Briefing: Coronavirus risks and preventative measures in Hol camp

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Contents:

  • Key points
  • Hol camp overview
  • Aid crossing closure
  • Camp overview – from internal briefing for NES NGOs
  • Health service provision in Hol camp – from NES health working group report

Key points

  • No suspected or confirmed cases in Hol camp yet (only 5 cases and 1 death across NES as a whole)
  • Hol has 14 health points, three ventilators out of 40 total across NES, five isolation beds in its central health center for moderate corona cases – far less than ideal, but meaning it is better-covered than other IDP camps and the general population in NES
  • Widespread tuberculosis in Hol and other camps and detention facilities mean medical staff fear a 10%+ death rate if the disease enters these facilities
  • No permanent health-center in foreigners’ ‘Annex’, served by visiting health teams but no 24/7 health points
  • Other medical services stripped down to skeleton service in all camps including Hol as part of quarantine on camps, which creates knock-on health impacts
  • Health center in Hol Camp affected by closure of sole UN aid crossing into NES in January 2020, resulting in shortages of medicine and supplies
  • Hol also affected by regular Turkish severing of water flow from Allouk station, preventing adequate sanitation measures
  • Generally better provision in Hol Camp – which is internationally recognized and receives support from multiple INGOs – than in camps and settlements housing IDPs displaced by Turkish invasions in 2018 and 2019, which are not recognized by the UN or international community

Hol camp overview

Precautions are being taken in IDP camps and detention facilities, similar to those being taken among the rest of the civilian population. In Hol, as in other camps, a quarantine and lockdown is in effect. Only essential food deliveries are arriving into the camp, with all other stalls in the camp market closed, and only essential health services being provided. This has a knock-on impact on the delivery of other health services, education services, etc. but is seen as the best alternative.

Operating with a skeleton staff and minimizing rotation in and out of the camps, authorities hope to prevent the spread of corona Since there are both areas of Hol camp which the authorities are unable to effectively control, and clandestine routes in and out of the camp operated by smugglers, it is unlikely they will able to achieve total lockdown. One coronavirus case passing into the camp will mean rapid proliferation. Widespread tuberculosis means health officials fear an up to 10% deathrate in camps and detention facilities across NES, Hol included, if coronavirus enters these locations.

An isolation area is being set up for suspected cases in Hol camp. Suspected cases will be transferred to Heseke or Qamishlo for testing – the AANES has managed to acquire a number of PCR testing machines via the KRG, without WHO/UN support. There have previously been issues with foreign nationals being transferred out of the camp when they need medical attention, but it is hoped this won’t be experienced again if coronavirus cases develop. There are three ventilators in the health facilities in Hol Camp out of c.40 across North and East Syria total, and five dedicated coronavirus ventilation beds. This is far less than ideal, but means Hol camp is relatively better-equipped than other camps in NES.

The UN/WHO is offering virtually no support to AANES areas during coronavirus, instead routing all its aid to regime-controlled areas. The UN had indicated they were going to support one sole health facility in NES, in Hol camp, but these plans appear to have been shelved. While Hol camp generally is better-supported by INGOs than other, unrecognized camps housing IDPs displaced in the 2018 and 2019 Turkish invasions, there are shortcomings in the ‘annex’ housing foreign nationals. The camp as a whole is served by 7 INGOs and 14 health points, but none of these are stationed in the ‘annex’, which is served by regular team visits but has no 24-hour health facility at present.

The camp is also affected by Turkey severing the waterflow from Allouk water station, under its control since its 2019 invasion of Sere Kaniye and Tel Abyad. Turkey has cut the water flow on six separate occasions in the past two months to exert political pressure on AANES. This cuts off the supply of drinking water to at least half a million people, including the residents of Hol camp, at a time when sanitation and hygiene are a particular priority.

Hol camp is also currently being expanded, and up to 2500 of the c. 10,000 foreign women and children in the ‘annex’ should be transferred to the smaller, better-equipped Roj camp to relieve tension and demand. There is the plan to construct a larger camp in replacement of Hol Camp with better facilities, but this project will not be completed in time to deal with the pandemic.

Aid crossing closure

In January 2020, Russia exercised its veto at the UN Security Council to close the only UN aid crossing into NES.

This means all UN aid into Syria is now sent into areas controlled by al-Qaeda offshoot Hayat Tahrir-al-Sham, factions under the control of the Turkish intelligence service, or directly to the Assad regime. The AANES is forced to try and access UN aid via Damascus, but the reality is that most aid sent to Damascus lines the pockets of those close to the Assad regime, or remains in areas loyal to the regime. Little or nothing ever arrives to the AANES.

A recent report by UN agency OCHA indicated this decision will seriously reduce NES’ ability to combat coronavirus. 7 health centers in Raqqa are facing severe shortages of medicines and supplies as a direct result of this decision, with 1 soon to close, while the health center in Hol Camp is also severely affected.

Camp overview – from internal briefing for NES NGOs

“Coverage in camps: Various IPC measures have been implemented in camps. At the entrance to camps, humanitarian actors have supported the Camp Administration to establish temperature screening points and installed mandatory hand-washing stations, with partners providing equipment including thermometric scanners as well as basic training on medical screening to the guards. Visitors to camps have been banned, along with community gatherings and focus group discussions comprising more than 7 individuals.

Across camps partners are installing additional sanitation facilities, scaring up water provision and distributing COVID kits (containing additional soap, towels, buckets, bleach, gloves and a basin- to facilitate HH level handwashing). Gaps remain most extensive in the informal camps (Washokani, Abu Khashab, the Menbij camps, Tal Samen and Twaihina), particularly in relation to infrastructure improvements such as handwashing facilities and sanitation enhancements.

Isolation and quarantine facilities in camps: As previously mentioned there continue to be a number of questions around the case management strategy in camps including how to avoid contamination/ transmission in the isolation areas (e.g how will suspected cases be separate) the level of care which will be provided in the isolation facilities on site (i.e. mild or moderate?) and, related to this, the ability to refer moderate cases to designated isolation facilities outside the camp. Although the global health cluster has advocated for the early isolation of suspected cases and quarantining of close contacts in camps and camp-like settings, it remains unclear how this will work in practice

Given the high anticipated attack rate of the virus in camps (50% is the current working number according to the global health cluster) combined with the limited available testing capacity. As such, should the virus penetrate a camp, quarantining and isolation would likely have to be implemented at a vast scale, with considerable risks of contributing to additional transmission (so far the main contingency measure is to increase the distance between beds to 1.5 M). Based on global guidance, NES health partners are working with WHO to established technical guidance around the establishment and operation of isolation spaces in camps to be integrated under the Camp Strategy.

Preparation of isolation areas is ongoing across camps: In Al Hole the location has been confirmed and site design completed. The isolation area will comprise 2 rub-halls for suspected cases and 2 big sized tents for confirmed cases.”

Health service provision in Hol camp – from NES health working group report

“21 active health partners implementing a range of activities and services in the camp, of which seven are cross border NES NGOs. The operational desk supported by one of the partners continued to function in the camp to coordinate/refer patients and provide a comprehensive service. A total of 3 vaccination teams, 14 medical points, 1 ITFC- Inpatient Therapeutic Feeding Centre, 6 mobile medical teams, 3 vaccination teams, 5 ambulances, 1 specialized Leishmaniasis team, 3 normal delivery clinics, 2 field hospitals delivered health care services (a third field hospital is still temporarily  closed).

 A gap continues to exist in terms of 24/7 coverage in the annex, as there is also no fixed facility at the moment (services provided through mobile convoys). Inadequate health care service coverage is also observed in phases 5, 6 and 8. Operationalization of a 12-bed children hospitalization facility in phase 6 by one NES NGO has delayed due to staff recruitment challenges for this facility.”