A refugee camp in north-west Iraq.Photo: Gavin Douglas/Concern Worldwide.A refugee camp in north-west Iraq.Photo: Gavin Douglas/Concern Worldwide.A refugee camp in north-west Iraq.Photo: Gavin Douglas/Concern Worldwide.

Tackling COVID-19 in the Middle East

Tackling COVID-19 in the Middle East

As Lebanon confirms its first case of COVID-19 within its refugee population, we look at the impact of the pandemic on the Middle East within communities who are already facing considerable challenges.

Uncertainty and instability are two things that many communities in the Middle East are well used to, having endured years of war and conflict.

The prolonged fighting has taken its toll in countries like Iraq and Syria, resulting in a limited capacity at every level to rebuild the country - with health infrastructure particularly underdeveloped. COVID-19 has now presented yet another challenge and is putting increasing pressure on already struggling populations.

Rising numbers

As of April 30, 2,003 confirmed cases and 92 deaths have been recorded in Iraq. In Syria, there are 43 confirmed cases and 3 deaths recorded.

In Lebanon, there have been 721 confirmed COVID-19 cases and 24 deaths as of 30 April – with the first diagnosis within a refugee camp raising huge strong concern over the potential for the infection to spread.

In Turkey, as of April 30, there are 118,000 confirmed cases - with over 3,000 deaths.

Taimur Ahmed, Concern’s Country Director for Iraq and Syria, says that the COVID-19 emergency has demanded a more flexible and adaptable approach to humanitarian aid.

Currently, it is all about adaptation. Our programmes in Iraq and Syria have been completely adapted to a COVID-19 response in the last 3-4 weeks.

Taimur Ahmed - Concern Iraq Country Director

In addition to a weak public health system, there is also a large amount of fear and stigma surrounding COVID-19 as the illness requires quarantining in dedicated facilities – something that is challenging social norms in Iraqi communities. With limited testing facilities, there are growing concerns that the actual figure of confirmed COVID-19 cases is much higher.

Neighbouring countries like Turkey has 118,000 confirmed cases and Iran has over 93,657 confirmed cases, with numbers still increasing, so it is an understandable concern that the worst is still yet to come. In addition, due to high inflation as a result of border closures, people are deeply concerned about their livelihoods and income. With the suspension of some humanitarian support due to travel restrictions, anxiety is only increasing.

Response plan

With all this in mind, quick preventative measures are essential. In Iraq, with help from partner organisations and funding from Irish Aid, ECHO, and the Irish public, our teams have customised standard hygiene kits into COVID-19 response kits by adapting the contents to include bars of soap, washing detergent and sanitary pads.

Over 17,000 hygiene kits are currently in the process of being distributed to 84,500 individuals across nine Internally Displaced Peoples (IDP) camps in Northern Iraq. These are camps for people who are forced to flee their homes but who remain within their country's borders.

Logistically, these distributions are far from easy, as teams must navigate factors such as strict lockdowns and avoid community gatherings. Everything takes longer than usual and our teams must work fast but carefully when visiting each tent one-by-one. Items and kits must first be prepared, then packed, and then transported to nine different IDP camps - all while maintaining safe social distancing and working within a short time frame.

Normally, you could have a group of people together for distributions and demonstrations, but now it has to be individual and person-to-person.

Taimur Ahmed - Concern Iraq Country Director
Distribution of 2832 COVID-19 prevention Hygiene Kits at Khankay IDPs camp Dohuk Kurdistan Iraq Photo: Concern Worldwide.
Distribution of 2832 COVID-19 prevention Hygiene Kits at Khankay IDPs camp Dohuk Kurdistan Iraq Photo: Concern Worldwide.
Distribution of COVID-19 prevention Hygiene Kits at IDPs camp Dohuk Kurdistan Iraq Photo: OCHA.
Distribution of COVID-19 prevention Hygiene Kits at IDPs camp Dohuk Kurdistan Iraq Photo: OCHA.
COVID-19 Prevention Hygiene Kit (bath soap 10 bars, detergent 1 kg, sanitary pads 4 packets) Photo: Concern Worldwide.
COVID-19 Prevention Hygiene Kit (bath soap 10 bars, detergent 1 kg, sanitary pads 4 packets) Photo: Concern Worldwide.
A man keeps a social distance from others as he returns home after receiving a hygiene kit in a camp in Northern Iraq. Photo: Concern Worldwide.
A man keeps a social distance from others as he returns home after receiving a hygiene kit in a camp in Northern Iraq. Photo: Concern Worldwide.
Distribution of 2832 COVID-19 prevention Hygiene Kits at Khankay IDPs camp Dohuk Kurdistan Iraq Photo: Concern Worldwide.
Distribution of 2832 COVID-19 prevention Hygiene Kits at Khankay IDPs camp Dohuk Kurdistan Iraq Photo: Concern Worldwide.

With funding support from DG ECHO, good sanitation and hygiene promotion has also been adapted to prevent the spread of COVID-19, with a strong emphasis on the importance of handwashing with soap and water, coughing etiquette and social distancing.

Working closely with the government of Iraq, our teams are visiting all nine IDP camps to offer training in personal hygiene and to distribute adapted COVID-19 hygiene leaflets with information on how to keep themselves safe from COVID-19. As handwashing is one of our greatest tools in preventing the spread of the virus, we are also strategically installing handwashing stations at each block of tents to allow residents access to clean water.

We are very much firefighting at the moment.

Taimur Ahmed - Concern Iraq Country Director

No job is too small either, garbage collection bins were first established in these nine IDP camps in 2014, but over time, they have become damaged and are in dire need of repair. Our teams are installing new collection bins and repairing any damaged ones that they can, ensuring all garbage is safely disposed of.

In this together

A truly collaborative approach is the only way to meet the challenge of containing COVID-19 so we are planning to distribute 500 essential Personal Protective Equipment (PPE) kits to our partners in health facilities in and nearby camps.

An additional 50 PPE kits will be kept for our frontline staff to ensure that they are protected as they work in communities and Taimur says “one of the biggest challenges so far” was identifying and purchasing the kits.

Because of all of these measures, we have become one of the biggest NGOs to establish a COVID-19 response in Iraq, but there is still more work to be done. Over 200,000 people are currently living in cramped IDP camps and if COVID-19 were to reach these camps, the results would be catastrophic.

“There are no isolation places in these camps, there are no quarantine places in these camps, and there is no way to really implement social distancing in these camps. People are simply not in the situation where they can practice all of these precautions if it reaches here.”

Taimur Ahmed - Concern Iraq Country Director

In Syria, we have similarly adapted our programmes to a COVID-19 response. Our teams have worked with local vendors to allow beneficiaries to purchase both food and hygiene products with voucher provided by Concern. We are also distributing over 20,000 hygiene kits and food baskets to vulnerable people in camps, informal settlements, collective centres and urban areas.

As part of the response to Covid-19, Concern Syria have begun distributing hygiene kits in Northern Syria Photo: Concern Worldwide.
As part of the response to Covid-19, Concern Syria have begun distributing hygiene kits in Northern Syria Photo: Concern Worldwide.
Discussing Covid-19 in a northern Syria community. Photo: Concern Worldwide.
Discussing Covid-19 in a northern Syria community. Photo: Concern Worldwide.

New restrictions

In Lebanon, due to the relatively low-recorded confirmed cases so far, our team’s focus is all about adaptation, preparedness and mitigation.

On March 15, the Government of Lebanon imposed new restrictions aimed at reducing the risk of contamination and as a result, public administrations and institutions, public and private schools, and nurseries were all closed. On April 22, the first COVID-19 case was recorded in a refugee camp. With little access to lifesaving health care and not physically being able to practise safe social distancing, this is deeply concerning. 

As it is currently all about prevention, our teams are working to contain the virus amongst Lebanon’s most vulnerable communities by distributing hygiene kits to Syrian refugees and essential leaflets on how to keep safe from COVID-19, reaching 4,000 individuals so far.

We have also just finished the rehabilitation of a 50-room disused school as an isolation facility for suspected COVID-19 cases. We are strengthening remote case management work, which supports survivors of sexual and gender-based violence (SGBV), child protection and intimate partner violence (IPV).

A deeply distressing result of the extended lockdown in Lebanon is that SGBV and IPV cases are on the rise. To better assist those that need our help, our teams have set-up a 24/7 hotline for psychological support. Concern’s Case Management Officer in Lebanon, Siba Bizri, discusses how her team has had to adapt and rely on accessing people who contacted them through the hotline number, for providing the support to the targeted individuals.

The hotline is open 24/7 for regular calls. However, in times of emergency, Concern also activates WhatsApp phone calls, messages, and video calls.

Siba Bizri - Concern Lebanon Case Management Officer
Concern Lebanon are assisting in the building of tents for suspected positive Covid-19 cases. Photo: Concern Worldwide.
Concern Lebanon are assisting in the building of tents for suspected positive Covid-19 cases. Photo: Concern Worldwide.
Concern Lebanon are transforming a disused school into an Isolation Center, that will be used for suspected positive Covid-19 cases. Photo: Concern Worldwide.
Concern Lebanon are transforming a disused school into an Isolation Center, that will be used for suspected positive Covid-19 cases. Photo: Concern Worldwide.
Concern Lebanon is visiting people's homes to provide information on the prevention of the spread of the coronavirus. Photo: Concern Worldwide.
Concern Lebanon is visiting people's homes to provide information on the prevention of the spread of the coronavirus. Photo: Concern Worldwide.
Siba Bizri, Concerns Case Management Officer. Photo: Concern Worldwide.
Siba Bizri, Concerns Case Management Officer. Photo: Concern Worldwide.
Concern Lebanon is visiting people's homes to provide information on the prevention of the spread of the coronavirus. Photo: Concern Worldwide.
Concern Lebanon is visiting people's homes to provide information on the prevention of the spread of the coronavirus. Photo: Concern Worldwide.

Protection is another key area of focus in Turkey, where our team is continuing to provide urgent protection case management support to vulnerable individuals. This included the provision of urgent shelter support, cash support for food (in the form of shopping cards), basic household items (mattress, kitchen items, etc.), and emergency transportation.

Our team is adapting and piloting online training sessions to caregivers of children on measures to take to prevent the spread of COVID-19. Preparations for distributing 3,575 hygiene kits with soap, shampoo, and anti-bacterial surface cleaners to vulnerable families are also underway.

This is just the beginning of our response, and there is still much more work that needs to be done. We know that now more than ever, quick responsive and preventative measures are essential if we are to beat the spread of COVID-19, and that is exactly what we plan on doing. You can help by donating whatever amount you can afford. Thank you.

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