Rebel-held Syria braces for coronavirus 'tsunami' -- without soap, running water or the prospect of social distancing  03/26/2020 13:43:55  2

"We try with our limited capabilities to keep clean. All those sanitizers, cleaning materials that you are talking about, we can't get," Um Alitells CNN.

The family has dodged death multiple timesover the course of the ongoing nine-year conflict in Syria.They fled a regime assault inHama province when the war began in 2011, moving from one townto the nextas thefightingdragged on.

Butthey can't run away from the global pandemic.COVID-19is heading toward the war-ravaged province like a "slow moving tsunami,"the World Health Organizationsays, and could claimtens of thousands of lives.

Idlib's population of3million, already buckling under extreme shortages of medicine,isconsidered to be one of the world's most defenseless against the virus.

Medical facilitiesin Idlibhave been decimated in targeted airstrikesover the years.Doctors are already overstretched and hospital beds are in short supply.A brutal Syrian governmentoffensive-- propped up by Russiaand Iran--that was launched in Decemberaddedmore pressure on the flailing healthcare facilities. The latest string of attacksalsodisplaced nearly 1million people, crammingthegrowinginfluxof familiesinto sprawling camps with no infrastructure and increasingly unsanitary conditions.

The humanitarian crisiscouldculminate inan unparalleled health crisis whenCOVID-19reachesSyria's northwest, saysDr.Munther Khalil from the opposition-controlledIdlib Health Directorate (IHD).

"We don't know if we have the coronavirus yet, but we are expecting a tsunami with a high death toll because of the lack of medical infrastructure," he says.

Medics are raising awareness about hygiene requirements, butit'sa hard sell for a populationreeling fromthe effects of war. "They have been through bombs, freezing to death, chemical attacks, so they are already resignedto death," Khalil said.

Idlib has only 1.4 doctors per 10,000 people, according to the IHD. Hospitals are already running at over-capacity, withan average150% occupancy rate,according to the IHD. There are only around 100adult ventilators in opposition-heldparts ofSyria, which includes Idlib andsectionsof the countryside of nearby provinces, and fewer than 200 ICU beds.

Dr. Mohammed Shahem Makki is the only person in Syria's rebel-held territories who can carry out tests.

WhenCOVID-19spreadsthrough the rebel enclave, more than 100,000 people could die, according to Khalil.

TheEarly Warning and Alert Response Network(EWARN),the only disease surveillance group operating inthis part ofSyria,says that between40and70%ofthepopulationcould get infected,based on global transmission rates.

According to those estimates,at least1.2 million people in Idlibcould contract COVID19, explainsDr.Naser Mhawish,the surveillance coordinator of EWARN.

Testing for the coronavirus, another key component of the battle against the spread of the pandemic, has been slow to start.

In all of opposition-held Syria, only one doctor and one device can carry out tests for the virus. After weeks of waiting, 300 tests privately purchased by EWARN from a Turkish manufacturer arrived at the Idlib Central Hospital's laboratory on Wednesday. So far, they have tested four suspected cases -- all turned out negative.

The World Health Organization has said thatitwill also deliver some testing kits to opposition-held Syria.Sofar, these have not arrived, according to medical professionals in the enclave.

The organization has come under criticismfor its slow response to the possibility of the pandemic hitting opposition-held areas, while making a delivery of the tests to Damascus.

"Corona(virus)and after corona(virus)--the suffering in this area will continue and nobody will do what they have to do to stop this catastrophe," Khalil says. "In general we think that the WHO and some donors they don't care a lot about this area."

The country's ongoing civil war has complicated the emergency health response, according to WHO's acting RegionalEmergencyDirector Rick Brennan.

"The delay in supplying test kits tonorthwest Syriadoes not imply any favoring of one side of the conflict over the other, as some may choose to interpret it," Brennan says.

"We are busting our guts to make sure everything is ready,"he says.

Even in government-controlledparts of Syria,capacity for testing remains low.The country hasreported onlyfive confirmed cases, but experts expect a bigger spread.

The White Helmets, accustomed to rescuing people from the rubble and dodging bombardment, are now facing off with the new coronavirus.

Damascus has received1,200testing kits from the WHO. According to the organization's Damascusrepresentative,Dr.Nima Saeed Abid, 300 of these were used.

All of Syria is considered by the WHO to be a very high riskcountry in the event of the pandemic's outbreak. It has the largest population of internally displaced people in the world and its war has dealt a major blow to its health sector.

TheWhite Helmetsrescue group, officially known as Syria Civil Defense, are once again on the frontlines. Accustomed to pulling people from rubble as airstrikes pummel towns, the rescuers are now trying on hazmat suits.

"This pandemic is making my mind busy all the time, our work has been changed now and this is something that we are not used to do," says Laith Abdullah, a White Helmets volunteer.

The group has been retraining its volunteers to combat a new, invisible assailant. White Helmets volunteers have been disinfecting schools, IDP shelters and camps as a preventative measure against the spread of the virus. They have also helped set up quarantine facilities with limited resources.

"I am worried and have anxiety now because of the possibility of our capacity being divided while we face the coronavirus and a possible Syrian regime operation at the same time," says Ahmad Abu al-Nour, another volunteer.

One key humanitarianeffortin Idlib is to raise awareness about preventative measures to contain the spread of the virus. The Turkish aid organization IHHhasbeen going from tent to tent explaining containment measures for coronavirus. Other local NGOs havealsobeen doing similar work. But without basic infrastructure, there is little that leaflets toutingthe importance of hand washing can do.

Back at the makeshift camp, FatimaUm Aliwalks out of her tent and pointstoan empty blue plastic barrel. It's her family's allotment of water. A water truck is meant to come to the camp once a day to distribute water. But today the water tanker hasn't arrived, and the barrel is empty.

"When someone has been through everything we have been through from being displaced to bombardments, do you think that a virus would make that much of a difference?"Um Alisays.

She is resigned to her fateand has decided tocling to her faith.

"I am afraid that we will get sick just like everyone else in the world," she says.

"But I am also not afraid because in God I trust."

Gul Tuysuz reported and wrote from Istanbul, Turkey. Arwa Damon, Zaher Jaber and Eyad Kourdi contributed reporting from Turkey and Syria.

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