Country Report | COVID-19 Infection Control in Syria: The Need for Transparency

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Lily Zandstra https://www.linkedin.com/in/lily-zandstra-242967158/?originalSubdomain=nl
2020-05-14

Fear looms amongst the Syrian people as COVID-19 threatens the war-torn region, which lacks the means to prevent, diagnose, and treat an outbreak. With over 6 million displaced people residing in overcrowded camps and 85% of the population living below the poverty line, a nationwide epidemic would be catastrophic.1 The Syrian Health Ministry recorded on April 21st that there were 43 coronavirus infections, 19 recoveries, and 3 deaths.2 A COVID-19 outbreak in Syria seems inevitable. Syria’s high poverty rate, lack of resources, and prolonged conflict expose the vulnerabilities of the country to the virus. The lack of transparency is contributing to unforgiving transmission. Greater international initiatives on combating the pandemic in conflict-ridden countries, such as Syria, are needed urgently.

Research on government responses to the coronavirus has revealed that transparency is critical for effective management of COVID-19. Syria is certainly not the first to be accused of downplaying information during a national crisis. However, due to its limited resource capacity and its need to rely on strong preventative measures to counter the spread, greater levels of transparency are needed. Transparency is required for the dissemination of quality information and the building of trust-prerequisites for effective policy responses. Accurate information concerning the disease is needed for guidelines to be adopted. Policy responses should be factually based and comprehendible to the general public. Transparency also includes the promotion of trust between the general public and the authorities, presented clearly to ensure the adoption of the necessary practices.3 The Syrian people risk catastrophic exposure to the virus, as Syria’s lack of transparency leaves the healthcare system defenseless.

The Syrian government faced criticism on their downplaying of the number of infected cases of COVID-19.4 On March 10 the Syrian Observatory for Human Rights reported COVID-19 cases in Tartous, Damascus, Homs and Latakia.5 The government reported that the virus had not spread in the areas under its control. However, Syria’s rate of infection seems questionably low compared to its neighboring countries. Iran, for example, has witnessed an exponential growth of infections and has close ties to Syria. Syria hosts thousands of military forces and receives approximately 22,000 religious tourists from Iran each year.6

On March 14th, the Education Minister, Imad al-Azab, closed all schools and universities until April 2nd.7 The Ministry of Religious Endowments shut down all directorates and divisions, and suspended Friday prayers and group prayers for 2 weeks. Additionally, parliamentary elections were postponed until May 20th, and non-essential shops, restaurants, cafes, sports clubs, and places of public entertainment were abruptly closed.8 The sterilization and disinfection of the cities was another preventative measure taken, and the disinfection of vehicles entering the City of Aleppo became a common sight.9 Issuing of driver licenses and the completion of military service was suspended.10 On March 23rd, the government recorded its first case of COVID-19. The Minister of Health, Dr Nizar Yazigi, conveyed on state television that the person infected was a 20-year-old female who had come from abroad. It was reported that precautionary measures were taken and the patient was quarantined upon her arrival, despite her lack of symptoms.11 Initial voluntary measures were heightened later in March, as travel restrictions were implemented. The movement of citizens between provinces was restricted and a night curfew from 6 pm to 6 am was introduced. Thus far, the Syrian people have not followed precautionary measures, as people continue to attend religious gatherings and large market places. However, “great levels of fear” among the Syrian people have been reported. Some anticipate the government is underreporting for political purposes, leaving them with little knowledge on how to safeguard themselves against the virus.12 Yet, these fears do not stem from the management of the virus itself but rather the perception of the pandemic as a security threat. It has been reported that the Military Intelligence Agency has arranged funerals and a public awareness campaign was precluded from distributing flyers by intelligence officers. The government risks the health of its people by prohibiting the release of information to silence potential unrest.13

Syria’s lack of transparency creates increasing uncertainty about how the healthcare system can cope with the coronavirus. The medical resources needed to diagnose and treat patients are insufficient. A doctor in Aleppo revealed the testing capacity of the region. He described the lack of testing capabilities, as all suspected cases are sent to the central laboratory in Damascus. However, he suspects that patients who had previously suffered from lung disease may have been infected with COVID-19. 70% of healthcare workers have fled the country since the conflict began. He gave a hypothetical scenario of how Aleppo, a city with a population of 2 million people could deal with a COVID-19 outbreak. He anticipated that if 1,000 people were infected and 100 required intensive care, there would not be enough respirators to support their care.14 The cost of coronavirus tests is higher than the average monthly salary of Syrians. In some cases, tests are being distributed based on personal connections.15 Transparency is critical to control the outbreak, by allocating limited resources more equitably.16 Underreporting the number of infected cases has prevented practical response mechanisms.

The case in Syria is poignant. Infection control has been hindered by the governments’ lack of transparent communication. Currently, the number of reported COVID-19 cases in Syria is questionable. As we endure this pandemic globally, is it incumbent upon the international community to support Syria. The greatest priority is the promotion and incorporation of transparency in response plans to COVID-19 in conflict settings.

  1. Antaki, Nabil. April 24th, 2020. French RT.↩︎

  2. Sabbagh, Hazem. April 28nd, 2020. Syrian Arab News Agency. https://sana.sy/en/?p=190575↩︎

  3. O’Malley, Peter, John Rainford, and Alison Thompson. April 21st, 2020. Bulletin of the World Health Organization 87↩︎

  4. Moubayed, Sami. April 24th 2020. Gulf News. https://gulfnews.com/world/mena/has-the-coronavirus-reached-syria-1.70539898↩︎

  5. Cited in Petkova, Mariya. April 18th 2020. Aljazeera. https://www.aljazeera.com/news/2020/03/concern-mounts-catastrophic-coronavirus-outbreak-syria-200316003354976.html↩︎

  6. Gharibah, Mazen, and Zaki Mehchy. April 27th 2020. LSE Research Online. http://eprints.lse.ac.uk/103841/1/CRP_covid_19_in_Syria_policy_memo_published.pdf?fbclid=IwAR0-7fK6LGG9Y9jokt6XdM3Yxvubh4IFvcrmqZ4RM5JNIQALs7kvJT3qw70↩︎

  7. Knecht, Eric. April 18th, 2020. Reuters. https://www.reuters.com/article/us-health-coronavirus-syria/syria-insisting-it-is-coronavirus-free-takes-broad-steps-to-prevent-spread-idUSKBN2110SA↩︎

  8. Al-Khateb, Khaled. April 18th, 2020. Al monitor. https://www.al-monitor.com/pulse/originals/2020/03/syria-coronavirus-who-pandemic-denial-cases-detention-camps.html↩︎

  9. Syrian Arab News Agency. April 18th, 2020. https://sana.sy/en/?p=189486↩︎

  10. Manar Hamigo, Muhammad. April 18th, 2020. Alwatonline. https://www.alwatanonline.com/%D8%A7%D9%84%D8%AA%D8%AC%D9%86%D9%8A%D8%AF-%D8%A7%D9%84%D8%B9%D8%A7%D9%85%D8%A9-%D8%AA%D8%A4%D8%AC%D9%91%D9%84-%D8%A7%D9%84%D8%B3%D9%88%D9%82-%D9%88%D9%85%D9%86%D8%AD-%D8%AF%D9%81%D8%A7/↩︎

  11. Al-Khateb, Khaled. April 18th, 2020. Al monitor. https://www.al-monitor.com/pulse/originals/2020/03/syria-coronavirus-who-pandemic-denial-cases-detention-camps.html↩︎

  12. Petkova, Mariya. April 18th 2020. Aljazeera. https://www.aljazeera.com/news/2020/03/concern-mounts-catastrophic-coronavirus-outbreak-syria-200316003354976.html↩︎

  13. Gharibah, Mazen, and Zaki Mehchy. April 27th 2020. LSE Research Online. http://eprints.lse.ac.uk/103841/1/CRP_covid_19_in_Syria_policy_memo_published.pdf?fbclid=IwAR0-7fK6LGG9Y9jokt6XdM3Yxvubh4IFvcrmqZ4RM5JNIQALs7kvJT3qw70↩︎

  14. Antaki, Nabil. April 24th, 2020. French RT.↩︎

  15. Gharibah, Mazen, and Zaki Mehchy. April 27th 2020. LSE Research Online. http://eprints.lse.ac.uk/103841/1/CRP_covid_19_in_Syria_policy_memo_published.pdf?fbclid=IwAR0-7fK6LGG9Y9jokt6XdM3Yxvubh4IFvcrmqZ4RM5JNIQALs7kvJT3qw70↩︎

  16. O’Malley, Peter, John Rainford, and Alison Thompson. April 21st, 2020. Bulletin of the World Health Organization 87↩︎