With millions suffering from years of war and severely degraded medical facilities, countries at war cannot pay the price of a new frontline.

Iraq's borders with Iran, Turkey and Syria are shut down. Bars, cafes and schools are shut, and the streets are empty. The country is fighting yet another war, this time against a microscopic organism. 

Fears of Covid-19 are spreading among wartorn communities. Even Daesh has warned its members and other followers to steer clear of Europe and issued tips to avoid the virus. The region is on edge, and largely because of vulnerable and displaced populations whose access to healthcare is limited.  

In Kurdish-controlled northern Iraq, mostly aligned with the country’s borders, citizens who travelled to China and Iran are now being treated and quarantined. 

Dr Bjar Ali, who works with the diagnostic hospital in Erbil told TRT World that many of the patients he has seen were not immediately “symptomatic,” and initially came because of their travels, however, he admits, transmission to the local communities is a grave concern. 

“There was always war. When you look in the sky, the air is not clear. [Our] immune systems are not good for us. There are many people smoking, making them susceptible. Fortunately, we don’t have many cases.” 

That is, he admits, for now. What makes the threat of Covid-19 more dangerous is that the virus has plenty of asymptomatic carriers that could be spreading the virus without even knowing it. 

An airstrike on a hospital is pictured in Tikrit March 27, 2015. US and coalition forces conducted 10 air strikes against Daesh fighters in Iraq during this 24-hour period.
An airstrike on a hospital is pictured in Tikrit March 27, 2015. US and coalition forces conducted 10 air strikes against Daesh fighters in Iraq during this 24-hour period. (Reuters)

The patients he is treating continue to have “shortness of breath or a cough.” And while they presently have enough testing kits and medicine, any major outbreak would create a shortage. Ali is warning people to stay in their homes, exercise, avoid public gatherings and smoking. 

Across Iraq, there are nearly 200 cases and deaths have crept into double digits at the time of writing. Iraq’s central health ministry did not return calls to discuss how they are expanding their efforts and reports suggest there aren’t enough doctors in the country to address the crisis.  In a Central Intelligence Agency review three years ago, it suggested there were only .82 doctors for every 1,000 people. The Kurdish regional government plans to create make-shift facilities to support patients in the event of further transmission of the virus. But then, the question remains, will it be enough? 

Most hospitals across Iraq are designated to one area of expertise, whether it be heart surgery, neurology or perhaps infectious diseases. Movement in the country over the last decade has shifted significantly and since the end of the battle for Mosul in July 2017, much of the rebuilding efforts are still unfinished. So people are packed in family homes or still displaced in camps. 

Beyond the communities and refugee concerns in Iraq, Syria is even more deeply fractured. From Aleppo to Idlib and other areas, millions of people have little access to basic survival supply, let alone adequate healthcare. 

In a podcast released by a non-governmental organisation, Preemptive Love Coalition, (PLC), representative Ben Irwin said,  “If this happens, refugees in crowded shelters with limited access to medicine will be among the hardest hit. They are chronically exhausted from years of living in survival mode, many are malnourished, continuous exposure to the cold, rain have compromised their immune systems, and they're living in close quarters with each other. They're living in the perfect conditions for the disease to spread quickly....how do you wash your hands frequently when you have no source of water?”

The organisation works with local partners in the region to operate mobile clinics but there are always significant risks. 

The irony, here, is, it's not just infighting in these countries, which causes the destruction. Air to ground missiles, for example, used in airstrikes, are filled with chemicals, albeit legal, but can still result in harm to the land and infrastructure. This leaves Western countries largely responsible for the degradation in the region. And it’s left an entire generation unable to deal with the medical needs of the most vulnerable, namely elderly and children. 

A general view shows a besieged hospital in the town of Jisr al-Shughour, in the province of Idlib May 3, 2015.
A general view shows a besieged hospital in the town of Jisr al-Shughour, in the province of Idlib May 3, 2015. (Reuters)

Vaccinations are scarce. In a study conducted by the International Journal for Infectious Diseases, it suggested that "children exposed to the 2003 Iraq War”, for example, “were found to be 21.5 percentage points less likely to have received neonatal polio immunization." and due to shortages of vaccines, even years after the end of the war, were far more "at risk of vaccine-preventable" diseases. Years of war may also mean hospitals were and are without modern technology to treat appropriate illnesses and leaving people open to contacting more serious cases, such as Covid-19. 

Another study conducted in 2010, supported by the Children’s Health Foundation in London for Iraqi doctors in Fallujah examined the number of children born with congenital diseases due to depleted uranium often used in airstrikes and looked at the environmental effects of war. 

In the investigation, they found, “Congenital anomalies are part of a spectrum of adverse pregnancy outcomes,” and suggested that, “Environmental pollution can cause congenital anomalies through preconceptional mutagenic action” and “may include chromosomal anomalies and syndromes.” 

Their findings witnessed children who were born with heart problems, respiratory malfunctions, down syndrome and other side effects, which included physical deformities. Children who survived would need surgery and ongoing care. Their immune systems to fight off flu, colds and other common diseases were far more compromised. 

The study was never picked up by international investigation committees. But to hold governments accountable for war crimes due to environmental hazards is near impossible. 

Back to present circumstances, Dr. Muhamed Khoshnaw, an Iraqi epidemiologist, said in a brief statement to TRT World, while “anyone who has a respiratory problem is equal to someone who doesn’t, in catching the virus, the outcome can change. So a healthy person, of course, has a chance [to recover] more easily and faster. Compared to the other one [who] may go to the worst case scenario” and “need respiratory assistance, like a ventilator in the intensive care unit.”

While the displaced in Iraq were confined to the camps and outsiders were refused entry, all it takes is one person to trigger an outbreak, and Dr Ali said, “What worries me is the local transmission. If this happens it will be a disaster in our community.” 

He added he’s asking “the international community for support” and knows they can’t get by without it, once the disease spreads. 

No positive tests have been claimed in places like Syria or Yemen who have both been suffering from war for years, but this information cannot be verified at this time by independent sources. Doctors who operate within a war context dealing with trauma injuries from fighting are bracing themselves in case the pandemic does hit. How they will cope is anyone's guess.

In a statement released by the International Refugee Committee (IRC), director David Miliband stated, "As the world struggles to deal with the fallout of COVID-19 across its richest nations, the needs of the most vulnerable must not be neglected or forgotten."

It’s worth considering; as Western countries have contributed to the destruction of Iraq and Syria in the name of the ‘war on terror,’ but have done very little to invest in reconstruction and now, with little aid and no vaccine, fears are only multiplied for those facing this new threat on the ground. 

Disclaimer: The viewpoints expressed by the authors do not necessarily reflect the opinions, viewpoints and editorial policies of TRT World.

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