A journey into the core of Iran’s coronavirus outbreak

SAQQEZ, Iran — A few days after attending a funeral, Shanaz started coughing. An elderly relative had died from choking on a chicken bone, and since she had many relatives, the funeral was attended by a lot of people. When Shanaz developed a sore throat, she assumed it was just a cold, and called her sister to come over and cook for her. After a few days, her sister started coughing, too.

“We had heard about coronavirus, but there was no news of it spreading here in Rojhelat,” Shanaz told Rudaw English, using the name common among Kurds to refer to provinces in western Iran. “But we kept hearing from those who’d attended the funeral that they had fallen ill. I started to worry,” she said.

“One day, I almost fell out of consciousness because I was coughing so much and had difficulty breathing. My husband immediately rushed me to hospital. They told me that I had contracted the coronavirus. “Most of the patients hospitalized at the section of the hospital for coronavirus were my relatives, those who had attended the funeral," Shanaz, 52, who has recovered from coronavirus after 18 days, told Rudaw English.

Hundreds of cases of COVID-19 have now been traced back to that funeral, held on February 10 at the Hazreti Omer Mosque in Saqqez. Authorities say they identified ten cities that attendees of that one funeral spread the virus to.

Today, Saqqez is the center of the coronavirus outbreak in hard-hit western Iran. Data from the University of Kurdistan’s Faculty of Medical Sciences estimate at least 889 cases of coronavirus have been confirmed so far in the Kurdish provinces of Iran. In the sparsely-populated region, nearly a quarter of those are in the small city of Saqqez.

It’s a three hour drive through the mountains of Kurdistan province to get to Saqqez from Sanandaj, the nearest place that can be called a city. My driver puts a slow and relaxing music on the radio that suits the lush spring landscape this time of year, allowing me to enjoy the view and almost forget about coronavirus. But the peaceful ride is distrubed by the driver’s frequent complaints about the economic crisis. He tells me it has been two months he is unable to work due to coronavirus, and he is behind on his rent and car insurance payments.

Arriving in Saqqez, the first thing I could notice is the car garage – usually packed with noisy drivers calling out the destinations to hurried customers hauling their suitcases – now has barely a soul in sight. Saqqez is known for its clothing market and touristic sites – there is nothing like a shopping mall anywhere near this place. Mostly a stopover town for alcohol and foreign electronics making their way over smuggling routes from Iraq on their way to Tehran, Saqqez is also known for its outdoor theatre performances. Now, the famous market and amphitheatres sit empty, and you can barely notice a single person walking outside.

"As the coronavirus wave hit Saqqez, people started to close up shop in fear,” Ata Hijazi, the owner of a still-open clothing shop owner tells me. “The market in Saqqez has been completely closed for two months, negatively impacting the people who were already struggling financially in this city.”

Looking dapper and proud in his own traditional Kurdish clothes, at 45 years old, five more years working in this shop will mark precisely half of his life in the clothing business. After all, putting on fine clothes can make a person feel good and give them confidence, he recounts with a salesman-like enthusiasm. But these days, even new threads don’t overcome the stress that people are feeling financially. On top of the fear spreading with the virus, they barely can afford money to provide food for themselves.

"I bought a huge amount of clothes before the coronavirus came, but I haven’t been able to sell them. I’ve lost around 100 million tomans ($9,000) so far," Hijazi told Rudaw English. "The economic impacts of coronavirus will not be shown now, but will do in the next months and years," Hijazi added.

The hospital in Saqqez saw its first quarantine patient on February 20, when the first test for coronavirus came back positive. Since then, local health officials have been trying to screen as many people as possible through phone calls. But still, officials admit it is nearly impossible to locate every case of the virus.

Official figures have placed the nationwide toll at more than 82,211 infected and over 5,118 dead as of April 19. “Those numbers might not be accurate, not because we want to hide the real numbers, but because tests must go to the labs and it takes time for the results to come back, said Dr. Anwar Bahrami, the head of Saqqez health department, who is also working shifts as a physician treating patients. "Sometimes, we have 80 staff on a shift due to the growing number of the patients," he told Rudaw English.

"The lack of testing kits, and errors that the kits sometimes make also contribute to the lack of reliable data on COVID-19,” Dr. Bahrami said. He also estimates there are people who may display trace signs of the disease, but do not come in for testing until their symptoms worsen. Officials estimate 32 people have died of COVID-19 in Saqqez.

Iranian authorities were widely criticized for downplaying early reports of the pandemic’s spread, and have been reluctant to admit that taking action more swiftly would have saved countless lives.

Millions of people also ignored the health authorities’ social distancing warnings to travel for the spring holidays, likely spreading the virus to countless others.

On Tuesday April 14, Iran’s parliament published a report which estimated that the country’s actual death toll may be nearly double the officially reported figures, due to undercounting and because not everyone with breathing problems has been tested for the virus. The explosive charge came as merely a footnote on the sixth page of a 46-page document, written by a group of experts considered to be nonpartisan.

Iranian health officials have not commented on the report, but already, hard-liners have seized on President Hassan Rouhani's handling of the pandemic to criticize him and his reformist administration. Iran's leaders have said they had to consider the economic consequences of quarantine measures, as the country struggles under severe sanctions imposed by President Donald Trump after he withdrew the U.S. from Tehran's nuclear deal with world powers.

The parliamentary report came days before shops began slowly reopening in the capital, Tehran, after the government eased strict lockdown measures at the start of the business week on Sunday. It said Health Ministry death toll figures counted only those who were tested and died in hospitals, disregarding all coronavirus victims who died in their homes. The report also said that aggressive testing has lacked in Iran — meaning other cases likely have been missed. It suggested the true death toll in Iran is probably 80% higher than figures now given, or nearly double.

In order to have more compatibility between protocol and estimated statistics, it is necessary to increase laboratory and testing capabilities in the country,” the report said. "Needless to say that through increasing the capacities, diagnosis of disease will be more possible and spread of the disease will be more limited.”

Saqqez, in the northwest of Iran, is only home to around 236,000 people. But being in the province with the highest officially-recorded death rate in the country, many more may have died after contracting coronavirus in Saqqez.

One of those was Mohammed Yar Ahmedi, 41, a health worker, whom Dr. Bahrami describes as a "humble man" who died after contracting coronavirus. "I have witnessed many unpleasant things. It hurts when you see the patients are suffering the shortness of breath and the disease is really hurting them," he sighed. "But the death of Mohammed Yar Ahmedi was the saddest thing to me than all the others," Bahrami said, bursting in tears.

"We have no other choice. We must overcome our emotional feelings to work harder. I have no doubt that we will prevail over this problem," Dr. Bahrami said.

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