Coronavirus 2019 and health systems affected by protracted conflict: The case of Syria

Abstract

Introduction: Two thirds of countries globally are unprepared to respond to a health emergency as per the International Health Regulations ( 2005), with conflict-affected countries like Syria being particularly vulnerable. Political influences on outbreak preparedness, response and reporting may also adversely affect control of SARS-CoV-2 in Syria. Syria reported its first case on 22 March 2020; however, concerns were raised that this was delayed and that underreporting continues. Discussion: Syria's conflict has displaced more than half of its pre-war population, leaving 6.7 million people internally displaced. The consequent overcrowdingwith insufficient water, sanitation and healthcare (including laboratory capacity)could lead to conditions that are ideal for spread of SARS-CoV-2 in Syria. Political changes have led to the formation of at least three health systems within Syria's borders, each with its own governance, capacity and planning. This fragmentation, with little interaction between them, could lead to poor resource allocation and adversely affect control. As such, COVID-19 could overwhelm the health systems (particularly intensive care capacity), leading to high deaths across the population, particularly for the most vulnerable such as detainees. Conclusions: Locally implementable interventions that rapidly build WASH and health system capacity are required across Syria to ensure early detection and management of COVID-19 cases.

The Impact of COVID-19 on Vulnerable Populations and Implications for Children and Health Care Policy

“…56 Countries in conflict such as Syria were particularly unprepared with half of its population displaced. 57,58 The pandemic has led several countries to close borders and limit population movement forcing many refugees to return to countries in distress with little or no means to offer adequate medical care. 59 This situation is also present in the United States where immigration detention centers have had several outbreaks secondary to limited adherence to CDC guidelines with more than 1200 cases in 52 facilities run by Immigration and Customs Enforcement.…”

“Ten years of war! You expect people to fear a ‘germ’?”: A qualitative study of initial perceptions and responses to the COVID-19 pandemic among displaced communities in opposition-controlled northwest Syria

“…Globally, of 50.8 million IDPs at the end of 2019, 45.7 million were displaced due to conflict violence ( IDMC 2020 ). There are mounting concerns that IDPs in low-income countries could experience particularly severe COVID-19 cases and related deaths ( Orendain and Djalante, 2020 , Abbara et al., 2020 ).…”

Conflicts and the spread of plagues in pre-industrial Europe

“…The 2019/2020 coronavirus pandemic has highlighted how the geography of population movements can drive the rapid escalation of infectious diseases. Within this context, recent events in Syria and Yemen show that warfare creates opportunities for pathogenic microbes to spread rapidly in displaced human populations (Abbara et al, 2020;Daw, 2020). Nonetheless, the role of armed conflict in driving recurrent plague outbreaks in the Late Middle Ages to Early Modern Age of Europe, one of the most violent in the continent's history, is largely unknown despite its potential importance in constraining current human-microbe models of war-affected regions.…”