Syria + 2 more

Syrian Arab Republic: COVID-19 Response Update No. 13 - 9 December 2020

Situation Report
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This report is produced by the World Health Organization (WHO) and the Office for the Coordination of Humanitarian Affairs (OCHA), in collaboration with humanitarian partners. The next report will be issued on or around 30 December.


  • As of 8 December, the Syrian Ministry of Health (MoH) reported 8,580 laboratory-confirmed cases, 458 fatalities, and 4,059 recoveries in Government of Syria (GoS)-controlled areas.

  • In northeast Syria (NES), 7,256 confirmed cases of COVID-19 as of 6 December.

  • In northwest Syria (NWS), as of 7 December, 17,527 confirmed cases of COVID-19 were reported.


While current official numbers remain relatively low in GoS-controlled areas, in recent months, the epidemiological situation has rapidly evolved and all factors – including that the vast majority of announced cases have not been linked to exposure/contact with a known case – point to widespread community transmission. November represents the peak of official numbers reported in a single month (2,069), followed by 2,008 cases reported in August.

In GoS-controlled areas of the country, 8,580 laboratory-confirmed cases have been reported by the Syrian MoH as of 8 December. Of these, seven were in Ar-Raqqa; 22 in Deir-Ez-Zor; 35 in Al-Hasakeh; 115 in Quneitra; 473 in Dar’a; 470 in Tartous; 395 in Hama; 515 in As-Sweida; 1,326 in Homs; 965 in Rural Damascus; 886 in Lattakia; 1,516 in Aleppo; and 1,855 in Damascus.

As of 8 December, 239 health care workers (HCW) have tested positive for COVID-19 in GoS-controlled areas. Of these, 12 fatalities have been reported, while 114 cases remain active. Humanitarian actors continue to receive reports that HCWs in some areas do not have sufficient personal protective equipment (PPE). The WHO continues to lead efforts to support the increased distribution of PPE where needed to ensure the protection of HCWs.

In recent weeks, the number of reported cases in schools has sharply increased, with 828 cases to date, more than double of the figures at the start of November (399 cases). This highlights the challenges of preventing transmissions in schools due to overcrowded classrooms, insufficiently qualified teaching personnel, and poor/damaged infrastructure. Of these, 420 were reported to be teachers and other staff, with the highest reported cases in Rural Damascus, Aleppo, and Homs. Both WHO and UNICEF, along with Health and Education sector partners, continue to strengthen COVID-19 preventive actions in schools.

Humanitarian actors have received unverified reports concerning additional possible cases. This is supported by indications that in some areas, healthcare facilities, most recently in November, have been 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 further support concerns, including reports on difficulties in obtaining tests, as well as rising number of obituaries, death notices, and burials.

The actual number of cases remains difficult to confirm. This is due to limited testing across Syria with a subsequent prioritized testing strategy used, and, the likelihood that a significant number of asymptomatic and mild cases are going undetected. Contact tracing continues to be a challenge, including in more remote governorates and camps. Furthermore, community stigma and individual reluctance to go to hospitals mean it is likely that a significant number of people with symptoms are not seeking tests or treatment, or, they are obtaining private services offering home care, negatively impacting the long-term health prospects and survival of a subset of patients with compromised immunity or complications.

In NES (as of 6 December), there have been 7,256 confirmed cases of COVID-19. Of these, 5,984 are currently recorded as active, 1,058 have recovered, and there have been 214 confirmed deaths. Although infection remains widespread, the rate of transmission has slowed somewhat in the second half of November, particularly in areas where a full lockdown was in force. Overall, the number of confirmed cases does not provide an accurate reflection of infection prevalence. The decrease in new cases appears to be a result of multiple factors, including a reduction in testing capacity (due to supply shortages), low surveillance capacity, as well as continued challenges related to case diagnosis and detection.

Furthermore, the combination of partial and full lockdown measures appear to have slowed transmission in some areas. Low levels of case detection are linked to under-reporting due to social stigma, misapplication of the case definition/ clinical screening protocols, and challenges in activating the rapid response teams (RRT). Despite the imposition of lockdown measures during November, there remains limited adherence to basic protective measures such as mask-wearing, and limited enforcement of these measures.

As of 6 December, 667 of the 7,256 confirmed cases of COVID-19 (9 per cent of all cases) were recorded amongst HCWs. Of these, 205 (28 per cent of all cases among health workers) have been recorded in Al-Hasakeh city. Transmission continues to be reported at health facilities across NES. Although transmission among health workers and at health facilities continues to have a detrimental impact on health service continuity, health partners have continued to improve Infection Prevention and Control (IPC) measures/ compliance resulting in a reduction in facility closures and staff infections.

As of 30 November, according to updates provided by 10 NES NGOs, covering 88 health facilities, three health facilities were closed or partially closed, including one in Raqqa (Mahmoudli), one in Al-Hasakeh city, and one in Kobane. A further 13 health facilities were closed or partially closed at some point during November due to infection among staff. This is a reduction from 23 facilities which were closed or partially closed during October. As of 30 November, there were 77 staff in self-isolation/quarantine from nine NGOs, while a further 56 health staff from eight NGOs have been in self-isolation or self-quarantine at some point during November.

A total of 25 confirmed COVID-19 cases have been reported in camps, an increase of just five confirmed cases throughout November. COVID-19 cases have been recorded in the following camps: Al Hol (13); Areesha (4) Mahmoudli (6); and Sereniye (2). Despite the low number of confirmed COVID-19 cases in camps, significant concerns remain around possible community transmission. This is particularly true at the Al Hol internal displaced persons (IDP) camp, where confirmed cases have been recorded in five separate phases, indicating that it may be impossible to contain the virus through isolation and contact tracing alone. These challenges are compounded by the reluctance of people to move to designated camp-level isolation areas if they are considered suspect, an underreporting of symptoms, and a lack of adherence to basic preventative measures (including the use of face masks). As such, health partners in Al Hol are adapting their strategy for responding to the virus. Instead of prioritizing containment – with an emphasis on testing, tracing and isolation - resources will be directed towards increased community surveillance, focusing on the most vulnerable and suspect case, and saving lives amongst the most vulnerable. Health partners are also looking at how to enhance adherence/awareness around basic preventative measures to save lives and suppress transmission.

Throughout November, lockdown measures have been further tightened in NES, building on the partial lockdown measures announced on 30 October and since extended. Stringent restrictions have been implemented across different parts of NES in recent weeks, with three separate full lockdowns initiated in four cities (Ar-Raqqa, Al-Hasakeh, Qamishli and Tabqa) between 26 November and 5 December. Lockdowns were also in place in Derik between 6 and 19 November, and, the Euphrates Province between 15 November and 10 December (with measures temporarily lifted between 26 and 30 November). All essential humanitarian activities are permitted to continue although additional movement permissions procedures have been implemented at the local level, with some level of local variance. Although levels of enforcement vary, the partial lockdowns remain in effect across all areas of NES. On 6 December new measures were put in place until 20 December. While shops, grocery stores, schools, universities and educational facilities are allowed to open, places of worship are closed, except for Fridays and Sundays, and all mass social gatherings are prohibited. Public transportation is allowed to enter/exit NES. Across all areas of NES, schools, universities and kindergartens were closed between 26 November and 5 December. It is understood that education facilities reopened on 6 December.

In NWS (as of 7 December), a total of 17,527 confirmed cases were reported (9,648 from Idleb and 7,879 from Aleppo governorates), including 221 deaths. A total of 8,334 people reportedly recovered. Of all cases, 1,618 (9.23 per cent) were among HCWs, and 747 (4.26 per cent) were identified among community health workers, as well as other staff working in health facilities. A total of 1,596 (9.63 per cent) cases were reported from IDP camps.

Increasing testing capacity continues to be a focus in NWS, particularly in hotspot sub-districts such as Idleb (Idleb), Dana (Idleb), Afrin (Aleppo), Al Bab (Aleppo) and Azaz (Aleppo). In total 60,497 polymerase chain reaction (PCR) tests have been completed, including 31,261 in Aleppo and 29,236 in Idleb governorates, with a test positivity rate of 23.18 per cent.

Currently, three laboratories have been operationalized (Idleb, Jarablus, and Afrin), with a total of four PCR machines (two of which were delivered in September). Daily testing capacity has nearly doubled since October, to an average of over 1,000 tests per day. Procurement of additional testing kits continues, as do efforts to enhance human resources, including through training. An NGO, with the support of WHO, has activated a community-based quarantine centre (CQC) in Idleb, specifically for IDPs living in camps, for those who are not ill but who are believed to have been exposed to COVID-19. These persons, when identified, are usually expected to quarantine in their homes, but due to overcrowded living conditions in camps, this may not always be possible. Partners have also increased outreach activities in and around camps located in areas of underreporting, as identified by the COVID-19 Task Force. One major initiative has been to mobilize community health workers to improve community-based active screening and early detection of suspected and undetected COVID-19 cases, prioritizing camps that have reported the highest incidence rates in Idleb.

A strong emphasis is being placed on increasing capacity in hospital settings across NWS, regarding both staff and resources. The COVID-19 Task Force Case Management Group continues to assess the availability of oxygen therapy and beds in community-based treatment centres (CCTC), as well as repurposing beds in hospitals for emergency cases, across NWS.

UN Office for the Coordination of Humanitarian Affairs
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