If Covid-19 gains a foothold in Syria, there’s not much to stop it, according to Dr. Mufaddal Hamadeh. A health system in collapse, more than a million refugees crowded in camps, and scarce medicines and supplies – of any sort – put the embattled country in a dangerous position.

But the Syrian American Medical Society (SAMS), which Dr. Hamadeh heads, and which helps provide everything from maternal care to cancer treatment in war-torn Syria and neighboring countries, is doing what it can.

Working with the WHO and a range of NGOs, the organization is working to bolster the country’s health infrastructure and train its health care providers.

Dr. Hamadeh spoke to Direct Relief about what things look like on the ground in Syria, why Covid-19 hasn’t yet swept the country, and what’s being done on the ground to prevent its spread.

Direct Relief: What does the Covid-19 picture look like in Syria right now?

Dr. Hamadeh: As you know, the healthcare system has been under a lot of stress. It’s been desecrated by eight, nine years of war and the recent closure of about, probably, 84 facilities since December. A lot of doctors have left Syria [as well].

Luckily we have not seen any major spread of Covid-19 generally in Syria, even though we can’t trust the numbers the government is putting out there. All we can say is, officially, the government announced 10 cases in the area under their control, with two deaths.

There are some reports coming in from Idlib and from Syria of several deaths happening from a viral pneumonia, but Covid is not confirmed.

Direct Relief: What is being done to screen for and prevent the spread of Covid-19 – by SAMS, other aid organizations, and government entities?

Dr. Hamadeh: There has been a lot of work and talk about what we were going to do in the Northwest. There are probably 3.6 million people there.

A lot of them, approximately 1.5 million, are in crowded settlements and camps where social distancing and the preventative measures that we usually take in the U.S. and other areas basically cannot be applied. No matter how much you educate the public, it’s too much of an ask. It’s impractical and it’s not going to happen. Even though we have been educating the public, if you don’t have clothing, water, nutrition, food, soap, and sanitary things, it’s very difficult.

So it’s not feasible to do any of the preventative measures that we are seeing in European countries and even in some of the government-controlled areas.

And SAMS, through the WHO, our number one goal is to protect the healthcare workers, the doctors and the nurses and the staff. Because quite honestly, if those people get affected down the line, the whole health care system will collapse.

There is a WHO plan that we are part of implementing, and that WHO plan is shared by what we call the health cluster, which includes many NGOs and INGOs.

In the whole northwest of Syria, there are not more than 105 ICU beds. 85% of them are already occupied. There are 30 ventilators in the whole area, and 85% of these ventilators are already occupied. So the situation is very crucial.

We decided in the cluster [and] we built three hospitals dedicated to receive Covid patients. We just opened one up today – no patients so far. But those are units that were sponsored and basically supported by the WHO.

We also created about 33 isolation units [in addition to] these hospitals that are going to be throughout the province. They have a few beds, each unit, and eventually [patients] will be transferred to the three hospitals that were designated for Covid patients.

We also try to teach the medical staff and the health care workers about best practices, and try to teach them some of the experience we were able to gain here in the U.S. and from China. Unfortunately, protective gear is very scarce.

There’s an entity called the Early Warning and Alert Response Network. They predict that 40-70% of the population in Idlib will be infected, which means anywhere between 1.6 million to 2.8 million people will be affected.

In my own opinion, all the protective measures that we’re talking about – sanitation and separation and all that stuff – I don’t think they will work in Idlib.

I think our only hope is herd immunity, where if you have enough patients get infected, and hopefully the vast majority will be asymptomatic or minimally symptomatic, then eventually that will stop the spread of the disease. If you’ve got about 60% of the people infected – or vaccinated for that matter – [that will be enough for] herd immunity.

But that is not the policy of the WHO or the health care cluster that is participating in the prevention plans.

Direct Relief: This disease has taken a long time to gain a foothold in Syria. Why is that?

Dr. Hamadeh: Well, that is a million-dollar question.

There is this theory that has been circulating in the medical community and the research community, that people who were vaccinated against TB, they [may be less sensitive to] Covid-19 infections. And most of the people in the Middle East, including myself, have been vaccinated in the past.

In my opinion, something that is going well for the people of the northwest is, this is an area that has been isolated. You don’t have any people coming in or out. So as a matter of fact, they were in quarantine for a long time.

Direct Relief: What’s going on with the conflict right now, and how does that affect the country’s ability to respond to Covid-19?

Dr. Hamadeh: That’s another good thing that is happening now: There is a truce. There is no reported fighting or shelling so far. And in this difficult period, it’s really hard to see how people are going to start fighting again.

I wouldn’t be surprised [if the fighting started again]. I also won’t be surprised if the world also turned a blind eye on something like that. Nothing surprises me after the failure of the world to stop the carnage and the slaughter of half a million people in Syria so far.

I think the whole world is now consumed with this pandemic. So if it did stop the war in Syria, even for a short period of time, that’s one of the positive side effects of Covid-19 in the Middle East.

Direct Relief: What is most needed right now to prevent the disease’s spread in Syria?

Dr. Hamadeh: Everything. Everything is needed. Basically, a miracle is needed, and good luck, because if it starts spreading in Syria, or in Idlib in particular, there is nothing to stop it.

You need to protect the most vulnerable people. And the most vulnerable are basically the elderly and the medical workers.

Basically, protective gear is the most important thing right now. Obviously ventilators and ICU units, but you know, if the United States is having a problem getting to those things, what do you think about somewhere like northwest Syria?

Now we’re realizing that anything, anything that happens in the world will affect us all together. There’s no isolation anymore. The whole world is one place now.