The city of Idlib is the capital of the Idlib Governorate in Northwest Syria, located about 60 km north of Aleppo. It is the last stronghold for opposition forces engaged in over a decade of conflict with the Assad regime. The city has been subjected to aerial bombardment and chemical weapons attacks, while more than 1 million people have been forcibly displaced within the Idlib region and are dependent on humanitarian aid. As COVID-19 spread around the world, the autonomous health authority, the Idlib Health Directorate prepared for the arrival of the disease by adopting a “delay approach.” Border closures and public awareness characterized early responses to the impending pandemic threat, while volunteer-led testing and contact tracing programs were scaled up in collaboration with the WHO-led health cluster based in Turkey. Within Idlib, collaboration with organizations including the White Helmets affected a locally driven decentralized response.