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Scientific study could help save thousands of displaced people in camps in northwestern Syria

Editing: Malek Al Haddad |
Publication date: 2020/09/02 18:52

The Pax Syriana foundation, in collaboration with a group of volunteer researchers recruited by CrowdfightCovid-19, a non-profit online platform involving thousands of scientists to help fight the Corona virus epidemic, published a policy report relative to the protection of refugee camps in northwestern Syria from the Corona epidemic. This report is based on an academic research study pre-published on the September 1, 2020, which details a preventive strategy that could help save thousands of displaced people living in the camps of northwestern Syria.

The scientific research was conducted by five researchers specializing in biology and mathematics: Chamsy Sarkis, a former molecular biologist and founder of the Pax Syriana foundation, a non-profit organization concerned with social issues, in partnership with four volunteer researchers, Alberto Pascual-García, a theoretical biologist at the ETH-Zürich Federal Institute of Technology in Switzerland, Eduard Campillo-Funollet, mathematics researcher at the University of Sussex in the UK, Jordan Klein, health and demographic policy researcher at the Princeton University in the United States, and Jennifer Villers, a modeling specialist also at the Princeton University.

The study describes three inexpensive measures to protect the camps from an outbreak, in the context of a healthcare system that is under important pressure in northwestern Syria, as it was mentioned previously by Maram al-Sheikh, Health Ministry in the Syrian Interim Government on April 23, 2020

Three measures to protect thousands of internally displaced persons (IDPs): 

According to a press release published by Pax Syriana, the application of three non-medical interventions is sufficient to save up to 85,000 displaced persons by slowing down the Coronavirus epidemic (COVID-19), preventing its spread within the camps and reducing the number of deaths, told Chamsy Sarkis, Pax Syriana’s founder.

C. Sarkis said that the three outcomes of the study resulted from “the implementation of three interventions: self-distancing, self-isolation, and the protection of vulnerable fraction of the population (elderly and those with chronic diseases such as diabetes, blood pressure, and cardiovascular disease) in a safety-zone”.

A press release related to the study explains that self-distancing amounts to "encouraging people to reduce physical contact with others, wear masks, and wash hands regularly, which are similar to what the World Health Organization (WHO) has recommended since the beginning of the epidemic."

C. Sarkis pointed out that the application of self-distancing and the reduction of daily contacts among its population by 20% to 50%, can reduce the number of deaths up to 30%.
The research showed that self-distancing depends on, reducing meetings as much as possible, dispensing with unnecessary meetings, wearing face masks during meetings or in markets, in addition to hand washing and improvement of hygiene in the common spaces.
The second intervention alone could reduce the mortality rate up to 30%, according to C. Sarkis, by securing between 5 and 15 individual isolation tents per 1,000 people. He explains that for the success of self-isolation, residents who feel symptoms resembling those of COVID-19 or in the event of a fever should isolate themselves rapidly in an individual isolation tent that can be placed in a dedicated area in the camp, or alternatively next to the family tent for proper care.

The third intervention, according to the research, consists in dividing the camp into two areas: an exposed area where most of the camp's residents will reside, and a smaller "safety zone", where 10 to 30% of the camp is self-protected and self-organized. The "safety zone" will host the elderly and individuals with comorbidities and a limited number of accompanying family members to ensure appropriate care for those in need. Residents from the safety zone are allowed to meet with individuals from the exposed side in a "neutral zone", complying to protective measures such as wearing face masks and 6-feet spacing distance. In addition, the community should organize to provide food, water, sanitation and all necessary assistance to the protected population residing in the safety zone.

Chamsy Sarkis said that the implementation of the three measures together in the camps will reduce the number of deaths of the Coronavirus epidemic by 80%, stressing that this is provided by the results of the study, which was based on a comparison of about 70 combinations of simple interventions that can be implemented in the camps. The research looked into the number of lives that could be saved in each case, the mechanism and speed of transmission of the virus within the camp, as well as other factors important to implement an effective response.

The International Rescue Committee (IRC) has previously warned of the risk of corona outbreaks in the camps, and the International Rescue Committee (ICRC) has warned of a rapid outbreak of COVID-19 in refugee camps, including IDPs living in camps in Syria.
The committee's senior policy adviser, Marcus Skinner, said COVID-19 has a "more deadly" risk to camp residents, living in a tighter, more densely populated area, citing a lack of adequate health care, shelter, water and sanitation.

About the importance of a specific response for the camps:

According to the press release issued about the research conducted by Pax Syriana and researchers gathered by crowdfightCovid-19, the researchers modelled the risks posed by COVID-19 in camps in the absence of any preventive measures. The results indicate that the number of fatalities may reach as many as 10% of the residents of these camps, and that the implementation of simple non-medical procedures can significantly reduce the impact of the outbreak of coronavirus in the camps, also benefiting to the local populations living in the same areas of the camps by reducing the pressure on a weakened healthcare system.

The press release mentions that other areas of Syria with high concentrations of camps for IDPs, such as the north/north-east (under the control of the Kurdish autonomous administration) and the southern suburbs of Damascus (controlled by the Syrian government), may benefit from this research. Researchers also believe that similar strategies can and should be adopted in slums, potentially benefiting up to 2 billion people living in slums worldwide.

Chamsy Sarkis told on August 20, 2020, that the study on the camps showed that if only ten to twenty camps faced an outbreak, out of a thousand camps scattered in Idlib alone, would be enough to result in the collapse of the local healthcare system within few weeks.
He explained: "If there are 10 concomitant outbreaks in ten different camps, the local healthcare system will collapse. Indeed, each camp hosts an average of 1,000 IDPs and in less than 2 months, each camp will have about 100 severe or critical cases (about 10%) in need of a ventilator and an intensive care (ICU) bed. For 10 camps only, we predict the need for 1000 places in ICUs, which is already beyond the healthcare capacity in northwestern Syria".

According to the Health Cluster team for northwestern Syria, which is administered by the World Health Organization (WHO), there are 114 ICU beds and 86 ventilators in the region, according to the data updated on August 24, 2020.

Earlier, the Coordinator of an MSF project in northwestern Syria, Christian Rinders, warned of a humanitarian disaster in the event of the arrival of COVID-19 in the region, calling on the international community to assume all its responsibilities towards the people forced to live in rudimentary and informal camps lacking healthcare and preventive measures, pointing to the worsening health situation in the context of dozens of health facilities that are out of service. 

The Syrian Civil Defense Organization also warned of a "real disaster" for more than four million people in northern Syria in the event of a COVID-19 outbreak, announcing in a video statement in the night of Sunday 20-21 April 2020, that "although no casualties have been recorded so far, that does not mean that there is no cases. There will be no ability to deal with cases that may turn into an explosion, especially in the camps where more than 1.5 million IDPs live in camps and half in overcrowded camps, lacking basic necessities, including water and sewage systems."

Coordination and leadership at the local level:

The third measure consisting of a safety zone within the camps to protect the elderly and chronically ill relies on the support of relief and humanitarian organizations to provide food, drink and medicine.
C. Sarkis told Smart that the safety zone inside the camps needs support from humanitarian and relief organizations to ensure their needs and keep them protected from mixing with exposed individuals. He pointed out that it would be preferable to have a local leadership to ensure the coordination of an organized response, suggesting the Health Directorate in Idlib could be an appropriate candidate for the coordination.

According to the WHO plan, 1,410 isolation beds should have been set up in wards by the end of June 2020, but as of August 24, 2020, only 330 beds had been equipped, and the number of intensive care beds and breathing machines should have been increased to 188 beds and 159 breathing machines, of which 144 beds and 86 breathing machines are currently available.
In a recording on August 1, 2020, the Health Ministry of the Interim Government stated that the World Health Organization (WHO) is leading the plan for northwestern Syria, not the Ministry of Health, noting that the health sector is very complex because there are many stakeholders" without naming these parties, and that their ability to work in Idlib is limited to the work through the Health Directorate in Idlib.

C. Sarkis explained that the leadership of the coordination process needs to be able to coordinate directly with the United Nations Health Cluster, and that the authority or department that will lead the coordination process must be accepted locally and internationally, and must have experience dealing with health disasters, and be able to gather a human force of volunteers who are able to help implement the three interventions proposed in the study, in addition to being able to provide information and awareness campaigns and training. He suggested that the plan stats by implementing these measures in homogeneous camps because it would be easier and it would provide on the ground evidence that the interventions are feasible, which can be communicated to other camps in the next phase.

Chamsy Sarkis concludes that the findings of the research highlight the effectiveness of non-medical and interventions to protect the IDP populations living in the camps of NW Syria. Furthermore, they highlight the importance of engaging and empowering local communities to implement camp-specific responses, in addition to the response plan developed by the WHO. Therefore, there is an immediate need to shift the priorities of international donors towards alternative prevention strategies to protect these vulnerable populations and to alleviate the burden on the local healthcare system.

The research opens the door to community-led responses to the Coronavirus epidemic, that can be more efficient, effective and less costly, especially for one third of the world's population living in camps or slums, and demonstrates the important role played by the scientific community in finding feasible, effective and tailored strategies to help these communities. It reveals that through international solidarity, solutions can be found at the lowest cost to the international community, stressing that protecting the most vulnerable populations from the pandemic is the most effective way to protect the world's population.