The number of reported confirmed COVID-19 cases in northwest of Syria (NWS) has reached 76,632 with 1,311 confirmed COVID-19 related deaths. This is a three-fold increase of cases in September in comparison with July 2021. The rapid increase has been recorded since mid-August with the number of cases increasing by an average of 30 positive cases a day in July this year to an average of 1,750 by the end of September. The numbers were much higher at the beginning of the month, but due to limited testing capacity this affected the adequate surveillance of actual COVID-19 cases in NWS. With a decimated health system, and exacerbated needs across the response, there is a significant gap in COVID-19 response due to the recent surge in cases because of the Delta variant in NWS. Oxygen supplies, capacity expansion, intensive care units (ICU), Risk Communication and Community Engagement (RCCE), case management, referral services, and PCR testing kits are the main components to be urgently scaled up and improved in order to cope with the increasing incidence rate of COVID-19.