This week Syria confirmed its first case of COVID-19 — amidst accusations the regime has covered up thousands of infections. Somalia, long insulated from international travel due to years of instability, has also reported its first case, as has Gaza. As cases of coronavirus trickle in to some of the world’s conflict zones, people are bracing for the worst.
The co-existence of CIVOD-19 and armed conflict could create a perfect storm of factors for the spread of the virus. While coverage to date has centered on the challenges faced by developed, stable and resource-rich countries, a host of additional factors are likely to further complicate the response in poor, war-torn spaces.
Active conflicts lead to large-scale displacement, where thousands flee from home. Displaced persons bunker down in urban areas, host communities and slums, or are forced into crowded camps. In camps, families share tents, packed in, with little personal space. Conditions in camps vary by region, but I’ve seen tents housing up to 25 people during acute phases of emergencies. These conditions offer no realistic opportunities for social distancing.
Sanitary facilities in camps are often poor, with communal — sometimes filthy — washing and toileting facilities, shared by hundreds. While hand washing is said to be the best protection from the virus, soap is often a limited resource. In interviews conducted with women in South Sudan and northern Nigeria, many listed soap as one of their urgent needs; something they never had enough of. Lines of women waiting with yellow jerry cans at communal taps, is a common sight in camps across conflict zones. Taps are often broken or switched off, and women have to spend hours of their day waiting for water. None of this encourages the frequent hand-washing touted by experts to slow the spread of the virus.
Adding to these problems are the decimated health systems of countries suffering years of war. National health capacities are often undermined by years of under-investment. Skilled health workers might have fled, leaving large parts of countries with skills shortages — a problem that grows worse the further you go from capital cities. Existing health services are badly over-stretched, with resources already pulled towards a range of urgent health priorities.
Fighting and instability further threatens health services. Since December 2019, fighting in the Idlib and Aleppo provinces of northwest Syria have forced as many as a million people from their homes. During this same period more than 80 health facilities have been shut down — as medical facilities and hospitals are systematically targeted by the government offensive. Those fleeing are crammed into confined spaces; damaged buildings, temporary camps and open fields, bunkering down from Syria’s winter cold. Similarly, health facilities in Afghanistan, South Sudan and Yemen have all been attacked, leaving thousands without medical services — and drastically reducing their virus-readiness. Unstable conditions create challenges around access, with the ability to provide health services being reliant on government or rebel forces permitting organizations to operate. Interestingly, Afghanistan’s Taliban have publicly promised safe passage to healthcare organizations fighting coronavirus, urging aid agencies to bring the response to areas under their control.
Coronavirus prevention relies on community education; on teaching people about the importance of limiting personal contact, and of proper hygiene and hand washing. This too is challenging in conflict, where access, security and resources serve as barrier to community mobilization. Many might not have access to the internet — including those in some refugee camps, where internet and mobiles services are banned by governments. A lack of understanding by local populations can quickly translate to rumors, misinformation and suspicion of health interventions — often compounded by a mistrust of state institutions and leaders. The week before last, 38 patients attacked hospital staff at Shaidahe Hospital in Herat, Afghanistan, after being told to quarantine for coronavirus, before fleeing the scene. In Iran, a cleric declared that applying violet oil to the anus would cure people’s coronavirus. So too, in Iran, at least 27 people died from drinking methanol, trying to protect themselves from coronavirus. Where health workers cannot get into communities to provide real information, people are more likely to accept false ideas.
It’s important to also consider the social effects of this virus, which will be compounded by conditions of conflict. Rates of domestic violence spike in war — a well-documented phenomenon. Coronavirus adds to the risk of domestic violence, with these two stressors compounding each other. Women stuck inside with abusive partners due to social isolation policies, will be at a heightened risk of abuse. Police might be less ready to respond to reports of violence in the context of an emergency, where resources are stretched — as well as due to the risks of entering people’s homes during an outbreak. For women, the closing down space for movement resulting from this virus means they have nowhere to go to escape violence, further limiting options already eroded by war.
Conflict leads to desperate poverty. Displaced families live hand to mouth, with rapidly-depleted savings and little economic buffer. Those affected by war often become reliant on daily earnings; small informal trade and coping mechanisms like survival sex. Coronavirus, which has served a heavy hit on the world’s economy, will affect conflict-affected populations hard; people with few social safety nets or options. In these circumstances, lockdowns might quickly give way to desperation and disorder. This in turn will exacerbate tensions — with economic hardships being a major driver of conflict.
The effects of COVID-19 are filtering over into other aspects of humanitarian aid. As borders have shut, many aid workers have left the field before their routes home are closed. Where humanitarians remain in-country, many are on lock down, hardly allowed to leave their compounds. Programmes have been paused. There are concerns about the effects of movement restrictions on humanitarian supply chains. All of this will affect other, critically needed, facets of humanitarian aid, including food aid, sanitation and shelter.
Other peace-making efforts are also impacted. In Afghanistan, direct negotiations with the Taliban were due to start on March 10. These talks have now stalled because of to the ongoing political crisis in Kabul, as well as travel restrictions created by COVID-19. Kenya’s president called off a 16 March summit, to deal with escalating tensions between Kenya and Somalia. The UN Secretariat has asked 9 troop-contributing countries to suspend the rotations of peacekeepers, which will impact peacekeeping efforts. The United Nations has also announced that global refugee resettlement is being put on hold, due to the pandemic.
It’s not all bad news. There are certain ways in which conflict areas are well placed to deal with COVID-19. Some conflict countries have significant experience in dealing with outbreaks, that will prepare them well for this. The DRC, having battled with successive Ebola outbreaks, has developed local skills and expertise in infection control. Ebola treatment centers in DRC are being repurposed to deal with coronavirus, complete with molecular testing machines already on site, leftover from the last Ebola outbreak, giving the country a head start in its efforts. Conflict zones can have certain protective features against epidemic spread. Sometimes, a country’s isolation, resulting from years of war, can provide protection. Angola’s HIV prevalence is significantly lower than its neighboring countries — seen as likely the result of restricted mobility resulting from Angola’s civil war.
When the coronavirus properly hits conflict areas, the results will be significant. Cases are likely to spiral, overwhelming health facilities, probably leading to high numbers of deaths. Along with this may come panic, by people in conditions that make it impossible to protect themselves. This could lead to disorder, and to further violence and instability. Urgent interventions are needed to avoid this.
It is critically important that those responding to coronavirus do not neglect conflict zones. For one thing, coronavirus is likely to further exacerbate human suffering in conflict; already sites of untold misery. But, it’s not just for humanitarian reasons that this must be done. In the absence of vaccines and treatment, given the interconnected nature of the world, this crisis will only be as over, as it is in its worst-hit places. Where pockets of outbreak remain, no one will be safe.