key: cord-0724625-rpo1c00k
authors: Almhawish, Naser; Karah, Nabil; Elferruh, Yasir; Aksh, Aya; Abbara, Aula
title: Protecting healthcare workers in conflict zones during the COVID-19 pandemic: northwest Syria
date: 2021-02-03
journal: J Infect
DOI: 10.1016/j.jinf.2021.01.027
sha: 89391efed2c227030c21fb21262ecade44478d7d
doc_id: 724625
cord_uid: rpo1c00k

• In northwest Syria, healthcare workers account for 13% of confirmed COVID-19 cases; • Surveillance systems e.g. EWARN are key to outbreak identification and response; • Understanding SARS-CoV-2 dynamics in conflict is key to mitigating spread; • Protection of healthcare workers in Syria, e.g. vaccine prioritisation is important.

Discussion: The increase in the numbers of cases of COVID-19 in NWS was initially slow however as of mid-September 2020, cases increased rapidly and have overwhelmed hospital and staff capacity though the rate of new cases appears to be slowing. We highlight a number of findings. As elsewhere, the impact on healthcare workers both personally and professionally has been grave with a large proportion affected; however, healthcare workers in this area work in an already exhausted and under-resourced health system after almost a decade of conflict and face ongoing attacks 5 . The effects on the health workforce in areas under government control have been even more stark with suggestions that at least 165 doctors have lost their lives, however, official confirmation has been suppressed 6 . Seroprevalence studies among healthcare workers have not been performed so the true extent of exposure remains unknown.

The high representation of healthcare workers among positive cases is likely due to increased exposure as in other contexts but also access to testing, particularly early in the outbreak.

Secondly, early in the outbreak, there were fewer cases than expected in the camps however, as of the end of October 2020, cases are increasing; the slow increase is likely a result of poor access to testing, poor trust in local healthcare providers and restricted movement. This is being addressed and a number of activities including more sampling locations, camp screening around the first confirmed cases in some camps, and more community engagement activities were conducted targeting the camps area. Lastly, the declared number of cases (around 0.5% of the population) likely represents an underestimate of cases due to under-testing and underdiagnosis due to weakened health system capacity after almost a decade of protracted conflict.

Conclusions: The high prevalence of COVID-19 among healthcare workers in NWS is of major concern. Measures to protect healthcare workers from increased rates of infection are urgently required; these include prioritization for vaccination, improved access to PPE, and refining IPC precautions in health facilities.

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Figure 1: This shows a map of northwest Syria showing Bab Al-Hawa border crossing and the density of COVID-19 cases across districts covered by the Early Warning and Response Network Figure 2: This bar chart shows the number of cases in Idlib and Aleppo governorates over time