The situation in Syria creates an environment favorable for communicable diseases, but also one difficult to track and monitor. A large percentage of the 6 million IDPs live in overcrowded temporary settlements and live with lack of adequate water, sanitation, and healthcare. Another 1.1 million live with limited access to basic services. There are millions of displaced children who have never been vaccinated (World Health Organization [WHO], 2018).

• Acute bloody diarrhea outbreak due to high levels of E. coli in the Euphrates river.

• 1,219 people diagnosed with typhoid fever due to unsanitary water.

• Outbreaks of hepatitis A due to unsanitary living conditions and water

• Increased rates of cutaneous leishmaniasis with 71,484 reported in 2018.

• Several outbreaks of measles with 24,004 reported infections in 2018.

• In 2017, there was a small outbreak of vaccine-derived polio virus.

• HIV infections are very rare.

• Tuberculosis is on the increase with 22 cases per 100,000 people.

• In June 2020, the WHO has been notified of influenza like illness, acute diarrhea, lice, leishmaniasis, and suspected hepatitis.

(IHME, 2018; WHO, 2018; WHO, 2020)

Covid-19

Syria is at a very high risk for a pandemic due to its destroyed health system, energy, water, and sanitation infrastructure. The 6 million IDPs along with tens of thousands of suspected ISIS fighters and families in camps and detention centers live in cramped conditions with lack of access to health care services, lack of clean water and poor hygienic conditions. Treatment and testing remains a difficulty due to lack of resources. Multiple border crossings have been closed to aid. The numbers of COVID-19 cases are relatively low, but are likely not reliable statistics. Healthcare workers are at increased risk due to lack of PPE.

• 4,102 cases with 194 recorded deaths (last updated Sept. 9, 2020)

• health care facilities unable to absorb suspected cases

• health care professionals report far higher

• estimated that only 1.25% of cases are being counted

• increase in deaths have been noted

• estimated at least 100 patients die a day in the capital city alone from suspected COVID-19

• Many people are reluctant to go to hospitals

Negative effects:

• severe economic crisis (80% living below the poverty level)

• Syrian pound (SYP) decreased significantly (2,200 SYP to 1 USD; 694 SYP to 1 USD one year ago)

• Food increased by 22.8 times the average price

• 9.3 million are considered food insecure

Precautions:

• border crossing closed with some limitations

• widespread easing of preventive measures

• business as normal with mandated precautionary measures

• public transportation resumed

• schools and universities reopened

• North-East Syria is still banning public gatherings, postponing the school year, and mandating face coverings.

• website created to monitor cases

• COVID-19 hospitals created and supported by WHO

(Baghdadi, 2020; OCHA, 2020)