24 March 2021 – A few months ago, I visited Damascus, Homs and Hama, witnessing firsthand the devastating impact of the decade-long conflict and the resulting humanitarian crisis, now worsened by COVID-19.

While there, I met frontline workers who continue to brave dangerous working conditions to save lives.

I spoke to parents desperate for a better future for their children. In Damascus, I visited a WHO-rehabilitated emergency wing of a hospital which treats hundreds of children daily, suffering burns, injuries and life-threatening infections.

Nonetheless, I was struck by the resilience and positive spirit of people who remain resolute in restoring peace and prosperity to Syria.

After 10 years of fighting, the situation in Syria remains dire. In fact, humanitarian needs are increasing. Today, 90% of the population live below the poverty line and more than half are in urgent need of humanitarian health assistance – a statistic that has increased due to COVID-19.

Safe drinking-water and adequate food are not readily available for many, resulting in an increasingly complex disease profile. One third of the population, most of whom are women and children, are internally displaced within camps and other settings across the northwest and northeast pockets of the country.

Internally displaced people in Syria, in camp and settlements, and among the host population, represent the most vulnerable subsets of the population. Due to the overcrowded nature and poor hygiene in camps, practising COVID-19 preventive public health and social measures is difficult. This presents an ever-looming possibility of a potentially disastrous outbreak; particularly as ongoing conflict may lead to further displacement.

By some estimates, 60%–70% of health professionals have left the country and only 53% of all primary health care centres are functional and are unable to cope with rapidly rising health needs. Acute shortages of quality medical equipment, supplies and medicines serve to compound an already devastated health system. Reduced humanitarian access and attacks on health care workers and health care facilities – such as the latest attack on a hospital in Aleppo just a few days ago – additionally prevent a full-scale and appropriate health response. Numbers of vulnerable populations requiring health assistance have further increased since 2020.

To date, a total of 47 966 cases of COVID-19 have been reported in Syria, with approximately 2168 fatalities. Over the past 2 weeks, we have observed a sharp increase in the number of cases, especially in government-controlled areas and the northeast of the country. This is similar to trends we are currently observing across the Region and, indeed, in other parts of the globe. Specimens have recently been sent to a regional laboratory to help us determine whether one of the new variants that is driving increases in cases in other countries is circulating in Syria. Public adherence to protective measures such as wearing masks and physical distancing is low. Frontline workers are also at high risk of contracting the virus due to insufficient stockpiles of personal protective equipment. The upcoming holy month of Ramadan will pose additional challenges as people traditionally gather for prayers and to break their fast.

The global rollout of COVID-19 vaccines presents a glimmer of hope for us all. I would like to take this opportunity to express my appreciation for the COVAX Facility, which aims to ensure fair and equitable allocation of vaccines across the globe.

Against the backdrop of a larger humanitarian emergency, WHO is working closely with partners to launch a comprehensive response to COVID-19, including through the COVAX Facility. We will leverage the existing immunization programmes to vaccinate 20% of Syria’s population, including frontline workers and high-risk Syrians, by the end of 2021. Vulnerable and underserved groups across the whole of Syria will be included in vaccination campaigns managed from both Damascus and Gaziantep; the humanitarian ‘buffer’ represents an option if these groups cannot be covered through current plans and micro-plans. We commit to working with health authorities and partners on the microplanning and distribution to ensure that there is fair and equitable distribution of the vaccines.

To date, a small number of health workers have already been vaccinated in Syria; despite global vaccine shortages, we are working hard with COVAX to ensure that Syrians all over the country have access to these tools, including people living in hard-to-reach areas. However the global community may be presented with challenges related to vaccine production/manufacturing which may cause some delays for countries across the globe to actually receive and start the vaccination as was hoped in quarter 2 of this year. In parallel, we are continuing to expand COVID-19 surveillance, testing and isolation capacity throughout Syria, as well as training medical personnel on COVID-19 clinical management, and public health teams on rapid response.

Multisectoral partnership and collaboration have been key to WHO’s work in Syria over the years – and this has been especially critical over the past year. In 2020, WHO worked alongside donors, partners, and local communities to provide essential health services, including over 11 million outpatient consultations, 10 million treatments, 271 000 trauma consultations and 241 000 mental health consultations across the whole of Syria.

Although COVID-19 is currently at the forefront of our priorities, I would like to commend the efforts by partners on the ground who are ensuring minimal disruption to essential health services. This level of cooperation is vital in providing a lifeline to the Syrian people. WHO is committed to continued engagement with partners under the whole-of-Syria approach, applying all modalities so that we can collectively optimize the delivery of essential health services.

Risk communication and community engagement plays a critical role in slowing the transmission of COVID-19 and protecting communities. Localizing the response further and outreach to affected communities in newly accessible areas is central to this. Shifting towards community engagement to ensure participatory approaches, build trust and social cohesion are vital to controlling COVID-19 and to mitigating the negative impact of the pandemic. Coordination with different stakeholders, including non-state actors, and generating evidence will ultimately support these efforts. Capacity building is a continuous process but this needs to be targeted and innovative.

Syria is one of the most complex and politicized emergencies in the world. Shortfalls in humanitarian funding severely threaten assistance to millions of Syrians at this very crucial moment, and will lead to preventable losses of lives. Under our regional Vision, we strongly believe in “Health for All by All”, which means nobody is left behind. To achieve this, further investment in gaps faced by the health sector is crucial.

I call on the international community to deliver on our promise to the Syrian people. We must remind them that there is hope. COVID-19 has shown us that the only way we can all succeed is through solidarity. Let us now build on this momentum and work together to fulfil our humanitarian and moral obligations.

We remain with the Syrian people every step of the way.

WHO response to Salheen & Al-Fardos neighborhoods and Al-Atareb Hospital attacks, Aleppo, Syria

Related links

WHO condemns attacks on residential neighbourhoods in Aleppo
23 March 2021

Statement by WHO's Regional Director for the Eastern Mediterranean on the 10th year of the Syria crisis
15 March 2021

1. Vaccination rollout in Syria

Syria received the first batch of COVID-19 vaccines (256,800 doses of AstraZeneca SII COVIDSHILD) on 21 April 2021, which were delivered as part of COVAX mechanism. 203 000 doses were allocated for Syrian governorates, including northeast Syria and 53 800 were allocated through Gaziantep to target populations in northwest Syria. In the first phase, the vaccines were allocated for frontline health workers as a priority group.  

The online pre-registration platform in Government of Syria-controlled areas was launched on 5 May 2021 with support of WHO. The platform is not considered mandatory, and anyone who belongs to priority groups can get the vaccine without pre-registration.

The Ministry of Health started vaccination with AstraZeneca on 17 May 2021. The first governorate to start the vaccination was Aleppo followed by other governorates. As of 2 June, 46 397 individuals in Government-controlled areas received their first dose of vaccination. Overall, the aim is to vaccinate over 100 000 of people in the priority groups. 203 000 doses are divided into 2 phases with the first dose administered in May-June and the second administered within 2 months after the first dose as vaccines will expire in late August. There are currently no clear details as to when the second batch of AZ vaccines will arrive.

2.  Northeast Syria

COVID-19 vaccination in northeast Syria is implemented as part of the national immunization programme of Syria, which serves as an overall vaccination framework in all of Syria regardless of areas of control.

The first batch of AstraZeneca vaccines provided to Syria through the COVAX mechanism has been airlifted to Qamishli (Al-Hassakeh governorate) on 3 May 2021. In total, 17 500 doses arrived in Qamishli airport. Out of these 17 500 doses, around 13 320 doses were allocated for Al-Hassakeh governorate, and 4180 doses were allocated for Self-Administration controlled areas of Der-Ez-Zor governorate. Additionally, 6200 doses have been delivered by road to Ar-Raqqa governorate.

Allocated doses for northeast Syria are sufficient to cover 100% of the health workers (approximately 8900) with two doses, which is more than what other governorates received (around 80%). The target vaccination groups are all healthcare workers in public and private health facilities, including those affiliated with the Government of Syria’s Department of Health, Self-Administration’s Local Health Authority, Kurdish Red Crescent, cross-border international nongovernmental organizations, and health workers based in camps.

Prioritizing health care workers is an essential component of COVID-19 vaccination activities in northeast Syria. Health care workers are the frontline service providers who serve local populations as the first point of care in health facilities around Northeast Syria. They play a crucial role in fighting the pandemic; hence their vaccination is of utmost importance.

Health authorities in northeast Syria approved the vaccination for all health workers in Al-Hasakeh, Ar-Raqqa and Deir-ez-Zor governorates as well as parts of Aleppo governorate (Manbij and Ain Al-Arab).

Coordination challenges between health authorities in northeast Syria have been faced since the vaccination campaign was launched. WHO intervened and mediated with health authorities in northeast Syria to agree on operational and technical elements of the vaccination campaign. After a full day of negotiations, WHO was able to bring both sides for the vaccination in Al-Hassakeh Hospital on 25 May 2021, where several health care workers from the Self-Administration were vaccinated by the Department of Health. This has been a trust building exercise and WHO hopes to gradually build upon this first step and expand vaccination to greater number of individuals representing target vaccination groups.

In Al-Hassakeh governorate the vaccination rollout started on 18 May 2021 in limited fixed vaccination sites in areas controlled by the Government of Syria and Self-Administration targeting mostly health workers from the Department of Health. A wide-scale COVID-19 vaccination campaign was launched in Al-Hassakeh governorate on 23 May 2021. A mix of fixed and mobile vaccination teams have been deployed. The vaccination teams are targeting all health workers in the governorate irrespective of their affiliation (government and self-administration). While the Department of Health has mentioned that they would target elderly, people with comorbidities and health workforce as part of the first phase of the vaccination, WHO advocated for prioritization of healthcare workers, before the vaccination was offered to the next priority group (elderly people aged 55+).

As of 9 June, more than 1600 people were vaccinated with AstraZeneca in Al-Hassakeh governorate. Vaccination was administered through seven vaccination points including those based in Al-Hassakeh, Qamishli, Darbasiyah and Amouda.

In Ar-Raqqa governorate, the vaccination in eastern part of the governorate has started on 7 June. The Department of Health has vaccinated approximately 1000 people with AZ. Around 8 fixed vaccination teams in areas controlled by the Self-Administration have been deployed and WHO is following up with the health authorities to get the most up-to-date information.

In the eastern part of Deir-ez-Zoir governorate the vaccination started on 1 June 2021. About 12 fixed vaccination teams are deployed in various areas controlled by Self-Administration to vaccinate the healthcare workers. Several mobile vaccination teams are also deployed. WHO is in contact with health authorities to expand the vaccination efforts. As of 7 June, 809 people have been vaccinated in eastern part of Deir-Ez-Zor.

In Aleppo governorate, 2 vaccination teams are on stand by to access Ain Al-Arab and Manbij, pending the approval from the Self-Administration.

 Vaccination priority groups in northeast Syria

 3.  Vaccination process in the camps 

Al-Hassakeh governorate

Al-Hol camp

The vaccination campaign started as planned on Sunday, 6 June 2021. Two vaccination points were deployed: one in phase 1 and the second one in phase 3.

The total number of the population over 60 years old is 1168.

There are more than 1600 patients with comorbidities.  

Al-Areesha camp

The vaccination campaign started on Sunday, 6 June 2021 in the tents (7 tents for 7 phases).

The total number of the population is 14 200, including 301 above 60 years old.

There are 300 patients with comorbidities.

Deir-ez-Zor governorate

Abu Khashab camp

The vaccination campaign started on Saturday, 5 June 2021. 

The total number of the camp residents is 11 296, including 340 over 50 years old.

4.    Challenges and mitigation measures in Government-controlled areas and in northeast Syria

 5.  Northwest Syria

53 800 doses (AstraZeneca SII) are allocated to northwest Syria.

Targeted groups are 21 313 health workers and 25 000 community workers.

Micro-plans for the first targeted group (health care workers) are finalized.

93 newly assigned vaccination teams with 4 members/team were deployed.

Training of service providers took place.

More than 495 health facilities are covered (285 in Idlib and 210 in Aleppo).

Each team vaccinates the health staff of defined health facilities and community workers in non-health NGOs.

More than one visit to each health facility will be conducted to vaccinate the staff.

On Adverse Effects Following Immunization (AEFI) pre-vaccination checklist was developed to be signed by each vaccinated person. Post vaccination monitoring for 20-30 minutes by a designated team member is ensured. Each team has anaphylactic shock kit. 93 AEFI doctors were selected and assigned (one for each team). The AEFI advisory committee of three doctors in each governorate, in addition to a central committee (ERC) was established. Training for Idleb and Aleppo AEFI doctors was conducted.

Supporting supervision will be offered by 9 central supervisors, 2 governorate supervisors, 12 district supervisors, and 23 field supervisors.

The campaign started on 1 May as planned with two teams (one in Idleb and one in Aleppo).

As of 5 June, a total of 17 593 health and social workers were vaccinated.

In Afrin 11 teams were identified after being granted the needed approvals and trained. The campaign started in Afrin on 29 May 2021.

The next target group to vaccinate will be NCD patients. 

Vaccination priority groups in northwest Syria

 6. Challenges in northwest Syria

There was some hesitancy among the health staff due to the negative effect of rumours in the social media, there is gradual increase in the numbers of vaccinated beneficiaries.

There were some difficulties in coordination with non-health NGOs.

United Nations resolution renewal.

Unclear future of vaccine shipments (dates and quantities).

Vaccinating beyond the 20% of population supported by GAVI.

Fund availability.

Previous updates

Update on COVID-19 vccinations in Syria, 28 April 2021

Update on COVID-19 vccinations in Syria, 29 March 2021

Update on COVID-19 vccinations in Syria, 17 March 2021

Update on COVID-19 vccinations in Syria, 1 March 2021

Update on COVID-19 vccinations in Syria, 16 February 2021

Update on COVID-19 vaccinations in Syria, 9 February 2021

Update on COVID-19 vaccinations in Syria, 26 January 2021

16 March 2021 – Exactly 10 years after the conflict in Syria began, new challenges have emerged, perpetuating the suffering of Syrian people already exhausted by the ongoing conflict, violence, political fragility, and the burden of unmet socioeconomic needs. COVID-19 and the regional economic crisis have brought further devastation to individuals and communities all over Syria. Given the fragility of the situation, the capacity of the health system is likely to fall short of a successful response to COVID-19 and global efforts to stop its transmission. 

With over 90% of the population living below the poverty line, many people cannot afford basic social services, including health care. The conflict has had a dramatic impact on all Syrians, but especially on the most vulnerable groups, such as women and children, internally displaced people and persons with disabilities. 

As the situation is turning into a protracted emergency, overall needs are increasing. Out of 20.5 million people in Syria, more than half of the population are in dire need of health services. At least 15% of the population requires mental health and psychosocial services and this has increased since COVID-19, and shortages of safe drinking-water, due in part to the deliberate targeting of water networks, have left up to 35% of the population relying on alternative and often unsafe water sources. In northwest Syria, the number of people without access to safe water is much greater.

Almost one third of all people – most of them women and children – are still internally displaced in camps or camp-like settlements across the northwest and northeast with limited access to food, shelter, safe drinking-water, health and sanitation services. Many Syrians have suffered disabilities because of the conflict, and almost half are likely to have lifelong impairments that will require specialist support. With acute shortages of orthopedic and reconstructive services to treat critically injured people, and lack of emergency surgery for trauma patients, opportunities are limited to address the needs of these vulnerable populations. 

People are prematurely dying due to lack of access to life-saving procedures and lack of medicines for managing chronic diseases. Some of the greatest humanitarian needs inside Syria are a result of high prevalence of noncommunicable diseases and lack of specialized treatment facilities for cancer, chronic diseases, injuries, and disabilities among the Syrian population. 

The state of health care infrastructure is a matter of major concern. Nearly a quarter of all hospitals and one third of all primary health care centres remain non-functional and unable to respond to the growing health needs. According to recent WHO data, only 1 out of 16 public hospitals is fully functioning in northeast Syria, while other hospitals are either partially functioning or not functioning at all.

Economic downturn and high rates of inflation exacerbated by the COVID-19 pandemic have a dramatic impact on livelihoods. They also have significant impact on humanitarian programmes, affecting the capacity of humanitarian actors to effectively implement their projects and programmes in support of vulnerable children, women and men. Sanctions imposed on the country continue to aggravate an already overstretched situation, affecting all people and all sectors, reducing the health sector's capacity to respond to growing needs and health threats.  

In northeast Syria, with its population of around 2.6 mlllion people, the security situation remains volatile with pockets of violence contributing to overall instability and fragility. Internally displaced people in the area are some of the most vulnerable across the entire country, and most people living in camps are children under the age of 17 and women. 

In northwest Syria, over two thirds of the Region’s 4.1 million population (76% of whom are women and children) are internally displaced in camps across Idleb and northern Aleppo. Ongoing conflict means that host communities and displaced populations may be forced out of their homes and be displaced for more than one time with no guarantee of safety.   

WHO on the frontlines of the response 

Despite all challenges, WHO responded to fast-changing concerns and demands with flexibility and agility. WHO works to reach all people across Syria through its main office in Damascus and sub-offices in Syria, complemented by cross-border operations from a northeast Syria and 5 subnational health sector groups. From Gaziantep, Turkey, WHO coordinates cross-border operations with more than 70 partners. 

A network of more than 1700 health facilities across the country report to the WHO-supported disease surveillance system. This is critical to detect and respond to outbreaks quickly, especially in a country whose population is so vulnerable to infectious diseases.  

Against the backdrop of a larger humanitarian emergency, WHO is working closely with other United Nations agencies and nongovernmental partners to implement a consolidated response to COVID-19. WHO is working with UNICEF and partners across all 14 governorates in Syria to bring vaccines to cover 20% of the high-risk population against COVID-19 through the COVAX Facility, including the northwest and northeast.  

In 2020, together with donors, national, international, and local communities, WHO supported over 1 million medical procedures, more 8 million treatment courses, 700,000 outpatient consultations, including consultations/treatments related to mental health, psychosocial support, and trauma. In 2020, more than 2.6 million children were vaccinated against measles and polio. 

WHO worked hand-in-hand with health care professionals to provide over 10 000 physical rehabilitation sessions; 1500 pregnant women received access to skilled birth attendant for normal and emergency delivery; 12 000 patients were referred for specialized treatment; and thousands of health professionals were trained, including on COVID-19 clinical management, infection prevention and control, and surveillance and response.  

People in Syria are caught up in a crisis that needs a political solution, and while these solutions are sought on the political level, WHO remains committed to continue its support to Syrian people, by protecting public health and serving the vulnerable people . Under our Regional vision, we are working to ensure “Health for All, by All” – including for the people of Syria. 

On this anniversary date, let us remember that we must live up to our responsibilities in supporting the Syrian people; we must let them know that there is hope. Let us all, partners, donors, supporters make sure that we are rallying millions of generous people to provide ongoing relief.