced earlier in the year. In the North East of the country, an estimated 100,000 people live in camps. Millions of displaced people in other parts of the country are experiencing similar conditions. The danger is the temporary accommodation and camps are crowded with often poor sanitation and shelter as well as little access to medical care and adequate nutrition. 

Presence and adaptation are needed to cope with the crises

The impact of the COVID-19 pandemic across the globe is enormous. For countries that have already seen long term conflict and crises, such as Syria, the stakes are very high. With limited capacity to detect, manage and follow-up cases of sickness throughout its territory, the risk of transmission is considerable. 

For people living in war zones, COVID-19 is just one more though a very serious threat to deal with. The response of humanitarian actors needs to be adapted accordingly. The International Committee of the Red Cross (ICRC) worked in Syria from the outset of the conflict, building up its largest operation globally. I can affirm that over the last nine years, the ICRC operations have been a life-line for millions of Syrians, to a large extentthanks to support of our operational partner, the SARC. 

Faced with the spreading pandemic, the ICRC, in cooperation with SARC, had to move swiftly, reviewing its activities to both maintain a broad range of live-saving activities and integrating COVID-19 responses into all our programming. This will remain an ongoing exercise as the scope and effects of the pandemic become clearer. The new emergency measures require financial support: in its recent appeal to donors, the ICRC proposed a concrete plan for close to 30million dollars out of our planned budget of operations in Syria of around 200 million dollars in 2020.

Our large-scale programs aimed to improve access to water and habitat, healthcare, economic security and humanitarian protectionwill continue addressingconflict-related needs. Being focused on particularly vulnerable communities, these programs play a significant role in improving the sanitary, nutritional and health status of millions of people in Syria as they face the COVID- 19 pandemic. 

The increasing restrictions are making it more difficult for humanitarian organizations to carry out their work. To secure its operations, the ICRC has negotiated exemptions for its movements, it is also making use of alternative procurement channels, and has maintained its in-country national and international workforce. 

Despite the challenges, with our permanent structures in six locations and witha staffof around 700 people, we are in a good position to continue implementing our programs. The ICRC sees them particularly crucial for places of detention, camps and communities with displaced, and areas that have experienced active or recent conflict, where other humanitarian actors have traditionally less access.

The ICRC will continue working closely with the SARC to maintain or increase the range of critical programs, whether in response to conflict related needs or focused specifically on the mitigation of COVID-19. We will, in coordination with the International Federation and other partner national societies, provide support to SARC’s Preparedness and Response Plan for COVID- 19. For SARC’s 52 health facilities, 45 first aid centers and 112 ambulances special operations procedures were developed to immediately report any suspected cases and for transportation of suspected cases to minimize exposure. Based on our assessment and coordinated planning, we have identified three priority areas, where assistance is needed.

Key areas of the ICRC humanitarian response

1. We are working with SARC to mitigate the spread of COVID-19 among vulnerable populations. For example, the joint SARC / ICRC field hospital at the Al Hol camp, where around 66,000 people live in dire conditions - mainly children and women - continues to offer critical medical services to the camp population. To ensure the hospital can remain open and functioning to capacity, our team is taking all necessary and preventive measures to protect the patients and themselves against any spread of the virus.Preventative measures include fencing to avoid overcrowding, additional handwashing points, extra protective equipment for triage staff and others. The ICRC also continues providing water trucking and garbage collection through contractors. We have changed the way we operate our collective kitchen, now delivering meals daily to tents individually, to avoid gathering and queuing. We are stillproviding 50,000 meals per week, as usual.

In different parts of Syria, the ICRC has started respond to the needs of internally displaced communitiesthrough a 3-month distribution of hygiene kits to 50,000 households. We are supporting primary health care services at SARC’s polyclinics in seven areas and providing water disinfectants for water treatment plants in four governorates to serve 3 million people daily. In addition, we are providing financial as well as technical resources to enable SARC conduct the information and communication campaign on COVID-19.

We plan to scale up support to the Ministry of Health hospitals and programmes, such as on diabetes, dialyses and leishmaniasis, delivering personal protection equipment, sanitizers, and other items.

2. We are supporting the capacity of SARC, health and humanitarian workers to respond by protecting against exposure to COVID-19. We have initiated and will increase distribution of disinfectant and personal protective equipment to allow SARC and ICRC colleagues, as well as medical staff and volunteers to work with adequate protection. We are providing the same assistance for personnel of selected public health structures important for vulnerable populations, as well as to a Palestinian Red Crescent Society Syria Branch hospital. 

3. We are supporting authorities to prevent or mitigate the spreading of COVID-19 in places of detention. These are places, where hygiene and access to medical assistance may be a problem and physical distancing is a privilege.We are providing disinfectant for premises cleaning and personal protective equipment to prison and health staff, along with technical assistance for use. In addition, we are providing hygiene materials for detainees and help mitigate the effects of the temporary suspension of family visits. 

It is of utmost importance that humanitarian actors minimize the exposure of staff and protect beneficiaries, preservingtheir ability to continue working in support of the Syrian people. The ICRC is currently implementing a series of strict precautionary measures in its structures across the country. These include awareness sessions, enhanced workplace hygiene, safe behaviors with colleagues and beneficiaries. These are part of our duty of care towards our employees, as well as our commitment to operate in a way that does not create additional risks for the people who need our help.

Looking into the future

In the longer term, movement limitations and other measures implemented to contain the outbreak are likely to have significant economic repercussions – and more so for those with pre-existing vulnerabilities, such as women-headed households, the disabled, IDPs and recent returnees, which the ICRC prioritizes in its traditional economic security programs. 

The ICRC therefore plans to step up its assistance to beneficiaries supported previously to cultivate their lands or set up small businesses, so they can shore up their projects. We are also assessing possibilities for additional assistance to other vulnerable populations assisted in the past and not benefitting from government support, such as daily wage workers, workers associated to small and medium enterprises and the self-employed. 

On a final and more optimistic note, I would like to highlight that COVID-19 does not have to be catastrophic for countries with weakened healthcare systems, but it does require the international community to scale up support for countries with limited capacity to respond to the threat. We must do so in a coordinated way, scaling up resources and response to avoid the worst and save lives.