The number of patients with suspected and confirmed COVID-19 in northwest Syria is surging, as reflected by an increase in patients at the isolation and treatment centre supported by international medical organisation Médecins Sans Frontières/Doctors Without Borders (MSF) in the national hospital in Idlib city.
Of the 542 patients treated at the centre since its opening in April 2020, more than 80 per cent were admitted in the past two months. Since 9 July, more than 19,538 confirmed COVID-19 cases had been recorded in northwest Syria as of 21 December. For a population of four million people, this figure might seem relatively small, but compared with the limited number of tests performed, this is indicative of an alarming situation, say MSF staff in Idlib.
The 30-bed centre in Idlib national hospital was initially established to provide care for patients with mild to moderate symptoms of COVID-19, yet in recent months staff have seen an increase in patients arriving with severe symptoms.
“People showing severe symptoms should be directly admitted to hospital,” says Dr Ibrahim, a medic who works at the centre, “but the capacity of hospitals to receive them is diminishing as the number of cases increases. Referring severe cases to other hospitals is also becoming more challenging.”
As well as the threat of hospitals becoming overwhelmed, the lack of testing in the region is a cause for concern. Without a test, people cannot know if they have COVID-19 when they first get symptoms. Just three laboratories in northwest Syria, all of them private, currently perform coronavirus tests. These labs provide free testing only on referral from a health facility; otherwise they charge for tests, making an early test unaffordable for many people with limited or no incomes. As a result, people often delay coming to a health facility until their condition is serious.
“People often don’t get tested until their health condition gets really bad,” says Dr Ibrahim. “Very rare are the ones who get tested as soon as they start showing symptoms. The more severe a case is, the longer they have to stay in the centre, making it harder for us to admit more people at higher risk.”
Every morning Dr Ibrahim, accompanied by the nursing team, does a ward round to check on patients in both wards of the centre: an 11-bed ward for patients with suspected COVID-19 and a 19-bed ward for patients with confirmed COVID-19. “The ward for suspected cases is full most of the time now and it can be hard to find a vacant bed,” says Dr Ibrahim.
MSF is also providing mental health counselling to patients at the centre. “Talking about COVID-19 is almost a taboo,” says Sara, an MSF nurse providing remote support to the centre. “Stigma is an issue within the communities, and we need to listen to people’s fears and concerns about COVID-19 in order to help them cope with it. We also fear this will contribute to more people hiding their infection and contribute to the virus spreading faster within communities – which is another reason why we find it important to work on this aspect.”
However, persuading patients to take up the offer of counselling can be a challenge, says Sara. “Despite the need for it, we are still seeing a big number of refusals by patients willing to receive mental health support,” she says.
From the onset of the pandemic, MSF scaled up its activities in northwest Syria to contribute to the fight against coronavirus. This has ranged from donating protective equipment to setting up triage stations in the hospitals it runs, supports or co-manages, to supporting the treatment centre in Idlib. MSF has constantly tried to work on different fronts while continuing to keep most of its regular activities running.
To further increase its COVID-19 response in northwest Syria, MSF recently opened another isolation and treatment centre for patients with mild to moderate symptoms. Since 8 December, 54 patients have been admitted, 12 of whom have tested positive for coronavirus. In the coming weeks, the capacity will be increased from 12 to 32 beds. MSF is also working in a 34-bed COVID-19 treatment centre in the town of Afrin in partnership with a local organisation. The centre provides care for patients with moderate symptoms and associated risk factors and for patients with severe symptoms who need oxygen support.
MSF teams are also working on coronavirus prevention, especially in camps across the region. For the almost 1.5 million internally displaced people living in camps in northwest Syria, overcrowding and shared living spaces mean that practising physical distancing is not an option, while a lack of regular access to soap and water can make it challenging to practice good hygiene. MSF teams have been distributing hygiene kits to displaced families and spreading awareness messages about COVID-19.
“The camps are overcrowded and people live close together,” says Dr Ibrahim. “The general situation could deteriorate quickly. If it does, I doubt the health system will be able to cope.”
Names in the article have been changed to protect anonymity.