Rojava Information Center: How far has coronavirus spread in the remainder of Syria, and do you expect it to spread to the north-east as well?
Dr. Nima Saeed, World Health Organisation representative in Syria: According to the IHR (International Health Regulations) from whom we receive the notification of confirmed cases, so far we have received notification of only one confirmed coronavirus case in Syria. However, as WHO we assess the risk in Syria as very high for many reasons.
First of all, even before the closure of the border, Syria is a destination for immigrants, for religious tourism, particularly at [Shia Muslim holy sites] Sayyidah Zainab and Sayyidah Ruqayya. Most of the immigrants come from Iraq, Lebanon, Iran, Pakistan, as well as many countries in the region. So this creates a risk of introduction.
Secondly, Syria has many vulnerable populations, including the IDPs, slum areas, the camps. Thirdly, the capacity of the health system to respond – and I am taking Syria as a whole here, whether in the south, north or north-east – during these nine years, the health system has suffered a lot. We assess the capacity of the health system to respond at 40%.
So we have the possibility of the virus to be introduced. And you know, now, globally, we are living in a small village. The virus doesn’t respect borders, and it’s moving quickly from country to country, it’s crossing continents. Now we are speaking about more than 190 countries and territories affected by the virus. So we as the WHO say that there is no country that is immune. If it happens, god forbid, among the IDPs and areas of high population density, certainly it will spread faster than among the general population.
RIC: Multiple reports indicate that the virus has spread in Deir-ez-Zor due to the presence of Iranian militias there, also in Damascus, and as far as Aleppo. Do you think that’s accurate?
NS: As I said, we receive information from official sources. For us, currently I don’t think there are so many cases in so many areas. But it could happen later on. Now, we are also advising the government that you have to expand the case definition, you have to enhance the surveillance, and you have to do a lot of testing. Now, they are doing more testing. Currently, these are mostly cases with severe acute respiratory infection (SARI).
For us, cases of SARI with no other apparent symptoms could be suspected as coronavirus. When the swab comes, and the sample is transported in good condition and reaches the lab and they do the testing, then we can call it COVID-19 and determine if the test is positive or negative. What I can confirm here is that the public health lab in Damascus does have the capacity to test for cases.
RIC: In terms of testing, the WHO has provided 1200 testing kits to Syrian Government-controlled territory. For the north-east, outside government control, there is no such provision. As the WHO, are you taking any provisions for the north-east?
NS: We are trying to assign a lab in the north-east, at least one. Wherever there are the human resources trained and capable of doing the testing, we are planning and we are working on that. However, I can say now – the samples can be tested in Damascus. With the current system for polio, for example, when we have what we call ‘acute classic paralysis’ cases which are suspected polio, the samples are transferred to the public health lab in Damascus and they are tested. The same for influenza, it’s tested in the central lab which is the same lab that’s testing now for coronavirus. Currently, for any suspected cases the sample can be transferred to Damascus and tested in Damascus.
RIC: From the north-east, some weeks ago they were able to send a very small number of samples to Damascus for testing, but it took so long to send the samples to Damascus and then on to the WHO and then back to the north-east that it took about a week. This is not practical.
NS: It works well for influenza and polio. But definitely, with land transportation and the flight from Qamishlo to Damascus which is now less frequent than before, that will definitely affect the timeline for testing and getting the result. We should also not forget that even in Damascus, there is only one lab which is doing this. We are planning to expand, and we gave this advice to the government – we need to expand with more labs, at least one in each region if not one in each province. To have a lab specified for coronavirus.
Unfortunately, we as the WHO are also facing a problem in bringing in the machines that are necessary, and testing kits also. Because even 1200, this is a really limited number if you compare it to other countries and how many tests they are doing each day. So what I am saying now, it is a phenomenon like an iceberg where you see only the top above the surface. What is important is that the greater number are below the surface, and these are the mild cases that will not go to the health facilities, and may even be misdiagnosed with other diseases if they do go. These are transmitting the disease. I am afraid that because of the limited number of tests, we will reach a stage where we have a very large number of cases. We will not be able to pick up the disease with the current level of sampling. We have increased the number recently, but we need to get more and more testing, to expand.
They have PCR machines, they also use them to diagnose other diseases like HIV, hepatitis. But to use them for coronavirus you need to provide them with biosafety, biosafety cabinets, isolation and so on. And because of the closure of the borders, the closure of airlines and so on, it is making it more difficult for us, the WHO, to support.
Our first priority in Syria is lab testing. The second priority is to protect health workers by providing them with protective equipment. The third priority is case management, isolation, contact prevention. Because to prevent this disease you have to find each case and isolate it. And then the fourth priority is communication, and raising community awareness. This is absolutely necessary, and being done in other countries.
Whether in north-east Syria, or in other countries, these measures are very important. By closing the schools, preventing mass gatherings. But the most important thing is really the individuals themselves, the citizens themselves. They have to keep up the distancing, handwashing, etiquette of touching and sneezing, all of these are extremely important.
RIC: Here in the north-east, there’s a big public health campaign underway, quarantine is in place. And so, apart from the testing kits, the health authorities here are saying they need more ventilators, masks, sterilization equipment. Are these things which the WHO will be able to provide?
NS: Absolutely, you need all of these things. If you see now, the biggest economies in the world, the most advanced health systems, are also struggling to cope with this pandemic. You are following the news. And what about a country that’s nine years into war, and then you have the health system which has suffered also, and then you have this vulnerable population? So it will be more serious compared to other countries.
RIC: Has the closing of the sole UN cross-border aid crossing into North and East Syria at al-Yaroubiah had an impact on your ability to deliver aid into the north-east?
NS: For service delivery, certainly, it has added more challenges. The logistics is manageable, but for service delivery, it takes time for the health system to cope. So definitely, it has an impact.
Now, if we want to send aid to the north-east, we have to get what is called a ‘facilitation letter’ from Damascus. So far, we did not have any problems. From mid-July until now, especially during the crisis in the north-east, we didn’t face any problems. All the requirements were met, and more than 50% of supplies were going to non-government-controlled areas. Either directly to the hospital, or even to the Kurdish Red Crescent and other partners, NGOs, and of course, 30% or 40% to areas under government control. So actually, they were not preventing this during the crisis. It was smooth.
RIC: So then, what is the reason that these 1200 testing kits are being distributed to government-held areas, and none are being sent to the north-east?
NS: It’s not only about the north-east. No single province has testing kits right now. It’s not about north-east, north-west or other provinces, no province has a designated laboratory. It’s all in the public health lab. The rationalization at the beginning was because they had a limited number of available kits, so they wanted to be centralized, and following the same system which is now functional for polio and other viral diseases.
RIC: But polio testing is different. Particularly for corona virus, it must be done fast to be effective, and this is a key preventative measure.
NS: I want to be clear. We are advocating for expanding the testing, increasing the labs, in Latakia, Aleppo, Hasekah, in any province that has the capacity and the trained human resources to do so. And we can also provide training for those who do not have training. But we need labs with safety cabinets, with the kits to be able to do the testing. And the government in principle agreed on that. But still the equipment, lab material, the kits, these are not available.
RIC: For these proposals, the lab in Hasekah, the testing kits, you are negotiating directly with the Autonomous Administration of North and East Syria or this is all via the Damascus government?
NS: We discuss with the Damascus government, and our colleagues are discussing with the local authorities as well. We do have staff there.
RIC: Across the whole of Syria, do you have the impression that the Syrian government is taking the necessary precautions, that it’s taking this threat seriously?
NS: I think they are taking it seriously, with all available resources. But definitely more is needed. Not only from the government, but from all actors. Now, from the UN, it’s not only WHO which is working on this: you have the Crisis Management Committee, all key agencies are part of this, and they are discussing every day what is needed and how they can support to contain the virus, and how to encourage the government in what to do. And of course, to be prepared well you need a lot of resources, a lot of money.
Not only in the north-east, but everywhere, it’s a huge challenge, capacity is limited, and the virus is very fast. Time is extremely important here. Especially for logistics, it’s extremely challenging. And add to that the global supply shortage of PPE, of ventilators, of all these things. So it’s going to be very tough. So we are hoping for the best, and planning for the worst-case scenario.
This is a global pandemic, it needs a coordinated effort. All countries should forget their political differences and come together and fight this virus together.
RIC: Last night, the Syrian Democratic Forces said they would be halting military operations and called for a cease-fire across all zones of conflict in Syria. Is this something you would endorse?
NS: I have seen that, and really, that is a very good move. Because the virus does not respect borders or line of control. Having it in north-east Syria will affect other areas, and vice versa.
RIC: Thank you.
Interview has been edited for length and slightly edited for clarity.