Covid-19: 'If there was a severe outbreak in Syria, there would be a bloodbath'


While the Covid-19 pandemic has killed more than 180,000 people worldwide and infected more than 2.5 million, Syria has officially reported relatively few cases. If the epidemic were to worsen there, the death toll would be all the higher as the country, still under international sanctions, lacks basic medical equipment.

Nine years of war have left Syria battered. Although a ceasefire was reached by Russian President Vladimir Putin and Turkish President Recep Tayyip Erdogan on 6 March, the fighting gave way to a new invisible enemy: the coronavirus.

Covid-19 has already achieved a strong foothold in the region, particularly in neighbouring Iran. But it appears to have spared the Syrians, at least for the moment. According to official figures published by the Syrian Ministry of Health on April 19, Syria has only recorded 42 cases of Covid-19, three deaths and six recoveries.

In March, as the whole world was beginning to go into lockdown, Syrian President Bashar Al-Assad closed borders, schools, restaurants and restricted the movement of people between provinces in order to prevent the spread of the virus.

Roughly 100 people are currently tested every day, mostly in Damascus. But the number tested is far too few, according to Dr. Nabil Antaki, a gastroenterologist in Aleppo and founder of the Maristes Bleus d’Alep (Blue Marists of Aleppo), an association that has been helping the most destitute in the former economic capital of Syria since 2012.

The doctor, who never abandoned Syria despite the war, fears that the COVID-19 epidemic could result in "a bloodbath" in a country where 83 percent of the population lives in poverty and where the economy has been drained by international sanctions.

Has Syria been affected by the COVID-19 pandemic?

Nabil Antaki: There have been 39 cases reported in Syria to date. Three people have died, others are cured, others are still in quarantine. The majority of these cases are in Damascus and its suburbs, and there have been a few cases in Homs. The diagnosed cases were all concentrated in the same neighbourhood or village. They were completely quarantined. There are no reported cases in Aleppo.

Many people doubt the veracity of these figures and believe that the authorities are hiding the truth. I do think there are more, but they are simply not reported because they have not been formally diagnosed. As in other countries, we don't test everyone, only the really sick people. Someone with an asymptomatic coronavirus or with very few symptoms is not tested with PCR (a nasal swab used to determine if the patient is currently infected with the coronavirus). Everything is centralised in Damascus in the laboratory of the ministry of health. Samples are taken in the other cities and sent there. In the beginning, there were only 300 tests. But the WHO has provided thousands, so now we are able to test more people.

Are you in lockdown like much of the world? 

Antaki: The government’s response measures have developed in several stages. About a month ago, schools, universities, public places and gardens, restaurants were all closed. A week later, there was a ban on opening boutiques such as hairdressing salons and all shops were closed apart from food shops and pharmacies. The following week, a curfew was imposed from 6 p.m. to 6 a.m. On 20 April, the authorities allowed small shops to re-open in rotation. Two weeks ago, travel was banned from one town to another, including within the same region. On 19 April, they announced two days to travel between towns, probably because Ramadan starts on Friday and families have to be reunited. People had been caught off guard by the lockdown and had not been able to return home.

Do you have any masks, hydroalcoholic gel? Are the hospitals prepared to receive serious cases?

Antaki: There are enough masks. When I listened to Emmanuel Macron's speech promising enough masks for 11 May in France, I burst out laughing because a country like Syria, after 9 years of war and suffocated by international sanctions, we already have enough! As for the hydroalcoholic solutions, these are made locally. There were already a few companies that used to make them for hospitals. With the arrival of the virus, they have increased their production. On the other hand, if we experience a crisis as serious as in Europe or the United States, we don't have enough intensive care beds and ventilators. When there is an epidemic, out of every 100 patients, 10 will need to be hospitalised and between 5 to 6 will need ventilators. If there were 1,000 cases of Covid-19 in Aleppo, that would mean between 50 to 100 people would need a ventilator. And we don’t have 100 in public or private hospitals. The WHO has provided some and the Pope offered about 10 to Syria last week. But if there were a severe outbreak, there would be a bloodbath. People would die for lack of ICU beds and ventilators. We don't have enough equipment to handle the heavy cases.

The real problem here is prevention: people put on their masks, use disinfectant solutions, but there is no social distancing. In the Middle East, people like to stick together. Even if everything is closed, they are side by side in front of bakeries and shops. They can't manage to apply this rule. I tell them, "There's no point in putting masks on and using gel if you're standing next to each other".

How are patients with a positive diagnosis treated? Do you use hydroxychloroquine?

Antaki: There is no accepted protocol. The department of health has given several options to doctors treating COVID-19, including French Professor Raoult's suggestion and an anti-viral currently in vogue in the United States. The rest is supportive treatment with oxygen and a ventilator. When we started hearing about Professor Raoult's ideas, many people went to pharmacies to buy plaquenil (hydroxychloroquine) and azithromycin. I also bought enough to treat four people, just in case. But I don't know if I will use them, given the ongoing controversy.

What about the camps for internally displaced people and refugees? Should we be concerned about the spread of the virus there?

Antaki: So far, there are no recorded cases. The Maristes bleus are running a Kurdish refugee camp 20 miles outside Aleppo. Two years ago, they fled the region of Afrin in northern Syria when the Turkish army arrived. We go there twice a week. I'm in charge of the camp's medical team and we haven't found any cases. When we distribute food and health kits, people stand three metres apart. We take our precautions.

How is the security situation now? Is there still fighting, especially near Aleppo?

Antaki: On 16 February, the Syrian army launched an offensive to liberate part of Idlib province. It took control of the main motorway linking Aleppo to the rest of Syria and liberated the western suburbs of Aleppo, which were still under the control of armed rebel groups. These groups had continued to bombard Aleppo every day, even after the liberation of the eastern neighbourhoods three years ago. When the Syrian army did this, the people of Aleppo rejoiced. After years of war, they could finally sleep without fear of a shell falling, and they could also use the motorway that links Homs, Damascus and even Lebanon. The next day, a civilian plane landed in Aleppo for the first time in eight years. But then there was a counter-offensive by armed rebel groups supported by the Turkish air force and drones. They regained control of the motorway and some areas liberated by the Syrian army.

At the end of February, negotiations between Russia and Turkey led to a ceasefire agreement. The rebels withdrew from the motorway and, since the beginning of March, there has been no more fighting in Syria. The situation is completely frozen. No bullets have been fired since 1 March. And, with the COVID-19 crisis, young people are no longer being called up for military service.    (FRANCE24)

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