This is a fast-moving issue and should be read as correct at the date of publication (09.04.20).
Experts warn there could be a coronavirus catastrophe in the Middle East. This is especially true in conflict zones and among refugees.
The movement of fighters and refugees threatens to spread the virus around the region quickly. People in conflict zones, especially refugees, have precious little health infrastructure. The past two years have seen a return of mass protests in the region, and more recently oil prices have collapsed. As a result, the coronavirus pandemic is expected to have geopolitical as well as health implications for the region.
Coronavirus in conflict zones
On 23 March, the UN Secretary General, Antonio Guterres, called for a global ceasefire to allow people to focus on the coronavirus emergency.
The Middle East has seen some of the world’s most violent conflicts.
Libya is highly vulnerable to the pandemic, with its civilian infrastructure decimated by conflict. There are around 200,000 internally displaced people and some 700,000 migrants in the country. Fighters have been recruited in Syria by both sides of the civil war, raising concerns that coronavirus will be brought in from the Levant. Libya reported its first confirmed case on 24 March 2020 and by April 5 there were 11 confirmed cases. With very little testing, the true figure is probably a lot higher.
On 17 March, the UK and several other countries called for a ceasefire. Nevertheless, General Haftar’s self-styled Libya National Army stepped up its assault on Tripoli at the beginning of April 2020.
In Syria, aid has always been a tool of the conflict. Agencies must negotiate with Kurdish authorities as well as Turkey and the Syrian Government to distribute aid.
A ceasefire was announced in Syria on 5 March. On 1 April, the Syria Observatory for Human Rights reported the lowest number of civilian fatalities since the conflict began in 2011.
Many refugees are returning from the Turkish border to the city of Idlib. This mass movement presents further contagion risks and the health infrastructure in the city has been devastated by the conflict.
Researchers at LSE concluded that the Syrian health service could cope with about 6,500 Covid-19 cases before its critical care capacity would be overwhelmed.
Yemen had already been named the world’s worst humanitarian crisis by the UN. It has warned of an imminent explosion in Covid-19 cases.
On 26 March a nationwide ceasefire was agreed by the warring parties to allow Yemenis to tackle the virus, the first national agreement since 2016. Earlier ceasefires have seen patchy implementation.
Iran has the region’s worst coronavirus outbreak. It has many more confirmed cases than the rest of the region put together. This could have unpredictable consequences for the government. Some have called for urgent temporary sanctions relief to stabilise the situation.
Refugees and the internally displaced
The United Nations High Commission for Refugees (UNHCR) counts tens of millions of people of concern in the Middle East and North Africa. For many of these people, protecting against the virus is almost impossible. There is “no soap, hardly any water, and no space for quarantine”. Health services for many barely exist.
In Syria there are 6.6 million internally displaced persons, many recently driven out of Idlib towards the Turkish border. These include children, who are particularly prone to hypothermia and respiratory tract infections. Many of them sleep in the open in freezing conditions.
The UNHCR is doing its best to prepare medical facilities and encourage precautions among 120,000 Syrian refugees, many of them children, in overcrowded Jordanian camps. A UNHCR representative said:
A large portion of the population are children, and it’s hard to make them understand the need for isolation and extra hand washing. My real concern is that this is a very crowded environment, so if we do have cases it will be very hard to contain.
UK Government policy
On 31 March 2020 Lord Ahmad of Wimbledon set out the UK Government’s policy on coronavirus in refugee camps in answer to a PQ. The Government has committed £241 million of UK aid to support the global efforts to combat the pandemic. It has agreed to work with UNHCR to minimise the impact of this crisis on refugees.
Unreliable data on incidence and control
Obtaining accurate figures on confirmed case numbers and deaths from Covid-19 is a challenge. The Johns Hopkins Coronavirus Resource Centre published figures on 5 April for countries in the WHO Eastern Mediterranean Region, but the reliability of these figures is difficult to assess. The definition of confirmed cases varies between countries which makes comparisons difficult. Deaths are often more reliably reported than cases but the numbers are often hospital-based, excluding people infected but not hospitalised. This uncertainty varies significantly between countries.
Figures from the Johns Hopkins Coronavirus Resource Centre. Their data sources are quoted as: WHO, CDC, ECDC, NHC, DXY, 1point3acres, Worldometers.info, BNO, state and national government health departments, and local media reports.
The ability to detect and deal with cases depends on a country’s public health infrastructure. A recent study looked at countries’ health security capacities. Of the 21 WHO Eastern Mediterranean Region countries, only 13 countries are assessed as well prepared.
The study doesn’t discuss individual countries. However, based on the underlying dataset, Egypt appears best prepared, while Libya is much worse.
A model developed by researchers at the London School of Hygiene and Tropical Medicine indicates that for every death there could be around 200 cases. So, the 58 deaths in Egypt could mean 11,600 cases, a far higher number than the 865 reported.
As well as existing poor governance and terrorism, the onslaught of Covid-19 in the region will combine with a collapse in oil prices, slashing revenues for many Middle East governments
The oil price collapse is particularly threatening to Iran, Iraq – already weakened and needing a high oil price to cover spending commitments. Half of Iraq’s public sector wages might not get paid as soon as next month.
The challenge of terrorism may get worse. ISIS/Daesh says it will not call a ceasefire. The group told its fighters to increase attacks while national and international authorities are distracted.
The United Nations Economic and Social Commission for Western Asia predicts Covid-19 will increase the number of poor in the region by 8.3 million, and the number of malnourished by 2 million.
Jon Alterman, of the Institute for Strategic and International Studies, warned: “It could provoke […] another set of political explosions like the Arab Spring” across the region.
Costs – and an opportunity?
The UNHCR has issued an appeal for an extra $222 million. The WHO has called for $675 million in the first instance. The UN Economic Commission for Western Asia has called for Arab governments in the region to establish a coronavirus solidarity fund.
While the crisis will cause problems, coronavirus could be an opportunity for parties to entrenched conflicts to make concessions without losing face. The ceasefires already announced strengthen that hope.
Coronavirus is exacerbating the precarious situation of Syrian refugees and IDPs, Atlantic Council, 27 March 2020
You can’t practice social distancing if you’re a refugee, Foreign policy, 20 March 2020
The Coronavirus Crisis is a Diplomatic Opportunity for the United States and Iran, International Crisis Group, 18 March 2020
Lina Khatib, COVID-19 Impact on Refugees is Also Political, Chatham House, 31 March 2020
LSE blog, Coronavirus and Refugee Populations: An Imminent Humanitarian Catastrophe, 19 March 2020
Sally Hargreaves et al, ‘Europe’s migrant containment policies threaten the response to Covid-19’, British Medical Journal, March 2020
Hans Henri P Kluger et al, ‘Refugee and migrant health in the COVID-19 response’, Lancet, 31 March 2020
Renad Mansour et al, COVID 19: Assessing Vulnerabilities and Impacts on Iraq, Chatham House, 7 April 2020
About the author: Ben Smith is a researcher at the House of Commons Library specialising in the Middle East.