The COVID-19 outbreak and several other new factors have further complicated the already complex situation in Idlib, Syria.

Firstly, medical facilities have been hit repeatedly and most of them have been partly destroyed. They lack the infrastructure to cope with a serious epidemic outbreak. Secondly, many doctors and medical staff have already left the country, leaving hospitals and all healthcare facilities understaffed.

Thirdly, downtown Idlib and the surrounding settlements at present house a much higher population than they can accommodate. Fourthly, medicines and COVID-19 test kits are in short supply. Last but not least, hundreds of thousands refugees live in the wilderness in areas close to the Turkish border where medical care is almost totally unavailable or extremely limited.

There is now also a new complicating factor stemming from the proliferation of fighting groups in Idlib. Until recently Turkey’s main opponent in Idlib has been the Syrian government’s forces. Two Turkish soldiers were killed and one wounded last week along the M-4 highway that links Latakia to Aleppo.

Turkish authorities used a slightly different language than previously to assign blame for this attack, saying it was carried out “by certain radical groups in the region” adding: “Turkish forces carried out immediate retaliatory acts and fired at the targets that were identified in the region.” This language suggests that either Turkey could not identify accurately which “radical” group carried out the attack or that this fighting group was one of the groups protected in the past by Turkey but now it has turned against Turkey, because their priorities have diverged. Whatever the reason, the result is that there is further proliferation of actors on the battlefield in Idlib, which complicates the already complex situation.

There are indications suggesting that last week’s attack on Turkish soldiers might have been carried out by a terrorist group called Tanzeem Hurras ad-Deen (Organisation of the Guardians of the Religion), an al-Qaeda affiliated group. Some of its leaders were arrested in the past by Hayat Tahrir a-Sham (HTS) in an effort to prevent the formation of an al-Qaeda affiliated group in Syria. At the height of the COVID-19 threat, the Turkish media and the opposition political parties have not questioned the details of this incident.

As if this unfortunate attack and the COVID-19 outbreak were not enough, another new complicating factor is now added to the Idlib quagmire by the attitude adopted by James Jeffrey, the United States special representative for Syria, who last month made a statement that constituted an important deviation from the earlier U.S. approach to HTS.

“We [the United States] recognise that…HTS is an al-Qaida offshoot. It is considered a terrorist organisation, but it is primarily focused on fighting the Assad regime. It claims and we haven’t accepted that claim yet, but they do claim to be patriotic opposition fighters, not terrorists. We have not seen them generate, for example, international threats for some time,” he said.

Jeffrey’s words suggest that there is a softening attitude in Washington towards HTS. On the other hand, HTS avoids direct attacks against the Turkish army in Idlib, because it wants to primarily focus on its fight against the Syrian government.

If both Turkey and the U.S. adopt a softer attitude towards the group, they may be tempted to support HTS in a major confrontation with Syrian government forces. Such a scenario would necessarily invite the Syrian government’s reaction, which will be backed by Russia and Iran, and may well unleash a new wave of refugees towards the Turkish border.

The COVID-19 pandemic will now put pepper and salt on the wound. Self-isolation and other protective measures will become much more difficult to adopt to protect the refugees herded towards the border. Once the epidemic spreads among the refugees, containing it will be almost impossible with no available hospitals, doctors, nurses, quarantine facilities, and test kits. Most of the refugees are at present living under appalling conditions in cramped camps or in makeshift tents under trees.

This is a crisis that may easily deepen if the U.S. lures Turkey into using this opportunity to attack the Syrian forces.