COVID-19 in Conflict Zones, with Kelly Razzouk

ALEX WOODSON: Welcome to Global Ethics Weekly. I'm Alex Woodson from Carnegie Council in New York City.

This week's podcast is with Kelly Razzouk. Kelly is director for policy and advocacy at the International Rescue Committee (IRC). In this role, she represents IRC at the United Nations.

Kelly and I spoke about the COVID-19 pandemic in active conflict zones and what the IRC is doing to help. We focused mostly on Syria where the health care system has been ravaged by hundreds of attacks since the start of the civil war. We also discussed the role of the UN Security Council during the pandemic and the status of a global ceasefire.

For more from Kelly, check out her CNN.com article "The world is celebrating the valor of health workers. But in Syria, they're still being killed." She wrote that with her colleague Amanda Catanzano.

And for a lot more on the pandemic and international relations, including podcasts, articles, and webinars, you can go to carnegiecouncil.org.

But for now, calling in from Southern California, here's my talk with Kelly Razzouk.

Kelly, thank you so much for talking today. I'm looking forward to this.

KELLY RAZZOUK: Thank you for having me, Alex. Glad to be with you.

ALEX WOODSON: I want to start with an article you wrote on April 29 with Amanda Catanzano for CNN.com, and it's called: "The world is celebrating the valor of health workers. But in Syria, they're still being killed." I think a lot of our listeners are dealing with the COVID-19 pandemic in their own countries and their own communities and have a lot to think about, but obviously things are a lot worse, a lot more desperate in some other countries.

What's the situation in Syria right now, and why did you decide to write this article?

KELLY RAZZOUK: Thank you so much.

I wrote this article with my colleague, Amanda, as you mentioned, and the reason we wrote the article was that we wanted to shine a spotlight on what is happening in Syria and the situation with Syria's health care system given COVID-19. Many of us have experienced the overwhelming support for our health care heroes here in the United States and in other countries. We have celebrated them. They have been the frontline heroes in this pandemic.

But when you look at our situation and juxtapose that with the situation in Syria, you get a much different picture of a decimated health care system, a health care system that has been under attack for years now. According to the World Health Organization, there have been 494 attacks on health care in Syria since the start of this war, and we as the International Rescue Committee (IRC) have had 13 of our IRC-supported hospitals and facilities bombed, and we have lost colleagues in the field due to these attacks.

In just the last four months there have been 84 health facilities in Northwest Syria that have been forced to suspend their operations, and many of these health care facilities were on what was called the UN's "deconflicted" list, so they were supposed to be no-go zones for the parties to the conflict. Despite that, we have seen the direct targeting of these health care facilities. Given the needs in Syria and given the population there, this has left the health care system truly decimated when it comes to handling this pandemic.

ALEX WOODSON: So attacks have continued through the pandemic in Syria?

KELLY RAZZOUK: There have been a lot of attacks that have occurred that have made it difficult for the health care system to continue. As the International Rescue Committee, we have had to move many of our facilities underground and create mobile health clinics and things like that to address the concerns and deal with the needs.

ALEX WOODSON: I know this is a very hard thing to research, especially in Syria, but it seems like there hasn't been as much of a COVID-19 outbreak in Syria as in some other nations. I think it was under [60] reported cases.

Should we believe those numbers? Could it be worse in Syria than they're letting on, or is there some reason why—maybe just because it has been isolated because of the civil war for so many years that they don't have the same international travel that other nations do?

KELLY RAZZOUK: I think it has been very hard to document exactly how many cases there have been due to the lack of testing. We don't have the accurate picture right now of the number of individuals. We do have some cases, and there is a fear because you have 6.6 million Syrians who are internally displaced; you have overcrowded camps and settlements.

You take just one camp, the Al-Hol camp, where you have 68,000 people living in an area that is four times more densely populated than New York City, so you can only imagine what a COVID-19 outbreak would do in those types of situations. And that doesn't even touch on the fact that there are only 10 to 11 ventilators in the Northeast. And it's not just a matter or shipping ventilators because you have to have people who are trained and able to operate these ventilators, so the needs are very great when it comes to a potential outbreak in these scenarios.

ALEX WOODSON: Also, I was looking at your Twitter page. The IRC put out a press release about attacks in Libya as well on health care facilities. What can be done to stop these attacks? Connected to that, what is the IRC doing to help that?

KELLY RAZZOUK: Exactly. You've pointed to the Libya case, so Syria is not an isolated incident. We are seeing these attacks happening around the world.

The International Rescue Committee has called on the United Nations. We have called on the secretary-general to appoint a UN focal person who would focus on these attacks and who would highlight them, draw attention to them, and ensure that these attacks are investigated and that there is real accountability. That is not something that we have seen. We have not seen accountability for these attacks in any way, shape, or form at this stage.

ALEX WOODSON: You talked about Syria and Libya. I know the IRC is active in many other countries. What are some other things that you would like to highlight about IRC's response to the pandemic right now?

KELLY RAZZOUK: IRC has 30,000 staff in 40 countries around the world, and so we are very focused on the COVID-19 response and ensuring that our frontline responders have what they need. We have been looking at what we have called the "double" emergency and how this will impact countries that are already fragile due to political and economic instability.

There are countries like South Sudan, where you have four ventilators for the entire country, and countries like Yemen, where only half of the hospitals are fully functional. You also look at the situation in camps, which is a real concern, and we have been focusing on ensuring that in refugee camps and places like that we are getting things to the people in terms of just getting the basics.

So, handwashing. There has been a real focus on handwashing in this country and around the world, and for many of us that just means walking down the hall, turning on the faucet, washing our hands, and singing "Happy Birthday," but for refugees in so many countries, like in Greece, you have a situation where there are around 1,200 people queueing for one station to wash their hands.

So we have been putting an emphasis on handwashing stations in places like Afghanistan and places where we are working, ensuring that our frontline responders have the tools that they need, setting up isolation units where we have these clinics to ensure that we're ready for the COVID-19 response. That has been something that we have put an emphasis on. Also, we are trying to adapt our current programming to the needs and to the challenges that are being presented by COVID-19.

One example of that is the program that we have. It's a partnership with Sesame Workshop through a MacArthur grant, where we bring Sesame Street programming in Arabic—called Ahlan Simsim—to refugee children in Lebanon, Jordan, and elsewhere.

Given the COVID-19 pandemic, the producers got together and decided to make a film about COVID-19, about hygiene and handwashing, and also to help children cope mentally with the challenges of not being able to see their friends, social isolation, and things like that. That has been really helpful. I saw a short video of one of the refugee children in Lebanon who was watching this film that was produced, and it has been important to see this ingenuity and adaptability to ensure that children are getting education and that we're dealing with needs that will be ongoing perhaps for months throughout this crisis.

ALEX WOODSON: It's a little hard to believe on my end. We have been dealing with the pandemic in New York City and the United States for two months—a little longer in Europe and obviously a lot longer in China and other parts of Asia.

I have a couple of connected questions. Obviously a pandemic is something that the IRC has dealt with, but no one has dealt with a pandemic on this scale. Did you have a plan in place for a global pandemic like this, and how has the response adapted and changed over the course of the two or three months that the Western world at least has been dealing with this pandemic?

KELLY RAZZOUK: It's an important point. Preparedness is something that everyone seems to be talking about in this country and beyond.

IRC has a great team in place. We were on the frontlines of the Ebola outbreak, so there were a lot of lessons learned from that in terms of engaging communities and how we ensure that we get the right information out to people. I think that's an issue that people are talking a lot about in the news, the right information and getting the facts to the people, and we learned a lot of lessons from that about the need to build relationships within the community.

The IRC model is one of employing locally engaged staff and ensuring that we have that community investment and build that trust. I think that is something that has served us well throughout this crisis in preparation. So we had a lot of tools that we put in place and lessons learned from the Ebola outbreak, and that has helped us to adapt and quickly think about solutions and think about ways that we can adapt our programs.

But one of the biggest challenges has been ensuring that the funding gets to frontline responders. That's something we have conveyed throughout to the United Nations in their response and in our discussions with other donors, that it's important that we get that funding out to the frontline responders so they can disburse that to people who are most in need at this time.

ALEX WOODSON: Is there any aspect of the pandemic or response that has surprised you, something that you didn't expect all, looking back over the last two months, something that might just be conventional wisdom that you weren't thinking about maybe in early March or early April that you're dealing with every day now?

KELLY RAZZOUK: I think the thing that surprised me the most is that despite the international solidarity we have seen at the local level—we have seen people coming together and doing everything they can to get frontline responders the personal protective equipment they need and to salute our health workers. Despite this we haven't seen the world leaders responding in the same way. I think that has been one of the most surprising and definitely frustrating aspects of this conflict.

You had the UN secretary-general going out on March 23 and making a very strong call for a global ceasefire, for countries to ensure that warring parties stopped what they were doing and allowed humanitarian access and allowed frontline responders to get to where they needed to go to curb this outbreak. Despite that call, now two months later basically, we still don't have global solidarity around that call. We haven't seen action from the UN Security Council; we haven't seen the type of international solidarity to back that up. That has been something that has been surprising to me and frustrating as well.

ALEX WOODSON: I want to talk a little more about the UN Security Council. As you said, the secretary-general made the call in March for a global ceasefire. It seems like common sense. Obviously, everyone in the world is dealing with this pandemic.

What has been the stumbling block? Two months later why hasn't there been a resolution about a global ceasefire?

KELLY RAZZOUK: It's unfortunate. You've asked the right question that we're all asking: Why is it so difficult? Why hasn't this happened? Because it seems like something that should have been done the moment we realized that this was a global pandemic.

There have been a lot of things in the Council lately. There are political considerations and discussions that are happening behind the scenes, but it is unfortunate that that is preventing the Council from speaking out on such a critical issue.

The point about humanitarian access is one that is of vital importance as well, and that's another area where we have seen the Council take some dramatic steps to curb humanitarian access in a way that is very harmful, given this pandemic. We saw the Council in January with regard to Syria take steps to remove a border crossing for use for access to get goods and health supplies into Syria across the border via the Al Yarubiyah-Iraq crossing.

That was shocking to us at that point in January. But when you look at it now, in the middle of a pandemic, where Syria needs all the help that the country can get, it has been deeply, deeply distressing to see that the Council has not taken steps yet to correct that.

That's something that we as the International Rescue Committee have been calling on the Council to also rectify urgently. We think that it's important for the Council to adopt a resolution urgently reauthorizing the Al Yarubiyah crossing so that the World Health Organization can utilize that to get urgent health supplies into Northeast Syria, as that is the critical access point to ensure that access is flowing into that country in the northeast.

ALEX WOODSON: Are you optimistic that that issue will be resolved and that the global ceasefire will come into effect? I think there was a new resolution proposed a couple of days ago about a ceasefire, and you mentioned to me that you're meeting some people at the United Nations next week, so are you hopeful that these issues can be resolved and that there can be some renewed energy maybe on the part of the Security Council?

KELLY RAZZOUK: It's easy to get disillusioned, but we continue to try to hold out hope that the Council could reach some agreement on this. The Council has its monthly Syria briefings where they discuss Syria specifically, so we hope this issue of humanitarian access would not be a politicized one, that just reaching people in need could be an area where the Council could come together. The Council does need to renew the Northwest cross-border access points by July 10, when that mandate expires, so the Council will need to discuss this in the next two months. There are 4 million Syrians who rely on cross-border aid and who need this as a vital lifeline, and COVID-19 has made that even more important right now.

As a humanitarian organization, we are holding out hope that the humanitarian needs will prevail upon Security Council members and that they will reach some agreement on the global ceasefire and on the COVID-19 resolution. There have been multiple attempts at a resolution; there have been multiple tries by different countries that have been put forward, trying to find some solutions to this.

We feel like it is a missed opportunity if the Council doesn't act, given this "once-in-every-hundred-year" pandemic that people are calling it. To go down in history as the Council not proclaiming itself and not making any formal statement on this is very distressing for the Council going forward.

ALEX WOODSON: If the global ceasefire resolution were to pass, what would that mean exactly? How would that improve the situation in some of these countries where there is conflict going on? Obviously, you don't call a ceasefire, and everyone puts down their arms; I don't think anyone thinks that. But what effect would this resolution have?

KELLY RAZZOUK: That's true. Things don't always change overnight, but I think the Security Council still does have global resonance with governments and also with non-state actors. I think the absence of the call almost speaks louder than a call itself in this case.

If members of the Security Council are able to agree to this, I think it does put forward a powerful symbol because you have had the UN secretary-general putting himself out there and calling for this directly, so I think for the UN Security Council to have legitimacy going forward they do need to come together and adopt a resolution on this. It needs to be backed up by concrete resolutions like we have just discussed that provide for humanitarian access so that humanitarian aid and these health kits that are needed can reach the most vulnerable, but I think this is an overarching step that needs to be taken urgently.

ALEX WOODSON: Just a couple more questions to finish up.

Stepping away from these global issues, the discussion that we have been having, your work I imagine before this was very much face-to-face, meeting people at the United Nations, and meeting with your colleagues at the IRC. Is the UN Security Council completely on Zoom now? Is there anyone in the building meeting? And how does that change the way that you work, the way that you meet with people at the United Nations, the IRC, and other organizations?

KELLY RAZZOUK: It is not on Zoom, but it is on a platform that is entirely virtual, so the Security Council started off their meetings virtually. The first month they had entirely closed sessions, so non-governmental organizations (NGOs) were not able to view the sessions, which is something that we were very concerned about from a transparency point of view because, as you mentioned, I am no longer able to sit in the seats in the balcony of the Security Council and observe what's happening. To be entirely shut out of the open meetings of the Council was something that we were very concerned about as an organization.

So the International Rescue Committee and a group of NGOs wrote to the Security Council and encouraged them to be more transparent. To their credit, the Dominican Republic took over as the presidency of the Security Council last month and made strides in terms of trying to open up the access for nongovernmental organizations, which is important. So we are able now to view the open sessions. We are able to see the Council's statements being made, so that part has been incredibly helpful.

And we are seeing some positive developments in terms of NGOs being able to brief Council members. I think this has opened up the door for colleagues from the field to do briefings for Council members. So I think that has been a positive aspect of this, but it does look like we could be seeing more of this, and that part has been important.

We have also seen the Council trying to take steps to issue press statements after the closed meetings to give the public a little bit more insight into what's happening in these discussions. It was a rocky start in terms of transparency for the public, but I think the Council is taking some steps forward and trying to make it as transparent as possible in this virtual world that we're living in now.

ALEX WOODSON: Last question: What will the next few weeks, the next month or two, look like for you? Are you focused on your work with the United Nations or focused on other aspects of the IRC? What are your days looking like as the pandemic gets into month three and month four?

KELLY RAZZOUK: It is very focused on our work at the United Nations. As an organization we're very focused on using every single week we have to ensure that we're prepared in these countries that have fragile health systems and that our colleagues on the frontlines have what they need. Whether that's through discussions with the United Nations or discussions with donors that continue, that has been a real priority.

Also, we are trying to give briefings to Member States to help them understand what's happening on the ground and hopefully make progress on some of these things like humanitarian access in Syria—coming back to where we started with this conversation—and ensuring that those people are not forgotten in this pandemic. Countries are very focused inwardly and domestically, as they should be as well, but it has also been important for us to highlight and to shine a spotlight on the needs of those around the world to ensure that their needs are not forgotten in this pandemic and that their voices are heard.

ALEX WOODSON: Thank you very much, Kelly.

KELLY RAZZOUK: Thanks so much for having me, Alex.