With low incomes – or no income – Syrians in government-controlled areas are avoiding private hospitals, even after showing severe symptoms consistent with Covid-19.
Public hospitals are also not an option because most of them lack basic supplies and do not observe best practices. Oxygen canisters are in short supply and methods for treating complications from the disease are seldom followed. Beds have exceeded their capacity.
The National spoke to four Syrians from different households in Damascus and a doctor in the western city of Tartus.
Fearful of expensive medical bills and citing concerns about hygiene in public hospitals, or even compulsory quarantine in government-run health centres, they speak of a growing trend for old-fashioned home visits by doctors.
After surviving a decade of civil war, they all requested anonymity to speak freely and for their own safety. Covid-19 has become the new enemy and added to their economic and social woes.
Treating Covid at home
A local journalist also spoke to 10 Syrians for this report. All of them had the same overriding financial concerns about contracting the virus and developing severe symptoms.
Parents said they would weigh up whether to put food on the table for their children or consider their need for treatment.
"I was obsessed with the thought of dying if I go to a public hospital and in the meantime I couldn't afford the mind-boggling bills at a private hospital," said one of three mothers .
Her symptoms started with a mild headache and tiredness for five days then turned into fever, dry cough and a shortness of breath that lasted for 10 days.
The woman, 39, resorted to social media. She joined groups on WhatsApp and Facebook that provide tips on the food and drink patients should consume every day to obtain the vitamins their body needs.
Such advice is often accompanied by misinformation that can go viral: some believed women wearing the niqab, the face veil, were immune to the virus.
"I didn't have 1 per cent of trust in our public hospitals. I stayed at home and sought advice from WhatsApp on what to do. It was easier for me to quarantine at home, because I don't have children and my husband works for long hours away from home," she said.
"Who on Earth can afford the costs of intensive care units in a private hospital in Damascus?" she asked.
She explained that the average price of one day at an intensive care unit in a private hospital was about 700,000 lira, or as much as $560 depending on the central bank exchange rate.
National data barely reflects how bad the crisis is. The health ministry has reported 14,906 cases of Covid-19 and 981 deaths in government-held areas since last March.
But the UN believes the actual figures are significantly higher.
In recent months doctors and nurses have told several human rights groups, including Physicians for Human Rights, that major hospitals such as Al Assad University Hospital have exceeded their capacity or do not have the necessary equipment.
They reported a severe shortage of oxygen canisters, ventilators and beds, on top of a lack of access to clean water, sanitation and power after years of war.
Frontline workers said they did not have the protective equipment or training to treat complications from Covid-19.
The Syrian government defends itself against such reports, saying it was taking all steps needed to save lives and insisting it did not leave health workers to fend for themselves.
Despite this, testing capacity is highly limited and is not free of charge. A generic PCR test costs 120,000 lira – about $100.
A single oxygen canister, depending on the size, between 20 and 40 litres, can sell for more than $200. If available, the canisters are free of charge in public hospitals and can be refilled if bought privately.
As for the home visits by doctors, one visit costs roughly 50,000 lira, about $40 depending on the exchange rate used, and some of the doctors already shun them, fearing infection.
Such figures are prohibitive for most Syrians, because many of them live in abject poverty.
"I can't afford that," said Safaa, commenting on the medical bills for Covid-19 patients.
The government employee, with a monthly income of 50,000 lira, contracted the virus and developed painful symptoms, including a bad cough and bone ache that she said "were worse than the pain of labour" when she gave birth to her seven children.
Safaa avoided taking a PCR test when she developed symptoms along with her husband. They both viewed government activities to tackle the virus with deep suspicion.
"Our health system is in shambles. The sight of the unhygienic condition of toilets and wards at public health facilities makes me retch," she said.
But the consequences of delaying medical care can be serious, as was the case with a diabetic man who asked his family whether his condition merited the expense of a test or a visit by a doctor.
“He resisted going to the hospital for two weeks until his cough became severe, then he experienced difficulty breathing,” said his son, 24.
“We managed to get oxygen canisters, but his condition needed a sustained supply of oxygen.”
He took his father to a private hospital.
“I took him to Al Mahaini Al Hadeeth hospital thanks to the financial support of one of his close friends and the company he worked for,” he said.
His father needed an intensive course of treatment that included seven antibiotic injections that cost about $1,000 each, after he developed acute respiratory distress syndrome.
“The virus damaged 75 per cent of his lungs,” the son said.
It was too late to save his life. His father died last September even after completing the expensive treatment course. He was 54.