The Impact of Syria’s Fragmentation on COVID-19 Response

Jesse Marks, Tsinghua University and Schwarzman College

Syria reported its first COVID-19 cases on March 15 — and has now reported its first coronavirus deaths. Many analysts say the total number of cases is much higher, noting independent reports of coronavirus-like cases in Damascus, Tartus, Latakia, Homs and Deir-Ezzor.

How does a country engaged in civil war for the past decade face the coronavirus challenge? The U.N. special envoy called for an immediate ceasefire to prevent an outbreak of the virus in the conflict-ridden country — but no single authority can implement a ceasefire.[1] Syria is ill-equipped to face a global health crisis, but the World Health Organization (WHO), state authorities, and non-state actors in all three administrative regions of Syria have no choice but to take preventative measures to lessen the impact of the coming COVID-19 crisis.

Several key challenges impede any meaningful nation-wide disaster response across contested regions. Few actors trust the Syrian government, which they largely blame for the country’s humanitarian conditions, to manage an emergency response. The state’s explicit targeting of hospitals and clinics have severely damaged the country’s healthcare infrastructure. State-led political impediments to UN humanitarian access limit the flow of life-saving equipment into high-risk areas on Syria’s periphery. If the war continues, as seems likely, Syria’s fragmented and limited health services may leave many regions with little or no outside assistance to fight COVID-19 outbreaks.

State contestation and emergency response

The responsibility for healthcare service and emergency response to a crisis normatively lies with the state. When global health crises emerge, the World Health Organization (WHO) supports governments and non-state actors at the state level to strengthen their national health policies and strategies to effectively respond in the midst of crises.[2] However, coordinating disaster response efforts in Syria means partnering with a state accused of war-crimes and genocide against its own—this will deter many international and non-state actors from joining.[3] The offer and delivery of international aid to the Syrian government could also empower the state to inhibit or appropriate humanitarian aid to contested regions, actually increasing the vulnerability of those-in-need in peripheral areas.

State authority over the disaster-relief response in affected areas of Syria is contested. The country is presently fractured into three competing administrative zones—the Syrian government-held center/south, the Turkish-held north/northwest (including Idlib); and the Syrian Democratic Forces (SDF)-controlled east/northeast. These regions are governed or administered by competing, distinct political entities and a kaleidoscope of militant non-state actors who rely on a series of fragile, inconsistent ceasefires brokered by competing international actors to facilitate humanitarian access for aid providers in order to reach the nearly 6.2 million internally displaced Syrians (IDPs), most of who fall outside of government areas.[4]

A state divided by civil conflict often lacks the capacity to mitigate, prevent, prepare, or respond to natural shocks and stresses in both their own territory and those in contested areas.[5] This is driven not only by military realities on the ground but also by the costs of conflict.[6] The cost of the Syrian civil war on the Syrian government has strained state resources and manpower, reducing state spending on other critical public goods, such as health and medical services. This has severely diminished and weakened the national healthcare system and limited the regime’s patient threshold.

Outside of the government-controlled areas, the systematic targeting of critical medical infrastructure—hospitals and clinics—throughout the course of the civil war has severely diminished the capacity of the healthcare infrastructure to meet the increasing demand resulting from compounding humanitarian crises. The WHO has identified more than 500 military attacks on medical facilities in Syria since 2016, the majority of which occurred in northwest Syria.[7] This has forced many Syrian doctors to flee to neighboring countries leaving critical areas-in-need with limited healthcare access. Even if a dedicated healthcare workforce remained, access constraints and conflict-related impediments will inhibit the level of healthcare services to adequately support civilians-in-need in areas outside of state control.

Syria’s government’s response to COVID-19

The Syrian government unrolled sweeping measures on March 15 to combat the spread of the coronavirus, closing universities, schools, government offices, restaurants and markets, as well as shutting down all intercity public transportation across the country.[8] The government also suspended military conscription, a cornerstone of its sustained military campaign.[9]

On March 20, the government banned entry for foreigners, after the first coronavirus victim reached Syria by road from Lebanon after returning from Europe.[10] Health officials have limited testing capacity, but have deployed medical teams at the national level and to 1,864 health clinics across the country.[11] The World Health Organization also supplied the government with testing kits, but only one Damascus-based lab is reportedly testing for the virus.[12] Damascus has further committed to setting up labs in all governorates, with three underway in Aleppo, Homs, and Lattakia.[13] Prices for masks, disinfectant and medicine have surged while the public health infrastructure remains fractured and under-resourced.

The pandemic response has offered Syria the opportunity to break out from its diplomatic isolation. China has already deployed several medical teams to assist with the outbreak in Iraq and Iran, and has provided testing kits to Syria.[14] China’s U.N. ambassador joined the U.N. call for the lifting of sanctions on Syria. It is only a matter of time before Beijing assists Damascus. The U.S. has committed an additional $16.8 million for humanitarian programming for Syria under its USAID’s $274 million fund for countries affected by coronavirus.[15] Perhaps most significantly, last week, following the G20 summit, Abu Dhabi Crown Prince Sheikh Mohamed bin Zayed extended the UAE’s support for the Syrian people in his first call with the Syrian president since a 2011 break in bilateral ties.[16]

Idlib braces for the worst

Syria’s opposition-held areas face a dire threat without the proper resources to prevent the spread of the disease – or even identify it. In Idlib, nearly 3 million Syrians are particularly vulnerable, particularly the 1 million living in crowded camps along the Turkish border.[17]

The World Health Organization has shipped 300 test kits to the city of Idlib, and promised to supply an additional 2,000 tests, and a testing lab at Idlib Central Hospital is currently testing suspected cases.[18] The WHO will deploy an additional 1,000 healthcare workers and as many as 10,000 masks and 500 respirators to the city and surrounding areas to run the emergency response and testing process in the few remaining healthcare clinics and hospitals.[19]

But tests alone will not be sufficient to prevent the spread of coronavirus, particularly in densely populated displacement camps. Many in these camps already lack shelter and access to water and food. The simplest preventative actions – quarantine, washing hands, disinfecting – are infeasible options for most displaced Syrians. Any coronavirus outbreak would likely prove fatal for hundreds of thousands of civilians, particularly the elderly and those with chronic illnesses.[20]

The compounding needs in Idlib suggest extensive multilateral support will be needed for logistics and delivery of medical services to respond to coronavirus cases, as well as a comprehensive response from emergency aid providers to address existing shortages of food, water, shelter, and other daily essentials. However, hope for such an outcome is grim as major donor countries—the U.S. , U.K., and E.U. states—address their own coronavirus crises.

Out of reach in Northeast Syria

In northeast Syria, the Kurdish-led administration ordered the closure of businesses, restaurants and events as well as a curfew. The border with the rest of Syria is now closed, other than cross-border aid deliveries from Damascus.[21] Only 1 of 16 hospitals in the region is fully-functional.[22] Two additional hospitals identified to quarantine and treat patients, are under-equipped, with only 28 beds for intensive care and 11 ventilators reported, as well as two doctors trained to use them.[23]

Ongoing disputes between Turkish-held groups and the SDF exacerbate the situation. On March 24, Turkish-backed groups shut off water to the city of Al-Hasakeh, creating increased risks of coronavirus and other disease outbreaks for some 460,000 residents, including tens of thousands living in the Al-Hol displacement camp.[24]

The immediate challenge for Northeast Syria is access to outside coronavirus experts. The region received a U.S. donation of $1.2 million in humanitarian assistance and medical equipment. However, the bulk of USAID-allocated medical equipment is delayed because the Whitehouse coronavirus taskforce froze USAID medical shipments to countries-in-need.[25] While WHO officials can reach Idlib via U.N.-approved borders, they cannot cross from Iraq into northeast Syria. China and Russia’s push to end the Syria cross-border aid mechanism under Resolution 2449 in January left the northeast out of reach of U.N. assistance.[26]

Obtaining testing kits and expanding the region’s healthcare capacity depends heavily on if the WHO can access northeast Syria from Damascus, a process which historically has been fraught with political challenges for U.N. agencies.[27] The U.N. Security Council could opt to grant WHO authorization for cross-border assistance at all official crossings – allowing aid to arrive via Iraq and Jordan. This might give the peripheral areas of Syria access to life-saving medical care as the coronavirus spreads – which seems inevitable, given other countries’ experiences.

Moving Forward

The WHO faces steep odds in its efforts to coordinate a response with government and nonstate groups that addresses all of Syria’s medical needs, but the country’s geographic and political fragmentation, deteriorating health-care infrastructure and lack of government resources could derail emergency response efforts. Time is rapidly running out for considering alternatives. A fragmented emergency response, like Syria’s political situation, will leave peripheral regions ill-equipped to face the coming crisis.


[1] UN News, “‘Immediate nationwide ceasefire’ needed for all-out effort to counter COVID-19 in Syria,” March 30, 2020.

[2] World Health Organization, “Working for better health for everyone, everywhere,” Accessed April 4, 2020.

[3] Markus Kostner and Rina Meutia, “Considerations for Responding to Natural Disasters in Situations of Fragility and Conflict,” Washington, D.C.: World Bank. 2011. “

[4] UNHCR Syria, “Internally Displaced People,” Accessed April 3, 2020.

[5] Katie Harris, David Keen, and Tim Mitchell, “When disasters and conflicts collide: Improving links between disaster resilience and conflict prevention,” Overseas Development Institute, February 2013.

[6] World Health Organization, “Re-energizing the HRH Agenda for a Post-2015 World – Responding to the needs of fragile states,” Working Paper for Global Strategy for Human Resources for Health, 2015.

[7] World Health Organization, “More than 500 medical sites struck in Syria since 2016: WHO,” March 11, 2020,

[8] Reuters, “Syria, insisting it is coronavirus-free, takes broad steps to prevent spread,” March 14, 2020.; Edward Yeranian, “Syria Acknowledges One Coronavirus Case,” March 23, 2020.

[9]Suleiman Al-Khalidi, “Syria reports first coronavirus death as fear grow of major outbreak,” March 29, 2020.

[10] Reuters, “War-ravaged Syria takes new steps against coronavirus, says no recorded cases yet,” March 20, 2020. https://w”; Syrian Observatory for Human Rights, “Regime confirms three Coronavirus cases in Al-Dwayer quarantine center and spread of pandemic looms ever closer,” March 25, 2020.

[11] Press TV, “Syria parliamentary elections adjourned to May 20 over coronavirus concerns,” March 14, 2020.

[12] Alice Fordham, “The Challenges of Preparing for Coronavirus in Syria,” NPR, March 20, 2020.; Eric Knecht, “Shattered by years of war, Syria braces for coronavirus spread,” Reuters, March 24, 2020.

[13] World Health Organization, “Syrian Arab Republic: COVID-19, Humanitarian Update No. 5,” April 10, 2020.

[14] Middle East Monitor, “China calls for the lifting of sanctions against Syria to fight coronavirus,” April 1, 2020.

[15] US Department of State, “The United States Is Leading the Humanitarian and Health Assistance Response to COVID-19,” Fact Sheet, March 27, 2020.; Center for International Disaster Information, “Coronavirus Disease 2019 Response,” Accessed April 3, 2020.

[16] Tawfiq Nasrallah, “COVID19: Mohamed bin Zayed expresses solidarity with Syrian people,” Gulf Times, March 27, 2020.; Edward Yeranian, “UAE Crown Prince Chats with Syrian President in Apparent Bid to Improve Ties,” Voice of America, March 30, 2020.

[17] UN News, “UN determined to stand by the people of Syria’ says Lowcock, as grave humanitarian crisis intensifies around Idlib,” March 3, 2020.; Ammar Cheikh Omar, Mustafa Hashim and Saphora Smith, “Trapped between 2 armies, almost 1 million Syrians have nowhere to go in Idlib,” NBC, March 1, 2020.

[18] Al-Jazeera, “War-torn Syria braces for lockdown after first virus case,” March 24, 2020.

[19] Lisa Schlein, “Attacks Prevent Displaced in Syria’s Idlib from Getting Health Care,” Voice of America, February 28, 2020.

[20] World Health Organization, “Syrian Arab Republic: COVID-19, Humanitarian Update No. 5,” April 10, 2020.

[21] Amberin Zaman, “Kurdish-led northeast under lockdown as Syria announces first coronavirus case,” Al-Monitor, March 23, 2020.

[22] International Rescue Committee, “COVID-19 in Syria could lead to one of the most severe outbreaks in the world, warns IRC,” Press Release, March 23, 2020.

[23] Ibid.

[24] Human Rights Watch, “Turkey/Syria: Weaponizing Water in Global Pandemic,” March 31, 2020.

[25] Nike Ching and Jess Seldin, “US Trying ‘Urgently’ to Stave Off Coronavirus Outbreak in NE Syria,” Voice of America, April 8, 2020.; Natasha Bertrand, Gabby Orr, Daniel Lipman, and Nahal Toosi, “Pence task force freezes coronavirus aid amid backlash,” Politico, March 31, 2020.

[26] Jesse Marks, “Northern Syria depends on U.N. aid. Its delivery could end tomorrow,” Washington Post, January 9, 2020.

[27] Jesse Marks, “Humanitarian aid in Syria is being politicized — and too many civilians in need aren’t getting it,” Washington Post, August 19, 2020.