On 8 April 2020, a hospital in Idlib, in northwest Syria, co-managed by Doctors Without Borders (MSF) teams, received a 65-year-old man suffering from a heart condition and showing symptoms of COVID-19, including breathing difficulties and fever. Upon arrival, he was immediately admitted in an observation tent outside the hospital, set-up by MSF as part as our COVID-19 response.
Trying to provide the patient with the best care
The team provided him with oxygen and gave him the best medical care possible, while waiting for an ambulance to refer him to a dedicated structure for test and follow-up, in accordance with referral plans agreed amongst the World Health Organization (WHO) and health organisations in the region.
The medical staff then tried to organise his referral by contacting two facilities dedicated to treat people with suspected or confirmed COVID-19 cases, one by WHO and the other by local health authorities. However, neither of the two hospitals could accommodate him.
The necessary supplies for his treatment were not available in one of the medical facilities and the other one was not yet ready to admit suspected or confirmed COVID-19 patients. The ambulance service, contacted for the referral, was also not yet ready to handle the patient’s transfer.
“Despite these different refusals, the medical team on site kept looking for solutions for this patient,” explains Cristian Reynders, MSF field coordinator for northwest Syria.
An hour after the patient’s arrival at the MSF co-managed facility, the WHO's disease surveillance team came to collect a test sample that confirmed, 24 hours later, that the patient was not ill with COVID-19.
Healthcare in northwest Syria is overstretched, struggling
Later that day, another ambulance was mobilised to transport the patient to the first hospital contacted, which had done its utmost, in the meantime, to find the necessary supplies to be able to admit him, despite facing shortages, even in protection equipment to be able to treat such patients.
"It is well-known that the health system in Idlib is completely overstretched and low on supplies. And this already-challenging situation to keep people healthy will be overrun if COVID-19 spreads here. Just a single suspected case has shown that this region will struggle to cope in the face of this pandemic.”
Cristian Reynders, MSF field coordinator for northwest Syria
“This course of events demonstrates two important lessons. One that we knew and another that we have been concerned about: it is well-known that the health system in Idlib is completely overstretched and low on supplies,” says Reynders. “And this already-challenging situation to keep people healthy will be overrun if COVID-19 spreads here. Just a single suspected case has shown that this region will struggle to cope in the face of this pandemic.”
“Over the past months and years, MSF has been vocal about the critical situation in northwest Syria but also about the limitations that we, and other medical organisations, face to properly respond to the needs and offer an adequate treatment to patients,” says Reynders. “Today, we struggle to get supplies and human resources into northwest Syria and this is massively hampering our capacity to scale up our response.”
“We coordinate with other organisations on the ground, but many are facing similar challenges. Yet, in our activities, we are constantly reminded of how medical assistance is urgently needed, even more so in the face of a pandemic,” Reynders says.
Preparations for “coming storm” made – but it’s not enough
The following day, the patient died of a heart failure.
“We are saddened by this patient’s death. And although the test came back negative, this experience has shown that the region is not ready to cope with the pandemic,” warns Reynders. “Urgent efforts are needed to be ready to face the coming storm.”
“We renew our calls on the relevant Turkish authorities to facilitate the urgent transit of essential supplies and access of staff into northwest Syria, in order to allow the scale-up of our humanitarian and medical response there.”
Cristian Reynders, MSF field coordinator for northwest Syria
Six more patients with COVID-19 symptoms have already arrived at MSF’s co-managed hospital this week. The hospital admission system has been adapted to screen, detect and refer patients showing COVID-19 symptoms, to protect the medical staff and other patients of infections. But more needs to be done in the face of this situation.
“We’re all doing the best we can with the means available to us and the context that we need to deal with,” says Reynders. “But our incapacity to scale up our activities in Idlib and to do more in the face of this health emergency is a daily reality and could have dramatic consequences.”
“We renew our calls on the relevant Turkish authorities to facilitate the urgent transit of essential supplies and access of staff into northwest Syria, in order to allow the scale-up of our humanitarian and medical response there,” Reynders concludes.
Across northwest Syria, MSF teams provide maternal healthcare, general healthcare and treatment for non-communicable diseases (NCDs) through mobile clinics. They distribute relief items and improve water and sanitation systems.
They also support regular vaccination activities in two vaccination centres and one hospital and through mobile clinic services. MSF also runs a specialized burns unit that provides surgery, skin grafts, dressings, physiotherapy and psychological support. MSF provides distance-support provides support to primary and secondary healthcare in several hospitals and clinics around Idlib and Aleppo and has co-management partnerships with three hospitals.
Since the beginning of the COVID-19 worldwide pandemic, we have been reviewing the triage systems and patient flow to ensure fast detection of potential COVID-19 cases in some of the hospitals and health centres that we support in Idlib governorate.
This measure is taken to put symptomatic people under observation until an ambulance arrives to take them to a dedicated structure for tests and follow-up. We have also set-up hygiene committees and reinforced them with additional staff.
We have strengthened the infection prevention and control measures in our facilities, equipped our staff with the needed protective equipment, donated protective equipment to the staff and donated additional supply for to these facilities to cope with an increased number of consultations.
In some of the camps we intervene in, we have spread awareness messages, adapted the triage system of our mobile clinics and have implemented social distancing measures and reviewed our protocols to be able to also continue non-food items (NFI) distributions and healthcare services while diminishing the risk of contamination.
To ensure independence from political pressures, MSF receives no government funding for our work in Syria.