As the number of coronavirus cases in Syria increases, strained ties with the government and restrictions on aid into the north-east have left the Kurdish-led administration unprepared for an outbreak.
The Autonomous Administration of North-East Syria took control of the region amid the civil war that began in 2011, but President Bashar Al Assad is seeking to reassert his authority over the entire country.
This has left the local authority isolated in the face of the coronavirus pandemic that has killed more than 68,000 people.
Syria confirms its first case of coronavirus
“The Syrian government doesn’t negotiate with us because they don’t think we are an official government. They don’t work with us at all,” said Raperin Hassan, co-chairman of the region’s health authority.
The World Health Organisation has started testing for coronavirus in the war-ravaged Idlib region in north-west Syria and delivered 1,200 testing kits to the government in Damascus.
But the north-east has been left without access to testing, protective equipment or international assistance.
"The government doesn't let us know how much they get and they won't send us anything that they receive," Ms Hassan told The National.
The Syrian government has reported 10 confirmed coronavirus infections, far fewer than other countries in the region.
Observers say the low figure suggests a lack of transparency from Damascus, while the UN called it the "tip of the iceberg".
The Syrian Observatory for Human Rights war monitor says there were 260 cases in regime-controlled areas, with two deaths.
There have been no confirmed cases in north-east Syria, although this could be attributed to the lack of testing.
Ms Hassan said she hoped Damascus would help if the coronavirus spread to the north-east, but the Kurdish administration considers it unlikely because the Syrian government did not assist them, even in the fight against ISIS.
Nima Saeed, the acting WHO representative for Syria, said the UN agency did not see any problem with Damascus sharing test kits with the north-east.
"Both parties know very well that the virus doesn't respect lines of control," Dr Saeed told The National.
Even if the authorities in the north-east obtained testing kits, the samples would have to be sent to the Central Public Health Laboratory in Damascus, which can take more than a week to return results.
The region's most advanced testing centre, in the town of Ras Al Ain, is no longer operational after being shelled during the cross-border incursion by Turkish and allied Syrian rebel forces in October last year.
Dr Saeed said the WHO was “strongly advocating” the expansion of testing across the country but could not give a timetable, saying it depended on “the equipment in the market”.
Even if testing was available, the north-east lacks the medical facilities to treat people with Covid-19, the respiratory disease caused by the coronavirus.
The health authority said there were only 27 ventilators available for a population of about five million.
“If there are any suspected cases it would be a disaster for us,” Ms Hassan said.
“The biggest thing we need is protective equipment, ventilators and training.
"We are looking for help from the WHO to train people to deal with coronavirus and help to make places for isolation.”
Medical assistance to the region has been severely affected by the closure of the Yarubiyah border crossing from Iraq in January.
The UN Security Council approved the move under pressure from Mr Al Assad's ally Russia, which threatened to otherwise veto the extension of any cross-border aid.
Yarubiyah was the only viable route to deliver humanitarian assistance directly to north-east Syria.
The two other crossings still available, Bab Al Salam and Bab Al Hawa, are on the border with Turkey, which considers Syria's Kurds to be allied to its own Kurdish insurgents.
The UN Emergency Relief Co-ordinator, Mark Lowcock, said the north-east faced “significant shortages” of medical supplies since the crossing was closed.
“Many medical facilities and individuals in north-east Syria who depended on medical supplies via Al Yarubiyah have not received these supplies through alternative channels,” Mr Lowcock told the Security Council on March 30.
Adding to the worries of the administration is the sprawling Hol refugee camp, with more than 70,000 women and children – including at least 5,000 foreigners – who emerged from ISIS’s last stronghold of Baghouz in March last year.
The administration barred visitors from the crowded camp and installed body temperature monitors at the entrance to stop people with possible coronavirus infection having contact with residents.
NGOs have been told to reduce personnel working in the camp to a minimum.
Heval Mehmud, co-chair of the administration’s internal affairs authority, said it was setting up quarantine areas inside the camp but was concerned about managing an outbreak without direct WHO support.
"There are three field hospitals in Al Hol camp but they cannot do anything if the disease spreads because of their modest capabilities," Mr Mehmud told The National.
“We do not even have respirators in the main cities, so what does this mean for the camps?"
