‘If there was a severe outbreak in Syria, there would be a bloodbath’

While the Covid-19 pandemic has killed more than 180,000 people worldwide and infected more than 2.5 million people, Syria has officially reported relatively few cases. If the epidemic were to worsen there, the number of deaths would be all the higher since the country, still subject to international sanctions, lacks basic medical equipment.

Nine years of war have left Syria battered. Although a ceasefire was concluded on March 6 by Russian President Vladimir Putin and Turkish President Recep Tayyip Erdogan, the fighting has given way to a new invisible enemy: the coronavirus.

Covid-19 has already successfully established itself in the region, particularly in the Iranian neighborhood. But he seems to have spared the Syrians, at least for the time being. According to official figures released by the Syrian Ministry of Health on April 19, Syria has registered only 42 cases of Covid-19, three deaths and six recoveries.

In March, as the world began to shut up, Syrian President Bashar Al-Assad closed borders, schools, restaurants and restricted movement of people between provinces to prevent the spread of the virus.

A hundred people are currently being tested every day, mainly in Damascus. But the number tested is far too low, according to Dr. Nabil Antaki, gastroenterologist in Aleppo and founder of the Blue Marists of Aleppo (Blue Marists of Aleppo), an association that has been helping the poorest in the former economic capital of Syria since 2012.

The doctor, who has never abandoned Syria despite the war, fears that the Covid-19 epidemic could lead to “bloodshed” in a country where 83% of the population lives in poverty and where the economy has been drained by international sanctions.

France 24 – Has Syria been affected by the Covid-19 pandemic?

Dr Nabil Antaki – To date, 39 cases have been reported in Syria. Three people died, others are healed, others are still in quarantine. The majority of these cases are in Damascus and its suburbs, and there have been a few in Homs (a city in western Syria). The diagnosed cases were all concentrated in the same neighborhood or village. They were completely quarantined. No cases have been reported in Aleppo.

Many people doubt the veracity of these figures and believe that the authorities are hiding the truth. But I don’t think they are. They have nothing to gain because no one would blame the government if there were more cases. However, I think there are more, but they just aren’t being reported because they haven’t been officially diagnosed. As in other countries, we do not test everyone, only the really sick people. A person with asymptomatic coronavirus or with very few symptoms is not tested by PCR (a nasal swab used to determine if the patient is currently infected with coronavirus). Everything is centralized in Damascus in the laboratory of the Ministry of health. Samples are taken from other cities and sent to the site. In the beginning, there were only 300 tests. But the WHO has provided thousands, so now we can test more people.

Are you locked up like much of the world?

The government’s response measures have developed in several stages. About a month ago, schools, universities, public places and gardens, restaurants were all closed. A week later, it was prohibited to open shops such as hair salons and all stores were closed, except food stores and pharmacies. The following week, a curfew was imposed from 6 p.m. at 6 a.m. On April 20, the authorities authorized the reopening of small stores 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, possibly because Ramadan begins on Friday and families must be reunited. People had been caught off guard by the lock and were unable to return home.

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

There are enough masks. When I listened to the speech of Emmanuel Macron promising enough masks for May 11 in France, I burst out laughing because a country like Syria, after 9 years of war and suffocated by international sanctions, we have already enough! As for hydroalcoholic solutions, they are produced locally. There were already a few companies that manufactured them for hospitals. With the arrival of the virus, they increased their production. On the other hand, if we are going through a crisis as severe as in Europe or the United States, we do not have enough intensive care beds and ventilators. In the event of an epidemic, out of 100 patients, 10 will have to be hospitalized and between 5 and 6 will need ventilators. If there were 1,000 cases of Covid-19 in Aleppo, this would mean that between 50 and 100 people would need a ventilator. And we don’t have 100 in public or private hospitals. WHO provided it and the pope offered a dozen to Syria last week. But if there was a serious epidemic, there would be a bloodbath. People would die from lack of intensive care beds and ventilators. We do not have enough equipment to manage heavy boxes.

The real problem here is prevention: people put on their masks, use disinfectant solutions, but there is no social distancing. In the Middle East, people like to stay united. Even if everything is closed, they are side by side in front of bakeries and shops. They fail to apply this rule. I tell them: “There is no point in putting on masks and using gel if you stand side by side”.

How are patients with a positive diagnosis treated? Do you use hydroxychloroquine?

There is no accepted protocol. The health department has given doctors treating Covid-19 several options, including the suggestion of French professor Raoult and an antiviral currently in vogue in the United States. The rest is supportive therapy with oxygen and a ventilator. When we started hearing about Professor Raoult’s ideas, many people went to pharmacies to buy plaquenil (hydroxychloroquine) and azithromycin. I also bought enough to treat four people, just in case. But I don’t know if I’m going to use them, given the ongoing controversy.

What about camps for displaced persons and refugees? Should we be worried about the spread of the virus there?

So far, no cases have been recorded. The Blue Marists run a Kurdish refugee camp 30 kilometers from Aleppo. Two years ago, they fled the Afrin region in northern Syria 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 health kits, people are three meters apart. We take our precautions.

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

On February 16, the Syrian army launched an offensive to liberate part of Idleb province. He took control of the main highway connecting Aleppo to the rest of Syria and liberated the western suburbs of Aleppo, still under the control of armed rebel groups. These groups continued to bomb Aleppo every day, even after the liberation of the eastern neighborhoods three years ago. When the Syrian army did this, the people of Aleppo rejoiced. After years of war, they could finally sleep without fear of a shell falling, and they could also take the highway that connects Homs, Damascus and even Lebanon. The following day, a civilian aircraft landed in Aleppo for the first time in eight years. But then there was a counter-offensive by armed rebel 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-19 crisis, young people are no longer called to military service.

President Bashar Al-Assad and Iranian Foreign Minister Mohammad Javad Zarif, during his visit to Damascus last Monday, called for the lifting of sanctions against Syria and Iran. Do you hope to be heard?

I have been fighting for years for the lifting of sanctions. They are unjust, illegal. For us, it is a crime against humanity as defined by the Geneva Convention. It is a collective punishment inflicted on a civilian population. This does not concern the country’s leaders, but the 23 million Syrian citizens who cannot import anything or carry out financial transactions.

A month ago, in collaboration with a collective of European NGOs, we sent a letter to the French, American, British and German foreign ministers telling them that the sanctions should be lifted. With the Covid-19 crisis, there are other reasons and we have repeated these messages to western governments. The sanctions will not speed up the peace process, they will not bring down the government. These sanctions only harm the civilian population of Syria.

This article was translated from the original in French.