MSF believes that the few functional medical facilities in the region could very quickly become overwhelmed with an influx of COVID-19 patients. Many people will be at risk, as the functional health centres would be quickly overwhelmed.
“The response in northeast Syria at this time is not nearly enough. A significant increase in assistance from health actors, humanitarian organisations and donors is essential.” says Crystal van Leeuwen, MSF Medical Emergency Manager for Syria.
Nine years of conflict and military operations in northeast Syria have left the region with a broken health system. Many health facilities can no longer function and those that remain open were already struggling to respond to the existing medical needs before the COVID-19 outbreak. With the harsh reality of limited supplies and scarce medical staff, several health services and facilities have been forced to close, leaving patients with chronic diseases and compromised immune systems even more vulnerable during this outbreak.
MSF is working in collaboration with local health authorities and other organisations in northeast Syria to prepare for an increase in patients suffering from COVID-19 in the region with a focus from MSF side on Al Hassakeh National Hospital and Al Hol camp.
“We are deeply concerned about the lack of laboratory testing, the absence of contact tracing, inadequate hospital capacity to manage patients and limited availability of personal protection equipment (PPE),” adds van Leeuwen.
MSF is particularly concerned about the conditions in camps across the region where people are living in cramped, congested spaces, with little or no access to medical services or clean water. In Al Hol camp, where MSF started providing medical and humanitarian assistance in January 2019, the overcrowded camp now houses around 65,000 people, none of whom are allowed to leave. Ninety-four per cent of them are women and children.
According to local health authorities in northeast Syria, there has been one patient with COVID-19 confirmed in the region, although the sharing of the test results was delayed by two weeks. By the time the results were received, the patient had passed away. Currently, the only testing capacity available for the northeast region is through the Central Reference Laboratory in Damascus and challenges exist in getting patients with suspected COVID-19 tested and with receiving timely feedback on results.
"The lack of reliable and timely testing capacity in the region makes it nearly impossible to detect cases at an early stage, significantly hindering the ability to slow transmission within communities early on, when it is most important,” says van Leeuwen.
Significant challenges exist in ensuring that supplies and humanitarian personnel can enter northeast Syria through north-west Iraq.
“We respect the COVID-19 measures put in place by the authorities in Iraqi Kurdistan; however, exemptions and facilitation must be granted to humanitarian workers to ensure that appropriate levels of support reach northeast Syria,” says Will Turner, MSF Emergency Manager.
“Much of the humanitarian support to northeast Syria is reliant on passing through Iraqi Kurdistan. We have much needed additional supplies and medical staff ready to travel, but we lack the guarantees that they can enter Iraqi Kurdistan and move on into northeast Syria.”
MSF stands ready to support a COVID-19 response in northern Syria and Iraq however, its response remains limited as long as timely access is not granted. MSF urges authorities in Iraqi Kurdistan and northeast Syria to facilitate timely access for humanitarian organisations, including for humanitarian cargo and international staff to travel to and enter into both countries.
NOTES FOR EDITORS:
MSF is participating in the COVID-19 humanitarian taskforce, chaired by the local health authorities. At the Al Hassekeh National Hospital, MSF is training staff and preparing the facility for the arrival of COVID-19. This includes creating a 48-bed isolation ward, introducing surveillance measures, case identification and management, and patient flow and triage processes, along with infection prevention and control (IPC) and personal protective equipment (PPE) usage training (to mitigate over-use). MSF is also providing logistical support for preparedness of facilities for receiving patients (e.g. rehabilitating wards).
MSF is continuing its regular activities and support to Raqqa National hospital, Raqqa outpatient department clinic and Kobane Maternity Hospital, although the lack of supply and access for staff to enter the country is significantly hindering these responses.
In Al Hol camp, we continue to run an inpatient nutrition centre and a tent-based wound care programme for those who cannot reach the clinics, while also providing water and sanitation support in the camp. We have also started mapping vulnerable people who are more likely to develop severe illnesses as a result of COVID-19 and are sharing targeted health awareness messages and hygiene kits accordingly. We are preparing to transfer the inpatient therapeutic feeding centre (ITFC) for case management, if the needs for additional case management capacity is required in the camp.
In Al Hassakeh, and when there are water supply cuts in the region, MSF provides water trucking to the most vulnerable communities in Al Hassakeh.
Since the beginning of the COVID-19 pandemic, we have been reviewing the triage systems and patient flow in the hospitals and health centres that we support in Idlib governorate to ensure fast detection of potential COVID-19 patients. This measure is taken to put symptomatic patients under observation until an ambulance arrives to take them to a dedicated facility for tests and follow-up. We have also set-up Hygiene Committees and reinforced them with additional staff.
In the camps, we have adapted the triage system of our mobile clinics to protect the patients and the medical staff and we have implemented social distancing measures during NFI distributions. We are also spreading awareness and health promotion messages about the means of prevention and how to react in case of symptoms.
MSF is contributing to the COVID-19 medical response. On the first of April, we started supporting Ibn El Khateeb Hospital, a Ministry of Health (MoH) hospital in Baghdad, identified as one of the main hospitals treating COVID-19 patients in the city. We are providing the facility with technical training on patient triage and infection protection and control.
In Mosul, MSF has equipped a 50-room building (run by the MoH) in Al Salam hospital complex intended for the isolation of patients. Another hospital, called Al Shifaa, is located in this same complex. Al Shifaa was rebuilt by MSF in 2019 and is now being used as the main COVID-19 referral point for patients in the Ninawa province. MSF will support Al Shifaa by setting-up 40 isolation rooms and 30 beds for mild and severe case management in its center for post-operative care.
MSF’s existing projects in Ninawa, Diyala, Kirkuk and Baghdad have also been reinforcing their capacity to triage, support infection and prevention control, and refer cases to MoH hospitals; according to the protocol established by health authorities. MSF will continue monitoring the situation and discussing support possibilities with the Ministry of Health.
To ensure independence from political pressures, MSF receives no government funding for its work in Syria.