Introduction
On 22 March 2020, the Syrian Ministry of Health announced that it registered the first coronavirus case in Syria as other announcements of further cases continued on the following days. The ministry confirmed that all needed measures to prevent a spread of the deadly virus have been adopted, including partial curfew between 18:00 and 06:00 where government also stopped internal and external transportations by land and air, except for aviation for military purposes.
The health system in Syria has been heavily impacted by the bloody conflict after 2011 as hundreds of medical stations became out of service and experienced medical professionals became either refugees or internally displaced. As a result, medications, especially for chronic diseases, are no longer available. The situation differs from a city to another; the poor response for health issues is noted in many provinces such as Deir Ezzor, Al Raqqa, and Al Hasaka. There is a relative better response in the capital, Damascus, which explains why it is the destination for the critical cases.
Justice for Life organization sheds the light on the capacities of Health Sector in Deir Ezzor province as the first COVID-19 cases were registered.
A Fragile Health Sector
Syrian Government Held Areas
Since 2012, Deir Ezzor has had an armed conflict among Syrian regular forces and other parties that controlled vast areas of the province, starting from armed opposition groups, until “Islamic State” group. Many hospitals and public clinics were completely or partially destroyed. Most of medical staffs fled to safer areas such as al Hasaka, Damascus, and Aleppo, or towards the areas out of government control such as Aleppo and Idleb countryside, or even out of the country.
The conflict phases were increasingly aggressive, yet as the government forces controlled the areas located in the south of the Euphrates river, and the Syria Democratic Forces controlled the areas located in the north of the river, the level of aggressiveness decreased, except for some limited clashes once in a while, or attacks that target government forces, foreign militias, and Russian forces from the desert as they are likely launched by “IS” militants.
The government forces’ constant bombardments have resulted in significant damage to the hospitals like Al Sa’e and Al Nour along with others in Al Mayadin and Al Boukmal cities. The siege laid by “IS” between 2015 and 2017, and the military actions nearby the city of Deir Ezzor negatively impacted “Al Assad” hospital, which is one of the basic healthcare centers in the city. After 2017, medications became noticeably available, but the hospitals were not enhanced as of the time of writing this report.
Syria Democratic Forces Held Areas
The required capacities are not available in the town and villages located in the north of the river as there are some private hospitals, one public hospital that is funded by international organizations, along with private clinics. Medications are available in pharmacies.
No clear-cut efforts were made by the controlling forces to care for health sector as there is a major dependency on what has been provided by the international organizations. Civilians are obliged to go to Damascus, or north of Syria, seeking for better medial equipment. Moreover, reaching to “Euphrates Shield” or “Olive Branch” areas enable the critical cases to enter Turkey for medical treatment.
The Current Available Capacities
As mentioned in the introduction, the province is not ready to confront the pandemic, and this may threaten the lives and safety of civilians. No enough efforts are made to sensitize about the gravity of the pandemic or about measures to be taken.
Government Held Areas
The medical services in Deir Ezzor city are limited to what is provided by the hospital of “Al Assad”, the military hospital, “Al Furat”, which is considered relatively better in terms of equipment and the availability of respirators. “Al Assad” hospital has severe need to the very basic equipment and instrument such as a single respirator to face the pandemic. Only two respirators are available in the military hospital, yet no civil cases could be hospitalized as the service is limited to military staffs. There are three Syrian Arab Red Crescent clinics in the city; the first one is located in Al Qusour neighborhood, nearby the State Security Branch, the second one is in the same neighborhood nearby Khalid bin Al Walid mosque, and the third one is located in Al Joura/ Al Thawra neighborhood, nearby Al Jaz bakery.
In Al Boukmal city, there is a small-scale hospital that consists of ten rooms. There is also a public clinic. Additionally, there is one field hospital for the foreign militias members.
The Iranian hospital and the sole clinic are the two public medical stations available in Al Mayadin city to provide medical services, which are limited to emergency with limited working hours. The Iranian hospital works from 08:00 until 17:00, whereas the clinic works from 08:00 until 14:00.
The private hospitals of Al Salam and Al Hammad work around the clock, yet they are not fully equipped; no X-ray equipment are available in both hospitals. In the eastern part of the city, there is a hospital that receives only cases of foreign militants.
The civilians maintain the curfew imposed by the government, yet without complying with the necessary preventive measures during the duration of free movement. This is based on the public carelessness and lack of effort to familiarize the local communities with the reality and consequences of the current situation.
There are thermometers in airports and some of the governmental directorates. All directorates and public transportation were sterilized. One quarantine center was appointed in each of “Al Assad” and “Al Furat” hospitals.
Only one case for a Syrian person was registered in Deir Ezzor city up to now in addition to three foreign persons, who likely entered the country from the Iraqi borders. They were tested before they entered, and the results were positive. The borders with Iraq were closed ten days ago, where only cargo transportations are allowed.
Syria Democratic Forces Held Areas
There is only one public hospital in Al Kasra sub-district along with other clinics and mobile clinics in the villages of Mhaimeeda, Abu Khashab, and al Sa’wa. All of these medical efforts are supported and funded by international organizations such Relief International, Medical Relief, and HI. These centers provide vaccination, checks-up, and some surgical operations.
In eastern Deir Ezzor, specifically in Hajeen sub-district, there are ten private hospitals in Hajeen city, the villages of Al Kushkeya, Abu Hamam, and Gharaneej along with public clinics.
The civil council’ health committee and civil society organizations held a number of symposiums to raise awareness about the impact of the deadly virus.
No case was officially registered up to this moment. A curfew was imposed on 25 March 2020 as all schools and civil council institutions were suspended. All gathering areas, cafes, restaurants are closed. transport across the city and between various parts of the country are banned. Border crossings have been closed. The government also provided thermometers in the medical stations. Civil society organizations were asked to provide preventive means such as masks and sterilization materials.
Detention Centers
The government and SDF security apparatuses keep a big number of detainees in their detention centers. According to published testimonies of witnesses who were interviewed by JFL, the minimum standards to maintain the health of the detainees are not available in most of those centers. The space of detention centers is limited with huge number of detainees. There is no hygiene or water on constant basis. This directly threatens the lives of the detainees in case of the virus outbreak.
Several civil groups and organizations highlighted these risks in a statement published on 23 March 2020.
Recommendations
1-The populations’ collaboration has a fundamental role in preventing the pandemic outbreak, and consequently decreasing the number of cases. In the light of the poor healthcare services, the role of populations is more important. JFL calls upon Deir Ezzor populations to take all preventive measures and precautions and to comply with the instructions related to stay at home as much as possible.
2-The Syrian government and Syria Democratic Forces:
-To release the political prisoners and human rights defenders, and not to commit new detentions.
-To take all necessary measures to prevent the pandemic outbreak inside the detention centers, and to allow the Red Cross and international organizations to visit those centers.
-To equip more quarantine centers and provide more preventive requirements.
-To provide respirators in an adequate manner in all hospitals.
-To hold more symposiums to raise awareness via media outlets and social media to raise awareness about the pandemic consequences and precautionary measures.
3-International and Local Organizations:
-To intensify efforts to provide medical requirements.
-To participate in the awareness campaigns.
