After months of under-reported cases and relaxed lockdown measures, the rapidly spreading COVID-19 pandemic has gripped government-held areas. A worrying rise in daily deaths and infections, especially in Damascus, has left Syria facing what could be its biggest challenge yet.

For a country battling economic turmoil, widespread instability, and heavy sanctions, the outcome looks increasingly bleak. As hospitals overflow with COVID-19 patients, the battered Syrian health system — still reeling from the nine-year-long-war and a long-term lack of investment — is working at maximum capacity and struggling to cope with the resurgent pandemic.

COVID-19 has been shrouded in secrecy in Syria and official numbers have been consistently low due to the general lack of testing, while all information has been required to be channeled through the Ministry of Health.

The medical sector is in desperate need of emergency assistance and personal protective equipment (PPE), but the scale of Syria’s economic crisis has prevented a serious lockdown — put simply, the country cannot afford to shut down. As the bodies pile up, it remains to be seen how a nearly broken country can get through this pandemic without some form of serious international medical support.

A sharp rise in deaths

In recent weeks there has been a sudden rise in obituaries, death notices, and people falling ill in Syria. While the official number of COVID-19 cases as of Aug. 4 was 847, with 463 of those in Damascus, this seems greatly at odds with the situation on the ground, and the real number of cases and deaths is likely much higher.

There has been a distinct lack of credible information as to the precise figures, leading to a necessary reliance on projected numbers instead. Dr. Ahmed Habbas, the assistant director of health in Damascus, estimated that there could potentially be as many as 112,500 COVID-19 cases in the capital and its countryside alone. His estimate was based on assessments from burial offices, which showed an average of 800 deaths over an eight-day period in Damascus, or around 100 deaths per day.

Syrian social media is currently awash with condolences and obituaries, and burials and deaths are becoming an increasingly common sight across neighborhoods, creating a growing sense of concern similar to that seen in other countries hit hard by the pandemic. Contradictions between the official figures and the sudden spike in cases and deaths have led to growing calls for burial offices to be used as a more accurate source of information. After reports came out that there were 193 deaths in Damascus on Aug. 1 alone, activist Amer Tayfour said, “We are asking the burial offices to announce the number of deaths instead of the Ministry of Health.” With regard to the official numbers, Syrian journalist Ali Hassoun sarcastically suggested, “The Ministry of Health must issue its data in the following manner: Today we conducted a test for 23 people, all of them infected with corona.”

Syrian reporter Elham Obead noted that four deaths took place on her street, and that the hospitals reportedly refused to receive the infected before they passed away because they were already severely strained. As for the Syrian medical teams and doctors combatting the virus on the frontlines, the effects have taken a heavy toll and lives have been lost.

Mahmoud Sabsoub, an obstetrician at the University of Damascus Maternity Hospital, died after he was infected with COVID-19, while Rowan Sahtout, a nurse at the Al-Assad University Hospital, also passed away following cardiovascular irregularities. Meanwhile, the director of Al-Assad University Hospital, Dr. Hussein Mohamed, was placed in intensive care after contracting the virus. Medical staff in other hospitals have been infected as well, including three nurses at al-Taliany, and it is thought that dozens of Syrian medical professionals have died from COVID-19.

The lack of resources and testing kits has become so widespread that post-mortem results at some Syrian hospitals have listed “suspected COVID-19” as a cause of death. Journalist Gasia Ohanes, who has been covering the COVID-19 outbreak in Syria from Lebanon, told MEI, “Syria's hospitals and medical facilities were already in need of maintenance and were lacking medical supplies before the outbreak. Sanitary conditions are awful and because of all these factors containing a virus this contagious will prove challenging.” Ohanes added, “Outside help, like PPE donations, ventilators, and medicine for some of the coronavirus-caused health complications, can help manage the situation to an extent and limit the spread among health workers.”

Lockdown and then reversal

After initially imposing a lockdown and day-to-day preventive measures such as closing schools and banning communal prayers and social functions, the regime quickly reversed course and eased restrictions as the number of cases was low and the economic toll was rising. According to Dr. Ali Kanaan, the head of the Banking Department at the University of Damascus Faculty of Economics, the estimated economic loss from the lockdown was 33.3 billion Syrian pounds per day — over $200 million at today’s rate of 2240 Syrian pounds to the dollar — with losses for the months of March and April totaling around 4 trillion Syrian pounds. Although these numbers may be exaggerated, they reflect the essence of the problem facing Damascus, as a lockdown means inching ever closer to total economic collapse.

Even the World Health Organization (WHO), which relies on the Syrian Ministry of Health’s official reporting figures, asserts that the “Socio-economic impacts of COVID-19, notably in food security and livelihoods, are likely to exacerbate existing substantial humanitarian needs across the country.” The WHO has said that the official number of tests conducted as of July 24 — just 12,416 — was far below the required amount.

As the government has been strangely tight-lipped about its coronavirus struggles, Syrians have raised the alarm and tried to push it to be more transparent. Dr. Bassam Zawan, a member of the British Royal College of Surgeons, sent an open letter to the Syrian government, saying, “It is not a shame or a lessening of your capacity to shout and appeal to the world. The heads of government in rich countries have appealed to the world to save their people. Please, I appeal to you, that there be immediate and urgent steps before it is too late.”

There has been much debate about how to handle the crisis within loyalist areas. Some have advocated for more clarity in order to point the finger at the lack of outside assistance and support. A popular Facebook page in Masyaf directed anger toward the West: “Let us declare the real numbers of deaths so that the world knows the extent of its crimes when it imposes sanctions. Enough with saying that we are not affected. We were affected and many of our friends died.” Earlier that week, a death was registered in Masyaf from a patient who had travelled to Damascus, and the coroner’s report suggested the cause was COVID-19.

As a result of the dire economic situation, the price of PPE in Damascus remains high: Basic face masks can cost between 1,500 and 2,000 Syrian pounds, hand sanitizer can cost up to 3,000, while oxygen cylinders can go for as much as 150,000 Syrian pounds. The median state salary in Syria is around 50,000 Syrian pounds, and as prices soar due to inflation, medical equipment is often the last priority for people, with food and shelter taking precedence.

“Gatherings are biological weapons”

Even though Syria has been isolated internationally and was effectively closed off at the start of the pandemic, cases began to trickle in from the expatriate Syrian community, especially in the Gulf. Flights from Kuwait carrying Syrians back to Damascus also brought COVID-19 with them. Despite the imposition of a compulsory quarantine on all those entering the country, cases have continued to increase and there seems to be no urgency about preventing the spread.

One example of how the virus is spreading is the recent case of the Latakia-based Syrian soccer team Tishreen, which won the Syrian Premier League for the first time in over 20 years in July. More than 3,000 Tishreen fans entered the match stadium to watch the final game, despite a decision to prevent fans from other Syrian clubs from doing so due to the pandemic.

As the crowds gathered, fears grew that such large events would only exacerbate the spread of the virus, much like the celebrations of Liverpool fans after their team won the English Premier League. After Ramez Salha a long-time Tishreen supporter and activist, tested positive for COVID-19 and checked into al-Hafeh hospital in Latakia, he penned an open letter to the powers that be from his hospital bed, beseeching them not to allow any celebrations that could spread the virus. He called such celebrations a “biological disaster that could have a terrible impact,” adding that “you cannot imagine that the city [Latakia] is able to endure this disaster and danger. The atmosphere of celebrating your life is more important than everything.” This comes as the Syrian national soccer team has announced that four players and three technical and administrative staff were infected with COVID-19, with all players and remaining staff now in isolation.

In Aleppo the crisis has also been exacerbated by large gatherings. Images of dozens of people around Aleppo citadel have been posted frequently as a warning for others. A report from pro-government outlet Russia Today noted the “absence of measures to prevent COVID-19,” including the lack of people wearing masks and other precautionary measures, and said “Damascus has become a hotbed for the virus and Syrian citizens struggle to purchase already limited supplies of protective equipment due to the economic situation.”

According to Washington-based analyst Ruwan al-Rejoleh, “There seems to be a state of denial in Syria regarding COVID-19. In both government-held and anti-government areas, the governing bodies refused to admit that COVID even exists to deal with it in the first place. The delay in announcing that there is COVID in Syria is caused by two reasons: Firstly, no testing kits were available to trace the infected cases, and secondly, the literacy surrounding COVID and social fear. People have little proper education about the virus or its symptoms.”

A testing crisis

So far Syria has received only limited support in the fight against COVID-19, and what little it has received has been more about political gestures than real medical assistance. China reportedly sent 2,000 testing kits, protective suits, and face masks in March, while Russia, too, was reported to have sent aid shipments after Damascus requested help. Aside from countries allied with the Assad regime, little or no outside assistance has been forthcoming, and with the U.S. Caesar Act now in force, countries seem wary of even discussing support given the risk of sanctions. This could change, however, if the current crisis worsens.

Testing kits in Damascus are scarce and usually only made available to those with connections and enough money. Syrian actor Mustafa al-Khani criticized the bureaucracy surrounding testing and travelling from the country, saying, “Is it reasonable today in 2020 when a citizen wants a PCR test before traveling, they must to go to the examination site to submit an application, then take a receipt, go to the Commercial Bank to pay the amount in another part of Damascus, and then go to a third place in al-Zabaltani to receive the result?”

Dr. Zaher Sahloul, president of medical NGO Medglobal, told MEI, “COVID-19 patients are suffering from a lack of oxygen, ventilators, and other medical equipment,” adding that “the best way to combat the virus spread is to do sufficient testing. So far not enough testing is being done — only those with money and connections are being tested. The daily infection rate is estimated around 2,000-3,000, but it could be more and it’s going to get worse. It’s a desperate situation and bureaucracy is making things worse.” COVID-19 testing can cost up to 130,000 Syrian pounds, or roughly three times the average monthly salary.

Several measures have been taken in the immediate aftermath of the spike in infections, however. The Ministry of Religious Endowments announced the suspension of Friday prayers and congregational prayers in Damascus for a period of 15 days starting on Aug. 3. While local councils in al-Tal and Qudsaya have introduced measures to close all gathering places, no wide-scale lockdown has been reintroduced as yet. Fares Shihabi, head of the Syrian Chamber of Industry, has advocated for converting gyms into hospitals as Syria’s existing medical facilities have become increasingly unable to handle the growing number of patients.

As the COVID-19 crisis in Syria spirals out of control and the secrecy around the Syrian authority’s methods for dealing with it begin to fade away, the country is now braced for a turbulent and costly period. The pandemic comes at a time when the Syrian currency is under severe pressure, economic difficulties are widespread, and corruption is rampant, while the crisis in neighboring Lebanon and the Caesar Act sanctions have only made it more difficult and risky for those looking to aid Syria.

For now, the needs in Syria are vast, but the priorities are mainly ventilators and testing kits. Without them this crisis will only grow worse by the day, putting ever more pressure on an already shattered country and population.

 

Danny Makki is a journalist covering the Syrian conflict. He has an M.A. in Middle East politics from SOAS University, and specializes in Syrian relations with Russia and Iran. The views expressed in this article are his own. 

Photo by LOUAI BESHARA/AFP via Getty Images