Recent Developments in Northwest Syria - Situation Report No. 13 - As of 1 May 2020

Situation Report
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• The humanitarian situation in northwest Syria remains alarming as short-term emergency needs of the people who have been displaced since December are increasingly compounded by longerterm needs across host and IDP communities, such as malnutrition and lack of education.

• While a relatively calm situation prevails in northwest Syria as most hostilities came to a halt following the ceasefire of 6 March, the security situation and economic difficulties continue to take a heavy toll on the people.

• The economic situation in northwest Syria further exacerbates humanitarian needs as the prices of basic items such as food, water and hygiene items have reached new highs every month since November 2019.

• While no cases of COVID-19 have been identified in northwest Syria, humanitarian response focuses on preparedness, mitigation measures, and response planning to minimise the potential impact of COVID19 on communities and on humanitarian partners.

Situation Overview

The humanitarian situation remains alarming across northwest Syria. While active hostilities came to a halt in early March, the impact of recent military operations as well as multiple displacements, economic hardship and years of conflict continue to deeply affect the lives of civilians. The humanitarian needs of displaced people, returnees, and host communities, which are extremely high are further exacerbated by the potential impact of a COVID-19 outbreak in northwest Syria.

Of the nearly 1 million people in the area who fled their homes to escape from hostilities between December and early March, some 846,000 people reportedly remain in displacement in the northern parts of Idleb governorate and in northern Aleppo governorate. 60 percent of those who remain in displacement are estimated to be children and another twenty one percent women. The most urgent needs of the recently displaced individuals continue to be shelter, water, sanitation and hygiene, food and protection. About one third of the IDPs who are identified as needing shelter support are accommodated in IDP settlements while another 150,000 people would benefit from similar accommodation. Another 157,000 people who are identified as needing support for shelter rehabilitation have not been reached yet. While displacement becomes more protracted, needs with longer term impacts are increasing in prominence, including health, nutrition and education. In the last week, a significant gap in food assistance for 258,500 people has been identified. Malnutrition is also becoming an increasing problem. For example, 1 in 5 pregnant or lactating women are acutely malnourished, compared to 1 in 20 in the first half of 2019. Malnourished people have a compromised immune system and are therefore at elevated risk of mortality due to COVID-19. Only 20 percent of the treatment requirement for acute malnutrition has been distributed, in stock, or in the pipeline. Large gaps in the provision of learning materials and education in camps exist as well. About 20 percent of children and teachers who have been identified as needing support have received education services or learning material.

Humanitarian needs are also increasing in some parts of western Aleppo governorate and southern Idleb governorate as thousands of families reportedly return to areas from which they fled. As of 24 April, an assessment conducted by a UN partner estimated that 114,000 people who were displaced since 1 December 2019 have voluntarily returned to their areas of origin in these areas. An additional 21,000 people returned who had been previously displaced to these areas and then displaced again in the recent violence. Atareb in western Aleppo governorate and Ariha in Idleb governorate each received around a quarter of all who returned, with most others returning to Daret Azza in western Aleppo governorate and Sarmin, Ehsem, Jisr-Ash-Shugur and Mhambal in Idleb governorate. Some 80 percent of the 135,000 people who returned are women and children, roughly corresponding with the proportion of women and children among the overall population of those recently displaced in northwest Syria.

While most hostilities came to a halt in early March, the security situation and the economic difficulties continue to take a heavy toll on the four million people living in the area. Several IED incidents have been reported in March and April, both in the Idleb area and northern Aleppo. On 29 April, a truck loaded with explosives detonated in Afrin city, resulting in the death of at least 42 people including many women and children. The blast took place close to administrative offices and a market and the ensuing fire destroyed a large commercial area. Moreover, the economic situation puts additional strain on the limited resources that people have as the prices of basic items such as food, water and hygiene items have been increasing consistently, reaching new highs every month since November 2019. The purchasing power in northwest Syria has been eroding since autumn 2019 as the Syrian Pound began to rapidly lose value against the US dollar. Humanitarian actors are warning that vulnerable households are relying on negative and emergency coping strategies merely to meet their daily food needs, including the consumption of food items that have limited nutritional value.

Additional challenges have also arisen in light of the potential impact of the COVID-19 pandemic. As of 29 April, there are no known cases of COVID-19 in northwest Syria, while 43 cases have been confirmed by the Syrian Ministry of Health in other parts of Syria, including three fatalities. Current impacts on the humanitarian situation in northwest Syria are due to countermeasures taken to mitigate the potential spread of COVID-19. Precautions introduced by local authorities include the closure of schools and some markets, banning gatherings of people including for religious services, reducing operations of businesses including restaurants and grocery stores, and imposing curfews. At the Bab Al-Hawa and Bab Al-Salam border crossings between Turkey and Syria, individuals are no longer permitted to cross except in medical emergencies, while humanitarian staff crossing is limited. Both crossings remain open for humanitarian and commercial shipments, while similar restrictions in place at crossing points between Idleb and northern Aleppo have reportedly been eased with civilians now able to cross between the two areas. At the border, infection prevention and control (IPC) measures are in place on the Turkish side and will be established on the Syrian side.

The current humanitarian response to COVID-19 in northwest Syria is focused on two areas: prevention of, and preparedness for, potential cases, and ensuring that humanitarian assistance continues while mitigating the risk posed by COVID-19 to communities and humanitarian workers. A laboratory in Idleb has been equipped to test for COVID-19 samples from the Idleb area since 24 March. The shortage of personal protective equipment such as gloves, gowns and masks are being addressed through procurement processes. The process is also ongoing to procure 90 ventilators, eight oxygen concentrators and three X-ray machines for hospitals in northwest Syria, in addition to the existing 203 ventilators. 21 ventilators have been repurposed for COVID-19 use.

To treat confirmed cases, three hospitals with ICUs supported by Health Cluster members are ready to receive patients in this coming week, and three additional health facilities are being established as COVID-19 isolation case management centres, in Idleb, Salqin and Daret Azza. One other hospital has been identified in northern Aleppo governorate as a referral hospital with 46 ICU beds and 200 bed capacity. As self-isolation is largely not feasible in the densely-populated northwest Syria, community-based isolation (CBI) centres are being planned to separate and limit the movement of people with low risk profiles presenting mild COVID-19 symptoms. Humanitarian partners have begun installing CBI centres with a total capacity of 1527 beds across 30 locations in Idleb and Aleppo governorates.

Humanitarian partners are updating existing plans to adjust for new service and delivery modalities to accommodate COVID-19 precautions while enabling operational continuity. Wherever possible, activities have been shifted to virtual platforms or phone-based engagement, including for coordination and for awareness raising, education, and case management services, and gatherings have been further reduced through scale-ups of door-to-door distributions and consolidating distributions. An extensive communication awareness campaign on individual precautionary measures against COVID-19 has also been implemented across northwest Syria, amplified through mosques, local communities, and social and traditional media.

UN Office for the Coordination of Humanitarian Affairs
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