Yazan Douedari1,2, Mervat Alhaffar1,2, Muhammed Al-Twaish1,3, Hala Mkhallalati4, Raheb Alwany5, Nafeesah Bte Mohamed Ibrahim6, Ayshath Zaseela6, Nour Horanieh2, Aula Abbara7, Natasha Howard1,2,6. 1. Syria Research Group (SyRG), co-hosted by the London School of Hygiene and Tropical Medicine and Saw Swee Hock School of Public Health, United Kingdom. 2. London School of Hygiene and Tropical Medicine, Department of Global Health and Development, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom. 3. Hand in Hand for Syria/Yardim Uzmanlari Yardimlaşma ve Kalkinma Derneği, Idlib, Syria. 4. Faculty of Population Health, Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH, United Kingdom. 5. NHS Foundation Trust, York Teaching Hospital, Wigginton Rd, Clifton, York YO31 8HE, United Kingdom. 6. National University of Singapore, Saw Swee Hock School of Public Health, 12 Science Drive 2, 117549, Singapore. 7. Imperial College London, Department of Infectious Disease, St Mary's Hospital, Praed Street, W2 1NY, United Kingdom.
Abstract
BACKGROUND: Response 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. METHODS: We 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. RESULTS: Participants 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. CONCLUSION: This 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.
BACKGROUND: Response 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. METHODS: We 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. RESULTS: Participants 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. CONCLUSION: This 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.
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