Citizens worldwide have complained about their governments acting too slowly, or too quickly. But what if you live in a region where there is no government at all to tackle the pandemic?

In the conflict-ravaged northwest region of Syria, there are fewer than two doctors per 10,000 people and less than six intensive care unit beds per 100,000 people.

A coalition of local NGOs have tapped into one very valuable resource: a diaspora of highly skilled Syrian doctors around the world who are volunteering their time and expertise digitally via Zoom and WhatsApp to help protect the region from the virus.

Syria’s health system was once one of the most advanced in the Arab world, but almost half its doctors are thought to have fled the country since the conflict began

“In these times, no one cares about a conflict area like ours because each country and government has its own problems to solve,” said Fouad Sayed Issa, founder of Violet Organization, an NGO that has been working in northwest Syria since 2011. “That’s why the best people to help us are Syrian doctors.”

Syria’s health system was once one of the most advanced in the Arab world, but almost half its doctors are thought to have fled the country since the conflict began. And in the opposition-held northwest, the health system has faced particular challenges.

Daily attacks on facilities, the collapse of central governance and a chronic lack of resources and supplies have contributed to a weak health system that tries to serve almost three million internally displaced persons, many crammed into some 500 camps.

Because of the conflict, northwest Syria finds itself naturally isolated from surrounding territories, which means population movements into the region are very limited compared to the other areas of the country. That isolation gives its people a protective advantage that might delay the onset of the outbreak. But if the virus does enter the region, it could spread very quickly.

“Our biggest problem is economic,” said Issa. “People here need to work daily to survive, so they cannot stay home for a week, or even a day. There is no government that can give orders to help stop the spread of the virus. And in some areas, as many as one million people are living together, having to share food, water and toilets.”

The health system is barely capable of dealing with existing needs, let alone the predicted spread of Covid-19. But under the guidance of the World Health Organization and Idlib Health Directorate, a Covid-19 task force of local NGOs, including Violet, has developed a response plan that leans heavily on the knowledge, expertise and skills of Syrian doctors abroad.

That includes doctors like Abdulkarim Ekzayez, an epidemiologist who worked with Save the Children in north west Syria and now researches health in conflict areas in the Middle East at King’s College in London. Ekzayez helped design the algorithm behind an Arabic-speaking website and mobile app for people in the region to self-assess whether they have Covid-19 symptoms.

“You have the Minister of Health supporting people in the regime-held areas but, I asked myself, what about non-regime areas? Who's supporting them?” he explained.

Syrian consultants in the US, UK, France and elsewhere were asked to share resources and deliver training sessions to local doctors via Skype, Zoom, GoToMeeting and Google Meet on a range of urgent issues, from the epidemiology of the virus to best practice in screening and testing, community awareness activities and disinfection campaigns.

A central medical chat room has been established on WhatsApp where clinical information is shared on a daily basis with a small team of Syrian consultants in Saud Arabia, Europe, the US and Canada, enabling local doctors to get a second opinion on potential cases, discussing the evidence from blood tests or CT scans.

Much of the co-ordination has been done through membership organisations that represent Syrian doctors abroad, such as the Syrian American Medical Society (SAMS), the Syrian Expatriate Medical Association in Turkey and the Union of Medical Care and Relief Organizations, headquartered in Switzerland.

However Ekzayez, who [has published a paper](https://kclpure.kcl.ac.uk/portal/en/publications/covid19-response-in-northwest-syria(0be0a0b1-5908-4a41-9160-486536198648%29.html) about the Covid-19 response work in northwest Syria, thinks a similar approach could work in other areas of conflict. “It could be applicable elsewhere, in places like northeast Syria and Yemen. But it will only work if you go local and go small,” he argued.

The work of local NGOs and the Syrian medical diaspora is giving the region a fighting chance

“You need to engage local actors who have the technical capacity, but also the trust and legitimacy among local people in order to mobilise local resources, through small projects and interventions.” In northwest Syria, for example, Ekzayez says local actors, such as the Idlib Health Directorate and White Helmets, have played a key leadership role in the response.

With their help, for example, a ‘Volunteers against Corona’ campaign has mobilised thousands of volunteers covering most localities in the region, organised into technical teams and neighbourhood committees, using WhatsApp and Facebook for day-to-day communication and co-ordination.

Government-controlled Syria has reported 177 cases and seven deaths from coronavirus at the time of publishing, while northwest Syria has no confirmed cases of Covid-19 to date. Given the limited testing capacity in the region, it is impossible to say with certainty that northwest Syria is free of cases. But the work of local NGOs and the Syrian medical diaspora is giving the region a fighting chance. – Ian Wylie

(Photo credit: Tyler Franta/Unsplash)