Abstract
BackgroundResponse to the COVID-19 pandemic has challenged even robust healthcare systems in high-income countries. Syria, a country experiencing protracted conflict, has the largest internally-displaced population globally with most displaced settlements in opposition-controlled areas governed by local and international NGOs. This study aimed to explore community perspectives on challenges and potential solutions to reduce COVID-19 transmission among displaced communities in opposition-controlled Northwest Syria. MethodsWe used a qualitative study design, conducting 20 interviews with displaced Syrians in opposition-controlled camps in Northwest Syria between April-May 2020 and ensuring over half our interviewees were women. We analysed data thematically. ResultsParticipants described already difficult camp conditions that would be detrimental to an effective COVID-19 response, including household crowding, inadequate sewerage and waste management, insufficient and poor-quality water, and lack of cleaning supplies. Participants most frequently mentioned internet as their COVID-19 information source, followed by NGO awareness campaigns. Men had access to more accurate and comprehensive COVID-19 information than women did. Isolating (shielding) high-risk people within households did not appear feasible, but participants suggested ‘house-swapping’ approaches might work. While most participants had sufficient knowledge about COVID-19, they lacked practical tools to prevent transmission. ConclusionThis study is the first to explore perspectives and lived experiences of internally-displaced Syrians in the weeks prior to the COVID-19 epidemic in Northwest Syria. The challenging living conditions of internally-displaced people in Syria are further threatened by the spread of COVID-19. Tailored control measures are urgently needed to reduce COVID-19 transmission in camps.
Highlights
Response to the COVID-19 pandemic has challenged even robust healthcare systems in high-income countries
Much of the published literature on COVID-19 is from highincome countries, with less attention given to countries with weaker healthcare systems (Hariri et al, 2020)
This study aimed to explore challenges and potential solutions to reducing the spread of COVID-19 in IDP settlements in oppositioncontrolled Northwest Syria
Summary
The COVID-19 pandemic has resulted in over 61 million cases and 1.4 million deaths at the end of November 2020 There are mounting concerns that IDPs in low-income countries could experience severe COVID-19 cases and related deaths (Orendain and Djalante, 2020, Abbara et al, 2020 ). The opposition-controlled area (OCA) in Northwest Syria hosts an estimated 4.2 million people, over 2.8 million of them IDPs from across the country (WHO 2019, Mobility And Needs Monitoring | Syrian Arab Republic 2020). IDP camps in OCA shelter an estimated 1.5 million displaced Syrians - over 75% of whom are women and children - and are governed by local and international NGOs, while some are self-governed by camp residents or not governed at all (Syrian Arab Republic | ReliefWeb 2020). Displacement, lack of livelihoods, and inadequate food security increased IDP dependency on humanitarian organisations such as the World Food Programme, which provides food assistance to 4 million food-insecure people in Syria, including in OCA (FAO 2019). To better support COVID-19 prevention among displaced people in Syria, we need to know more about their lived experiences and perceptions of potential prevention and mitigation measures
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