Syria reported its first covid-19 cases a week ago — and has now reported its first coronavirus deaths. But many analysts say the total of cases is much higher, noting independent reports of coronavirus-like cases in Damascus, Tartus, Latakia, Homs and Deir-Ezzor.

How does a country engaged in civil war for the past decade face the coronavirus challenge? The United Nations special envoy called for an immediate cease-fire to prevent an outbreak of the virus in the conflict-ridden country — but no single authority can implement a cease-fire. And Syria’s fragmented and limited health services may leave many regions with little or no outside assistance to fight covid-19 outbreaks.

How did Syria prepare for the outbreak?

The Syrian government unrolled sweeping measures on March 15 to combat the spread of the coronavirus, closing universities, schools, government offices, restaurants and markets, as well as shutting down all intercity public transportation across the country. The government also suspended military conscription, a cornerstone of its sustained military campaign.

On March 20, the government banned entry for foreigners, after the first coronavirus victim reached Syria by road from Lebanon after returning from Europe. Health officials have limited testing capacity, but have deployed medical teams at the national level and to 1,864 health clinics across the country. The World Health Organization also supplied the government with testing kits, but only one Damascus-based lab is reportedly testing for the virus. Prices for masks, disinfectant and medicine have surged while the public health infrastructure remains fractured and under-resourced.

China already deployed several medical teams to assist with the outbreak in Iraq and Iran, and has provided testing kits to Syria. China’s U.N. ambassador joined the U.N. call for the lifting of sanctions on Syria, suggesting it is only a matter of time before Beijing assists Damascus. The United States has committed an additional $16.8 million for humanitarian programming for Syria under USAID’s $274 million fund for countries affected by coronavirus.

The threat of an outbreak could also thaw Syria’s relations with several countries in the region, and rally support for the Assad government. Last week, following the Group of 20 summit, Abu Dhabi Crown Prince Sheikh Mohamed bin Zayed extended the UAE’s support for the Syrian people in his first call with the Syrian president since a 2011 break in bilateral ties.

Other parts of Syria lack health-care services

My research suggests Syria’s opposition-held areas face a dire threat without the proper resources to prevent the spread of the disease — or even identify it. In Idlib, nearly 3 million Syrians are particularly vulnerable, particularly the 1 million living in crowded camps along the Turkish border.

The World Health Organization has shipped 300 test kits to the city of Idlib, and promised to supply an additional 2,000 tests, and a testing lab at Idlib Central Hospital will begin testing this week. The WHO will deploy an additional 1,000 health-care workers and as many as 10,000 masks and 500 respirators to the city and surrounding areas to run the emergency response and testing process in the few remaining clinics and hospitals.

But tests alone won’t be sufficient to prevent the spread of coronavirus, particularly in densely populated displacement camps. Many in these camps already lack shelter, and access to water and food. The simplest preventive actions — quarantine, washing hands, disinfecting — are not available options for most displaced Syrians. Any coronavirus outbreak would probably prove fatal for hundreds of thousands of civilians, particularly the elderly and those with chronic illnesses.

The compounding needs in Idlib suggest extensive multilateral support will be needed for logistics and delivery of medical services to respond to coronavirus cases, in addition to a comprehensive response from emergency aid providers to address existing shortages of food, water, shelter and other daily essentials. However, hope for such an outcome is grim as major donor countries — the United States, United Kingdom, and European Union countries — address their own coronavirus crises.

Northeast Syria has few hospitals

In northeast Syria, the Kurdish-led administration initiated a curfew ordered the closure of businesses, restaurants and events. The border with the rest of Syria is now closed, other than cross-border aid deliveries from Damascus. Only one of 16 hospitals in the region is fully functional. Two additional hospitals identified to quarantine and treat patients, are underequipped, with only 28 beds for intensive care, 11 ventilators, and two doctors trained to use them.

Ongoing disputes between Turkish-held groups and the SDF exacerbate the situation. On March 24, Turkish-backed groups shut off water to the city of Al-Hasakeh, creating increased risks of coronavirus and other disease outbreaks for some 460,000 residents, including tens of thousands living in the Al-Hol displacement camp.

The immediate challenge for Northeast Syria is access to outside coronavirus experts. While WHO officials can reach Idlib via U.N.-approved borders, they cannot cross from Iraq into northeast Syria. The push by China and Russia to end the Syria cross-border aid mechanism under Resolution 2449 in January left the northeast out of reach of U.N. assistance.

Obtaining testing kits and expanding the region’s health-care capacity depends heavily on whether the WHO can access northeast Syria from Damascus, a process that historically has been fraught with political challenges for U.N. agencies. The U.N. Security Council could opt to grant WHO authorization for cross-border assistance at all official crossings — allowing aid to arrive via Iraq and Jordan. This might give the peripheral areas of Syria access to lifesaving medical care as the coronavirus spreads — which seems inevitable, given the experience of other countries.

What happens now?

It will take more than a nationwide cease-fire to prevent a covid-19 disaster in Syria. The WHO hopefully will be able to coordinate a response with government and nonstate groups that addresses all of Syria’s medical needs, despite the country’s geographic and political fragmentation, deteriorating health-care infrastructure and lack of government resources. Otherwise, regions outside of government-held areas will be underprepared to face the crisis.

Jesse Marks is an associate with the University of Cambridge’s Centre for the Study of Global Human Movement and Schwarzman Scholar at Tsinghua University in Beijing. He is a former research consultant at Refugees International and former Fulbright fellow at the Center for Strategic Studies in Jordan researching humanitarianism and displacement in Syria.

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