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Period: September 23 - 20 October 2020 Period: September 23 - 20 October 2020 2 The outbreak of disease caused by the virus known as Severe Acute Respiratory Syndrome (SARS-CoV-2) or COVID-19 started in China in December 2019. The virus quickly spread across the world, with the WHO Director-General declaring it as a pandemic on March 11th, 2020. The virus's impact has been felt most acutely by countries facing humanitarian crises due to conflict and natural disasters. As humanitarian access to vulnerable communities has been restricted to basic movements only, monitoring and assessments have been interrupted. To overcome these constraints and provide the wider humanitarian community with timely and comprehensive information on the spread of the COVID-19 pandemic, iMMAP initiated the COVID-19 Situational Analysis project with the support of the ​ USAID Bureau of Humanitarian Assistance (USAID BHA), aiming to provide solutions to the growing global needs for assessment and analysis among humanitarian stakeholders. 3 Executive Summary / Highlights ● Epidemiological overview: As of 20 October 2020,1 the total number of reported confirmed cases across all ​ ​ areas of Syria was 11,575, an increase of 161% since 20 October where 4,429 total cases had been reported. Given the limited testing activity across Syria and scarce information, the actual number of cases likely far exceeds official figures. Of particular concern is the number of health workers affected by the disease, making up 16% of confirmed cases in northeast Syria and 15% in northwest Syria. Another major concern is the alarming positivity rate of COVID-19 testing: in northwest Syria the positivity rate has been 21% since 9 July 2020 and in northwest Syria it is 35% as of 30 September. A decade of conflict, multiple displacements, economic shocks in the country and in neighbouring countries, military operations, and violence had already severely affected the population and infrastructure, leading to a weakened capacity to manage the spread of the disease and its repercussions. ● Containment measures: While authorities initially reacted to news of the global transmission of COVID-19 by ​ closing most public services and heavily restricting movement, there was a progressive relaxation of these containment measures during the summer. Most activities have returned to pre-COVID levels, as authorities seem less willing to enforce public health measures and communities seem less willing or able to comply with them, with notably the reopening of schools across Syria despite the number of reported confirmed cases rising by 154% across Syria between 20 September and 20 October 2020. ● Information and communication: Despite multiple awareness campaigns conducted throughout Syria, survey ​ results show gaps in knowledge among the population regarding measures for self-protection against contracting COVID-19 as well as what to do while awaiting test results and in case of infection. While cumulative Risk Communication and Community Engagement efforts reached an estimated 15 million people as of end September, survey information and anecdotal evidence suggests the risk perception across Syria is very low and considerably low adherence to individual preventive measures has been observed in some communities. ● Humanitarian needs: The humanitarian situation remains dire as additional stressors created by the COVID-19 ​ pandemic and the economic downturn, involving currency devaluation, hyperinflation, rising unemployment, and an increasing number of businesses shutting down, are contributing to the erosion of household purchasing power and compounding the humanitarian needs of the 11.7 million people already experiencing need in Syria. While taking precautionary measures is crucial to mitigating the spread of COVID-19, they have ​ ​ added another layer of complexity to humanitarian response by both exacerbating existing vulnerabilities and creating new ones. The response has reported the reduced availability of and access to basic services and employment opportunities. Overall, safety nets and basic resources are strained more than ever before and unaffordability is reported across sectors as being the main barrier to accessing goods and services. 1 There is a possibility for authorities in different regions to report the same cases in some instances, leading to double-counting. 4 Executive Summary / Highlights 3 Context 6 Timeline 7 COVID-19 Epidemiological Overview 10 Confirmed COVID-19 cases are on the rise 10 Doubts remain over the true scale of the epidemic 10 High impact among health professionals 11 COVID-19 Containment Measures 13 Government-controlled areas 13 Northwest Syria 13 Northeast Syria 14 Compliance and resistance to COVID-19 measures 16 Adherence to personal preventative measures remains low in all areas 17 As enforcement of measures decreases, so too does compliance 17 Money is the main barrier to preventative measures 18 Reluctance to stay in camp isolation centres 18 Communication and Information 19 Information needs 19 Awareness of the virus improving 19 Gaps in knowledge persist 19 Rumours and misinformation 20 Communication Channels 20 Movement Restrictions 23 Sea ports remain operational but flights are restricted 23 Land borders are still mostly closed 23 Economic developments 25 Currency devaluation 25 Unemployment 26 Increased poverty 26 Overview of impact and humanitarian conditions 27 Livelihood 27 Income losses 27 Increase in prices 28 Coping mechanism 28 Food security 28 Reduced food availability 28 Increase in food prices 29 5 Movements restrictions 30 Food needs increasing 30 Coping mechanisms 30 WASH 31 Inadequate infrastructure exposing people further to the virus 31 Access to hygiene items 32 Protection 33 Increased child protection issues 34 Child labour, forced prostitution, and forced early marriage are increasingly reported 34 Gender-based violence significantly increasing 34 Closure of GBV-support structures 35 Food needs may be exacerbating gender and social inequalities 35 Stigma keeps people from reporting symptoms, seeking treatment 35 Housing Land and Property 36 Education 37 Schools reopening is further exposing children to the virus 37 Affordability will now be a greater barrier to education 37 Logistics 38 Fuel has become unaffordable for most households 38 Impact on food prices 38 Impact on humanitarian actors 38 Closure of border points leading to delayed shipments and urgent road maintenance work 38 What we are missing 40 Accurate epidemiological data 40 Health status of those entering Syria irregularly 40 Quantification of COVID-19 impact on the deteriorated humanitarian situation 40 Humanitarian actors' challenges in primary data collection and analysis 41 Remote data collection challenges 41 Additional health protective measures during data collection 41 Little to no impact on data analysis 42 Additional challenges for coordination 42 About this report 43 Contact 48 6 Context Map 1: Areas of Control in Syria (liveuamap, 08/11/2020) ​ ​ This report refers to three main areas of Syria as does most of the source data included in the analysis: Government of Syria (GoS)-controlled areas: This refers to the area of Syria controlled by the Government of Syria ​ and allies, primarily in cities along the western spine and central and southern Syria. Northwest Syria: This refers to the area of Syria controlled by non-state armed groups and Turkish-backed armed ​ forces in northern and western Aleppo governorate, a significant portion of Idleb governorate, and smaller areas of Lattakia and Hama governorates. Northeast Syria: This refers to the area of Syria controlled by the Syrian Democratic Forces (SDF) and administered by ​ The Autonomous Administration of North and East Syria (AANES). Sources may use different definitions of these three areas depending, amongst other factors, on the time of publication. Therefore it is crucial that original sources are consulted for an accurate understanding of what areas findings of this report should be applied to. 7 Timeline2 ​ 2 S​ ources for epidemiological data: (MoH GoS, WHO, OCHA 20/10/2020, AANES 20/10/2020). There is a possibility for authorities ​ ​ ​ ​ ​ ​ ​ ​ in different regions to report the same cases in some instances, leading to double-counting. 8 9 10 COVID-19 Epidemiological Overview Given the limited testing across Syria and scarce information, the actual number of cases likely far exceeds official figures. Of particular concern is the number of health workers affected by the disease. Confirmed COVID-19 cases are on the rise Reported cases have been rapidly increasing over the previous few months in all areas of Syria. On 20 September 2020, only a total of 4,429 confirmed cases had been reported across Syria and by 20 October this had increased to 11,575 (+161%) (MoH GoS, WHO, OCHA 20/10/2020, AANES 20/10/2020). ​ ​ ​ ​ ​ ​ Between 20 September and 20 October, the Ministry of Health reported that the total number of coronavirus cases in GoS-controlled areas increased from 2,682 to 5,134 (+91%), and the number of deaths increased from 172 to 254 (+48%). Cases have been reported most frequently in Damascus city and Aleppo governorate (MoH GoS). ​ ​ Northwest Syria saw a four-fold increase in the number of reported cases between 20 September and 20 October, with ​ 595 and 3,190 reported cases respectively (+436%). As of 20 October, the number of deaths reported is 42 (WHO). The ​ ​ population in the northwest, particularly the 59% that are internally displaced (HNAP 11/08/2020), are often in ​ overcrowded settlements
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