A displaced girl wears a face mask as she takes part in an event organized by Violet Organization, in an effort to spread awareness and encourage safety amid coronavirus disease fears, at a camp in the town of Maarat Masrin in northern Idlib, Syria, on April 14. (Khalil Ashawi/Reuters)

BEIRUT — With the coronavirus pandemic accelerating, Ithar al-Allam toured the sprawling refugee camps of Syria's embattled Idlib province last month to warn of the disease. But she realized awareness was not enough.

“People tell you, ‘I can’t buy face masks or hand sanitizer or do isolation, because whole families live in a tent.’ A tent is not a place equipped to provide full isolation from the illness,” said Allam, 34.

So her organization, which runs women’s centers in the area, launched a project sewing homemade face masks to distribute in the midst of Idlib’s humanitarian crisis, one of the worst in the world.

This pocket of rebel-held territory in northwestern Syria is home to over 3 million people, half of whom have been displaced from elsewhere in the country, according to United Nations estimates. Many have been displaced repeatedly — as many as five times. Children account for half the population, according to Save the Children.

The Washington Post spoke with Syrians in the rebel-held Idlib province, where one million residents have been displaced since late 2019 by fighting. (Video: The Washington Post)

There have been no reported cases of coronavirus in the Idlib enclave, but the vulnerability of the people means the virus, if it breaks out, is likely to rage through the local population.

“A health system in ruins, weak disease surveillance, population density, low levels of sanitation services, poor response capacity and suboptimal levels of public health preparedness; are all factors that are likely to trigger a rapid transmission of the virus in the region,” the United Nations Office for the Coordination of Humanitarian Affairs said of Idlib in a report released Thursday.

The World Health Organization has shipped over 5,000 tests to a lab in Idlib city and is seeking to accelerate further shipments, anticipating possible restrictions or disruptions in the cross-border flow of aid in coming weeks, it said.

“We could be in a situation in a few months where we have an outbreak on our hands and we’re all desperately scrambling to get in more protective equipment,” said Misty Buswell, policy and advocacy director for the International Rescue Committee in the Middle East. “We’re trying to prepare and preposition now as best we can to avoid that, but there are concerns about being able to access global supplies and the challenges of getting them into northwest Syria given covid-related restrictions.”

In addition to the closed international borders and other public health restrictions, the grinding war in Idlib is also a significant obstacle to addressing a possible outbreak of disease.

Since early March, a cease-fire has largely held under the terms of a deal brokered by Turkey, which backs some rebel groups in the area, and Russia, which supports Syrian President Bashar al-Assad. But cease-fires in Idlib rarely last.

As a result of the conflict, countless children are withering from malnutrition, and families lack basic amenities, often living in thin tents hastily set up on rocky, hard terrain.

The mass movements of displaced Syrians make it difficult to prevent, detect and respond to disease outbreaks, the U.N. report said. The ability to isolate, test, treat and trace the virus is extremely limited, because of living conditions and shortages in staffing and medical equipment at health centers.

“There are people who are living under very difficult life conditions, and we couldn’t tell them, ‘We’re here to make you aware about corona,’ when they don’t have any capabilities … to fight this illness,” Allam said, speaking from Idlib.

Families in the informal camps that she regularly visits are largely left to deal with the crisis on their own.

“We live in an environment and community that is different from communities around the world,” said Narmin al-Sweid, who works with Allam in the Mazaya Organization, which is running the face mask project. “We have a community of informal camps, a community that severely lacks basic life necessities and preventive measures. So we hope that, through this simple service, we can provide a serious measure to prevent the spread of this dangerous illness, in front of which we stand helpless.”

A small group of women work fastidiously to produce face masks, typically making around 100 a day, before other women head to the camp to distribute them free. Other local groups have also joined the effort.

The fabric for masks “is available to a certain degree in the area,” Allam said, “but if people are heading toward placing large orders, then we will definitely be cut off — unless there are imports from outside.”

Next week, they plan to begin making homemade hand sanitizers from material available in the market.

As epidemic menaces refugee camps, the Middle East’s most vulnerable face a deepening nightmare

Russia and Turkey agree to cease-fire in Syria’s Idlib province

Inside embattled Idlib province: A Syrian offensive wreaks terror on children

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