Throughout the region, there are 1,000 camps, accommodated by medical centers that have 1,689 inpatient bed capacity — that is one bed per 2,378 people. There are also 243 Intensive Care Unit (ICU) beds, each to accommodate 16,534 people, 107 ventilators, each to serve 3,7549 people, and 32 isolation units, where each unit is dedicated to 125,554 people.  

The first confirmed case was announced as of a Syrian doctor, who constantly travels from/to Syria and Turkey by virtue of his work. However, the puzzle pieces were not all in place as to ascertain whether the doctor’s was in fact the first positive case, or that north Syria did actually record, but not announce, cases before him. Equally uncertain is whether that case had carried the virus from Turkey or had contracted it in Syria.   

Therefore, this investigation seeks to track COVID-19’s infiltration into north Syria and the ensuing confirmed cases. The investigation’s scope, nevertheless, is not limited to monitoring the movement of people through border crossings with Turkey, but it also reports the daily two- way traffic of Turkish employees, who travel to areas in north Syria, and people who might have carried the virus from other Syrian areas into the target region, that is north Syria.  Furthermore, the investigation reports that the measures adopted at the Idlib-based Bab al-Hawa and the Aleppo-based Bab al-Salameh border crossings between Syria and Turkey were not feasible enough to ensure that the virus is not transmitted across the borders, according to medical reports and locals’ accounts, who have been tested in an assessment of potential infections. 

Indeed, the first confirmed case came from Turkey. But the northern regions of Syria share borders with areas held by the Syrian regime too, and others controlled by the Syrian Democratic Forces (SDF). The latter two regions have recorded positive cases that pre-date the spread of the virus in north Syria.

Seeking to curb the pandemic’s spread, most nations across the world imposed restrictions on travel by land, sea and air. They either completely closed crossings and airports, or conditioned passengers’ movement, who were asked to undertake the Polymerase Chain Reaction (PCR) test that proves they do not have the virus. 

The Syria-Turkey border crossings followed suit and adopted similar measures. They were completely closed, banning in and out movement  as of mid-March, a few days into the virus’ spread in Turkey, according to separate statements made by the Bab al-Hawa and Bab al-Salameh crossings. Nevertheless, the closure decision had some exceptions, as it allowed certain groups to travel back and forth, while conducting no smear tests to ascertain they are not carrying the virus. That puts both countries at the risk of potential outbreaks, if borders were crossed by asymptomatic passengers, who might have contracted the virus in either of the countries.  

On the condition of anonymity, an employee of a Gaziantep-based Syrian relief organization reported that lesser travel exceptions were granted during the pandemic, only a quarter of relief organization staffers, compared to the pre-pandemic figures, were allowed access. However, these continued to travel over the course of the pandemic through the Bab al-Hawa and Bab al-Salameh crossings. Moreover, when dealing with the exceptional passengers, the measures adopted at the crossings were a matter of “formality”. On the Syrian side, for example, the measures were limited to temperature assessment and a few routine questions, asking passengers whether they had any of the virus’ symptoms, the employee added.

Travel exceptions are granted to

Turkish postal service (PTT) employees

Turkish policemen and court employees

Medical staffers

Relief and humanitarian organizations’ employees

Merchants 

Cross-border travel measures

Temperature assessment

Symptoms-related routine questions

48-hour self-isolation, imposed on merchants only 

Such travel exceptions are granted by Turkey to Syrian doctors all the time, allowing them access through Bab al-Hawa, north of Idlib, and Bab al-Salameh, north of Aleppo, under a single condition, that doctors coming from Turkey or Syria get their temperature assessed. Merchants, holding the Turkish state-issued card, are also allowed access through the borders, however, on the condition of committing themselves to a 48-hour quarantine before moving in and out of Turkey, as well as getting a regular smear test, according to the same source. 

This case also applies to Turkish employees, operating in the Olive Branch and Euphrates Shield areas, whose work dictates that they travel in and out of Syria on a regular basis, an officer of the Syrian Civil Police in the Euphrates Shield area said. 

From border areas, such as Hatay, Turkish employees arrive in Turkey-run Syrian areas, heading to the branches of the Turkish postal corporation, police departments and courts there. Even though these employees do not mix with Syrian civilians to a large extent, they get in touch with Syrian colleagues, according to the civil police officer. This turns the exact date of the virus’ entry to Syria into a subject worthy of investigation, along with the maintained safety procedures and health protocols regarding social distancing, the one-meter distance rule, wearing masks and gloves, and placing hand sanitizers in the workplace.

As of mid-July, the Bab al-Hawa and Bab al-Salameh crossings have “officially” announced resuming traffic in and out of Syria, while adhering to “preventive measures”, after an official closure that denied civilians travel through the crossings since mid-March. Nevertheless, the preventive measures maintained by the crossings throughout the lockdown were described as “irresponsible and negligent” by an employee of a relief organization, based in southern Turkey. He recounted his experience with these measures, having travelled through the crossings regularly while they were officially closed. The source was tested himself, presenting an example of the border crossings’ mitigation policies which apply to other cases too. “Humanitarian organizations obtain an exception from Turkey, which allows employees to travel from/to Syria and Turkey once a month,” he said. 

 “It took us a temperature assessment only to be allowed to pass through the crossing. No other measures were maintained. Upon returning to Turkey, the same procedures were carried out. What strikes me as strange is that before arriving into the Turkish crossing, we were let into a cooled room on the Syrian side of the crossing. There, our body’s temperature cooled off, since we had to walk for about 15 minutes at the Bab al-Hawa Crossing,” he added, explaining that if any of the people granted the travel exception contracts the virus, he /she will not be certain about its source, whether it is Syria or Turkey. 

“Specialized teams were sterilizing all the crossing’s facilities and the buses that transported passengers to and from Turkey, in addition to sterilizing the departure centers. Furthermore, aboard free buses, social distancing was maintained between passengers, who were asked to wear masks and gloves,”  Mazen Alloush, director of the Public Relations Department at Bab Al-Hawa Crossing, responded. 

In the past few months, he added, they also established two medical posts in cooperation with the Syria Relief and Development Organization (SRD), one near the departure station and another at the entrance to Turkey. Doctors and nurses at the posts are assigned addressing the affairs of passengers travelling from/to Turkey only, applying measures such as assessing body temperature “only” and having them answer routine health-related questions. If passengers display COVID-19 symptoms, they are isolated and then transferred to quarantine facilities outside the crossing.

Coming from regime-held areas

Border crossings were not the virus’ only gateway to north Syria. The situation was the same at inside-Syria crossings, which demark the control areas held by the de facto authorities there.  

On July 25, the Infectious Disease Surveillance Laboratory announced recording the first COVID-19 positive case in the city of Sarmin, east of Idlib.  A source close to the confirmed case reported that the 60-year-old infected woman, originally from Sarmin,  was in the Syrian regime held areas and had to resort to illegal means to return to north Syria as internal crossings were shut down due to the outbreak. On August 10, the Epidemic Early Warning Alert and Response Network (EEWARN) recorded a second case, however, in the city of Darat Azza, west of Aleppo, which also came from the areas controlled by the Syrian regime. This is thus sufficient to prove that a number of the positive cases have carried the virus from the regime-held areas to those controlled by the opposition, even though the crossings between the two sides were back then closed. 

Muhammad Atallah said he was smuggled from the regime-held areas to north Syria, providing an account of his journey. “I lived in Lebanon for over seven years and had to return to Syria upon losing my job. I attempted entry through Turkey several times, but it did not work due to the visa. I was left one choice, passing through the Syrian regime’s control areas to reach Idlib province, my place of birth.”

“After I arrived in Aleppo, I stayed there for more than two weeks. There was no way to reach Idlib since the borders were closed for passengers by the opposition, fearing COVID-19. I had to seek smugglers. To get in touch with smugglers, my relatives told me that I should go to the bus terminal, where I will find them calling: ‘Idlib, Idlib!’ When I got to the bus terminal, I met a smuggler who appeared to be a fighter because he had a military outfit on. He presented me with the trafficking routes, adding that each would cost me a different price. The price reflects the level of comfort the passenger intends to enjoy. ‘If you do not wish to walk; you will be transported by a car for a couple of hours. This will cost you over $700 (about 1.5 million Syrian pounds). However, if you choose to take the Jabal al-Ahlam/ Mountain of Dreams road, where you have to walk for over two hours, you will have to pay $200 (420, 000 Syrian pounds), and it is not intended for families’,” he added. 

“After agreeing to take the Jabal Al-Ahlam road, we got on a bus, 10 of us, planning to reach the city of Nubul in northern rural Aleppo by evening. From there, we were next transported to a village in rural Aleppo, called Burj al-Qas, on a different bus, and then to the Brad village.  Finally, we had to take the Jabal al-Ahlam road on foot which led us to the city of Afrin, rural Aleppo.  It took me a few hours to arrive in the city of Idlib. Fearing to transmit the virus to my family in case I had it, I isolated myself at home for a week, until I made sure that I had none of the COVID-19 symptoms.” 

First case – track tracing

On June 21, a Syrian doctor entered north Syria through the Bab al-Salameh crossing. Less than ten days, on July 4, he began to feel COVID-19 symptoms, according to a medical source close to the doctor. On July 9, the tests proved he was positive for the virus. It has not been determined whether the doctor carried the virus with him from his residence in Gaziantep, Turkey, or had actually contracted it upon his return to Syria, for the virus’ incubation period is 2-14 days, said the Gaziantep-based doctor Yasser Farouh, a staffer of the Assistance Coordination Unit (ACU). “In both cases, what to blame is the measures adopted at the crossings, which they keep as a matter of ‘formalities’, when addressing the disorder caused by travel exceptions,” he added. 

On July 5, the infected doctor isolated himself in his residence at the doctors’ dorm of the Bab al-Hawa Hospital. He also underwent the PCR test two days later. The results came out on July 9, proving he tested positive. The Idlib Health Directorate, for its part, placed the Bab Al-Hawa Hospital under quarantine, including medical staff, inpatients, and clients for five days. Following this, it confirmed that all test results were negative. 

Before he was tested, the doctor stayed in al-Bab city between June 30 and July 1, visiting a relative who works in the al-Bab Hospital, where he could have possibly contracted the virus from a patient or a colleague in Syria, especially in the city of al-Bab, a doctor of the Idlib Health Directorate said on the condition of anonymity. 

Furthermore, on July 7, an inside medical source from al-Bab Hospital reported that a new COVID-19 case had been recorded of a non-resident Turkish doctor in the hospital. The case was not officially announced, neither by the Ministry of Health in the Syrian Interim Government, nor by the Turkish government. 

According to the source, the doctor is in charge of an ambulance and patients referred to Turkey. He carries out weekly shifts in the hospital and moves between the Euphrates Shield and Olive Branch areas. This means the stakes are high that other people in areas of north Syria are already infected, given the geographical scope of the Turkish doctor’s movement. 

June 25

Fist case enters Syria

July 4

Feeling the Symptoms

July 9

PCR test results  

July 30

Staying in al-Bab City for 2 days 

Following the first infection, several other COVID-19 positive cases were recorded in north Syria, all of them are medical personnel, who may have had contact with Turkish doctors or Syrian patients at their workplace. On August 10, a second Syrian doctor tested positive — a pediatric surgeon at the Hand in Hand Hospital in Atma town in northern rural Idlib. The newly confirmed case prompted the Idlib Health Directorate to place the hospital under quarantine, with all the people inside it.  On the same day,   a third positive case was recorded, of an oral and maxillofacial surgeon at the Bab al-Hawa Hospital, who was quarantined at the doctors’ dorm of the hospital, according to one of the hospital’s administration officers. 

On July 11, an infection of one of the staffers of the Emergency Department at the Bab al-Hawa and al-Shifaa hospitals in Idlib city was reported. In response, the Health Directorate quarantined the second hospital’s personnel, but it failed to identify the infected persons, which is likely to allow for a large outbreak in Idlib, a source of the Idlib Health Directorate noted on the condition of anonymity. 

As the COVID-19 spread map grows larger, the threats arising from the underequipped medical sector in north Syria will continue to increase, for “the measures plan to combat the virus, if the region is to suffer a spike in cases, are modest because they depend on hospital equipment and manpower readiness,” Doctor Muhammad al-Salem said. 

Doctor Muhammad al-Abrash, for his part, said that the Health Directorate has provided tests, but the number is still insufficient to cover the population throughout north Syria. “A number of ventilators were secured and three isolation and recovery hospitals were constructed. However, these are not enough, for there are only about a 100 ventilators in north Syria,” he said. “For the time being, hospitals are obliging staff to maintain preventive measures, which have not been properly withheld so far.”

On September 5, the date of reporting, the positive case number mounted to 98, whereas 66 cases were recorded as recovered, according to the ACU. As a mitigation mechanism, the health directorates in the region are tracing contacts of the confirmed cases and testing them for the virus, enforcing no further restrictions, however. The people, on their turn, continue to violate safety and preventative measures, particularly social distancing.

This investigation is hosted by the Syrian Investigative Reporting for Accountability Journalism (SIRAJ) and Radio Rozana.

The post Through Border Crossings, COVID-19 Infiltrates North Syria  appeared first on SIRAJ.

Dalya (46) is a Syrian refugee living in Lebanon. She is also a widow — her husband died in one of the Syrian regime’s barrel bomb attacks, which hit her home in Eastern Ghouta in Damascus Countryside. Besides chronic diseases, as an asthma, hypertension and diabetes patient, what adds to her suffering is that she could not afford to buy any of her medicines for almost six months. 

Working on the farms, Dalya barely made10, 000 Lebanese pounds (US$2) per day. However, as COVID-19 found its way to Lebanon and a nationwide emergency state was declared, in response, she lost her job. Dalya, accordingly, could no longer pay the rent for the place where she lived. 

Dalya, having spent an hour standing there on the street, now sits on her black suitcase, stuffed with all that she owns. I was living in a hangar [barn], set up for poultry farming in the first place, she said. She cleaned the place, connected it with the electrical power grid and laid down water lines. The place was made habitable for a monthly 150,000 Lebanese pounds (about US$25).

“I was two months late on paying the rent. The woman that owned the hangar decided to kick us out, despite these harsh conditions. Is it really possible that while people are ordered to stay at home, we get evicted?” She hugs her children, who were overcome by fatigue.   

A public bus finally stops for the woman and her children. With everything on board, the bus fares to Beirut.  

Dalya is subjected to forced eviction from shelters unfit for human use. Nevertheless, she was not alone in this. Thirty other Syrian families had to suffer the same fate after they sought refuge in Lebanon, escaping the atrocities of war that followed the March 2011 protests.  

Families at risk

Dozens of Syrian families lived in the al-Massri camp in Saadnayel before the landlord coerced them to evacuate, allowing them to stay there till the end of June. 

The camp people, thus, referred to the United Nations High Commissioner for Refugees (UNHCR) several times, but all their attempts at reporting the situation were to no avail. The commissioner did not respond, and they were ultimately evicted. 

The interviewed refugees expressed the same sentiment over and over again; they all lacked stability, particularity under the pandemic. While people around the world seek to stay at home and commit themselves to quarantine, worried over contracting COVID-19, Syrian refugees are being forcibly evicted from their tents and houses. 

A large proportion of Syrians cannot afford to pay rent, neither for houses, nor the lands on which they have set up their tents, especially since many property owners have raised rents exponentially. Furthermore, rents must be exclusively paid in dollars nowadays, given the worsening economic downturn, crashing exchange rates of the Lebanese pound, spiking prices, and mounting rates of poverty and unemployment in Lebanon. 

Syrian refugees’ unemployment rates since mid-March 2020:

61% of women refugees

46% of men refugees

7% of the families are forcing children to work, after parents lost their jobs  

Source: UNHCR – Lebanon 

On June 19, a resident of the al-Massri camp live-streamed the forced evacuation of the camp’s population. The tents were dismantled, but the matter still went unaddressed by any official entities. The landlord denied media outlets and organizations access into the camp to assess the situation or even negotiate the possibility of allowing the people to stay in their sole shelter during these most challenging times while the country is in pandemic mode. 

Due to restrictive Lebanese residency policies, only 22% of an estimated 1.5 million Syrian refugees in Lebanon have the legal right to live in the country, leaving the vast majority to live under the radar, subject to arbitrary arrest, detention, and harassment. Their lack of legal status means they cannot move freely through the ubiquitous checkpoints that predate COVID19, have difficulty getting services such as health care or education, and find it difficult to register births, deaths, and marriages, Human Rights Watch stated in a report published last April. 

Post-eviction journey

Forcibly evicted from the al-Massri camp, only a few families managed to rent a garage or a small room in a nearby place. Others, however, sought their neighbours or moved to different camps, intending to live with relatives while searching for a place to shelter them. 

Tracking the movement of several families, seven ended up in two hangars, barns, within a 10-minute walk from the al-Massri camp. 

“The barns were still full of trash and livestock waste when we moved in. We rented them for 600,000 Lebanese pounds (US$100), which we divide among us. You can see it for yourself, we are cleaning the place of garbage and dirt. But still, it is not a place to live in,” one refugee said, standing in front of his new place of residence. 

The two barns, where 29 people, including 13 children, live today, have tin roofs, dilapidated, cracked and full of holes. The walls are either destroyed or about to collapse, threatening to crush the people living within them. The place is thus accessible to rats and snakes, while at the same time poorly ventilated and lacking in proper hygiene. The barns are particularly vulnerable to COVID-19.  

 “What coerced us to move here [the barn] is that we cannot afford renting a cheap house. At the same time, we cannot set up a new tent due to state laws. So, we decided to use the tent’s canvas and wood to renovate the hangar. We also dismantled the bricks that made the tent’s bathroom and brought them here with us. We reassembled the bricks and patched up the holes in the hangar,” Abu Basil, a Syrian refugee evicted from the Saadnayel  camp, said.  

Abu Basil’s family does not only consist of eight people, but  one of his daughters is also extremely suffering, yet traumatized over her brother’s loss, who died in a car accident when they first sought refuge in Lebanon, seven years ago. 

Furthermore, his suckling granddaughter has been lately diagnosed as having a chronic disease, brain atrophy, and is in need of treatment and sustained healthcare. It is an abject situation that we are in, Abu Basil said, adding that aid and support are necessary. 

In one corner, two birds are kept in a cage, which they also moved to their new residence. Looking at the birds, the family says: “The reason we are keeping them is that we are caged ourselves.”  

23 forced eviction cases were recorded between mid-March and mid-July, all as a result of the refugees’ inability to pay rent for the house or land.

Source: Access Center for Human Rights (ACHR)

Living in non-viable places

Lying in the open air, being the remains of the place it once was, each of the holes in the hanger begs rain and the scorching heat during summer in, inviting also all types of insects and harmful creatures. The place is vast and high-roofed. The residents used the tents’ wood to create partitions. They divided it into smaller areas, craving order and privacy. However, it is impossible to spend winter in that place, for it is particularly hard to keep it warm.   

The families recount their stories, how they escaped death and sought refuge in Lebanon, scared for their lives of the Syrian regime, how they were arrested and their houses destroyed by air raids. They also recount the story of their forced eviction from the camp, keeping the landlord’s name a secret afraid of persecution and harm as they continue to live in the town.  

In fact, these families are scared of going back to Syria. Yet, their living conditions in Lebanon can barely be called safe. 

According to Abu Basil, he and his family were evicted due to the decision providing for dismantling and flattening the camp. The dismantlement of several tents and shelters every now and then grew into a familiar occurrence in different areas, seeking to prevent refugees from settling down there. One reason for demolishing the camp is that many families were two months late on paying the tents’ rent due to the lockdown and their inability to work under the state-imposed COVID-19 mitigation policies. 

A number of the forcibly evicted camp people stressed that the proposed justifications are only a hoax. The real thing, they said, is that the landlord decided to turn the land on which the camp was constructed into a horse barn. 

No matter what the actual reasons are, the reality is that the life of this family and many others has become unbearably difficult. They today live in an unviable place, even after they themselves cleaned it and turned it with their own money from a barn into their living place. 

One resident said that the UNHCR and other international partner organizations have visited the barn and assessed the refugees’ living conditions in their new shelter. They filmed the place and said they were sorry. They also apologized for their inability to provide any aid, “one organization helps camp residents exclusively. The other helps renovate houses, not farms.”

In the barn, the refugees contemplate their near future. Summer is ending and winter is around the corner. But still, the place is absolutely inhabitable. 

“It is harsher than COVID-19, which affects people everywhere. In the case of the virus, measures can be kept to prevent contracting it; medicines can be taken to help boost the immune system and recovery. But we are helpless, nothing can help us get a shelter,” one refugee described their situation as a group.   

In the al-Hindi camp in Bar Elias, another group of Syrian refugees is enduring the same suffering. They were asked to evacuate the camp, and a deadline was already set, while they have no other place to seek given the lockdown. 

Even though his family consists of nine people, Abdulkarim, the father, cannot send his children to work, for they do not have identity documents. To make a living, he thus attempts to find informal jobs, such as gardening, or working on farms during harvest seasons.  

“We were managing. We are now holding to patience because we have only till early September to evacuate the tent. Yesterday, [the landlord] saw me at the tent’s door and threatened me. ‘If you do not leave in a week, your stuff will end up on the street,’” Abdulkarim, a Syrian refugee, recounted his story and spoke of the circumstances pressing him to evacuate the al-Hindi Camp. 

The refugees’ living conditions turned severe when the landlord decided to raise the rent on the land where the tents are set up for a number of refugees. To his misfortune, Abdulkarim was among the refugees notified of the need to pay the additional rent money.  

The landlord is whimsical, Abdulkarim said.  He has relatives neither in the camp nor in the area, unlike several other families who make up a network of relatives there, preventing the landlord from pressing them into paying further money in rent, which he finally kept as it is. He asked Abdulkarim and numerous other families to pay 300,000 Lebanese pounds (US$), or otherwise leave. 

“What coerced us to move here [the barn] is that we cannot afford renting a cheap house. At the same time, we cannot set up a new tent due to state laws. So, we decided to use the tent’s canvas and wood to renovate the hangar. We also dismantled the bricks that made the tent’s bathroom and brought them here with us. We reassembled the bricks and patched up the holes in the hangar,” 

Abu Basil, a Syrian refugee who lives along with his family in a hangar near the al-Massri camp in al-Bekaa, Lebanon. 

Affected by Lebanese pound’s turmoil

Over twenty refugee families across al-Bekaa were interviewed, they were all equally distressed due to the dire living conditions in Lebanon, a situation that has been thus for months. 

They are basically grappling with mounting prices and the Lebanese pound turmoil, which has been begging to the dollar, for it takes between 6000 and 8000 Pounds to buy a dollar, while the official bank exchange rate is 1500 pounds. 

This spiralling reality increased the refugees’ inability to pay the rent for their homes, since many have turned unemployed with the spread of COVID-19 in Lebanon. To cope with their tightening finances, a group of Syrians is borrowing money to pay the rent, others are reducing their food consumption. 

Intissar (41), a Syrian woman, shared the same house with 11 members of her family, including her father, a pneumonia patient, her mother, who suffers from chronic diseases, her widowed sister, along with her children, her brother, his wife and their children.

Intissar’s family rented the house seven months before they were expelled from it. When COVID-19 hit Lebanon in March, Intissar’s volunteer work in an educational organization stopped, so did her monthly grant of 300,000 Lebanese pounds (less than US$50). Worse yet, digging wells, her brother’s work, also stopped due to the imposed curfew.

“We could not pay the rent for three months in a row, which prompted the women owning the house to evict us in June. We turned homeless at the most critical time. A few days before we left the house, we borrowed money and paid her all the dues, but she unscrew the taps, vandalized the house and filmed it. She then went to the police station, and filed a complaint against my father,” Intissar said. 

“On top of everything, and as if it was not enough that she expelled us from the house during the pandemic, she also demanded $100 as a compensation for the damage she did herself,” Intissar added, yelling. 

UNHCR’s role

A segment of Syrian refugees blames the United Nations High Commissioner for the deteriorating living conditions, especially when it denied a large proportion of refugees the aid it provided them, who could no longer afford food and drink, not to mention the rent, given that dozens of Syrians turned unemployed.

According to human rights reports, a large number of Syrian refugees lost their jobs. As a result, their living, economic, social and psychological conditions declined further, since most of the Syrian refugees in Lebanon depend on seasonal or day labour which either stopped completely or became rare. The lacking job opportunities, however, ensued the pandemic, which coincided with the country’s economic slump. Therefore, the refugees’ conditions under COVID-19 cannot be assessed in isolation from the existing economic crisis.

In a report, Access Centre for Human Rights (ACHR), a Syrian human rights organization that documents and monitors Lebanon-based Syrian refugees’ conditions, recorded over 23 cases of forced evictions and/or the threat of forced evictions between mid-May and mid-July 2020, all as a result of the refugees’ inability to pay rent for the house or land (in the case of those living in the camps). 

Cases of eviction and/or threat of eviction were not limited to individual cases, for others occurred on the camp level. Several Syrian refugee camps in Lebanon have been threatened with eviction, and a few families were indeed expelled from them. Furthermore, the ACHR recorded two cases of camp evictions, and other three cases of camps threatened with eviction. 

As of mid-March, a report by the United Nations High Commissioner for Refugees in Lebanon found that 61% of Syrian refugee women and 46% of Syrian refugee men have lost their jobs, whereas 7% of the Syrian families are sending their children to work, after their parents turned unemployed. 

Due to a lack of money and rising food prices, the report added, refugees face difficulties buying their basic necessities. Till May 18, 75% of refugees went further into debt to pay for basic necessities, and 78% of families consulted reported difficulties buying food. 

 “Having lost their jobs, while goods prices soared insanely, the refugees have hit the low of almost no daily income — that is they cannot pay the rent for the house or the land on which the tent is set up. This increases the cases of both individual and mass eviction or threats of eviction of refugees from their residence places, whether in the camps or concrete homes, despite the COVID-19 outbreak and the urge to sustain quarantine,” an al-Bekaa-based Syrian human rights activist said, describing the living conditions of Syrian refugees in Lebanon.

The Syrian Investigative Reporting for Accountability Journalism (SIRAJ)

The post Sleeping in the Open Air, or in a Barn: Syrian Refugees Left Homeless in Lebanon  appeared first on SIRAJ.

In Idlib’s countryside, elderly residents of informal camps are deprived of primary healthcare services, usually offered by makeshift hospitals, and quarantine facilities, which camp areas lack. The situation corresponds to increasing concerns over the outbreak since the first positive case was announced on 10 July 2020 by the Minister of Health of the Syrian Interim Government, who constantly posts updated case figures. In areas held by the Syrian regime, cases are also on the rise, amounting to 417, according to the Ministry of Health. Furthermore, cases throughout Syria are being tracked by the World Health Organization (WHO), which reports new confirmed cases, as well. 

The United Nations (UN), for its part, warned against a healthcare catastrophe if the pandemic continues to spread significantly in north Syria, given the failing healthcare system, shortage for ventilators, and other supplies necessary for combating COVID-19. Moreover, the UN designated $385 millions to cover additional 2020 needs, as to cope with the pandemic in the full range of Syria.

Nonetheless, it appears that the UN warnings are in no way close to being heeded.

Suffering from diabetes and hypertension, Badriyah is fretting over contracting coronavirus, saying that she is regularly feverish due to the extremely hot weather. This had her obsessed, particularly with the surge in confirmed cases.  

Like most of the elderly in the informal camps, Badriyah complains about the absence of healthcare facilities, while test centres are tens of kilometres away from the camp where she lives. The situation is made further complicated by extreme poverty and the people’s inability to reach these centres to conduct the necessary texts or purchase preventative needs.

Camps off preventative formworks

One-third of Idlib’s population lives in tents, urging Cristian Reynders, Doctors without Borders (MSF) field coordinator for northwest Syria, to say that indeed, most recommendations for protecting people against the virus and slowing down its spread simply cannot be implemented in Idlib. He, furthermore, raised an ethical question, that probably will remain unanswered: “People are also asked to practice good hygiene measures and wash their hands frequently. But how can you practice good hygiene when you live surrounded by mud?”

Sharing Reynders’ thoughts on the matter, Ahmad al-Dabis, UOSSM Syria Program director,  told the reporter that: “Preventative measures cannot be maintained in the camps, for they are extremely crowded. Moreover, the personal hygiene-related preventative rules cannot be kept due to lacking water, sanitation and joint bathrooms, which do not adhere to requirements. This applies to villages and cities alike, for there are group housing places that cannot be controlled, not to mention that thousands of families are coerced to share one or two rooms with one or more families.”

UOSSM is a non-government union for relief and healthcare organizations, registered in Turkey, UK, US, Canada, France, Germany, Netherlands and Switzerland.

Displaced from southern rural Idlib, Abu Ahmad (64) lives in an informal camp near the Turkish border. He does not show the slightest interest in our COVID-19-related questions after the first positive case was reported in north Syria. He is, rather, busy counting the money he made today for working on a nearby farm. “We do not care about Corona any more. Even without it, we were barely having enough food. Anyways, we are almost dead,” he said. “How could we keep preventative rules? Is it with masks, sanitizers and detergents that cost a fortune, or with dirty shared bathrooms? Or should we do it with water that we do not really have?” 

On his turn, Yakoub Murad, a Syrian doctor based in the Turkish city of Reyhanlı, explained that to boost the immune system, older people need to eat various types of healthy food, maintain psychological stability, and keep away from stress and anxiety. Even upon contracting the virus, they have to uphold the same measures. However, none of these requirements can be met in the camps, for living conditions are pretty challenging there, at the villages also, including that mad rise in prices and lacking emotional stability caused by military operations and constant displacement.  

 Nursing homes in the clutches of fear

Mustafa al-Nasser (63), originally a resident of Damascus, has been living in Dar al-Salama Nursing Home in Azaz City, northern rural Aleppo,  for three years, after he lost his family, wife and three children in the military combat in 2012. “I am scared that the disease might spread here as well. I quit going outside altogether. I no longer shake hands, and I frequently wash my hands.  I am not sure when the disease will disappear, but I always wonder, what would happen to me if I caught the virus? What if I needed healthcare?” he said. 

Founded in 2013, the nursing home was a mere tent, with a capacity to accommodate nine persons. In early 2018, however, the nursing home was moved to a four-room-building, with utilities. Today, the home can host 18 to 25 persons, along with six staffers.

Ziad Najar, the nursing home director, stressed that the management was keen on adopting preventative measures against COVID-19, including disinfecting the building, distributing masks, washing clothes on a regular basis and preventing elderly from mixing with strangers. A number of the inmates are mentally-disordered, who cannot be controlled in terms of hygiene and social distancing, while tightness of space continues to give them a hard time, he added.

The nursing home does not receive stable funding from any entity, Najar reported, and it is completely dependent on personal donations, adding that the home is today deficient and burdened with debts. Asking the director about potential COVID-19 positive cases, he said: “Inmates are transferred to the nearby International Blue Crescent Hospital once suspected of contracting the virus. But still, we are not sure how we will manage if cases continue to increase.”

 In north Syria, places such as first-class nursing homes do not exist. Rather, there are big and modestly furnished houses, occupied by elderly and persons with disabilities, which are operated through personal donations only, spreading in Salqin, Azaz, and al-Dana, among other areas. In the strip between rural Aleppo and Idlib, where four million persons at least live, quarantine facilities are either lacking or are not properly equipped to accommodate elederly, who might contract the virus. 

Fear and concern necessitate unity

Difficulties suffered by elederly and nursing homes in north Syria almost match those endured by old people in the northeastern parts of the country,  particularly in al-Hasaka and Raqqa, where the Women’s Committee of the Autonomous Administration supervises nursing homes. 

In Rmelan, far east of Syria, officials, running the Viyan (Emarah) Elderly Women Nursing Home, are also facing COVID-19 severe repercussions and its ever increasing threat, amidst shortage for supplies and medicaid. 

Opened in March 2016, the nursing home has the capacity to accommodate 10 women only, and it is run by four women staffers, who take turns around the clock. 

“Even staffers must adhere to certain daily measures. They have to change their clothes upon entering the nursing home, for instance. They also have to keep their hands sanitized and masks on all the time. Furthermore, they are on a diet, drinking lots of liquids and eating fruits, to boost their immune system in case an outbreak occurs,” Najah, a supervisor at the nursing home, said. 

 Family visits are also conditioned by a set of preventative measures, which the home adopts to protect the eledrly women, including social distancing, wearing masks, disinfecting hands and keeping a safe distance as a basis to prevent the transmission of the virus. 

“A major difficulty that we constantly face is that eledrely women have their families in mind all the time. One woman, for example, asks her son to come and see her regularly; another asks her daughter to do so; a third would miss having her sisters around. We, thus, ask family members to visit the elederly women at their request. When the latter meet their relatives, the emotions we get to feel cannot simply be put into words,” Najah added. 

insufficient awareness and prevention 

Addressing responsive action in the area, Dr. Ahmad al-Dabis pointed out to the awareness campaigns launched by UOSSM, which target locals in the suburbs of Aleppo and Idlib, adding that masks, disinfectants, sinitizers, and gloves were distributed at the camps, particularly to the most vulnerable groups, including elderly and people suffering from chronic diseases, such as  diabetes, cancer, asthma and  hepatitis. The population is massive and the demand is overwhelming, al-Dabis said, stressing that UOSSM’s response covers very little of the humanitarian needs of four million civilians in the area. 

Suffering thus at the camps, some hundred thousand internally displaced persons (IDPs) decided to abandon the tents and head back to their destroyed homes, mostly located near fronts or war lines, one of whom was Abu Muhammad. The sixty-something man went back to his home in Taftanaz city, rural Idlib. Having returned, Abu Muhammad told the reporter that he is not scared of the disease anymore, for he washes frequently to perform prayers.  At the same time, he noted that no leaflets were distributed, nor prevention-aimed awareness campaigns were launched to address the disease, adding that he performs group prayers everyday because the pandemic has not spread in the city yet. Furthermore, staying in his city, despite the danger and the bombing, is better than being displaced at the camps, where preventive measures and healthcare services are nonexistent, he said, especially that at a certain point he was coerced to share the same room with 13 other people when he was still at the camp. 

Interviewed in Taftanz city too, Basheer al-Khatib, seventy-something, said that he tries to keep a distance from people with flue, refrains from showing up at public gathering places and tight spaces were people tend to assemble, stressing that no prevention-awareness campaigns are addressing the disease, despite the large population density. Masks or disinfectants were not distributed, as well. 

Almost in all the cities in north Syria, bazzars, popular markets opened on specific days of the week, were still being held when the report was being prepared, and no decisions were passed as to officially prevent such gatherings. 

The Early Warning Alert and Response Network (EWARN), a local healthcare group operating in north Syria, posted counsel and guidance to help edlerly protect themselves from contracting COVID-19, including washing hands, avoiding large-scale gatherings and staying away from people showing symptoms of any illnesses. 

Moreover, the EWARN stressed that diabetic people must ont skip their medications and that they should closely monitor their blood glucose, adding that people should immediately seek medical assistance upon coughing, having a fever or shortness of breath, pointing that asthma patients must keep inhalers close by. Cancer patients, the group advised, must also seek medical assistance upon coughing, having a fever or shortness of breath, accentuating that keeping these measures is a necessity, for no vaccine or treatment has been developed to counter COVID-19 so far. 

Healthcare facilities out of service

In northwest Syria, namely Idlib and rural Aleppo, medical supplies are very few, for healthcare sectors were systematically targeted by Russia and the Syrian regime in early 2020. The military campaigns rendered about 70% of the healthcare facilities out of service, estimated at 75 makeshift medical posts, either dispensaries or hospitals, that were inoperable partially or completely. Additionally, a number of facilities were turned unserviceable when controlled by the regime’s forces.  

This situation, UOSSM reported, led to the collapse of the already over stretched  healthcare system. There are 200 intensive care beds, and only 100 ventilators for more than four million people, which are extremely insufficient to accommodate Covid-19 patients, especially since these modest numbers of beds and ventilators are already in use, accommodating cancer, trauma, and wounded patients, as well as those with cardiac and liver diseases.  

The Ministry of Health of the Syrian Interim Government, for its part,  stated that since it first started to conduct Covid-19 tests last March, about three thousand people were examined, as they were suspected of being infected with the virus, adding that most of the tests were carried out at a single testing center and using the only device available.  Confirmed cases in the target areas amounted to 12, when the investigation was being conducted on 18 July.

Alarming scenarios

On 7 May 2020, a predictive report, obtained by the reporter, prepared by the Health Information Unit (HIS) of the Health Directorates in northwest Syria, in cooperation with a number of Syrian and international experts, showed that either of the three following scenarios lies ahead of the area.

The first scenario expects that in the eighth week into the outbreak, positive cases will jump to 16,384, while 2,458 cases will need hospitalization. The severe cases, however, that require admittance into intensive care and ventilators will be 819.

In the eighth week, the second scenario expects, positive cases will mount to 185,364, including 9,268 requiring intensive care and ventilators.

As for the third scenario, it focuses on the status of the population most in need, namely the newly displaced and elderly, whose number amounts to 1.2 million. This scenario expects that in the sixth week, the number of cases will reach 240,000 in the camps alone, 12,000 of which will require intensive care and ventilators. 

Given these alarming predictions and the scarce resources of the healthcare sector, elderly will be in a battle with the pandemic, unprotected and uncared for, particularly those living in the camps. 

During the latest military campaign, which Russian and regime forces embarked on in early 2020, about one million Syrians from Hama, Idlib and Aleppo suburbs were displaced to separate areas of northwest Syria, bringing the total number of displaced people there to 1.4 million, according to statistics issued by the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) in May 2020. These people reside either in uninhabitable homes or in official or otherwise unofficial camps, most of which lack all life’s essentials, thus, turning them into the most vulnerable group to contract Covid-19, since the random environment and absence of hygiene measures, drinking and household water, and disinfectants make the area an ideal incubator for the the virus to spread, as reported by the HIS of health directorates in Idlib. 

In a tweet, Mark Cutts,  the UN deputy regional humanitarian coordinator, warned against a modest response to the predicted health disaster, which he attributed to the reduced number of authorized crossings for the crossborder response into northwest Syria, decided by the Security Council in its recent meeting on the means of delivering humanitarian aid to north Syria. 

The warning was also echoed by Dr. Muhammad al-Issa, the health official of SAMS office in Turkey (the Syrian American Medical Society), who said that the pre-Covid-19 health status  was already critical and that people with chronic diseases were not fully provided with needed healthcare services. If the pandemic spreads, some healthcare facilities might turn inoperable, unable to provide primary services necessary to combat the outbreak, which places north Syria before a new healthcare dilemma.  

Regarding SAMS precautionary measures, al-Issa added that it has conducted (online) training, preparing many medical staffers to cope with COVID-19, and set up three quarantine facilities, in addition to the logistic support it provided to healthcare facilities as to help them affront all outbreak forms, explaining that the healthcare sector in Syria ranks as low as the second place out of five, the thing that keeps it out of  international top ratings. 

Given that situation, while UN and non-government organizations fail to answer the needs reported above, Badriyah will continue to be caged by fear, and hundreds of thousands of old people will be having an unfair battle against a fatal pandemic that might bring them to their demise.

The Syrian Investigative Reporting for Accountability Journalism (SIRAJ)

Accounts addressing northeast Syria were obtained by colleague Rusheen Habo, based in al-Qamishli. 

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