Syria: iMMAP/DFS COVID-19 Situation Analysis (April 2021)

Originally published


1. COVID-19 and containment measures overview


As of 30 April, a total of 60,8001 confirmed COVID-19 cases were recorded across Syria (293 per 100,000) (WHO Syria Dashboard, WHO NWS Dashboard, NES COVID-19 Dashboard 30/04/2021), up from 50,400 by the end of March, and with a common assumption that those detected and reported are only a small proportion of the actual figures.

Government-held areas: Intensive care rooms remain at maximum capacity, death rate among older people surges, and more reported cases this month than any previous

The resurgence in the rate of newly reported cases in Government controlled areas towards the end of May has continued throughout the entire month of April, ranging from 101 to 154 reported daily, totalling more cases than any month previous (WHO Syria Dashboard, 30/04/2021).
Urging the public to adhere to containment measures, the Director of Communicable and Chronic Diseases from the Ministry of Health highlighted a surge in deaths amongst the eldery early in the month (The Syria Report 07/04/2021)
As of 30 April a total of 22,733 cases (163 per 100,000) have now been reported in Government-controlled areas. Of these, 1,596 have died, with a case fatality rate of approximately 7%, significantly higher than every other country in the region with the exceptions of Sudan and Yemen. The high case fatality ratio may be partially explained by delayed treatment seeking until symptoms are more severe and a focus of testing towards those in healthcare facilities with more severe symptoms. Approximately 4% of all recorded cases so far have been among health workers (WHO Syria Dashboard 30/04/2021,

Northwest Syria: Rate of newly detected cases remains far below the peak in November and December 2021

During April, 665 new cases were reported in northwest Syria reaching 21,983 cases overall (543 per 100,000) including 649 reported deaths. Reported cases and deaths have been much lower throughout 2021 compared to the much higher figures observed between October and December 2020. Positivity rates have also been relatively low both in comparison to previous months as well as other areas of Syria: The overall positivity rate since July 2020 has been approximately 18% (WHO NWS Dashboard, 30/04/2021). However, as COVID-19 cases have been rapidly increasing in Turkey, concerns remain of cross-border transmission, leading to higher levels of infection in northwest Syria.

Northeast Syria: More tests and detected cases reported than any month previous, a critical shortage of RNA extraction kits

The total number of reported cases in northeast Syria as of 31 March was 15,900 (686 per 100,000) including 653 deaths. Reported cases continue to be most frequent in Al-Hassakeh governorate. Although more cases have been reported throughout April than any month previous, the rate of newly reported cases has been decreasing throughout: The 7-day rolling average on 1st April was 193 cases by the 31st this had fallen to 90. The relatively high number of cases coincides with much more frequent testing than previous months (13,298 tests in April compared to 1,493 in February) and therefore also a rise in case detection. Positivity rates have remained consistently high, however, with the 7-day rolling average ranging from approximately 45% to 55% throughout the month. COVID-19 deaths continue to be recorded without confirmation via PCR test and a significant number of people are only reporting symptoms or going to the hospital when their illness is advanced (as is likely the case across all areas). As such, there continue to be concerns that the true number of COVID-19 deaths may be much higher than the reported figures (OCHA & WHO 18/03/2021).