BEIRUT — In an act of defiance, Syria's union of doctors announced last month that 61 physicians had died of the coronavirus in the span of just a few days.

The disclosure contradicted the Syrian government, which had said a day earlier that it had registered exactly 60 deaths in the entire country since March, and represented an uncharacteristic challenge to a state known for its tight control of information and severe intolerance for alternative views.

The tally released by the Syrian Medical Association signaled that the outbreak was already widespread, because reported cases among medical personnel often indicate a far larger number of unreported cases in the general public. One Syrian medical student called the number of doctors who have died “terrifying.”

Since mid-August, the official count of all coronavirus infections has increased dramatically, with just over 4,000 reported cases and about 185 deaths. But Syrians suspect the numbers are even higher.

“Patients are dying, but to rule the cause of death [is coronavirus], you need to do a swab. They need to have been previously diagnosed. And that isn’t happening,” said the medical student, who spoke on the condition of anonymity for fear of reprisal.

The Health Ministry bases its count on positive coronavirus tests, but there are only six testing centers in government-held Syria, the ministry says.

In the absence of sufficient testing, doctors are trying to diagnose cases based on chest X-rays and other symptoms, sending patients home to quarantine and care for themselves, according to medical students and patients’ relatives.

A first-year medical resident in one of Damascus’s major hospitals, speaking on the condition of anonymity for fear of retaliation, said that only severe coronavirus cases are being admitted and that many patients with coronavirus symptoms are turned away.

“Many cases need respirators, but there are no respirators. Many need oxygen [tanks]; there are none. They need to be admitted to the hospital, but there’s no beds,” he said in a telephone interview. “The hospital has been transformed: They stopped the other wings of the hospital, and the hospital’s entire energies have focused on corona and isolation. And still, it cannot handle this pandemic.”

Woefully unprepared

The relatives of a 78-year-old man from a prominent Damascene family said he had been turned away from hospitals because of a lack of beds, even though doctors assessed that he had the coronavirus. He later died, and his death certificate, issued by a university hospital in Damascus and obtained by The Washington Post, gave the cause of death as pneumonia.

The relatives of another elderly man said he tested positive for the coronavirus and was admitted to a government hospital in Damascus, where he died. His family was ordered to bury him in Najha Cemetery.

Over the past few months, Damascus residents said they have noticed the name of that cemetery cropping up with unusual frequency on the black-and-white death notices posted around town. Satellite imagery taken between June 27 and Aug. 4 by Maxar Technologies, a Colorado-based space technology company, shows about a dozen rows of graves added to that cemetery over the past few months, suggesting to some Syrians that this has become a prime burial ground for covid-19 victims.

Amid war and economic crisis, Syria has been woefully unprepared to deal with the burgeoning epidemic. For years, President Bashar al-Assad has relied on Russia, Iran and China for support, but he found himself facing the pandemic largely alone as these allies struggled with their own outbreaks. Russia and China each sent five aid shipments, but not nearly enough of the testing kits Syria desperately needs.

The case number announced by the doctors union was another blow to the government’s credibility and came at a time when it has been facing dissent on a scale unseen since Assad’s forces brutally quashed popular demonstrations nearly 10 years ago, sparking the long civil war. The country’s economic crisis has grown so extreme that lines for rationed fuel and bread now snake for blocks, more than half the population faces possible hunger, and even some of the president’s staunch supporters have begun to criticize his government, though not Assad himself.

Citizens voice concerns

Syrians in government-held ­areas have been airing their public health grievances on Facebook, the preferred social media platform. In one coronavirus-focused group, someone questioned the official decision to reopen schools. A person from the city of Aleppo said he didn’t have money to buy enough masks for his child to go to school five days a week. “This is a crime,” another user said.

Reusable masks now cost more than two days of salary for average government employees. One Damascus resident recalled in an interview watching a man bending over in the street and picking up a used mask from the ground to reuse.

Across Syria, mask-wearing remains rare even in crowds. Big beach parties and concerts continued into this month, and mosques, along with schools, have reopened.

After Education Minister Darem al-Tabaa’s announcement that schools would open in the middle of this month, the dean of the medical faculty at Damascus University, Syria’s top university, suggested that they remain closed for at least two more weeks to give authorities time to get the coronavirus outbreak under control.

Tabaa responded sharply. “We respect the dean of the faculty of medicine and his opinions that he’s put forth regarding postponing schools. But he did not close hospitals nor the university he oversees,” Tabaa said in a local radio interview.

The dean was fired. Anger flared — especially after Tabaa called his critics “parrots” on television and gestured to his necktie decorated with a pattern of white parrots.

A growing peril

In recent days, the United Nations has acknowledged the growing peril that Syrians face.

“While official numbers of covid-19 in Syria are still relatively low, they have recently risen very quickly — and have indeed more than doubled in the past month,” Imran Riza, the U.N.’s humanitarian resident coordinator in Damascus, said in an email last week. He added, “Given the limited testing capacity in Syria, we do believe that it is likely the number of actual cases far exceed those officially recorded.”

A spokesperson for the U.N. Office for the Coordination of Humanitarian Affairs said there have been 42 positive tests among the 8,185 U.N. employees and their dependents in Syria and that “just over 200 staff and dependents have reported symptoms of covid-19, and have self-isolated under medical guidance until they completed the quarantine period.”

A local employee of an international organization in Syria, who spoke on the condition of anonymity out fear for reprisal, said the running joke is that “everyone in the U.N. has corona.” In July, a soccer tournament involving personnel from U.N. agencies and other international groups in Damascus had to be postponed for a month after it was discovered that many participants had contracted the coronavirus.

Asser Khattab in Paris contributed to this report.