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Coronavirus information
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Women hold stacks of bread as they walk along an empty street, as restrictions are imposed to prevent the spread of COVID-19 in Qamishli, Syria, on March 23, 2020.

RODI SAID/Reuters

The coronavirus pandemic has stretched, and in some cases broken, the health-care systems of developed countries. Now it’s beginning to test the defences of some of the world’s poorest and most vulnerable societies.

The confirmation of the first cases of COVID-19 in war-torn Syria and the densely populated Gaza Strip heralds a new phase in the crisis, one that aid workers fear could see the virus wreak havoc on populations in crowded refugee camps that do not have the options of social distancing or self-isolation and which often lack access to basic sanitation.

“It’s just a toxic combination of risk factors,” said Louisa Baxter, a medical doctor who heads the humanitarian health team at the international charity Save the Children. “Once the first case [of COVID-19] is seen, you’re fighting a losing battle after that.”

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The Syrian government recorded its first confirmed case Sunday – a 20-year-old woman who had recently arrived from abroad, state media said – prompting a rush to buy groceries and fuel and to withdraw cash from banks ahead of an expected lockdown. Even before that, President Bashar al-Assad had already shut down public transportation and ordered restaurants, cafés and most businesses to close.

Syria’s health-care system, which was already creaking before the eruption of civil war nine years ago, has been devastated in parts of the country that fell under the control of anti-Assad rebels. Regime forces and their Russian allies regularly targeted hospitals as a means of pulverizing populations in those regions, killing hundreds of health-care workers in the process.

Aid organizations focused on Syria say they fear the country’s sparse medical resources will be distributed solely to regime loyalists. There’s also concern that Syria’s coronavirus problem may already be much bigger than reported, given that planes from the regime’s close ally Iran – which has the region’s biggest outbreak, with more than 23,000 confirmed cases and 1,812 deaths as of Monday – have continued to land in Damascus even though other flights have been suspended.

Of particular concern is the northwestern province of Idlib – the last major area still under the control of anti-Assad rebels – where an estimated one million people are crowded into makeshift camps near the Syrian-Turkish border that lack running water and other basics. Aid workers say the epidemic has made it even more difficult to deliver supplies and services.

“Governments in Iraq, Yemen, Syria and other places are already making it impossible for us to move around with goods and people,” said one aid worker, whom The Globe and Mail is not identifying out of concern it could have repercussions on their organization’s ability to work in the region. “This is only gonna get worse.”

The Gaza Strip, where an estimated two million people live tightly packed into just 365 square kilometres, also recorded its first two cases Saturday, both of whom had returned to Gaza after travelling to Pakistan via Egypt. That set off a panic among a population who had previously hoped that Gaza’s isolation from the outside world – due to a 13-year-old Israeli military blockade that was imposed after the extremist Hamas movement seized control of the territory – might spare it having to deal with COVID-19.

“All of a sudden, we were seeing people storming to shops and buying in bulk in expectation of a curfew. I just heard reports of a fistfight outside a shop,” said Matthias Schmale, Gaza director of the UNRWA, the United Nations agency responsible for the welfare of Palestinian refugees around the Middle East.

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Mr. Schmale compared conditions in Gaza – and in the Palestinian refugee camps in Lebanon, which are similarly cut off from the country that surrounds them – to the cruise ships that have become infamous for the rapid spread of coronavirus among those trapped on board. “If it breaks out here in an indigenous way, it would spread like wildfire,” he said.

Save the Children’s Dr. Baxter said the measures Western societies are adopting to slow the spread of COVID-19 simply can’t be applied to refugee situations such as the Syrian and Palestinian camps, or the more than one million Rohingya Muslims living along the Bangladesh-Myanmar border.

“Some of the messaging that we’re using in the West – like washing your hands and practising social distancing – how do you translate that to a refugee camp where, for example, you’re all living in one room as a family and where there is enough water to perhaps cook a meal that night but not to wash hands repeatedly? Or where you have to go outside to get to a food drop or else your children will go hungry?”

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