Syria

Syrian Arab Republic: COVID-19 Humanitarian Update No. 20 As of 29 October 2020

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Situation Report
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Originally published

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This report is produced by OCHA Syria in Damascus in collaboration with WHO Syria and Damascus-based humanitarian partners, and does not reflect cross-border operations.

HIGHLIGHTS

• Number of people confirmed by the Ministry of Health (MoH) to have COVID-19: 5,580 (278 fatalities, 1,861 recovered).

• Areas of concern: Densely populated areas, notably Damascus/Rural Damascus, Aleppo and Homs, and those living in camps and informal settlements in NES, collective shelters throughout the country, as well as other areas including Deir-Ez-Zor, and where hostilities may be ongoing making sample collection more challenging.

• Populations of concern: All are susceptible. However, the elderly; people with underlying health conditions; vulnerable IDPs and refugees; and healthcare workers with inadequate personal protective equipment (PPE) are at greater risk.

• Of the cases announced by the MoH, 193 are reported to be healthcare workers, largely in Damascus.

• As of 27 October, the MoH has reported approximately 47,500 tests have been performed in laboratories in Damascus, Aleppo, Homs, Lattakia and Rural Damascus governorates.

• Socio-economic impacts are likely to exacerbate existing substantial humanitarian needs across the country.

SITUATION OVERVIEW

The global situation remains highly fluid. However, at the time of writing, 44,002,003 laboratory-confirmed cases of COVID19, including 1,167,998 deaths (CFR=2.7 per cent) had been reported globally. The United States has the most confirmed cases (8,683,298) and the most deaths to date (225,073). In the Eastern Mediterranean Region, more than 2,976,313 COVID-19 cases have been reported, including 75,640 deaths.
In Syria, 5,580 laboratory-confirmed cases have been reported by the MoH to date: 7 in Ar-Raqqa; 16 in Deir-Ez-Zor; 35 in Al-Hasakeh; 90 in Quneitra; 155 in Dar’a; 180 in As-Sweida; 188 in Hama; 248 in Tartous; 501 in Lattakia; 585 in Rural Damascus; 705 in Homs; 1,241 in Aleppo; and 1,629 in Damascus. In total, 1,478 new cases have been announced since the last report on 29 September. The MoH has also announced 267 fatalities, representing an increase of 86, in addition to 1,861 recoveries; the CFR is approximately 4.9 per cent.
Highlighting the particular risks faced by healthcare workers, according to the MoH, 193 healthcare workers have tested positive for COVID-19, an increase of 50 in October. Of particular concern, 11 healthcare workers are reported to have died. The ongoing increase in affected healthcare workers reported since July underscores – given Syria’s fragile healthcare system with already insufficient numbers of qualified healthcare personnel – the potential for its overstretched healthcare capacity to be further compromised. Humanitarian actors continue to receive reports that healthcare workers in some areas do not have sufficient PPE. WHO continues to lead efforts to support increased distribution of PPE where needed to ensure the protection of healthcare workers already operating under very challenging circumstances.
Also of note, since schools have reopened, at the time of writing the MoH had reported 303 confirmed COVID-19 cases among school children and teachers/school personnel. Of these, three had sadly died, including one teacher, one school cleaner, and one student. These cases also highlight the challenges of preventing transmission in schools, particularly given the overall country context of overcrowded classrooms, insufficient qualified teaching personnel, and poor/damaged infrastructure. Both WHO and UNICEF, along with Health and Education sector partners, continue to support schools in COVID-19 preventive actions, including through teacher and school health worker trainings, PPE distributions, and infection prevention and control (IPC) measures including increased water trucking and soap distributions.
Even while the current official numbers remain relatively low, it is clear in past months the epidemiological situation in Syria has rapidly evolved and all factors – including that the vast majority of announced cases to date have not been linked to exposure/contact with a known case – point to widespread community transmission. Since July, official numbers have risen sharply; including a peak of more than 2,000 confirmed cases in August.
As earlier reported, humanitarian actors have received ongoing numbers of unverified reports concerning additional possible cases, in addition to other information which has indicated in some areas, existing healthcare facilities, particularly in July and August, were unable to absorb all suspected cases and/or are suspending surgeries or adapting wards to accommodate increased COVID-19 patients. While the UN is not in a position to verify or directly link such reports to COVID-19, other unverified reports received include difficulty obtaining a COVID-19 test; and rises in obituaries, death notices and burials.
Given the limited testing across Syria, it is therefore likely that the actual number of cases may far exceed official figures.
In particular, it is likely significant numbers of asymptomatic and mild cases are going undetected. Contact tracing is also a particular challenge, including in more remote governorates and camps. In addition, for reasons including community stigma and individual reluctance to go to hospitals, it is further likely significant numbers of people with symptoms are not seeking tests or treatment or are obtaining private services offering home care. In addition to making actual numbers of cases difficult to ascertain, this may increase the risk of late referral of severe/complicated cases for treatment, negatively impacting the long-term health prospects and survival of patients.
As of 27 October, authorities in Northeast Syria (NES) have reported 4,164 cases (2,756 in Al-Hasakeh, 587 in Aleppo, 757 in Ar-Raqqa, and 64 in Deir-ez-Zor), including 112 fatalities and 672 recoveries. Healthcare workers have also been affected, with 435 reported cases. As is the case elsewhere, limited testing likely means significantly higher numbers exist.
As of 27 October, the MoH reported around 47,500 tests have been conducted by the Central Public Health Laboratory (CPHL) in Damascus and the public health laboratories in Aleppo, Lattakia, Rural Damascus and Homs. The UN continues to advocate for the enhancement of laboratory and case investigation capacity across Syria, including in NES, and the timely communication of all relevant public health information.

Points of Entry

Border crossings remain impacted as Syria and neighboring countries continue implementation of precautionary measures.
Most land borders into Syria remain closed, with some limited exemptions (from Jordan, Turkey and Lebanon) including commercial and relief shipments, and movement of humanitarian and international organization personnel. International commercial passenger flights resumed at Damascus International Airport from 1 October. Tartous and Lattakia ports remain operational, with precautionary measures.
From 16 August, the GoS has implemented new requirements for individuals arriving from official border crossing points with Lebanon, including presentation of a negative PCR certificate obtained within the past 96 hours at accredited laboratories. Those unable to present such a document are quarantined. The GoS further announced Syrians transiting through Lebanon must reach the borders no more than 24 hours before their flight and within 96 hours of a negative PCR test. Private laboratories offer testing, including one center dedicated to UN staff and diplomats.
In NES local authorities continue to provide exemptions for humanitarian goods and personnel at the Fishkabour/Semalka informal border crossing, and in other limited cases, including urgent medical cases to cross to Iraq, however other movements generally remain restricted. In addition, on 8 September, local authorities announced individuals holding expired European residency permits can cross to Iraq to undertake renewal processes once per week. All border crossing points remain closed as a precautionary measure. Humanitarian personnel and medical cases are reportedly exempt.
On 12 October, local authorities in NES announced that all internal crossings would be open for movement, and reports indicated this is occurring at Tabqa, Akeirshi and Abu Assi in Ar-Raqqa and Al-Taiha in Aleppo, although reports also indicate some individuals have been prevented moving to GoS areas in the former. Further reports indicate that internal crossings in the Tal-Abiad-Ras al-Ain remained closed for all movements. In addition, restrictions appear to remain in place at Um Jloud in Aleppo; at Awn Dadat, the crossing was initially opened at 12 October, but closed again on 19 October.
Al-Bukamal-Al Quaem crossing is reported open for commercial and military movements; Ras al-Ain border crossing is partially open for humanitarian shipments, voluntary returns and visits relating to the agricultural harvest. Abu Zendin in Aleppo remains closed, although reports indicate in practice, crossings do occur. Ghazawiyet Afrin and Deir Ballut in Aleppo are open for commercial, military, and humanitarian cargo movement. On 20 July, Bab Al Hawa in Idleb partially re-opened for humanitarian workers and emergency medical cases to cross to Turkey. Syrian citizens in Turkey can reportedly apply for voluntary return to Syria through the crossing.

Preventive measures

The GoS continues to maintain a widespread easing of preventive measures introduced throughout May, albeit with some ongoing, ad-hoc changes, including recent suspension of some schools/classrooms where students or teachers had been confirmed to have contracted COVID-19. Otherwise, markets, restaurants, cafes, gyms, parks, theaters, cinemas and most leisure facilities remain open, with mandated precautionary measures. Mosques and churches are open, with physical distancing requirements. Public and private transportation services have resumed, as have schools, universities and institutions. While broad-based restrictions are not anticipated to be re-imposed due to economic and social impacts, it remains possible the GoS may enforce localized lockdowns.
In NES, local authorities have similarly largely lifted general preventive measures and resumed schools, with some mandatory precautionary measures in public spaces, including wearing of face coverings and physical distancing.

Humanitarian Impact

For most of the past year, Syria’s economy has experienced an unprecedented downturn that has had profound impacts on the welfare of a significant proportion of the population. While these economic hardships have not been primarily driven by COVID-19, the pre-existing and underlying fragility of the Syrian economy – in addition to multiple shocks over the span of the past 12 months – has meant that COVID-19 related factors has had a disproportionate negative socio-economic effect across the country. In practical terms, families across Syria have largely faced heavily eroded employment opportunities, skyrocketing prices and shortages of basic goods and services, and widespread deterioration of household coping mechanisms.
Among these shocks has been the extreme volatility of the informal SYP/USD exchange rate, which on 8 June rose to its highest rate on record – approximately SYP 3,200 to US$ 1. While the informal rate has rallied somewhat, fluctuating in past months between approximately SYP 2100 - 2,400, the current value is still a significant devaluation compared to one year ago, when it was around SYP 694. On 17 June, the Central Bank of Syria devalued the official exchange rate to SYP 1,256 to US$ 1. In some areas, local authorities have announced local adoption of the Turkish Lira as an accepted currency.
Due to exchange rate volatility, the regional banking crisis and other factors, including knock-on effects of COVID-19 such as disruptions to supply chains, panic buying and hoarding, and restrictions on trade, industry and agriculture, food prices have soared in past months. According to WFP VAM data, the price of an average food basket (a group of basic goods providing 1,930kcal per day for a family of five for a month) in September 2020 was SYP 83,715, which, while fairly consistent with the preceding month’s cost, remains an increase of 236 per cent over the past 12 months. Overall, the current price is 21.8 times higher than the average price recorded in 2010.
Food prices, in addition to other factors such as periodic shortages of staples including wheat, has led to a significant deterioration in food insecurity indicators across Syria. According to WFP, as of April 2020, 9.3 million people were considered food insecure, with one million severely food insecure. With the loss of job opportunities due to the impacts of COVID-19, particularly in daily wage labour or seasonal work, combined with rises in food prices, disruptions to food supply chains and deterioration of access to markets particularly during the time of lockdowns, it is likely more families have now been pushed into food insecurity. Reports indicate even households with regular income have been adversely affected as the cost of living has spiraled. For example, WFP’s national average food basket has for the past few months exceeded the highest paid official government monthly salary of SYP 80,240.
According to a WFP report on the socio-economic impacts of COVID-19, current projections indicate a likely further deterioration of the food security situation in Syria, with possible longer-term, entrenched consequences, including the likely increase of acute and chronic malnutrition. A recovery is not expected in the short term. An inter-agency socio-economic impact assessment of COVID-19 completed in August found that in the preceding months, an estimated 200,000-300,000 jobs had been permanently lost. In April, more than 320,000 people registered for the National Campaign for Emergency Social Response for assistance due to work lost as a result of COVID-19 preventive measures, the vast majority being daily labourers. The informal sector and businesses have been heavily impacted, with 15 per cent of small and medium sized business reporting permanent closure. In addition, remittances – on which many families heavily rely – are estimated to have reduced up to 50 per cent.
For many currently living in Syria, the current socio-economic situation represents some of the most challenging humanitarian conditions experienced in the past ten years of crisis. While estimates one year ago suggested at least 80 per cent of the population lived below the poverty line, current conditions indicate that it is likely more families have been pushed toward poverty and destitution. In mid-October, the GoS announced some new economic measures, including a restructuring of income tax brackets and increase in the tax-free threshold, and one-time payments of SYP 40-50,000 to civil servants and military, including retired personnel. However, this is unlikely to provide much alleviation for the most vulnerable, particularly those without a formal income.
In recognition of the likelihood of far-reaching socio-economic impacts of COVID-19, the UN Country Team (UNCT) has from an early stage worked with UN agencies and humanitarian partners to ensure ongoing provision of life-saving assistance while supporting initiatives to bolster social and economic resilience. Life-saving food assistance to 3.5 million people has continued with adjusted distribution modalities, as has agricultural and livelihoods programs. UNDP and partners have further focused on support for micro, small and medium enterprises for workers temporarily out of employment with social safety net activities, dedicated assistance to people with disabilities, in addition to distribution of agricultural inputs and livestock to sustain food security in rural areas.
Nevertheless, as the economic situation has worsened, some humanitarian partners report that the informal exchange rate volatility and inflation has forced temporary suspension of local procurement and redesign of budgets, leading to delays in programme delivery. Recent surveys of partners across all sectors has indicated that most organizations have experienced some negative impact to their programming in recent months, including due to fluctuations in the informal exchange rate,
COVID-19 precautionary measures, difficulty transferring funds, reduced capacity due to COVID-19, and more recently, due to fuel shortages and/or increased fuel prices. Almost all (96 per cent) reported an increase in operating costs since July. Precautionary measures, even as restrictions have eased, continue to also impact programming, with Health, Nutrition and Protection sector partners in particular reporting challenges in implementing alternative modalities.
However, at the same time, other humanitarian programs have resumed with implementation of measures to ensure safety of staff and beneficiaries. While the Protection sector reported a steep decline in interventions in March and April; in May to end July, just over one million people were reached with protection interventions. UNFPA reported that during October, mobile health teams and 36 out of the 48 women and girls’ safe spaces continued to operate, providing individual counseling and GBV Case Management to those at risk, including GBV survivors. UNDP also continued to support, with WHO, of “Fadfada”, an online psychosocial support platform, to support increased needs reported related to COVID-19 stressors.

UN Office for the Coordination of Humanitarian Affairs
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