BEIRUT – As coronavirus spreads around the world, the government of war-torn Syria has maintained that the country has no cases.

But with testing limited, and in some areas unavailable, cases may be going undetected. International organizations and local health workers have raised concerns that the spread of the virus in the country, whose health care infrastructure has suffered heavily from the nine-year civil war, would be disastrous.

The sizable population displaced by the recent government offensive in the last rebel-held enclave in northern Syria is particularly vulnerable.

"The reality is that, after nine years of conflict, the health system and infrastructure that would be vital in combating any public health emergency have been decimated," says Amjad Yamin, a spokesman for the NGO Save the Children in its Syria response unit. "It would be incredibly difficult to control an outbreak among nearly a million newly displaced people in overcrowded conditions hemmed in by vicious fighting."

In regime-controlled areas, the government has ordered the closure of schools and disinfection of buses and the Damascus airport – ostensibly as preventive measures – and, on Tuesday, also ordered restaurants, gyms, and other gathering places be closed.

Despite those measures, officials have maintained that there are no confirmed cases. In a televised interview last week on the subject, Health Minister Nizar Wahbeh al-Yaziji said there had been no cases to date, adding, "Thank God, the Syrian army has cleansed many of the germs that were present on Syrian soil."

The assertion that the virus is not present in Syria has been met with skepticism, particularly given that all of Syria's neighbors have reported cases and given the close relationship between the Syrian government and neighboring Iran, which with more than 17,000 reported cases and more than 1,100 deaths is one of the countries hit hardest by the virus. Pakistani officials have asserted that at least five cases in their country came from people who had come from Syria by way of Qatar.

World Health Organization spokesperson Hedinn Halldorsson confirms to U.S. News that to date there are no positive tests reported in Syria. Indeed, a real-time global map from Johns Hopkins University charting the global spread of the coronavirus shows no cases in the country.

However, the number of tests has been limited. As of Sunday, Halldorsson says, 34 tests had been performed by the Ministry of Health. As of Monday, the Syrian state news agency, Sana, reported that 103 tests had been conducted, and all were negative.

In comparison, Lebanon's Rafik Hariri University Hospital reported that it had performed 2,756 coronavirus tests as of Tuesday -- Lebanon's population is about one third the size of Syria's.

On Wednesday, although he did not mention Syria by name, Ahmed Al-Mandhari, WHO regional director for the Eastern Mediterranean, said that "even today, as the situation is becoming critical, information on cases is insufficiently communicated by countries (in the region) to WHO," Reuters reported .

Meanwhile, tests are not yet available in Idlib, a northwestern region hit hard by the civil war. Halldorsson says tests are currently being procured and shipped to Idlib and should arrive within a week. A task force has been formed of organizations working in northwestern Syria in an attempt to prepare health facilities there to handle cases should they occur and is developing a response plan.

Haldorsson says northwestern Syria is of particular concern because of "a surge of cases in neighboring countries, population movements between Syria and Iran, a disruptive surveillance system along with limited health care capacity, as well as co-circulation of other respiratory diseases such as an ongoing H1N1 outbreak," in addition to a "disrupted capacity of contact tracing and case management due to the fragile health system, and finally, the vulnerability of internally displaced people … susceptible to disease due to limited access to health care and deteriorated living conditions."

WHO officials are developing a response plan for the area, including screening at border crossings, providing protective equipment, and training health workers, Haldorsson says. Three hospitals in northwestern Syria with intensive care units will be outfitted with isolation units equipped with ventilators, and other ICUs will be rehabilitated to provide care for potential coronavirus patients..

Apart from the gaps in the health infrastructure, living conditions in the camps hosting internally displaced people present an added danger, health care workers say.

Human Rights Watch called for measures to be taken to protect detainees in Syria's prisons, believed to number in the tens of thousands.

Amany Qaddour, regional director of Syria Relief and Development (SRD), an NGO providing health services in northern Syria, says the spread of the disease could be impossible to control if not prevented, given the crowded living conditions in the country.

With multiple families sometimes sharing living quarters, she says, "You're talking about maybe 15 people in one tent, so one case could mean thousands of cases because it would so easily be transmitted."

And shortages of supplies as basic as bleach could also spell trouble, Qaddour says.

"Trying to quickly scale up is the ultimate goal, because there could be disastrous consequences if we don't," she says.

Ahmad Fawzia, a doctor who is coordinating SRD's activities in northern Syria, says some suspected cases have appeared, but to date health professionals have not been able to confirm them.

"We are now seeing in health facilities SARI (severe accurate respiratory illness) cases … but we have not received any kits for testing the corona," he says. "We have tests for influenza, flu virus, but not for the coronavirus so far. We hope the (task force) plan will be implemented as soon as possible, without any delay."

On the other hand, a medical resident working in a government hospital in Damascus says he believes the government's actions, in combination with people's fear of the disease, are having the intended preventive effect.

"I think there is a good management of this crisis in our country," he says, whose name was withheld in consideration of his safety. "Our community is very aware – there is no movement. And in Syria there is no tourism – there are no people coming from Europe or from China to our country. We are living in lockdown already. I think right now we are in good status and I don't think we will have an outbreak of the virus any time soon."

However, should an outbreak arrive, he says, the health sector is unprepared, with a shortage of intensive care beds and medical supplies.

"There is a major shortage of every medical supply, if you talk about masks or latex or nylon gloves," he says. "We are not ready for a catastrophe. "We've had enough."

