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Across parts of the Middle East, coronavirus compounds strain after years of war

At dusk in Beirut, a red and white Lebanese Red Cross ambulance parked quietly outside an apartment building as volunteers brought out another patient ill with the novel coronavirus, struggling with worsening symptoms and in need of a hospital visit. He was wrapped in white fabric overalls and face mask, just like the two men helping him walk slowly toward the flashing lights of the van. “My son, my son,” his elderly mother wept as the vehicle sped away. She stood in the street watching it disappear, sobbing behind her face mask.

While some countries were grappling with how to enforce social distancing while people were still out in public spaces, the citizens of many Middle East nations watched these images on the news from their homes. Their day-to-day life was very different. Military helicopters circled the skies above Beirut, ordering people by loudspeaker to stay in their homes, while soldiers patrolled the streets, chasing joggers back inside and checking for any open stores that are not the grocers or pharmacies that were approved to stay open.

As the virus spread across the world, quickly becoming a global pandemic, the response from governments in the region has spanned the extremes — from some of the most strict mitigation measures to stem the spread, to a sense of helplessness for those already buckling under years of war. For some nations, like Lebanon and Jordan, staying home in an effort to “flatten the curve” was their only real option.

Lebanese officials quickly recognized that the country’s health care system could barely cope before the pandemic. A financial crisis that sparked long-lasting protests in 2019 left the government bankrupt. Even before the toll of COVID-19, Lebanon was unable to pay its debts owed to the country’s private hospitals for treatment of people covered by social security. The flow of foreign currency into the country has dried up, leaving a major dollar shortage that could compound the COVID-19 health crisis. Importing protective masks, gloves and other equipment from European suppliers is even more difficult now as a result of the pandemic. “They are not allowed to export outside the Schengen [zone], outside any European countries, for all items related to COVID-19,” said Nadim Harb, who owns a medical supplies import company in Beirut. “So now we have another problem.”

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A realization that the health care system in Lebanon would quickly collapse with an onslaught of COVID-19 patients, in the midst of continued economic hardship and depleting health care resources, led to a rapid succession of shutdowns by officials across the country over the last month. By the end of February, all schools and universities in the country were closed, then offices shut down, with bars and restaurants following closely behind. Only grocery stores and pharmacies were allowed to stay open. The military descended onto the streets of Beirut by the end of March to implement the lockdown. “Maybe it will have an impact on the flow and the curve of the epidemic in Lebanon,” said Dr. Georges Ghanem, the lead physician at Beirut’s Lebanese American University Hospital. “It will help us, certainly, to flatten– a little bit– the curve.”

As Ghanem spoke from the hospital, workers rushed around him trying to finalize construction work on a new hospital ward to care for upcoming patients. So far most people in the capital of Beirut who need hospitalization for complications due to COVID-19 have gone to Rafik Hariri governmental hospital, transported by Red Cross ambulance drivers and volunteers, while private hospitals in the capital have had some time to prepare extra beds and wards, sending other patients home and canceling elective procedures. As of March 30, Lebanon has just under 450 reported cases of coronavirus and 11 deaths.

Amman, Jordan, saw the most extreme measures in the region so far, with a state of emergency declared on March 20, locking 10 million people in their homes completely. “We were given notice, a day or two in advance,” Nada Atieh, an American living in Amman, told PBS NewsHour. “I went to the grocery store to buy some groceries and it was packed. The lines were to the end of the store and there were no groceries on the shelves.”

The army patrolled the streets, warning that anyone caught walking around outside could face up to a year in jail. Local media reported scenes of panicked residents swarming military vehicles delivering bread and water to certain neighborhoods. Jordanian Prime Minister Omar Razzaz then announced a sort of loosening, saying that from now on people could walk to local bakeries and pharmacies between 10 a.m. and 6 p.m., but no private vehicles would be allowed in the streets. Jordan’s roads remain closed off to anything but essential transport of food and supplies, and security and health services. “But [the people] were also very appreciative of the measures the government were taking,” said Atieh. “The people here have a solid understanding of what is going on.”

The situation in those countries is also complex. Places like Jordan and Lebanon host roughly 3 million Syrian refugees– vulnerable families with little, or no, access to running water or ability to socially isolate. From informal camps in the Bekaa Valley on Lebanon’s border with Syria, to the U.N.-run facilities in northern Jordan, Syrian refugees live tightly packed in tents and cabins. U.N.- sponsored school facilities for refugee children closed in Lebanon at the end of February and Jordan has shut its camps off entirely from the rest of the country. No cases of coronavirus have been reported among Syrian refugee populations, but the closings come as the numbers of positive cases swell in their respective capital cities.

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Unlike other countries in the region that are able to enforce strict measures to prevent the virus’ spread, Yemen, embattled for years by constant war, is less capable of coping with the pandemic. Ravaged by nearly six years of war, leading to the world’s worst humanitarian disaster, over half of the country’s population of around 30 million people need food aid to survive. Half of all medical facilities across the country are not working as a result of the ongoing war within the country, and millions are internally displaced and living in makeshift camps. The country already has the world’s largest outbreak of cholera, stubbornly returning each rainy season. That season is just beginning now, with rains breaking out from late March and expected to last for the next few months. “Our projection is that there could be over 1 million cases of cholera this year in Yemen,” British charity Oxfam’s spokesperson on Yemen, Samah Hadid, told the NewsHour. “It would absolutely be a catastrophe given that context, for coronavirus to spread,” she added, calling for countries like the United States to continue with assistance to the Yemeni people.

At the end of March, the U.S. government’s decision to “partially suspend humanitarian programming in northern Yemen” went into effect, according to a USAID statement. Northern Yemen is controlled by Iran-backed Houthi rebels who have diverted aid and interfered with the work of humanitarian workers. It’s also home to millions of its most desperate civilians. Both sides of the conflict have agreed in principle to a cease-fire to help prevent the spread of the disease, but in reality, violence has yet to stop. Meanwhile, there is no coherent government on either side of the divided, war-torn country to implement social distancing, and advising people in unmaintained refugee camps without running water to wash their hands seems like a cruel joke. Yemen has no confirmed cases, but with testing seemingly nonexistent, it’s unlikely there is any knowledge about the presence or extent of the virus in the country.

In Israel, COVID-19 cases have exceeded 7,000 with a huge jump on March 31 of 760 new cases in 24 hours. As of Thursday, 39 people have died from the virus in the country. Israel’s health care system is one of the most advanced in the Middle East, and has so far been coping with the growing number of coronavirus patients. Last Wednesday, the country ordered its citizens to stay in their homes, only allowing them to go out for food and supplies and a short walk nearby. But the authorities have struggled to get sections of the ultra-Orthodox community to comply with social distancing rules, and scenes of clashes between the police and ultra-Orthodox men in the street in Jerusalem have been broadcast on Israeli channels. Those same media outlets claim that over half of all coronavirus cases in the country are within the ultra-Orthodox community. On Sunday, a funeral for a rabbi in the religious city of Bnei Brak saw several hundred mourners gather, in defiance of any measures to stop the spread of the virus, which angered other segments of Israeli society.

The country has, however, stepped up its testing, with drive-thru tests now available in a pilot program that officials hope to expand. As in other countries, like Iran, the highest levels of Israel’s government haven’t escaped infection. Israel’s health minister, Yaakov Litzman, has tested positive for the virus and gone into isolation, which prompted both Prime Minister Benjamin Netanyahu and Israel’s intelligence chief Yossi Cohen to take similar precautions (though they have now tested negative for the disease).

In Gaza, one of the most densely populated territories in the world, around a dozen reported coronavirus cases are causing alarm. The tiny strip of land — under Hamas control — is home to 2 million Palestinian people. It has been under blockades by Egypt, but primarily Israel, for 12 years, leading to severe shortages of power and clean water. Palestinians in the West Bank continue to see the number of COVID-19 cases rise by the day, with over 180 people confirmed as suffering from the virus.

Some countries, however, have tried to suppress news of their infection rates. In Iraq, a recent report quoted several medical and political sources confirming that the numbers in the country of those testing positive for COVID-19 is between 3,000 to 9,000, according to their estimates. One health ministry official told Reuters that there are over 2,000 confirmed cases in Baghdad alone. The Iraqi government said that the current number of infections in the country is just under 800, and have rejected the report.

Iraq shares a porous border with Iran, which sees the flow of religious pilgrims, goods and economic migrants on any normal day. Iran’s government initially repressed figures of those sick with COVID-19 and ignored warnings from doctors. It is now the epicenter of the outbreak in the Middle East, with government figures at nearly 50,000 confirmed cases and over 3,000 dead. The virus comes at a time when the Iranian government is under increased pressure from a protest movement that broke out last year, an economic crisis caused by increased sanctions from the U.S. and plummeting oil prices, and the killing in January of its top military commander, General Qassem Soleimani, by the U.S. in an airstrike. The authorities in Iran have now been forced to release some 85,000 inmates from prison as fears grow of an outbreak in the country’s packed jails.

Egypt has also moved to repress reporting of higher numbers than its officials say. In mid-March, the country forced the correspondent for the British newspaper The Guardian to leave the country after she reported on a study by the University of Toronto that suggested numbers of COVID-19 sufferers there were more likely around 20,000 people. The government currently claims the number of cases to be just under 9,000. A country of 100 million people, most of whom are crammed into a small amount of the total land in Egypt, the spread of the disease could be catastrophic.

Yet, the push to react quickly has been generally much more common across the Middle East. There has been a growing sense of the need to act quickly to reduce deaths, rather than rely on health care systems and luck.

“We in the Middle East are used to [living] in crisis mode,” said Ghanem, in his hospital in Beirut. “This is not the case of the Western countries where they are in a more comfort zone. Where everything is assured.”