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A member of the Syrian Civil Defence, also known as the 'White Helmets,' disinfects a tent in the Kafr Lusin camp for the displaced by the border with Turkey, in Syria's rebel-held northwestern province of Idlib, on March 24, 2020, as part of efforts to prevent the spread of the coronavirus.AAREF WATAD/AFP/Getty Images

Families living in war-torn countries do not have the luxury of staying home in self-isolation, social distancing, or washing their hands with soap. At the hospitals that are still functioning in Yemen, Syria and Gaza, ventilators and even beds are scarce.

More than 15 million families bracing for the COVID-19 pandemic across these regions have access to fewer than 1,700 ventilators and beds, says a new report from Save the Children, a group dedicated to improving the lives of children around the world. The organization said that as of March 29, Syria had reported nine cases of COVID-19 and one death, and Gaza confirmed 10. Yemen has yet to declare any cases. However, experts say testing capacity in conflict zones is limited.

The United Nations High Commission for Refugees representative to Yemen, Jean-Nicolas Beuze, said the UN agency is “extremely worried” about what harm the virus could do in Yemen. Conflict has destroyed half of the country’s medical facilities, and most people live in overcrowded neighbourhoods in camps for the internally displaced or refugees. He said social distancing is impossible.

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“It’s a country where, yes, we can distribute soap, but a lot of people have no access to water, or have real difficulty accessing water, where changing social behaviours is going to be extremely complicated, and where, if there’s an outbreak, they cannot turn to the health sectors for proper response,” Mr. Beuze said in a phone interview from Yemen.

Almost four million Yemenis have been internally displaced, Mr. Beuze said, adding that there is a systemic risk of famine, and many malnourished people are at risk for cholera. According to Save the Children’s report, the country has 700 intensive care unit beds, including 60 for children, and 500 ventilators.

Mr. Beuze said Yemen is not receiving enough financial support, whether from Canada or other countries, adding that it is in a “critical situation."

Last week, the UNHCR asked for US$255-million as part of a wider appeal from the UN, to focus on countries that need support.

International Development Minister Karina Gould announced last week that Canada would contribute $50-million to the World Health Organization and other bilateral aid as a part of a $1-billion coronavirus response package. Some of the funding, Ms. Gould said, has been allocated to the United Nations Office for the Coordination of Humanitarian Affairs.

“They are really doing a global environmental scan and trying to address what the needs are of vulnerable people right around the world,” she said.

Emmanuel Massart, co-ordinator of operations in Syria for Médecins sans frontières (Doctors Without Borders), said that in the northwestern province of Idlib, more than 80 medical facilities have been destroyed.

“On top of that, you have about one million refugees. So it means that the health system is completely incapable of coping with the medical needs,” said Mr. Massart, who is based in Brussels, clarifying that he is referring to everyday medical needs, such as the flu or bronchitis.

He said that if a COVID-19 outbreak was added to the situation, people could not practise basic preventive measures. Self-isolating or social distancing are impossible in a cramped refugee camp with little shelter, he said, and where some families share tents.

“You are told you have to wash your hands, but there is not enough water in the camp and it’s not like there is soap and water taps everywhere. It’s impossible to wash your hands," he said.

“Today, the refugees in Idlib are very, very vulnerable, and we are afraid that COVID could be a catastrophe.”

Save the Children’s figures show that northwest Syria has 153 ventilators and 148 ICU beds, and northeast Syria has fewer than 30 ICU beds, 10 adult ventilators and one pediatric ventilator.

Osama Damo, Save the Children’s regional manager for the Middle East, said in an interview from Gaza that his organization has identified 70 ICU beds and 62 ventilators. He said Gaza has a few hospitals, but not all have intensive care units.

“This brings a lot of fear and anxiety among the different populations here … because the whole system has been overrun for many years due to the blockade. We are speaking here about two million people living in the Gaza Strip, which is a very highly densely populated area," he said.

Mr. Damo said “fear is skyrocketing” because if the virus spreads, “it will be very difficult first to contain, and to provide the medical treatment needed."

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