Just a “matter of time”. That is what many healthcare workers in Syria’s Idlib province believe about the emergence of the new coronavirus in the war-battered northwestern region, according to a new report.

While it is difficult to predict exactly when a coronavirus case will be confirmed in Idlib, Syria’s last rebel-held area in the country, the majority of the medics cited in Tuesday’s report by Refugees International said they will be ill-prepared to cope with a severe outbreak.

“Idlib is surrounded by areas that all have been hit by the coronavirus,” report author Sahar Atrache told Al Jazeera.

“The closure of crossings notwithstanding, routes remain opened to commercial traffic, so a risk of a virus outbreak remains,” she said.

As of Tuesday, The Damascus-based Syrian government has reported 43 coronavirus cases including three deaths, in areas under its control.

Health officials around the world have issued a series of recommendations to avoid the spread of the coronavirus pandemic, but the report noted that compliance with such guidance is simply “out of reach” for most of Idlib’s three million population.

“Staying at home, frequent washing of hands, keeping space between individuals, stocking on food, medications, and other essentials, cleaning and disinfecting surfaces,” are among the many issues that prevail in the region, the report said.

‘When not if violence will resume’

Since December last year until early March, an escalation in fighting following the launch of an offensive by Syrian government troops, backed by Russia and Iran, created the worst displacement crisis of the war in Syria, now in its 10th year.

Nearly one million people were forced to flee the clashes, with many amassing in the already overcrowded camps near the sealed border with Turkey.

According to the report, titled A Crisis on Top of a Crisis: COVID-19 Looms over War-Ravaged Idlib, it is inside the many informal camps that the situation is most concerning.

Despite efforts to launch awareness and sterilisation campaigns by volunteers from Syria’s Civil Defence, a search-and-rescue group that operates in rebel-held parts of Syria, hygiene inside these camps is “very poor”, it said.

“Given the living conditions inside the province, prevention and early detection of patients are among the best strategies to avoid a COVID-19 outbreak in Idlib,” Atrache said.

On average, civilians inside the province have been displaced “between five and ten times” due to bombardment and recurring government offensives, the report noted.

A Russian-Turkish ceasefire in the area has helped maintain relative calm since March this year, but the recent deal “hardly guarantees an end to violence”, it said, adding that previous ceasefire efforts have quickly faltered.

Still, the pandemic might be playing a role in “maintaining the relative calm in the province”, according to Atrache.

“Turkey, Russia and Iran are all struggling to contain the spread of the virus at home,” she noted. But, for many inside the province, “it is a question of when not if violence will resume”.

Staying home ‘not an option’

Fighting in Idlib has put more than 80 hospitals out of service. The facilities that continue to function have “extremely limited capacity to provide intensive care”, the report found.

Meanwhile, most of the physicians and healthcare workers who remained in the area are exhausted and under-resourced.

“There is a lack of doctors, nurses and specialists, and some of those who remain lack the necessary training,” the report said.

Hospitals across the province have fewer than 100 ventilators, which are crucial for the treatment of severe cases of the disease, while all existing ones are in use.

The economic impact of the pandemic has also exacerbated an already devastated economy due to years of war.

“Many inside the province can’t afford to stay home,” explained a relief worker in Idlib, quoted in the report. “People need to work to feed their families, staying home is not an option for them.”

Countries that usually provide aid have turned their efforts and attention inward at a time where global efforts have shifted to address domestic concerns.

However, crises like the one in Idlib “should not be forgotten”, Atrache said.

The Health Directorate in Idlib and humanitarian organisations formed a taskforce to prepare for a coronavirus outbreak, but “no major funding of the $33m appeal … has been secured,” she said, adding that the US and European donors should “step up their support”.

The report recommends that the United States and European countries should exert diplomatic efforts to maintain the ceasefire in the area.

It also calls local groups to allocate existing resources such as “food, soap and clean water, and sanitisers” to the camps hosting internally displaced people.