Yazan Douedari a , b , Mervat Alhaffar a , b , Muhammed Al-Twaish a , c , Hala Mkhallalati d , Raheb Alwany e , Nafeesah Bte Mohamed Ibrahim g , Ayshath Zaseela g , Nour Horanieh b ,
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 glob- ally 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 comprehen- sive 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 ur- gently needed to reduce COVID-19 transmission in camps.
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“Ten years of war! You expect people to fear a ‘germ’? ”: A qualitative study of initial perceptions and responses to the COVID-19 pandemic among displaced communities in opposition-controlled northwest Syria