Coronavirus would be ‘impossible to manage’ in conflict zones, says Red Cross head of health

Having people give priority to containing coronavirus could be challenge in war zones, where many face more immediate threats

Displaced Syrian women walk at a camp in Kafr Lusin village on the border with Turkey in Syria's northwestern province of Idlib. When protesters in March 2011 demanded their rights and regime change, they likely never imagined it would trigger a reaction that has led to the 21st century's biggest war. Nine years on, President Bashar al-Assad is still in power and there to stay, more than 380,000 people have died, dozens of towns and cities razed to the ground and half of the country's entire population displaced. AFP

Syrian Ibrahim al-Ali is assisted by his children, at the Deir Hassan camp for the displaced where they reside, in Idlib's northern countryside near the Turkish border. The 33-year-old father of four first lost three fingers, later his hearing in one ear. Then all at once, both legs and eyes. Ibrahim al-Ali was wounded every time he tried to escape Syria's war. AFP

Syrian Ibrahim al-Ali sits in his wheelchair at the Deir Hassan camp for the displaced in Idlib's northern countryside near the Turkish border. The 33-year-old father of four first lost three fingers, later his hearing in one ear. Then all at once, both legs and eyes. Ibrahim al-Ali was wounded every time he tried to escape Syria's war. AFP

Displaced Syrian children pose for a picture at a camp created by Turkey's Humanitarian Relief Foundation (IHH) in Kafr Lusin village on the border with Turkey in Syria's northwestern province of Idlib. When protesters in March 2011 demanded their rights and regime change, they likely never imagined it would trigger a reaction that has led to the 21st century's biggest war. Nine years on, President Bashar al-Assad is still in power and there to stay, more than 380,000 people have died, dozens of towns and cities razed to the ground and half of the country's entire population displaced. AFP

Displaced Syrian children play in a camp created by Turkey's Humanitarian Relief Foundation (IHH) in Kafr Lusin village on the border with Turkey in Syria's northwestern province of Idlib. When protesters in March 2011 demanded their rights and regime change, they likely never imagined it would trigger a reaction that has led to the 21st century's biggest war. Nine years on, President Bashar al-Assad is still in power and there to stay, more than 380,000 people have died, dozens of towns and cities razed to the ground and half of the country's entire population displaced. AFP

Displaced Syrian children live in a camp created by Turkey's Humanitarian Relief Foundation (IHH) in Kafr Lusin village on the border with Turkey in Syria's northwestern province of Idlib. When protesters in March 2011 demanded their rights and regime change, they likely never imagined it would trigger a reaction that has led to the 21st century's biggest war. Nine years on, President Bashar al-Assad is still in power and there to stay, more than 380,000 people have died, dozens of towns and cities razed to the ground and half of the country's entire population displaced. AFP

A Syrian man rides his motorcycle in a destroyed neighbourhood of Sarmin town, about eight kilometres southeast of the city of Idlib in northwestern Syria. When protesters in March 2011 demanded their rights and regime change, they likely never imagined it would trigger a reaction that has led to the 21st century's biggest war. Nine years on, President Bashar al-Assad is still in power and there to stay, more than 380,000 people have died, dozens of towns and cities razed to the ground and half of the country's entire population displaced. AFP

A Turkish military tank is seen in a destroyed neighbourhood of Sarmin town, about eight kilometres southeast of the city of Idlib in northwestern Syria. When protesters in March 2011 demanded their rights and regime change, they likely never imagined it would trigger a reaction that has led to the 21st century's biggest war. Nine years on, President Bashar al-Assad is still in power and there to stay, more than 380,000 people have died, dozens of towns and cities razed to the ground and half of the country's entire population displaced. AFP

A Syrian woman waits with her children next to a motorcycle in Sarmin town, about eight kilometres southeast of the city of Idlib in northwestern Syria. When protesters in March 2011 demanded their rights and regime change, they likely never imagined it would trigger a reaction that has led to the 21st century's biggest war. Nine years on, President Bashar al-Assad is still in power and there to stay, more than 380,000 people have died, dozens of towns and cities razed to the ground and half of the country's entire population displaced. AFP

A mural painting is seen on the wall of a destroyed school in Sarmin town, about eight kilometres southeast of the city of Idlib in northwestern Syria. When protesters in March 2011 demanded their rights and regime change, they likely never imagined it would trigger a reaction that has led to the 21st century's biggest war. Nine years on, President Bashar al-Assad is still in power and there to stay, more than 380,000 people have died, dozens of towns and cities razed to the ground and half of the country's entire population displaced. AFP

People living in the most dangerous environments, including war zones and refugee camps, are worryingly defenceless against the coronavirus, aid agencies say.

Iraq's first suspected coronavirus cases at a camp for internally displaced people were found in Nineveh on Thursday, raising concerns about the spread of the disease among those living in close proximity.

Preventive measures have hindered humanitarian work in Iraq, with activities suspended and access constrained, the UN Office for the Co-ordination of Humanitarian Affairs said.

On Wednesday, the World Health Organisation confirmed a pandemic as countries tightened measures to combat the virus.

The US imposed a travel ban on 26 European countries as nations closed borders and imposed quarantines to manage rising infection rates.

But in conflict zones across the Middle East and worldwide, shattered health systems are ill-equipped to cope.

If the virus reached Syria and Yemen, the spread would be “impossible to manage", said Dr Esperanza Martinez, head of health for the International Committee of the Red Cross.

"When we look at the future and whether or not the countries affected by armed conflict will be able to respond," Dr Martinez told The National. "The situation is very bleak.

In Africa, health services in countries affected by conflict, including South Sudan, the Democratic Republic of Congo and the Central African Republic already struggle to meet demand.

“Any additional strain would bring these systems to their knees,” Dr Martinez said.

In Yemen, where sanitation facilities and water provision is scarce, even basic precautions such as regular hand washing are often beyond reach.

“This is a wake-up call to the fact that health systems in situations of crisis need to be strengthened to be able to tolerate shocks like this one,” Dr Martinez said.

The Red Cross is distributing educational material to people in conflict areas while teams try to increase access to clean water in dozens of areas affected by crises.

Soap is included in the assistance packages given to families fleeing violence.

But the issue is not just resources, it is time.

International funding has been allocated to support low-income countries but with no vaccine yet available, there's a need to support health services if infections do surface.

Syria, which has not yet confirmed a case of coronavirus, is particularly at risk.

In Idlib, where people have been pounded by months of bombardment that began the largest displacement since the start of the war, accessing food, clean water, medicine and warm clothing is already a daily struggle.

The bombing has depleted the number of hospitals in Idlib as the regime battles Turkish-supported rebels for control of the north-west province.

“These attacks have put out of service hospitals and clinics, but also specialised medical facilities that dealt with vaccinations, and laboratories that were essential to preventing the spread of diseases and epidemics, and containing them when they occur,” Mark Cutts, deputy regional humanitarian co-ordinator for Syria, said from the UN compound in Gaziantep, Turkey.

“It's a huge worry when you've got a large number of people living in overcrowded camps very close to each other in tents or in public buildings, sometimes all sleeping together in one big open space.”

For the thousands enduring freezing nights at the border between Greece and Turkey, and almost a million who have been displaced, coronavirus is not necessarily a priority.

“When you have a broken system, you cannot come in with interventions aimed at only one disease that might not be the most important cause of mortality for that community,” Dr Martinez explained.

For now, the focus is on preventing the virus from entering these areas, she said.

If it does, the danger zones would be detention centres and refugee camps, where a single case could spark a rapid transmission through communities living in close quarters.

But it is “uncharted territory”, Dr Martinez said.

“Governments, communities, humanitarian agencies – we are all walking into difficult times, particularly if we come to have a large number of cases in countries affected by armed conflict.”