Monday, March 30, 2020 — The situation in northern Syria leads us to believe that the spread of COVID-19 could quickly become critical if additional support and measures are not put in place. The disease would spread very quickly, especially in camp settings. Hospitals and health centers would become overwhelmed with a massive influx of COVID-19 patients that would be in need of hospitalization, while these same facilities are still handling casualties from the fighting as well as responding to other medical needs.

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The Syrian government reported the first case of COVID-19 in Syria on 23 March. While no cases have been declared in Idlib province, the last rebel stronghold, the disease may spread very quickly through the region, especially in camps, where people live in large settlements, in overcrowded conditions with little sanitation.

After nine years of conflict, the health system in Syria remains fragile. In the north of the country, where MSF is working, there is a limited number of functioning hospitals and health centers, and these facilities are already struggling to respond to all medical needs. Moreover, more than a million internally displaced people and refugees live in camps and in unofficial settlements and are exposed to extremely hard conditions that are prone to affect their health and even threatens their lives.

In northwest Syria MSF is currently taking part in a surveillance system set up by humanitarian actors, to monitor and get ready to respond for a potential spread of the virus in in areas that MSF can access. In northeast Syria, MSF is supporting the local health authorities to prepare for a potential outbreak.

As MSF teams are now focusing their activity on infection control measures, they are providing assistance for the triage and screening of patients in the two MSF-supported health centres, in Deir Hassan and Tal Karama.

Deir Hassan camp in Idlib hosts more than 164,000 people in settlements scattered over the hills. On 16 March, after assessing the needs in the camp, Médecins Sans Frontières/Doctors Without Borders (MSF) distributed essential items to nearly 300 families in the Latamneh, Abo Obeidah and Al Habeet settlements, including family tents, mats, plastic sheeting, blankets, cooking sets and hygiene kits.

“We witnessed people living in the open; we also saw two or three families sharing a tent which did not protect them from the cold or the rain. There were too few tents to accommodate the new arrivals." noted Ahmed, MSF project team leader.

In Deir Hassan camp, the water and sanitation facilities are inadequate for such large numbers of people, raising the risk of water-borne diseases. So far, upper respiratory infections have been the main condition seen by the MSF mobile clinics. But now the COVID-19 epidemic has become a huge challenge worldwide and in Syria. MSF has suspended some of its mobile clinics to allow its staff to attend training on infection prevention and control (IPC), and to make sure not to spread the virus. In the coming days, in 10 settlements in Deir Hassan camp, MSF community health workers will hold health education sessions on COVID-19 with displaced families and distribute leaflets and specific hygiene kits.

Since the beginning of March 2020, MSF has also distributed more than 300 tons of heating materials to more than 22 000 people in 21 camps and settlements hosting families who have been displaced by the conflict and are organising the distribution of much needed relief items in the Afrin area further north.

Considering the huge needs of IDPs in Idlib province, MSF’s response remains limited. But it must continue to increase. MSF’s ability to scale-up its assistance will depend on a steady flow of essential relief items, medical supplies and personal protective equipment reaching north-west Syria and also on its ability to send in MSF international staff to support their Syrian colleagues.

MSF has no presence in Turkey. To be able to scale-up the response, MSF asks all relevant Turkish authorities to facilitate the transit of essential supplies and international staff into north-west Syria.

Across north-west Syria, MSF teams provide maternal healthcare, general healthcare and treatment for non-communicable diseases through mobile clinics. They distribute relief items, including heating material and improve water and sanitation systems. They also support regular vaccination activities.

*In north-west Syria, MSF runs a specialised burns unit that provides surgery, skin grafts, dressings, physiotherapy and psychological support. MSF provides support to primary and secondary healthcare in several hospitals and clinics throughout Idlib and Aleppo governorates and has co-management partnerships with three hospitals. **In response to Covid-19, MSF is now implementing IPC measures in medical facilities it runs or supports, and also organising the triage and screening of patients and training on IPC. In camps, protective measures are put in place for the medical staff and the patients.*

*MSF’s medical programmes across Raqqa, Hasakeh and Aleppo governorates in north-east Syria continue. MSF runs activities in Al-Raqqa, Kobane/Ain Al-Arab, Al-Hol camp, Washokani camp, and Tal Kochar/Yaroubiyah, and is supporting the local health authorities with Covid-19 outbreak preparedness.

To ensure its independence, MSF receives no government funding for its operations in Syria.*