Why coronavirus is a ticking bomb in war-ravaged northern Syria

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Updated 01 August 2020
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Why coronavirus is a ticking bomb in war-ravaged northern Syria

  • People in Idlib and northeastern Syria see themselves as sitting ducks if infections begin to spread
  • Region is particularly vulnerable owing to dire humanitarian conditions and risk of further conflict

ERBIL, Iraqi Kurdistan: As the coronavirus pandemic cuts a wide and deadly swathe through the Middle East and Asia, people in war-torn areas are pretty much sitting ducks, waiting to contract the infection.

Nowhere are crisis-ravaged communities more exposed to the deadly virus than in large expanses of Syria, especially in the country’s northwest and northeast.

Northern Syria is particularly vulnerable owing to dire humanitarian conditions and the risk of further conflict, analysts told Arab News.

The northwestern governorate of Idlib and the mostly Kurdish-controlled northeast, the two remaining areas outside the Syrian regime’s control, now face an invisible enemy.

Syria confirmed its first case on March 23, after insisting for weeks that the virus had not reached the country.

The regime had been waging an aggressive military campaign to retake territory in Idlib. For the past several weeks fighting has abated, especially after Turkey, which backs several rebel groups, reached a cease-fire deal with Russia, Syrian President Bashar Assad’s main military backer.

The hundreds of thousands displaced by the fighting have sought shelter in already overcrowded displacement camps, where conditions make it impossible for residents to practice social distancing or self-isolation.

Out of Idlib’s 2 million-plus population, at least 900,000 were displaced by the latest round of fighting between the regime and rebels.

“About a million people are displaced, living in tents along the Turkish border,” said Mustafa Gurbuz, a non-resident fellow at the Arab Center in Washington DC. “Social distancing is a luxury. There’s nothing called home, water shortage is pervasive, hygiene is impossible, and people are already suffering from poor health.” 

Under the circumstances, if a COVID-19 contagion infects only a few people, it could spread very quickly.

“Only a few cases could result in an explosive outbreak. If the fragile cease-fire derails, a renewed conflict may cause more displacement, which could lead to further spread of COVID-19,” Gurbuz said, referring to the March truce that brought the fighting in Idlib to a halt.

The UN has called for a cease-fire across all of Syria so that efforts can be focused on preventing a major outbreak, which could affect the lives of millions of people living in deplorable and unsanitary conditions across the country.

Aron Lund, a fellow with The Century Foundation, said Idlib is too disorganized and poorly equipped to handle an epidemic.

“There’s no coherent government, just a gaggle of militias half-heartedly strung together by a system of councils,” he said, adding that Idlib sorely lacks staff, medical facilities and medicine to cope with the likely effects of any significant outbreak.

Hundreds of thousands of people live cheek by jowl with each other in tent camps and decrepit buildings.

“Old people, who are most at risk of dying or falling very ill from the virus, are mixed up with children and have no way of isolating themselves for protection,” Lund said.




A policeman wearing a mask as a means of protection against the cononavirus Covid-19, directs the traffic at an intersection in the northeastern Syrian Kurdish-majority city of Qamishli. (AFP)

Furthermore, many people in Idlib have no access to clean or hot water, or necessities such as soap that can help prevent the spread of the virus.

To compound the crisis, the regime’s Russian-backed air campaign in Idlib saw repeated bombing of hospitals and health facilities, which has crippled the local health infrastructure and rendered it incapable of handling any outbreak.

When it comes to a COVID-19 outbreak, Idlib’s fears and vulnerabilities are mirrored by those of northeast Syria, most of which is controlled by the Kurdish-led Syrian Democratic Forces (SDF).

The news of the first death here — in a hospital in the city of Qamishli, which is under the regime’s authority — drew a strong reaction from the Kurdish Red Crescent and the SDF-backed Autonomous Administration of North and East Syria (NES) on Friday.

The Red Crescent lamented the “high risk of a large spread of the virus” due to the announcement by the World Health Organization (WHO) of “the positive result after 15 days of the case.”

Joshua Landis, director of Middle East studies at the University of Oklahoma, describes the area as “a ticking time bomb for the coronavirus.”

For instance, on March 29 Turkey and its armed proxies, which occupy part of northeast Syria since launching an invasion last October, cut off water supplies to the area by shutting down the Allouk water station, on which 460,000 people depend.

If these supplies are indefinitely withheld, hundreds of thousands of local inhabitants could fall prey to coronavirus for much the same reason that makes many civilians in northwest Syria vulnerable.

“Tensions are extremely high as six armies are in a standoff: The Turkish Army, the Syrian Army, the SDF, the US Army, along with Russian and Iranian forces stationed in the region, not to mention the many proxy militias, which have their own agendas,” Landis said. “This makes getting aid to the region or coordinating policy impossible.”

The medical infrastructure in northeast Syria, which was at best primitive even before the uprising began in 2011, has been devastated by years of conflict.

The SDF began to enforce a lockdown on March 23 in an attempt to contain any spread of the virus.

However, it sorely lacks testing kits for detecting COVID-19 cases and determining which individuals or areas might have the virus and need to be strictly quarantined.

The US-led anti-Daesh coalition has partially addressed the issue through the supply of $1.2 million worth of medical supplies to help the NES, but that is unlikely to be even nearly enough.




Members of the Syrian Civil Defence (White Helmets) disinfect a mosque in the city of al-Bab in the north of Aleppo province on March 24, 2020, as part of protective measures against COVID-19 coronavirus disease. (AFP)

In December, Russia and China used their veto power to prevent the UN Security Council from renewing permission for the delivery of aid to northern Syria from neighboring countries, in a move denounced as “callous” by Amnesty International, the human-rights advocacy group.

As a result, up to 400,000 medical items that would otherwise have been delivered to northeast Syria were left stuck in trucks in neighboring Iraq.

The Syrian regime, likely as part of a bid to pressure the SDF, has also prevented the flow of aid through Damascus.

The WHO says it has provided Syria with at least 1,200 testing kits, but the NES says Damascus has failed to provide protective equipment and artificial respirators.

This leaves the NES in a bind and more vulnerable to any outbreak given its heavy reliance on aid from the UN and NGOs, especially for the region’s displaced-persons camps and overcrowded prisons.

In the absence of a resumption of the flow of UN aid or unhindered passage of medical supplies through Damascus to NGOs, the meager resources of the NES are bound to become overwhelmed quickly in the event of an outbreak.

A coronavirus contagion in northeast Syria could also pose a very severe security threat to the region and possibly beyond.

“Some 10,000 Daesh fighters, along with close to 70,000 Daesh family members, are held in tight quarters, where social distancing is impossible,” said Landis.

At the very least, the situation in northern Syria is a big cause for concern as the pandemic causes havoc throughout the Middle East.

What is certain is that the pain and suffering of the war-weary people of Idlib and northeast Syria are unlikely to end anytime soon.


How falling cases of tuberculosis in Iraq reflect a wider health system recovery

Updated 7 sec ago
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How falling cases of tuberculosis in Iraq reflect a wider health system recovery

  • Iraq has halved its tuberculosis rate over the past decade through tech-driven diagnosis and expanded mobile health services
  • AI-supported X-rays and GeneXpert machines now detect TB faster, even in remote areas and among high-risk populations

DUBAI: Sameer Abbas Mohamed, a Syrian refugee from Qamishli who fled to Iraq in 2013, was terrified when his one-year-old son, Yusuf, was diagnosed with tuberculosis. He knew the disease was life-threatening — and highly contagious.

“I have two older boys, and I was scared they would catch the disease,” said Mohamed, who lives in Qushtapa refugee camp for Syrians in Irbil, home to most of the 300,000 Syrian refugees in the Kurdistan Region of Iraq.

“Yusuf was also very young and I worried about losing him.”

An IOM medic checks a little girl at the family's rented house in Kirkuk. (Photo: Anjam Rasool/IOM Iraq, 2019)

Mohamed consulted several doctors when Yusuf began coughing. Scans revealed a mass on the right anterior wall of his chest. A diagnosis was finally made when a general surgeon reported the case to Iraq’s National TB Program.

Following surgery to remove the mass, Yusuf returned home, where nurses delivered an all-oral regimen, monitored his treatment, tracked his progress, offered support, and educated the family on isolation measures to prevent the disease’s spread.

Within six months, Yusuf was cured.

His journey reflects the progress made in combating TB in Iraq, especially the drug-resistant variant that has emerged in the conflict-affected country — which until recently had the region’s highest prevalence of TB cases.

Iraq’s NTP, supported by the International Organization for Migration, the Global Fund, and the World Health Organization, is tracking TB among displaced communities using advanced diagnostic technologies and artificial intelligence.

Giorgi Gigauri, IOM Iraq’s chief of mission, told Arab News that TB detection and timely treatment have helped to drive a significant decline in cases in Iraq.

This was achieved, he said, through a tech-driven strategy, including the installation of the advanced 10-color GeneXpert detection machine across Baghdad, Basrah, Najaf and Nineveh, enabling faster diagnoses.

IOM’s mobile medical teams were also equipped with 10 AI-supported chest X-ray devices, known as CAD4-TB, which can detect the disease in seconds — even in high-burden areas such as refugee camps and prisons.

FAST FACTS

• TB is caused by the Mycobacterium tuberculosis bacterium that primarily affects the lungs.

• It spreads through airborne droplets when an infected person coughs or sneezes.

• Symptoms include a persistent cough, chest pain, fever, night sweats and weight loss.

• With proper treatment using antibiotics, TB is curable, though drug-resistant strains exist.

Routine screenings by these mobile units helped to increase the detection rate of drug-resistant TB from 2 percent to 19 percent, and drug-sensitive TB from 4 percent to 14 percent between 2019 and 2024, according to IOM data.

After screening, sputum samples are taken to central labs, making testing accessible for those unable to travel or living in areas with limited health care access.

Thanks to these efforts, TB cases in Iraq have fallen dramatically — from 45 to 23 cases per 100,000 people between 2013 and 2023. The current prevalence is 15 per 100,000, with an estimated mortality rate of three per 100,000.

In many ways, these numbers reflect Iraq’s wider public health recovery after decades of instability, including the crippling sanctions of the 1990s, the successive bouts of violence that followed the 2003 US-led invasion, and the 2014 rise of Daesh.

“Despite years of instability, progress made in the detection, treatment and prevention of the spread of TB restored trust in health care services by strengthening infrastructure and extending care to vulnerable groups like prisoners and displaced populations,” Gigauri told Arab News.

“It also supports upskilling of health professions and creates sustainable systems that can support responses to other communicable diseases.

“Efforts made by all partners under NTP have contributed to national recovery by addressing urgent health needs and laying a foundation for timely detection of preventable and treatable diseases.”

Despite a period of relative stability, Iraq still faces considerable humanitarian pressures amid a fragile economy and an unpredictable security landscape. According to UNHCR, more than 1 million Iraqis remain internally displaced, with 115,000 living in 21 camps across the Kurdistan Region.

Roughly five million displaced people have returned to their towns and villages since Daesh’s territorial defeat in 2017. But these areas often lack basic infrastructure, increasing the risk of TB outbreaks.

In Mosul — Iraq’s second-largest city, which endured three years under Daesh — those unable to afford housing live in overcrowded settlements, where malnutrition and exposure to the elements weaken immunity.

The mobile medical teams have been a game-changer for these vulnerable communities.

Digital X-rays equipped with CAD4-TB, powered by AI, now enable quick and accurate TB detection — a stark improvement from the three-month wait many patients once faced for CT scans.

This technology also reduces radiation exposure. A single CT scan can expose patients to the equivalent of 300 X-rays, according to Dr. Bashar Hashim Abbas, manager of the Chest and Respiratory Diseases clinic in Mosul.

Abbas said that mobile medical teams and digital X-ray devices have been vital for reaching remote communities and detainees who lack clinic access.

“The mobility of these machines helped us examine prisoners who were difficult to bring into the clinic due to complex security protocols. We discovered many cases, especially multidrug-resistant TB patients, in this way,” Abbas told Arab News.

“We conduct X-rays and take sputum samples for further lab investigations. Therefore, we take the diagnostic tools to them as much as we can, scaling up TB prevention and providing treatment.”

A centralized disease surveillance system, District Health Information Software 2, allows lab results to be registered and coordinated across labs, facilities, and the Iraqi Ministry of Health, improving routine TB reporting.

IOM’s TB services reached 6,398 people in 2024, with 120 drug-resistant TB cases treated. These efforts have been bolstered by $11 million in Global Fund support since 2022.

A key breakthrough has been shifting the treatment of multidrug-resistant TB from a burdensome series of injections to a simpler, all-oral regimen, which shortened recovery time from two years to six months and significantly improved outcomes.

“Previously, treatments involved daily injections for at least six to eight months, which were difficult to sustain for patients and treatment outcomes were relatively poor at 50 percent,” Grania Brigden, senior TB adviser at the Global Fund, told Arab News.

“However, the innovation in treatment through the all-oral regimen has reduced treatment to six months with a 75 percent to 80 percent success rate.”

Although no new TB vaccines are currently available, researchers are optimistic about developing more effective ones in the next five years. The existing BCG vaccine offers only partial protection and is less effective for adults and adolescents, who are more prone to transmission.

New vaccines are vital for achieving the WHO’s End TB Strategy goals — reducing TB mortality by 95 percent and incidence by 90 percent by 2035. Brigden said ongoing investment is key to meeting these targets.

Meanwhile, the Global Fund is focused on halting TB’s spread in Iraq. “We have invested significantly in commodity security to ensure that everyone who tests positive or is notified of TB is put on treatment,” said Brigden.

Thanks to these steps, many — like young Yusuf — are alive today who might otherwise have succumbed without proper care.

“The discussions of tuberculosis we had with the nurse who gave the medication had a positive impact on us,” said Yusuf’s father, Mohamed.

“The nurse gave us information on how to isolate him after the first two to three weeks. He reassured us that if we gave him the medication regularly and made sure there were no gaps, everything would be getting well.

“This made us less scared.”
 

 


Anxiety clouds Easter for West Bank Christians

Updated 59 min 33 sec ago
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Anxiety clouds Easter for West Bank Christians

  • ‘There is a constant fear, you go to bed with it, you wake up with it’

ZABABDEH: In the mainly Christian Palestinian town of Zababdeh, the runup to Easter has been overshadowed by nearby Israeli military operations, which have proliferated in the occupied West Bank alongside the Gaza war.

This year unusually Easter falls on the same weekend for all of the town’s main Christian communities — Catholic, Orthodox and Anglican — and residents have attempted to busy themselves with holiday traditions like making date cakes or getting ready for the scout parade.

But their minds have been elsewhere.

Dozens of families from nearby Jenin have found refuge in Zababdeh from the continual Israeli military operations that have devastated the city and its adjacent refugee camp this year.

“The other day, the (Israeli) army entered Jenin, people were panicking, families were running to pick up their children,” said Zababdeh resident Janet Ghanam.

“There is a constant fear, you go to bed with it, you wake up with it,” the 57-year-old Anglican added, before rushing off to one of the last Lenten prayers before Easter.

Ghanam said her son had told her he would not be able to visit her for Easter this year, for fear of being stuck at the Israeli military roadblocks that have mushroomed across the territory.

Zababdeh looks idyllic, nestled in the hills of the northern West Bank, but the roar of Israeli air force jets sometimes drowns out the sound of its church bells.

“It led to a lot of people to think: ‘Okay, am I going to stay in my home for the next five years?’” said Saleem Kasabreh, an Anglican deacon in the town.

“Would my home be taken away? Would they bomb my home?“

Kasabreh said this “existential threat” was compounded by constant “depression” at the news from Gaza, where the death toll from the Israel’s response to Hamas’s October 2023 attack now tops 51,000, according to Gaza’s Health Ministry.

Zababdeh has been spared the devastation wreaked on Gaza, but the mayor’s office says nearly 450 townspeople lost their jobs in Israel when Palestinian work permits were rescinded after the Hamas attack.

“Israel had never completely closed us in the West Bank before this war,” said 73-year-old farmer Ibrahim Daoud. “Nobody knows what will happen.”

Many say they are stalked by the spectre of exile, with departures abroad fueling fears that Christians may disappear from the Holy Land.

“People can’t stay without work and life isn’t easy,” said 60-year-old math teacher Tareq Ibrahim.

Mayor Ghassan Daibes echoed his point.

“For a Christian community to survive, there must be stability, security and decent living conditions. It’s a reality, not a call for emigration,” he said.

“But I’m speaking from lived experience: Christians used to make up 30 percent of the population in Palestine; today, they are less than one percent.

“And this number keeps decreasing. In my own family, I have three brothers abroad — one in Germany, the other two in the United States.”

Catholic priest Elias Tabban adopted a more stoical attitude, insisting his congregation’s spirituality had never been so vibrant.

“Whenever the Church is in hard times... (that’s when) you see the faith is growing,” Tabban said.


Houthi media says US air strikes hit Sanaa

People inspect the site of a reported US airstrike in Sanaa, a day after the attack. (File/AFP)
Updated 16 April 2025
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Houthi media says US air strikes hit Sanaa

  • Houthi-held areas of Yemen have endured near-daily strikes, blamed on the United States, since Washington launched an air campaign against the militia on March 15

SANAA: Houthi media said more than a dozen air strikes hit the militia-held capital Sanaa on Wednesday, blaming them on the United States.
Houthi-held areas of Yemen have endured near-daily strikes, blamed on the United States, since Washington launched an air campaign against the militia on March 15 in an attempt to end their threats to shipping in the Red Sea and Gulf of Aden.
“Fourteen air strikes carried out by American aggression hit the Al-Hafa area in the Al-Sabeen district in the capital,” the Houthis’ Al-Masirah TV reported.
It also reported strikes blamed on the United States in the Hazm area of Jawf province.
The US campaign followed Houthi threats to resume their attacks on international shipping over Israel’s aid blockade on the Gaza Strip.
Since March 15, the Houthis have also resumed attacks targeting US military ships and Israel, saying they are acting in solidarity with Palestinians in the Gaza Strip.
The Houthis began targeting ships transiting the Red Sea and Gulf of Aden, as well as Israeli territory, after the Gaza war began in October 2023, later pausing their attacks during a recent two-month ceasefire.
Israel cut off all supplies to Gaza at the beginning of March and resumed its offensive in the Palestinian territory on March 18, ending the truce.
The vital Red Sea route, connecting to the Suez Canal, normally carries about 12 percent of world shipping traffic, but the Houthi attacks forced many companies to make a long detour around the tip of southern Africa.


At least 8,000 missing in war-torn Sudan in 2024: Red Cross

Updated 16 April 2025
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At least 8,000 missing in war-torn Sudan in 2024: Red Cross

PORT SUDAN: At least 8,000 people were reported missing in war-ravaged Sudan in 2024, the International Committee of the Red Cross (ICRC) said on Wednesday, adding that the figure is just “the tip of the iceberg.”
“These are just the cases we have collected directly,” Daniel O’Malley, head of the ICRC delegation in Sudan, told AFP. “We know this is just a small percentage — the tip of the iceberg — of the whole caseload of missing.”


Qatar renews $60m grant for Lebanon army salaries

Updated 16 April 2025
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Qatar renews $60m grant for Lebanon army salaries

  • The provisions were to enable Lebanon’s army to “carry out its national duties of maintaining stability”
  • The Lebanese President arrived in Qatar on Tuesday

DOHA: Qatar is to renew a $60 million grant to pay the salaries of Lebanon’s army and provide 162 military vehicles, the two countries said on Wednesday following Lebanese President Joseph Aoun’s first official visit to the Gulf state.
Qatar’s ruler Sheikh Tamim bin Hamad Al-Thani “announced the renewal of the Qatari grant to support the salaries of the Lebanese army, amounting to USD 60 million, in addition to 162 military vehicles,” a joint statement said.
It added the provisions were to enable Lebanon’s army to “carry out its national duties of maintaining stability and controlling the borders throughout Lebanese territory.”
Aoun, who was elected in January after more than two years of caretaker government in Beirut, has been tasked with charting a course out of the country’s worst economic crisis and reconstruction after all-out war between Israel and Hezbollah.
The Lebanese President arrived in Qatar on Tuesday accompanied by foreign minister Youssef Raggi, and departed Doha on Wednesday afternoon, the official Qatar News Agency reported.
The Gulf state in February pledged support for reconstruction in Lebanon after the recent conflict and was already a provider of financial and in-kind support to the Lebanese army.
“Both sides emphasized the national role of the Lebanese army, the importance of supporting it, and the need to implement Resolution 1701 in all its provisions,” the joint statement added, urging “de-escalation in southern Lebanon.”
United Nations Security Council Resolution 1701 ended a 2006 war between Israel and Hezbollah and formed the basis of the November truce that largely ended more than a year of fresh hostilities between Israel and the Iran-backed group.
The resolution calls for the disarmament of all non-state armed groups and said Lebanese troops and UN peacekeepers should be the only forces in south Lebanon.
Israel was due to complete its withdrawal from Lebanon by February 18 after missing a January deadline, but it has kept troops in five places it deems “strategic.”