Syria: Lack of adequate COVID-19 response puts thousands of lives at risk

Nearly eight months into the COVID-19 pandemic, the Syrian government is failing to adequately protect its health workers, still lacks a robust response to the spread of the disease, and is refusing to provide transparent and consistent information about the country’s COVID-19 outbreak, Amnesty International said today.

Relatives of COVID-19 patients, medical professionals and humanitarian workers have told Amnesty International that public hospitals have been forced to turn patients away due to a lack of beds, oxygen tanks and ventilators. In desperation, some residents have been forced to rent oxygen tanks and ventilators at exorbitant fees. Thousands of lives, including those of health workers, continue to be at risk with no transparent and effective information, or testing.

“Syria’s crumbling health system was already at breaking point before the pandemic. Now, the government’s lack of transparency about the scale of the COVID-19 outbreak, its inadequate distribution of personal protective equipment, and lack of testing is further endangering health workers and the general population,” said Diana Semaan, Amnesty International’s Syria researcher.

“As a matter of urgency, the Syrian government must ensure that health workers looking after COVID-19 patients are protected with adequate PPE and that they receive training on how to use this equipment. If the government does not have capacity, it should seek further support from international health organizations working in areas under its control.”

The Syrian authorities appear to be significantly under-reporting COVID-19 counts. On 22 March, the Syrian government declared the first COVID-19 case.  As of 10 November, the Ministry of Health reported 6,352 cases of COVID-19, including 325 deaths. On 29 August, Ramesh Rajasingham, Acting Assistant Secretary-General for Humanitarian Affairs and Deputy Emergency Relief Coordinator, told the UN Security Council “reports of health care facilities filling up, of rising numbers of death notices and burials, all seem to indicate that actual cases far exceed official figures”. Mr. Rajasingham added that the cases could not be traced to a known source, which also indicated weak testing and surveillance systems to control outbreaks of the disease.

Between August and October, Amnesty International spoke to 16 doctors, humanitarian workers, and family members of COVID-19 patients in Damascus and Daraa in Syria and outside the country. All testimonies indicate that the situation is worse than it was eight months ago.

The Ministry of Health is not publishing information about the impact of COVID-19 on health workers; the only available information is what the ministry reports to the UN. As of October, a total of 193 health workers had tested positive for COVID-19 but evidence suggests that the number could be much higher due to a lack of testing. Eleven health workers are reported to have died of COVID-19, but Syria’s union of doctors have reported that at least 61 health workers had died of the disease as of August 2020.

A crumbling health system

The outbreak of COVID-19 has added more pressure on Syria’s health care system, which has been decimated by almost a decade of conflict. According to the World Health Organization, only 50% of hospitals across Syria are fully functioning, 25% are partially functioning due to a shortage of staff, equipment, medicines or damage to hospital buildings, while the remaining 25% are not functioning at all.

While WHO and other Damascus-based international humanitarian organizations claim that they have provided the Syrian government with PPE, humanitarian workers told Amnesty International that the authorities have been extremely slow in its distribution for unknown reasons.

Relatives of people infected in Damascus told Amnesty International that despite providing much better medical care than public hospitals, private facilities have had to turn away COVID-19 patients because the authorities are only allowing public hospitals in Damascus to treat COVID-19 patients.

One doctor told Amnesty that after his grandfather showed COVID-19 symptoms around mid-July, his family took him to two public hospitals in Damascus but there weren’t any available beds. He died two weeks later. The doctor said:

“The hospital only ran tests and told my family he would need an oxygen tank. With some difficulty, we managed to rent an oxygen tank but three days later he died. My family was barely able to pay for the oxygen tank because prices have significantly increased as more and more people are in need of oxygen tanks and ventilators.”

Lack of transparency and access to testing

Testing is key in understanding the scale of the outbreak and informing government policy. Likewise, the publishing of data is crucial so the public is informed and understands the scale of infections and its impact on society and the health sector. And yet, testing sites remain significantly limited in Syria. According to the UN, there are five laboratories to process COVID-19 tests for the 15 million people living in all of the areas under the government’s control. There continues to be no testing sites in Daraa and north-east Syria where infection rates have significantly increased in past months.

In Daraa, residents and a doctor told Amnesty International that testing has not been available since June, and when testing was available the results took up to a week as all tests were sent to the Central Public Health Laboratory in Damascus for processing. In the north-east, the UN reported that cases are believed to be higher than 4,164 due to significant gaps in detection and testing capacity.

The Ministry of Health publishes a daily data report on the number of confirmed cases, deaths and recoveries; however, the data excludes the number of tests carried out per day. Relatives of people infected, humanitarian workers and a doctor in Damascus, told Amnesty International that testing is only available to people travelling outside Syria.

In August, the Ministry of Health stated that the government was unable to conduct public testing due to “an unjust economic blockade imposed on the country, which affected the health sector.” A month later, it said it would be allocating 300 tests a day for people travelling outside Syria at a fee of $100 [around 51,000 Syrian pounds] when the average monthly salary is around 60,000 SYP.

Two humanitarian workers told Amnesty International that the government’s low testing capacity is due to a lack of a coherent government policy to address the pandemic, lack of awareness about the importance of testing, and bureaucratic hurdles due to the centralization of decision-making.

Amnesty International calls on the Syrian government to ramp up its public health response by ensuring adequate access to quality health care for all, and ensuring that health workers have access to necessary protective equipment. Moreover, the expansion and disclosure of accurate and up-to-date information about the spread of the virus is key to effectively address COVID-19.