COVID-19 IN AREAS OF KURDISH SELF ADMINISTRATION CONTROL SITUATION REPORT 20 MAY 2020 1 / 16 SUMMARY As of 18 May, there have been six confirmed cases of COVID-19 in Kurdish self-administration (KSA)-held areas of northeast Syria, four of whom have recovered. The actual number of COVID-19 cases is likely to be significantly higher, as a lack of sufficient testing and the low surveillance capacity is impeding the KSA from accurately assessing the spread of the virus in its territories. The KSA’s COVID-19 related movement restrictions had a significant negative impact on small-scale commercial businesses and daily wage workers, while price inflation and the continuing devaluation of the Syrian pound further reduced residents’ purchasing power. Poor and vulnerable residents who could not work enlisted in unprecedented numbers into the Syrian Democratic Forces (SDF) as a coping strategy to mitigate the financial burdens of COVID-19. A continued decrease in the demand for fuel following the implementation of movement restrictions is likely to have a disastrous impact on the KSA’s annual budget which is heavily dependent on oil revenues. Restrictions imposed by the Government of Syria (GoS) and the Kurdistan Regional Government (KRG) are hindering COVID-19 prevention and treatment supplies from reaching the northeast. The KSA has been inconsistent in implementing preventive measures across IDP camps in its territories, leaving humanitarian organizations to act independently 2 / 16 INTRODUCTION On 17 April, the KSA announced its first COVID-19 related death, a 53-year old man who passed away on 2 April in Quamishli National Hospital in Al-Hasakeh governorate with no recent history of travel. Two additional cases were confirmed on 29 April – a married couple from Al-Hasakeh city related to the northeast’s ‘patient zero’ (the KSA announced on 11 May that the husband had recovered, however the wife 1,2 remains in quarantine), and following this, three more cases have since been confirmed. This report highlights the impact of COVID-19 on the local economy of northeast Syria, with a particular focus on livelihoods. It will also assess the KSA’s attempts to mitigate both the spread of the virus and the ensuing economic shocks on poor and vulnerable households, and investigate their effect on social tensions. In addition, the report will analyze the KSA’s COVID-19 response in IDP camps, focusing on Al- Hole camp in Al-Hasakeh governorate as a study. It will also discuss concerns regarding the KSA’s testing capability and the low number of confirmed cases in its territories, as well as ongoing impediments to the delivery of health supplies to northeast Syria. The research methodology used for this report includes both primary and secondary sources. To ensure a broad and accurate analysis, the Syria Humanitarian Access Team (HAT) collected data in all four governorates under the KSA’s control: Al-Hasakeh, Ar-Raqqa, Deir-ez-Zor, and Aleppo. The report also relies on information from UN operational partners, international NGOs, and local sources. CURRENT SITUATION 1. Precautionary Measures The KSA began implementing COVID-19 precautionary measures as early as 29 February when it announced the partial closure of the Semalka border crossing separating Al-Hasakeh governorate and Iraqi Kurdistan. On 12 March, the KSA announced additional precautionary measures, including the closure of all civilian crossings with opposition-held areas and Iraqi Kurdistan, the indefinite suspension of all public gatherings and educational institutions, and the extension of the partial closure of the Semalka border crossing. On 15 March, humanitarian agencies were mandated to suspend training activities that required gatherings and enclosed spaces. On 16 March, non-essential activities of the KSA’s public agencies were suspended and cafes, restaurants, gathering centers, cafeterias and gyms across northeast Syria were closed the following 3 day. The KSA also banned religious institutions from holding in-person mass prayers and large gatherings. 3 / 16 Additional measures were announced on 19 March including a travel ban on movement between main cities in KSA territories and the closure of commercial markets, among other restrictions. The KSA did make exemptions for public and private hospitals and health centers, international humanitarian organizations and the Syrian Arab Red Crescent (SARC), pharmacies, bakeries, and grocery shops, as well as trucks transporting food products, infant formula, and fuel. The lockdown was initially expected to only last for 15 days, however it has been continuously extended since then, and is now set to expire at the end of Eid al Fitr. By 29 March, all arrivals passing through KSA's border crossings were forced to undergo a 14-day quarantine at designated quarantine facilities. The KSA also announced the suspension of military 4,5 conscription from 5 April to 5 July, 2020. As a way of deterring violations to its lockdown and enhancing the effectiveness of COVID-19 mitigation measures, on 6 April the KSA announced penalties for violations. While these fines were being strictly implemented by the KSA’s security agencies at the time of their announcements, as of 18 May local sources 6 report that this was no longer the case. 2. Prevalence of COVID-19 O n 17 April, the KSA announced its first COVID-19 related death, a 53-year old man who passed away on 2 April in Quamishli National Hospital in Al-Hasakeh governorate with no recent history of travel. Two additional cases were confirmed on 29 April – a married couple from Al-Hasakeh city related to the northeast’s ‘patient zero’ (the KSA announced on 11 May that the husband had recovered, however the wife remains in quarantine), and following this, three more cases have since been confirmed. 5,6 3. Testing Facilities Despite the donation of four polymerase chain reaction (PCR) testing devices to detect COVID-19 by the KRG to KSA-held territories, the low number of confirmed COVID-19 cases in the northeast is partially due to the KSA not properly utilizing all of their available testing facilities. This is likely to be due to the lack of technical expertise among local health staff, despite KRG-affiliated doctors travelling to the northeast to implement training on the operation of the devices. In addition, testing is only conducted in Quamishli (1) https://www.facebook.com/smensyria/photos/a.955507237972547/1294877357368865/?type=3&theater (2) Three additional cases were confirmed using antibody tests which indicated that they had previously contracted COVID-19, however were no longer active. It should be noted that these cases were reportedly from the same cluster in Al-Hasakeh city as the previous three. (3) Exceptions were allowed for residents seeking urgent medical treatment, and cross-border travel by aid workers on Tuesdays. (4) Depending on the sighting of the new moon, Eid Al-Fitr is likely to begin on 23 or 24 May and will be celebrated until 27 or 28 May. (5) On 19 March, public gardens, private medical clinics, concert halls, and condolence tents were also closed and hospital visitations banned. 4 / 16 city and the PCR machine is reportedly only operational for two days per week. The lack of sufficient testing in the northeast is preventing the KSA from accurately assessing the spread of COVID-19 amongst residents, and the actual number of cases is likely to be significantly higher than those reported, particularly given that the apparent patient zero is likely to have contracted the virus locally (due to a lack of recent travel history). Previous to the procurement of PCR devices, testing in KSA-held areas was carried out by sending suspected patient tests to Damascus, a practice which has continued. The number of tests which have been sent are limited however; by 25 April only 48 samples (24 from Al-Hasakeh, 22 Deir-ez-Zor, and 2 from Ar-Raqqa) had reached the capital. Further indications of limited testing can be seen across the whole of Syria; as of 6 May, the Central Public Health Laboratory (CPHL) in Damascus had conducted approximately 2,000 COVID- 19 tests in total, including the northeast. Additionally, the Rojava Information Center reported that Damascus was refusing to collect COVID-19 test samples from the northeast, assumed to be due to tensions 7,8,9,10 between the two administrations, which is likely to further delay accurate assessments of the outbreak. 4. Low Surveillance Capacity Low surveillance capacity poses another significant hindrance to determining an accurate count of COVID- 19 cases. In a context such as this one, having a unified surveillance system in place that is able to not only accurately detect suspected COVID-19 cases, including through a contact tracing mechanism, but also alert the appropriate testing authorities in a timely manner is even more crucial. In the northeast, there are currently three separate surveillance mechanisms with three separate alert pathways, which is making timely coordination considerably challenging for both the KSA and health sector humanitarian organizations. The fact that all of the six confirmed cases in KSA territories to date have no history of recent travel and all originate from the same cluster suggests that there has been at least some level of undetected 11 community transmission. (6) First-time curfew violators would be fined 5,000 SYP, second-time violators would be fined 10,000 SYP, and third-time violators 15,000 SYP. After three violations, perpetrators would be fined triple the amount of their last violation’s fine. Also, vehicles were held for one day for first-time violations, for three days for second-time violations, and for a week for third-time violations which included a fine of 25,000 SYP. (7) UNOCHA, UNOCHA & WHO Syrian Arab Republic COVID-19 Response Update No.02’, May 2020 (8) ibid (9) Human Rights Watch, ‘Syria: Aid Restrictions Hinder Covid-19 Response’ April 2020 (10) Rojava Information Center, ‘The Coronavirus Crisis in North and East Syria’ April 2020 (11) Samples that are collected through the Early Warning Alert and Response System (EWARS) are transferred to the Central Public Health Laboratory (CPHL) in Damascus for testing.