Forty-seven Australian children remain trapped in the abject al-Hawl camp in north-east Syria, as the region braces for a potential Covid-19 outbreak. Syria has reported only a handful of cases, and there are none confirmed in the camp housing 68,000 women and children, most of them family of Islamic State fighters, but there has been little Covid-19 testing across the war-torn country. In neighbouring Turkey, more than 18,000 cases have been confirmed, and the rate of infection is on the steepest upward curve of any country in the world. Fabrizio Carboni, the regional director for the Near and Middle East for the International Committee of the Red Cross, tells the Guardian al-Hawl is “hell … this place really is hell”, and acutely vulnerable to a Covid-19 outbreak. “The challenge for us is prevention, to avoid the virus getting into the camp, and to isolate any cases at all costs to stop the spread in the camp. But really, if this epidemic gets into the camp, forget about having medical supplies, it will be impossible to control.” Kamalle Dabboussy, whose daughter and three grandchildren have been held in the camp for more than a year, says while there are no confirmed cases in north-east Syria “we are hearing reports of some women presenting with pneumonia-like symptoms”. “However, we note there are no testing kits, so we just don’t know what that means. “As family members, we are very scared… if Covid-19 hits al-Hawl camp it will be a catastrophe.” In al-Hawl camp, on a barren and windswept plain in Syria’s north-east, 68,000 women and children – most are children – live crammed into just 1.8sq km, in squalid and crowded conditions, in tents which flood regularly and are exposed to high winds. The past winter brought snow and waves of illness, including frostbite, diarrhoea, rickets and asthma. Syria is ill-prepared for an outbreak: weak state structures, an internally displaced population of seven million, and large parts of the country falling outside central government control make controlling the spread of the virus almost impossible. Al-Hawl camp is one of the most vulnerable places on earth to a Covid-19 outbreak, analysis from the International Rescue Committee shows. Social distancing is impossible in the camp, with large family groups, even multiple families, living in single tents. People need to queue for food, water and medical care. “This is also a weakened population,” Carboni said. “They have limited access to healthcare and psychologically they don’t know what will happen to them, they live in a permanent state of limbo.” Children are suffering acutely inside the confines of al-Hawl. “These are children who are highly traumatised, they have experienced war, almost all of them have seen family members killed,” Carboni said. “And they have nothing, they are on their own, these kids are held in a space with nothing, no school, no books, no playground, no toys.” Currently, there are 19 Australian women and 47 Australian children held in the camp. The Australian government is aware of their identities and the bona fides of their Australian citizenship or right to claim that citizenship. They are family members of former foreign fighters who have been captured or killed. None of the Australian women in the camp have been charged as being combatants, and many were coerced, forced or tricked into travelling to Syria. The youngest child in the Australian group is four months old, born on 30 November last year. Winter has been brutal on the Australian group, who live in close proximity to each other. One three-year-old Australian girl held in the camp contracted severe frostbite on her left hand. Unable to access treatment, she is likely to lose her fingers. The families held in the camp have consistently pleaded with Australia to assist with their repatriation: the women in the camp have said they would submit to monitoring, such as control orders, if they were returned. Were the children and their mothers able to get to an Australian embassy or consulate, the Australian government would be legally obliged to provide them travel documents to return home. But the Australian government has consistently refused to repatriate its citizens, despite the urgings of the Kurdish forces running the camp, its ally America, and other countries such as the UK, Germany, Denmark and France repatriating their citizens. A small group of Australian orphans has been repatriated to Australia, but no family members with adults have been brought back since the Australians were taken to the camp a year ago. The home affairs minister, Peter Dutton, has said the government is not prepared to risk other Australian lives in any repatriation effort. He said some of the Australians in the camp were “hardcore” and “have the potential and capacity to come back here and cause a mass casualty event”. “So I don’t think it should come as a surprise when we say we’re not going to send our soldiers to rescue people of this nature.” Sources in the camp say repatriating foreign nationals remains relatively straightforward. Kurdish forces have been taking foreign citizens to and across the nearby Iraqi border, without the involvement of third country troops or diplomatic staff. Carboni urged nations around the world to repatriate their citizens from al-Hawl camp. “You can’t keep people indefinitely in a quasi-detention regime. If they’ve done something wrong, prosecute them, sentence them, and for the ones who are not charged with crimes, just bring them home. “The international community has a collective responsibility to these women and children. This problem won’t disappear because you don’t pay attention to it. It will still be there, it will remain until it is addressed.”