Since March 2011, the Syrian war  has claimed over 400,000 lives and displaced an estimated 6.5 million people. This ongoing conflict has turned into one of the worst humanitarian crises in recent history.
The coronavirus only adds a new layer of potential threat to thousands of displaced Syrians.
Between February 1 to March 31, 2020, 312 civilians were killed in Syria as a result of airstrikes, improvised explosive devise (IED) explosions, and targeted killings carried out by all warring parties, according  to the Office of the United Nations High Commissioner for Human Rights (UNHCR). Warring parties include Syrian President Bashar al-Assad's regime and its allies from Russia and Iran, fighting against various rebel groups for power and control.
A record number of internally displaced persons (IDP) are gathering in the northwestern province of Idlib , — the last important rebel-held city in the northwest, and a potential outpost to reach Turkey. The area— with nearly 4.5 million displaced persons — remains under the control of the militant group Tahrir al-Sham. 
This gathering of IDPs has sparked international concern that this community — living under the harshest conditions — could be deeply affected by the COVID-19  pandemic.
An agreement carried out on March 6 between Russia and Turkey aims to limit aerial bombings on Idlib, in northwestern Syria, but the humanitarian situation remains alarming. No airstrikes have been reported since the March 6 ceasefire, but regime forces have pursued intermittent shelling. 
Indiscriminate attacks against civilians — while prohibited under international law  — continue nonetheless, including large-scale terrorist attacks. Multiple strikes on kindergartens and schools occurred in Idlib in February, during which at least 7 teachers and 10 children were killed, according to the United Nations. On February 10,  one child was killed and two injured in an airstrike on a camp in Idlib.
Meanwhile, the spread of the coronavirus in an already strained region has begun to loom as a potential threat. As of May 3, 45 COVID-19 cases  have been reported in Syria, mainly in government-controlled provinces. However, no cases have so far been reported in Idlib.
A dire humanitarian situation
According to the United Nations Office for the Coordination of Humanitarian Affairs (UNOCHA),  since last December — when hostilities intensified with repetitive airstrikes from Russia and the Syrian government in Idlib, — 846,000 people have been displaced and remain in displacement, and half  were displaced to Idlib just in the month of February 2020. Children make up 60 percent of those displaced.
The fighting in Idlib province displaced a huge number of civilians under horrendous conditions. Fleeing on foot or by truck in very cold weather, babies and young children reportedly died on a daily basis. Once they arrived in Idlib, some people only managed to find refuge  in open spaces under trees or on the street.
Food prices are soaring and food access remains difficult. The malnutrition rates among pregnant and breastfeeding women  are devastating: 1 in 5 women is currently acutely malnourished compared to 1 in 20 in 2019. An increased stunting rate  among children under five in Idlib has also been reported.
The coronavirus and a lack of resources could worsen this situation and limit humanitarian access. Experts expect the number of people with the need for humanitarian aid to double to 265 million by the end of the year, including in conflict zones like Idlib.
Abdulrahman Muhajir, an IDP from Homs, said: 
Now, we are suffering from expensive prices, we are suffering from this epidemic, and we are suffering from a thousand things and no one is helping you with anything,
The COVID-19 crisis
To prevent potential contagion in Idlib, one laboratory initiated testing procedures.  The World Health Organization  has also procured additional ventilators. Health infrastructure and trained personnel are generally missing in warring areas. Between 2011 and 2019, over 900 medical personnel  were killed in Syria while many others fled.
Still, medical professionals in Idlib are doing what they can to prepare for potential COVID-19 cases in area hospitals:
Hospital in #Idlib  being sanitized by the @SyriaCivilDef  to prevent the spread of #COVID19  (left) versus ‘hospital’ in an area terrorized by #Assad , who has been receiving billions of #UN  donor money for years. pic.twitter.com/nEpXFzrF5u 
— Simona Jeger (@simonajeger) April 5, 2020 
IDP camps are a critical concern for potential contagion. After a first COVID-19 death was reported in northeastern Syria, Kurdish authorities in control of the area set up a dedicated hospital in the area and authorities in Idlib expect to do the same.
We don’t have the right medicine or the appropriate place to quarantine the patients, There is nothing we could offer to them.
The camp has organized an awareness campaign to limit the spread of the coronavirus and UN authorities  are working to implement testing supplies, but mainly in government-controlled areas, limiting the possibility of access for IDPs.
The last time a humanitarian aid convoy reached the camp was in May 2019. Under such dire living conditions, dozens of children died from hypothermia in 2019. Humanitarian assistance has not stepped up and neither Jordan government or the Syrian Assad regime  are expected to provide assistance.
In recent weeks, a planned humanitarian mission by the UN and Syrian Arab Red Crescent was suspended due to a disagreement.
James Jeffrey,  the United States ambassador to Syria, said an agreement made between Russia and Turkey offers the chance for talks in Idlib.
But according to Turkish President Recep Tayyip Erdoğan , the Syrian regime is currently using the media focus caused by COVID-19 pandemic to ramp up the violence and violate the March 6 ceasefire without attention. A recent exchange of fire  in Idlib has been reported between Syrian and Turkish forces.
Despite the current constraints, the United Nations Office for the Coordination for Humanitarian Affairs (OCHA) managed to deliver more aid to Idlib in March than it did at any time since 2014, citing reduced military activity in the area.
In January 2020, Resolution 2504  voted by the UN Security Council extended the “authorization of cross border aid delivery” to Syria until July 10. António Guterres, the UN secretary-general, recently reminded the Syrian government that since 2012, under OHCR resolutions S-18/1  and 19/22,  it should allow for a UN field presence to protect human rights.
Yet, after nine years, this has still not been implemented.
The window of opportunity to prevent a further humanitarian crisis from COVID-19 is now — but it will close very soon. The international community should make every effort to protect affected civilians who face insecurity — and death — on a daily basis.