Covid-19: "If there was a severe epidemic in Syria, it would be a carnage"

Nine years of war have left the country bruised. In Syria, if a cease-fire concluded by Russian President Vladimir Putin and Turkish Recep Tayyip Erdogan silenced arms last March 6, the fighting has given way to another threat: the coronavirus pandemic. Although strongly present in the region, as with the Iranian ally, the Covid-19 seems to spare the Syrians for the moment. According to official figures released by the Ministry of Health on April 19, only 39 cases of Covid-19, three deaths and five healings have been reported in the country. 

As of March, as the whole world began to confine itself, President Bashar Al-Assad closed borders, schools, restaurants and restricted population movements between provinces, in order to prevent the spread of the virus. . 

Each day, a hundred people are tested, mainly in Damascus. Far too little according to Dr Nabil Antaki, gastroenterologist in Aleppo and founder of the association the Blue Marists, which has been helping since 2012 the most deprived of the former Syrian economic capital. The doctor, who has never fled Syria despite the war, fears that the Covid-19 epidemic will not result in "a massacre" in a country where 83% of the population lives in poverty and where the economy is bloodless due to international sanctions.

France 24 - Is Syria affected by the Covid-19 pandemic?

Dr Nabil Antaki - There have been 39 cases reported in Syria to date. Three people died, others are healed, others are in confinement. The majority of these cases are in Damascus and its suburbs, and there have been a few cases in Homs. The diagnosed cases were all concentrated in the same district or village. They were completely confined. There are no reported cases from Aleppo. Many doubt the veracity of these figures and believe that the authorities are hiding the truth. I do not believe that. They have nothing to gain because no one would blame the government if there are more cases. However, I think there are more but that they are simply not declared because they are not formally diagnosed. As in other countries, we do not test everyone, only people who are really sick. Someone with an asymptomatic Covid or with very few symptoms is not tested with the PCR [Thanks to a long cotton swab inserted in the nose, one can know if the patient is infected with the coronavirus at the time of the test, Editor's note]. Everything is centralized in Damascus in the laboratory of the Ministry of Health. The samples are taken in the other cities and sent. In the beginning, there were only 300 tests. But the WHO has provided thousands, so now we are able to test more people. 

Are you confined like much of the world?

The measurements were taken in several stages. About a month ago, schools, universities, public places and gardens, restaurants were closed. A week later, there was a ban on opening shops such as hair salons, all food stores and pharmacies. The following week, a curfew was declared from 6 p.m. to 6 a.m. On April 20, the authorities allowed the small shops to reopen in turn. Two weeks ago, travel was prohibited from one city to another, including in the same region. On April 19, they announced two days to travel between cities, probably because Ramadan is coming Friday and families have to be reunited. The people were taken aback by the confinement and were unable to return home. 

Do you have masks, hydroalcoholic gel? Are hospitals ready to accept serious cases?

There are enough masks. When I listened to Emmanuel Macron's speech which promised enough masks for May 11 in France, I burst out laughing because a country like Syria, after 9 years of war, suffocated by international sanctions , has had enough! As for hydroalcoholic solutions, they are produced locally. There were a few companies that made them for hospitals but with the crisis, they increased their production. However, if there is an epidemic as severe as in Europe or the United States, we do not have enough intensive care beds and ventilators. When there is an epidemic, out of 100 patients, 10 will need to be hospitalized and 5 to 6 will need ventilators. If in Aleppo there were 1,000 cases of Covid-19, 50 to 100 people would need a ventilator. There are not 100 in public or private hospitals. The WHO provided it, the Pope offered ten to Syria last week. But if there was a severe epidemic, it would be a carnage. People would die for lack of intensive care beds and ventilators. We do not have enough equipment to handle heavy cases. The only problem is prevention: people put on their masks, use disinfectant solutions but there is no distancing. In the East, people like to congregate. Even if everything is closed, they are side by side in front of bakeries, shops. They fail to apply this rule. I tell them "it is useless to put on masks and use gel if you put yourself next to each other". 

How are positive patients treated? Do you use hydrochloroquine?

There is no protocol accepted. The Department of Health has given doctors treating Covid several options, including Professor Raoult's protocol and an anti-viral currently in use in the United States. The rest is supportive therapy with oxygen and the respirator. When there were rumors about Professor Raoult's protocol, many people went to pharmacies to buy plaquenil (hydrochloroquine) and azithromycin. I also bought it to treat four people, just in case. I do not know if I will use them, given the current controversy.

What about IDP or refugee camps? Should we worry about the spread of the virus?

So far, there are no cases listed. With the Blue Marists, we are in charge of a Kurdish refugee camp 30 km from Aleppo. Two years ago, they fled the Afrin region when the Turkish army arrived. We go there twice a week. I am in charge of the camp medical team and we have not found any cases. When we distribute food and sanitary packages, people stand three meters apart. We take our precautions.

How is the security situation? Is there still fighting, especially near Aleppo?

The Syrian army has launched an offensive to liberate part of the Idleb province. On February 16, it took control of the main highway connecting Aleppo to the rest of Syria and liberated the western outskirts of Aleppo, which were still under the control of rebel armed groups. They continued to bomb Aleppo every day, even after the eastern neighborhoods were liberated three years ago. On February 16, the Aleppins were jubilant because, after several years of war, they could finally sleep without being afraid of a shell but also use this highway which links Homs, Damascus and even Lebanon. The next day, a civilian aircraft landed in Aleppo for the first time in eight years.

After this date, there was a counter-offensive by rebel armed groups supported by the Turkish air force and drones. They regained control of the highway and some areas liberated by the Syrian army. At the end of February, negotiations between Russia and Turkey led to a cease-fire agreement. The rebels have withdrawn from the highway and, since the beginning of March, there has been no fighting in Syria. The situation is completely frozen. No bullets have been fired since March 1. And with the Covid crisis, young people are no longer called upon to do military service.

President Bashar Al-Assad and Iranian Foreign Minister Mohammad Javad Zarif, who visited Damascus on Monday, called for the sanctions against Syria and Iran to be lifted. Do you hope to be heard?

I have been fighting for the lifting of sanctions for years. They are unfair, illegal. For us, it is a crime against humanity according to the definition of the Geneva Convention. It is a collective punishment that is inflicted on a civilian population. They do not concern the country's leaders but the 23 million Syrian citizens who cannot import anything or make financial transactions. 

A month ago, with a group of European NGOs, we wrote a letter to the French, American, British and German Minister for Foreign Affairs to tell them that the sanctions should be lifted. With the Covid crisis, there is an additional reason and we have repeated these messages to Western governments. The sanctions will not speed up a peace process, it will not bring down the government. It only hurts the Syrian civilian population.

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