This is What It’s Like to Vaccinate the Last Rebel-Held Enclave in Syria

When the COVID vaccination rollout finally began in Idlib this month, the first doses went to healthcare workers and those in high-risk groups.

But in this last rebel-held enclave in northwest Syria, surrounded on all sides by enemies, you could argue that everyone is at risk. 

The plan is to administer 54,000 vaccine doses over the coming three weeks under the UN-led COVAX programme. The World Health Organisation then hopes to coordinate the delivery of two more batches of vaccines to cover a total of 850,000 people in the region by the end of 2021, leaving the vast majority of Idlib’s four million residents waiting. 

People in Idlib, one of the last holdouts against the Russia-backed regime of Bashar al-Assad, have endured horror upon horror and bombing after bombing over the last decade of the brutal civil war, so perhaps this does not seem too great a hardship for them to be patient.

As violence in the conflict faces, at least by the terrible standards of the civil war, people in Idlib now face the problem of surviving the pandemic, as vaccinators reckon with the challenge of one of the most difficult environments on the planet to vaccinate a population against the coronavirus.

“It was relieving to get the first COVID-19 vaccines doses administered in northwest Syria, is it a knackering process to plan, purchase and move for a vaccination programme in a semi-sieged region, blocked and surrounded by conflict almost from all sides,” said Dr Mohammed Salem, the director of the vaccine programme at the Assistance Coordination Unit, a member of the COVID task force in the area.

“Despite the challenges, we started preparing from November last year, and finally we reached this stage, and now we are focusing on awareness programmes to convince and persuade people to take the jab. [The] first few days have gone slow, but we have picked up the pace, and more people came forward to get vaccinated.”

The horrors of war have actually swelled the population in Idlib and north Aleppo, from a pre-war figure of around 1.5 million people, as tens of thousands of families were displaced by the violence, now living in either overcrowded camps or temporary housing.

The region’s first case was recorded last July, and since then there have been 21,000 documented cases, and 641 deaths, although it is likely many other cases have gone unrecorded.

Isolation from the rest of the world and a lower ratio of people above 60 years old, around 7% of the population in the area, have been a significant factor in a low number of infections, said Dr Hani Taib, Executive Director of Relief Experts Association.

“Luckily, the first wave which peaked in November last year had a low fatality rate, but unfortunately, there is a high level of mistrust around the pandemic globally, and the Syrian society has got their own share of speculations around the approved vaccines, including the healthcare workers, but we have been running a series of awareness programs through teams on the ground, and many webinars and other initiatives,” Taib said.

Over 20,000 people are working in the health sector in the region. A limited number of professional doctors operating in a territory controlled by jihadi and Turkey-backed rebel groups, under constant threat of Assad and Russian attacks, has massively complicated the delivery of aid and medical assistance to the area.

“We have lost doctors to the virus, and we can’t afford any further shortage in the medical staff, and we need to vaccinate the medical workers otherwise in case of any setback we would be facing huge problems, we can’t even fill the gap for the doctors who would need a two-week quarantine or self-isolation,” Taib said.

Taib said that the Relief Experts Association’s own research showed up to 1 in 4 health workers saying they would not be vaccinated, a far higher ratio than in other parts of the world, with a similar proportion undecided.

Anti-Russian sentiment has prevailed when it comes to vaccines in a region scarred by brutal military campaigns of Assad regime forces backed by Russian airstrikes.

“Less than 3% of the people said that they will take the Russian Sputnik V jab, and only 12% are willing to take the vaccine from China,” said Taib.

“But we are hopeful as we receive more doses, we’ll be able to convince more people to get vaccinated.”