Northern Syria – The facade of the COVID-19 treatment centre in Tabqa, a town on the shores of Lake Assad not far from Raqqa, is riddled with bullet holes.
From 2013 to 2017, ISIL (ISIS) fighters used this former sports field and complex as a training base, and during the Kurdish-Arab offensive, backed by the United States-led coalition, they used a 2 x 2-metre (6 x 6-foot) tunnel to carry out surprise attacks.
On the walls, ballistic calculations can still be seen – a trace of the lessons for rebels on the use of heavy weapons.
In October, the facility was rapidly adapted to respond to the COVID-19 pandemic, which is surging in a region struggling from the devastating effect of a near-decade of war.
“We equipped the centre in a month to treat moderate cases of coronavirus and on November 20 it was ready,” Obeid Muslim, head of the Health Committee of Tabqa in the Kurdish-led Autonomous Administration of North and East Syria, told Al Jazeera.
“So far, we have four ventilators and 24 beds, but we are arranging for 50 more [beds]. The cases are increasing,” Muslim said.
In Manbij, a 100km (0.62 miles) further north, a school that ISIL used from 2014 to 2016 to train and indoctrinate fighters has been equipped with 20 beds for the COVID-19 emergency.
When the pandemic reached Tabqa and Manbij, there was a need to find new space for patients. The two former ISIL bases were available and large enough. Moreover, they could be equipped relatively quickly.
Only the ground floor and the first floor in Manbij are operational. The second floor is still unusable: The building was bombed by the US-led coalition during the battle to recapture the city.
Patients have access to oxygen, but not to ventilators or an intensive care unit.
“People are slowly understanding that they have to ask for help,” said the team leader of the Kurdistan Red Crescent (KRC) in Manbij, whose name may not be reported for safety reasons.
“But in most cases when patients get worse, we can’t save them. We are not equipped for intensive care yet.”
The Tabqa and Manbij centres are managed by the KRC in collaboration with Un Ponte Per (UPP), an Italian NGO that – in addition to Doctors Without Borders (Medecins Sans Frontieres, or MSF), Syrian Relief and Medical Relief for Syria – is fighting COVID-19 in the region.
This area, also known as Rojava and controlled by the Kurdish-led administration, has seen an extremely worrying boom in cases over the last few months.
As of September 14, the total number of confirmed COVID-19 cases in Rojava was 840, according to the Rojava Information Center.
According to the North East Syria Forum, a joint initiative of NGOs operating in the region, by December 9, there were a total of 7,322 confirmed cases of COVID-19 in Rojava, comprising 6,035 active cases, 1,063 recoveries and 224 deaths.
Of all confirmed cases, 670 – 9 percent of the total – were among health workers, and 42 percent of all samples tested returned positive.
The North East Syria Forum say there continues to be significant under-reporting of deaths and recoveries in the region. It says only a fraction of confirmed deaths in COVID-19 treatment facilities is currently reflected in the death total.
The situation is even more alarming considering the difficulties in procuring personal protective equipment, medicines, equipment for intensive care, and PCR tests, and a shortage of medical personnel.
In January, the UN Resolution 2504 – which reduced aid access to Syria from four to two crossing points – has “compromised the arrival of the necessary medicines”, Giacomo B, UPP Head of Mission in Syria, told Al Jazeera. He did not provide his full name for security reasons.
“One of the border crossings (on the Syrian-Iraqi border), which in the last three years had allowed humanitarian aid to enter northeast Syria, was closed.”
UN supplies that were previously coming from Iraq must now go through Damascus, under Syrian government control, which in practice has the power to block the shipments.
Human Rights Watch reported in April that bureaucratic obstacles were preventing the transfer of supplies to the region from Damascus.
Supply problems are not the only difficulty in the fight against the spread of the disease in northern Syria.
In a region scarred from 10 years of civil war, with clashes in the north among the militias supported by Turkey and the ongoing risk of an ISIL resurgence in the areas along the Euphrates, convincing the population that the virus is a threat is a difficult task.
“At first, people didn’t give any importance to the epidemic,” the KRC team leader in Raqqa said.
“Now they see that death is a real possibility and have started to take it more seriously. But they still have other priorities.”
According to the UN, in 2017 the Kurdish-Arab offensive against ISIL, together with the bombing of the US-led coalition, destroyed or damaged an estimated 70-80 percent of all buildings in Raqaa, ISIL’s former “capital”.
In the waiting room of the central hospital in Raqaa, almost no one wears a mask, and in the streets of the city, still covered in ruins, the situation is the same.
It is not uncommon to see policemen without masks, and sometimes even doctors and nurses – largely due to indifference, as public sector workers generally have access to personal protective equipment (PPE).
Amid such tragedy and destruction, aid workers and medical professionals say it is difficult to explain the danger of an invisible enemy.
The indifference of the population is accompanied by superstitions, unfounded rumours, and social stigma related to the disease.
“We know of people who died from COVID, but we are not afraid,” says a street vendor in Manbij, a city where ISIL sleeper cells are still present, located about 10km (six miles) from areas controlled by Turkish-backed armed groups and 20km (12 miles) from the territory controlled by the Syrian government’s forces.
The vendor, who preferred to remain anonymous, also told Al Jazeera about theories he had heard – which are not supported by scientific evidence.
“It seems that people who live in the sunniest places get sick less,” he said. “While, according to a theory, those who made the anti-malaria vaccine are less likely to get infected.”
At the end of March, when the number of cases was starting to rise, the administration implemented a partial lockdown across the region, but with little effect as infections and deaths continued to rise.
In late November, amid pressure from NGOs in the area, the administration decided to apply more restrictive measures.
From November 26 to December 5, a total lockdown was imposed in the cities of Qamishli, Hasakah, Raqqa and Tabqa and a partial lockdown in Kobane, Derik and Manbij.
From December 6 to December 20, a partial lockdown remained active across Rojava.
To go to Derik, northeast Syria, where there is another COVID centre managed by UPP and KRC, people have to pass through Qamishli, one of the most important Kurdish towns, on the border with Turkey.
Due to the lockdown, people need to justify their travel at the many checkpoints in the region. The streets of Derik are almost deserted.
In Derik’s hospital, internist Housein Mahmoud, in front of a screen showing the rooms where COVID patients are hospitalised, told Al Jazeera stigma is often a problem.
“The virus is seen as something wrong, it’s not uncommon that people try to hide their symptoms because they don’t want others to know that they are ill.”
Beside him, a nurse listened to the conversation without wearing a mask.
“This area of the hospital is sterilised,” he says when it is pointed out to him that he should wear one. Is he not worried that people coming from outside could be carrying the virus?
He smiled and put his mask on, but it was clear he did it only to please his guests.