The pandemic has been rated as an out of control pandemic with the limited capacity of the health sector to respond.

We the under signees, the non-governmental organizations working in the health sector in northwestern Syria in the regions of Idleb and the western and northern coun- tryside of Aleppo, are sounding the alarm for the imminent collapse of the health system in the region due to the recent outbreak of the COVID-19 pandemic and reach- ing its climax in the region.

We in the health organizations, in cooperation with the local health directorates in the region and the World Health Organization, have sought every effort possible to contain the pandemic during last year, where the region was able to overcome the last wave with minimal losses and without the health system collapsing. However nowadays, the current wave of the epidemic has reached an unprecedented dangerous limit with the latest epidemiological reports issued around the region indicating that the pandemic has reached the classification of an “Uncontrolled pandemic with a limited ability of the health system to respond". What escalates this catastrophic situation is that more health staff are already or will fall sick and stop working which will significantly paralyze the health system where in turn, the most treatable diseases will become a cause of death due to the unavailability of staff. In addition, the news of a new military cam- paign in the area and the subsequent displacement will worsen the situation.

Health actors’ response sought to utilize the available resources and was divided between preparing specialized facilities for the treatment of COVID19, distributing pro- tective equipment to medical staff, distributing cloth masks to the population and launching intensive campaigns to raise awareness at the community level. All teams made every effort to deliver the necessary messages about the importance of follow- ing prevention methods in the most affordable and efficient way to avoid the pandem- ic reaching its climax and the collapse of the health system. Despite all the efforts made, commitment to preventive measures at the community level is still below the minimum required, and this is what has brought us today to the extent of full occupan- cy of hospitals and COVID19 treatment centers.

We are making every effort with the World Health Organization, local health directo- rates and international donors to allocate more support to raise the capacity of the health system in northwest Syria and prevent it from collapsing, but, as we all witnessed globally, the largest and most advanced health systems could not and have

struggled to combat the pandemic without the cooperation of society and deci- sion-makers, foremost among which is the mandatory imposition of preventive meas- ures by local authorities. We have already seen how countries that have firmly imposed preventive measures have succeeded in preventing the collapse of the health sector and keeping the pandemic under control, based on their high sense of responsibility towards their societies.

The current capacity of the available health staff can only extend to the treatment and awareness of the population and therefore, we declare that the current magnitude of the pandemic has completely exceeded our capabilities and we appeal to all local authorities in northwestern Syria to impose all preventive measures on society and we call on them to assume their responsibilities towards this and not leave it to its inevita- ble fate in the face of the pandemic. Thus, avoid leaving the health sector on the brink of collapse.

The preventive measures that we demand to be fully implemented will contribute to slowing the progress of the pandemic towards its climax in order to save the lives of thousands and prevent the collapse of the health system. Such measures are the best available option that can be applied by decision makers in northwest Syria while taking into account the specificity of the living and economic situation in northwestern Syria, therefore, these measures must include:

1. Mandate mask wearing to all people in all public places (streets, markets, mosques, and means of transportation).
2. Suspension of working hours in schools and universities until the local health directo- rates announce that the situation is now allowing for the resumption of working hours, and replacing that with a remote modality when possible.
3. Imposing COVID19 testing to all those entering the area from all crossings or present- ing a card confirming receiving the full vaccination. Those proven to be infected to be asked to return back from where they have come from until a negative examination is provided.
4. Reducing overcrowding in public places as much as possible and preventing unneces- sary gatherings such as weddings, condolences/mourning’s, and social events. This is accompanied by imposing social distancing in gathering places such as service depart- ments and mosques.
5. Taking accurate information from reliable sources in the local health directorates and the EWARN epidemiological early warning program and adopting their recommen- dations to impose a temporary ban on villages, cities and camps where the percentage of infections exceeds a limit that is required according to the rates approved by them until the rate of infection decreases.

The urgent and immediate implementation of these measures by all local authorities in northwestern Syria is a major moral responsibility towards the local communities.

In conclusion, we sound our hope for our people in Aleppo and Idleb that they commit themselves to wearing masks, maintaining social distancing, and taking the vaccine as soon as possible, especially for groups that have priority to receive it from health service providers, the elderly and those with chronic diseases, and we appeal to every- one who is infected with the epidemic to adhere to the quarantine so as not to increase the spread of infection in society, and we ask God Almighty for safety for all.

20/09/2021

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