In Syria, hit by Covid, people ‘would rather die than go to the hospital’

All the troubling signs were there: fatigue, high fever, inability to taste or smell.

Still, Ahmed *, a salesman at a hardware store in the Damascus suburbs, never considered getting tested for coronavirus or going to the hospital. The first option was unaffordable, he thought; the second, dangerous.

“I was afraid of being quarantined and not receiving proper medical care,” the 20-year-old said, referring to facilities run by the Syrian government where COVID-19 patients are sent.

Instead, Ahmed confined himself to his room, sought medical advice on Facebook and consulted a local doctor by phone. Neither he nor anyone with whom he had been in contact were examined.

“I couldn’t afford it,” he told Al Jazeera by phone, explaining that it would have cost him 126,000 Syrian pounds ($ 246), more than his monthly salary.

Ahmed’s alleged coronavirus infection in late July is believed to be among thousands of cases that go unnoticed in Syria’s government-controlled areas.

Official data puts the number of confirmed COVID-19 infections at 4,366, with 205 related deaths, but several doctors, residents, and health experts who spoke to Al Jazeera from within and outside the war-torn country said these figures did not. they reflect the true scope. of the coronavirus outbreak.

“There is a big gap between the real number [of cases and deaths] and the one announced by the government due to its lack of resources and capacity to receive patients, but also because it wants to mitigate any unexpected impacts of the pandemic, such as social unrest. ”Zaki Mehchy, London-based senior researcher at Chatham House and co-founder from the Syrian Center for Policy Research, he told Al Jazeera.

‘People prefer to die’

With a collapsed healthcare system, a battered economy, and a dire lack of doctors and nurses as medical providers flee the brutal war in Syria, authorities face an uphill battle to control the spread of COVID-19.

Chronic shortages of medical equipment and supplies, coupled with poor conditions in quarantine facilities, the need to earn a living and a deep mistrust of state institutions after more than nine years of conflict, have resulted in many suspected patients not report symptoms associated with respiratory system disease.

To fill in the gaps, coronavirus-related Facebook groups have sprung up online where doctors offer medical advice, as have companies that rent oxygen tanks to patients for home use.

“People would rather die than go to the hospital,” Moustafa *, a doctor who works at a hospital in Damascus, told Al Jazeera by phone.

He said he is often contacted by people seeking medical advice, but he cannot afford any protective equipment to visit them in person. A high-quality mask that needs to be changed daily costs around 5,000 Syrian pounds ($ 10).

“This is too much for me,” said Moustafa, who earns 96,000 Syrian pounds ($ 188) a month. “Can you imagine? A doctor who can’t afford to buy a good mask?

‘Only formalities’

The Syrian economy has been in free fall in recent months, sagging under the weight of the country’s protracted conflict and the impact of a dollar liquidity crisis next to Lebanon.

The financial turmoil has been compounded by a sharp drop in the value of the Syrian pound, which has made life even more difficult for millions of long-suffering Syrians who survive on daily wages.

With more than 80 percent of the population living below the poverty line, the rise in the price of basic goods sparked sporadic protests during Syria’s summer as a new wave of US sanctions piled further pressure on the paralyzed economy.

“Economic sanctions that are coercive and unjust have been hampering the capabilities of many essential services, particularly health services,” Syrian Health Minister Nizar Yazigi told a virtual meeting of the World Health Organization (WHO ) in May, referring to the economic measures imposed by Western countries.

Faced with a deteriorating economic outlook, the government acted too slowly to impose coronavirus containment measures, critics say, and too quickly to eliminate them.

In May, despite a spike in infections a month after businesses and public markets were allowed to reopen, authorities lifted the two-month night curfew and allowed movement between government-controlled provinces. . Mosques also reopened the same month, while students returned to classrooms on September 13.

“The Ministry of Health is taking only paperwork, not [real] measures were taken [to curb the spread of coronavirus]especially now, ”said Jamal *, another doctor at a Damascus clinic, echoing similar calls of concern following a reported increase in the number of coronavirus cases and deaths in August.

While it is extremely difficult to establish exact data on the scale of the outbreak, a group of researchers at Imperial College London warned last month that only an estimated 1.25 percent of COVID-19 deaths were reported in Damascus, and that they fear up to 4,380 deaths. undetected as of September 2.

“Given that Damascus is likely to have the strongest surveillance in Syria, these findings suggest that other regions of the country may have experienced similar or worse death rates due to COVID-19,” the researchers said.

In the city of Aleppo, the impoverished family of a man in his 60s who fell ill with coronavirus in August hesitantly decided to take him to Aleppo University Hospital.

“Nobody trusts Aleppo hospitals; everyone knows that if a patient with coronavirus comes in, they will not succeed, ”said Khalil *, the man’s nephew.

Once at the overcrowded facility, Khalil said a paramedic told his cousin: “You have to wait if one of the [other] patients dies, only in this case would their father be admitted ”. Two days later, the man died at his home.

‘Like a prison’

Meanwhile, low-income medical professionals say they must perform their duties under the watchful eye of powerful security services at state healthcare facilities.

This, some say, acts as an additional deterrent for patients already reluctant to seek treatment in a country where fear of the state apparatus is high and any critical discussion about handling the pandemic could be seen as a threat to a government determined to transmit a message of control.

“The hospital is like a prison: you can see the intelligence people, they check everything you do and say,” Moustafa said. “We have to hide everything, not talk about anything [related to covid-19]. “

Jamal said: “Patients come to the hospital with their last breath.”

“These cases need equipment that hospitals do not have and people know,” he added by phone, noting that the government does not have the resources to implement preventive measures and cannot treat or test patients.

‘A million other reasons to die’

In an attempt to help address the crisis in government-controlled areas, WHO has established five testing facilities, in the capital, rural Damascus, Aleppo, Homs and Latakia, that carry out up to 1,000 coronavirus tests per day. .

But that’s not enough, according to Akjemal Magtymova, WHO representative in Syria.

“Even if I could detect tens of thousands more cases, what do I do if we don’t have the resources to cure them?” Magtymova asked, her voice infused with a tone of exasperation.

According to the world health agency, only half of the country’s 113 public hospitals were fully operational at the end of June. There are less than three beds available for every 10,000 people, three times less than international standards.

But what is even more alarming for Magtymova is the shortage of medical professionals. According to a United Nations report released in March, a staggering 70 percent of them have left the country since the start of the war in 2011.

“One of my biggest concerns is that we are working with a very limited number of healthcare workers, who are at high risk of infection,” he told Al Jazeera.

“We are waiting for a new wave, we have to check that those children return [from school] to his extended family, “Magtymova said, emphasizing that while the transmission rate is not as high as in August, the situation remains” very fragile “amid deepening economic problems.

“People are starving; 9.3 million are food insecure and dependent on a daily wage, ”Magtymova said. “Why would they declare themselves sick and isolate themselves?”

Mustafa agreed: “It is not just about covid-19, it is the least fear we have. Here, you can die for a million other reasons before covid-19. “