Urban Conflict: A Breeding Ground for COVID-19

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Before the end of April, the world reached the threshold of three million documented cases of COVID-19. For months, it seems, everyone in the world has been watching only the advance and spread of this virus, as it has shut down society after society.

But not everything has been halted by the pandemic.

Conflict continues to rage in the global south. According to the civilian casualty recording outlet Airwars, in Syria this past January, between 145 and 213 civilians were killed from bombardment and airstrikes in Idlib and Aleppo alone. Aerial campaigns continue in Yemen, Iraq, and Libya.

Unfortunately, war zones are not immune to COVID-19. But conflict—particularly the use of explosive weapons in populated areas (EWIPA)—does make an effective response to the virus almost impossible. UN Secretary-General António Guterres noted the relationship between COVID-19 and conflict in his March appeal for a global ceasefire.

Urban warfare meets COVID

The use of EWIPA has profoundly negative effects on civilians and the lived environment. When explosives are used in cities, on average, nine out of 10 casualties are civilians.

The characteristically wide-area effects of EWIPA usually extend much outside the intended target, launching blast and fragmentation in largely indiscriminate ways.

After 10 years of civil war, Syria, once the envy of the Arab world for its healthcare, is now known as “the most dangerous place on earth for health-care providers.”

The use of EWIPA damages and destroys critical infrastructure, including healthcare facilities, taking away an essential service when civilians need it most. When hospital wings aren’t destroyed, the power grids or water-treatment plants necessary to keep them operating frequently are. And evidence shows that the use of EWIPA directly facilitates the transmission of communicable diseases.

So far, many of today’s hottest conflict zones appear to have few COVID-19 cases. For instance, only 39 cases had been reported in Syria by April 23. However, the likely reason for the low number is the lack of testing for and reporting of the virus. Shortcomings in authoritative statistics may also foreshadow an inability for healthcare professionals to adequately respond to potential outbreaks.

After 10 years of civil war, Syria, once the envy of the Arab world for its healthcare, is now known as “the most dangerous place on earth for health-care providers.” By October of last year, half of the healthcare facilities in Syria were non-operational, mainly because of the effects of EWIPA. In the first three months of 2020, dozens more hospitals were put out of service by the fighting. Under these conditions, who is supposed to report, track, and treat the new disease?

Since the beginning of its civil war in 2015, Yemen has suffered a consistent string of airstrikes against healthcare facilities and other infrastructure. By last December, Yemen had 1.2 million active cases of cholera, along with outbreaks of diphtheria and measles. All are transmitted via respiratory droplets, as is COVID-19.

The scale of destruction posed by an outbreak in Yemen, already the Arab world’s poorest country before civil war broke out, would be hard to comprehend. On April 10, the country announced its first confirmed case in Hadramawt province, which had recently experienced an outbreak of dengue fever. As the two viruses share similar symptoms, some have postured whether or not many assumed dengue fever cases were actually misdiagnosed cases of COVID-19.

The use of EWIPA in war zones remains a major driver of displacement. People flee besieged cities and end up in refugee camps. These settlements, lacking even basic healthcare infrastructure, are uniquely vulnerable to COVID-19 outbreaks. For example, Greece’s Moria refugee camp houses 204 persons per 1,000 square metres. Moria has approximately one water tap for every 1,200 inhabitants, limited or no access to soap, and no possibility of social distancing.

According to the International Rescue Committee, the Diamond Princess cruise ship housed 24 persons per 1,000 square metres. This density resulted in a COVID-19 transmission rate on the ship that was four times higher than peak transmission in Wuhan, China. What happens when the population density is 10 times higher?

Limiting the destruction of EWIPA

The reverberating effects of war are magnified during a global pandemic. The destruction of hospitals, for example, results in immediate injury and death of noncombatants. Yet it also deprives others of healthcare and access to health practitioners. The use of EWIPA creates unsafe conditions, in which disease breeds freely once it gains admission.

It is already commonly argued that COVID-19 will prolong conflict in the Middle East. Conversely, the conflict will make it increasingly difficult to control any outbreak of disease. War zones could actually incubate the virus, providing fertile ground for second or tertiary regional outbreaks.

The multilateral process to generate a political declaration on the use of EWIPA continues, but has, like so many other activities, been impacted by the pandemic. In the meantime, heeding the call for an immediate global ceasefire is critical.

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