Nurses hover over a patient to insert a breathing tube as his condition suddenly deteriorates. ICU beds fill up almost overnight.
COVID-19 infections in the last opposition-controlled territory in Syria have increased rapidly. Except as of July, the region now records 300 to 500 infections per day, and the number is increasing rapidly.
The area, hit by repeated military offensives by the government of President Bashar Assad, is home to nearly 4 million people, most of them displaced and living in tent camps or unfinished buildings.
Infection rates increased nearly 20 times between September and October, the UN said. Since then, it is up 300 percent, with nearly 11,900 cases recorded as of Nov. 16, up from 8,100 the week before.
The number of infections is probably much higher. Cities have been hit the hardest, but workers fear the virus will take root in overcrowded camps.
“There are many patients, most of them in very bad condition. We don’t have time to give them everything they need, ”said Aref Shabib, one of more than 95 nurses and technicians at the 70-bed isolation hospital, one of two in the city of Idlib, now a hotbed for viruses.
The pandemic, which has severely tested even developed countries, is the biggest challenge for Syria’s health sector, already depleted by years of conflict. Authorities are preparing, deploying equipment and supplies where needed in areas marked by war.
The ambulance driver, Rami Khalaf, transported a patient and a nurse for three hours from Idlib city to a southern city to be put on a respirator.
When they arrived, they found that oxygen was not available, so they headed to a third location, another three-hour drive.
With the nurse tending the unconscious patient with one hand and operating a walkie-talkie for rescue equipment with the other, they drove more than 200 kilometers.
Khalaf sat sweating behind the wheel for seven hours in his hazmat suit and mask, driving on unpaved and bombed roads.
“We are living a new difficult experience,” he said.
At least Khalaf didn’t have to dodge bombs. Medical teams and hospitals were often targeted by government forces accusing them of treating “terrorists”, their label for opposition fighters.
But transporting patients with viruses is a new challenge. Khalaf transported nearly 50 patients in 10 days, up from virtually none in October. He stays away from his children for two to three days to avoid infecting them.
“It is a new terror that is circulating among us,” he said.
Ads of virus deaths on social media or mosque loudspeakers compete with posters honoring those killed in battle, with 95 deaths related to COVID-19.
As the winter rains began, bringing new rumors of war with them, fears are growing that exhausted medical teams will not be able to cope.
Almost 17 percent of the infections occurred among healthcare workers, who were the first to contract the virus. At least three doctors and one administrator died.
The medical workers who survived the battlefield find themselves battling an invisible enemy that pushes their resistance to new limits.
Unlike war-wounded, a full 24-hour shift can be devoted to a single COVID-19 patient, said Shabib, the ICU specialist.
“We could work six or eight hours non-stop without even sitting down. It is very hard work, ”he said.
At Ziraah or Agricultural Hospital, most of the 42 patients were elderly. At least 16 were receiving some form of respiratory assistance, said Dr. Salah Eddin al-Saleh, in charge of the ICU at the hospital operated by the Syrian American Medical Society.
Al-Saleh said he had to turn away some patients.
“We are working at full capacity and all our beds (ICU) are occupied. The moment a bed is empty, the patient is admitted, ”he said.
In northwestern Syria, which has been out of government control for most of the last decade, the distribution of aid is as complicated as the politics of the conflict.
According to the coordination efforts of the UN task force, there are at least 142 ICU beds and 155 ventilators in the area. The plan is to have 219 ICU beds and 162 machines. Almost 500 doctors and nurses work at COVID-19 centers.
Seven of the eight hospitals in northwestern Syria that are equipped to treat the virus are already overwhelmed.
“The increase in COVID infections, hospitalization cases and the almost total occupation of ICUs, brings us closer to the state of emergency,” said Salem Abdan, Idlib health director.
Infections are also increasing in the overcrowded camps that are home to many of the nearly 1 million people who have been displaced since the last government offensive in March.
Dr Nasser AlMuhawish, who collects virus data from his base in Turkey, said that only about 8 percent of infections have been recorded in the camps and that teams are increasing their testing.
For Syrians who have survived such adversity, the virus seems to be the least of their worries. Social distancing is nearly impossible, with a single tent or temporary shelter housing between nine and two dozen people, some of whom have been repeatedly displaced.
“The people in Idlib have suffered the worst impacts of the conflict in 10 years,” said Misty Buswell, Middle East defense director for the International Rescue Committee.
“Many people say … being displaced is much more difficult than anything from COVID. At this point, I think we have to qualify that and say, ‘So far.
With an economic crisis gripping Syria, the local currency plummets and resources in war zones shrink, even the price of water and soap skyrockets.
Residents who have supported each other through cycles of violence describe a new sense of fear.
“I don’t leave my house except to buy bread and food,” said Yasser Aboud, a father of three who has tested positive in seven relatives. “I am diabetic and I am worried that I might get infected.”
A neighbor died of COVID-19, but Aboud was afraid to pay his respects.
With the threat of a resumption of fighting and a new wave of displacement, Buswell fears a “perfect storm” is building up, especially if infections rise like in Europe and the United States.
The misinformation of the virus is also spreading, such as eating garlic and onion as a preventive. Some see masks as a sign of infection, adding to the stigma of covering up.
The children play a game in which one picks up a mask found on the street and chases others shouting: “COVID! COVID-19! “