Since the start of the war in Syria 10 years ago, the lives of Syrian people have been under threat. Back in 2011, the situation quickly shifted from localised protests to a full-scale war, leading to a devastating humanitarian situation that persists a decade later.
Over the course of 10 years, 12 million Syrians – half the pre-conflict population – have been forced to flee the conflict and leave their homes behind, often multiple times, making it the biggest displacement crisis of this century. Many of them are still displaced today.
A significant part of Syria’s infrastructure has also been destroyed. Notably, Syria’s relatively functional health system has been devastated. Hundreds of medical facilities have been bombed, large numbers of medical staff have been killed or have fled, and there are still desperate shortages of medical supplies in many parts of the country. Today, the medical needs of the Syrian people are huge.
Médecins Sans Frontières (MSF) has been responding to the crisis in Syria since the start of the war. We have been providing support to people in need across different areas of the country: from donating medical supplies, to setting up hospitals and clinics, to providing remote support to medical facilities and networks of doctors in areas that MSF could not access directly. Today, MSF is providing support to Syrians within Syria as well as in various neighbouring countries that host Syrian refugees.
This timeline outlines a decade of conflict, highlighting the increasing humanitarian and medical needs of millions of Syrians and MSF’s efforts to respond to them.
2011: Protests turn to armed conflict
In 2011, large numbers of Syrians took to the streets to demand democratic reforms. The uprising quickly evolved, from initially minor protests, into massive protests during March. The demonstrations were met with police and military violence, mass arrests and a brutal crackdown, resulting in hundreds of deaths and thousands of people wounded. As the protests turned into conflict, Syrians started leaving their hometowns, either for different parts of the country or to neighbouring countries.
For MSF, providing medical care to people within Syria proved challenging from the start of the conflict. From 2011 until today, we have not been granted approval to work in government-controlled areas of Syria, despite repeated requests for permission; as a result, our areas of intervention have always been concentrated on areas outside government control.
MSF still managed to provide medical assistance to people in need within Syria by supporting networks of Syrian doctors and providing donations of medical and relief items to field hospitals and clinics in Homs, Idlib, Hama and Dara’a provinces. Unable to access the capital, we made donations to the Syrian Red Crescent in Damascus in response to the increasing medical needs and lack of medical supplies in the city.
In neighbouring countries, such as Lebanon and Jordan, MSF started supporting Syrians who needed medical care that was unavailable inside Syria; we set up projects to assist refugees who had started to flee the violence in their country.
Delivering medical supplies
MSF provides stocks of emergency medical supplies to health centres near Lebanon’s border with Syria.
War-wounded reach Jordan
Initially opened in 2006 to treat war-wounded from Iraq, MSF’s reconstructive surgery hospital in Amman, Jordan, receives its first wounded patients from across the border in Syria.
Syrian refugees in Lebanon
MSF provides medical care to Syrian refugees in three locations in Lebanon: Tripoli, Wadi Khaled and the Bekaa Valley.
2012: A full-fledged war
In 2012, the conflict escalated, with the formation and participation of different parties to the conflict. Despite various attempts to arrange a ceasefire, the conflict soon evolved into a full-fledged war, and the number of deaths and injuries increased drastically across the country.
MSF opened hospitals across northern Syria to respond to people’s increasing medical needs in these areas. Most had to be set up in unconventional places, including villas, chicken farms, schools and basements, after a number of medical facilities were hit and destroyed. In these hospitals, our teams provided emergency medical treatment with a major focus on trauma care and war-related surgeries.
As numbers of Syrian refugees increased in neighbouring countries, MSF expanded its activities in places such as Lebanon’s Bekaa Valley and camps set up in Domiz, Iraqi Kurdistan. Increasing numbers of Syrian refugees were also seeking refuge further afield, moving away from the Middle East and towards Europe.
Syrian refugees in Iraq
MSF starts working in Domiz refugee camp, Iraq, becoming the main provider of healthcare for Syrian refugees sheltering there.
Trauma surgery in north Syria
Over six days, MSF sets up our first field hospital in Syria, focusing on emergency trauma surgery, in a villa donated by a local doctor in the town of Atmeh, northwest Syria. The hospital is later turned into a burns unit and is still providing services to date.
Medical care on the frontlines
MSF sets up a hospital in a former school in Azaz, 30 kilometres north of Aleppo, to provide medical care for people fleeing the frontlines for the Aleppo area. MSF teams continue working there until 2020, when the hospital is handed over to local health authorities.
Cave transforms into hospital
Close to Syria’s border with Turkey, MSF sets up a hospital inside a cave previously used for storing fruit, vegetables and fuel. Despite major logistical and medical challenges, the MSF team creates a sterile surgical unit suitable for providing emergency care and trauma surgery.
Field hospitals in unlikely places
As frontlines shift in northwest Syria, MSF converts a disused chicken farm into a field hospital, providing emergency trauma surgery as well as primary and secondary medical care.
2013: Syrians’ needs increase
By 2013, Syrians were not only exposed to high levels of violence, but also to the direct consequences of a dysfunctional and deteriorating health system. MSF teams started to witness the resurgence of preventable diseases. Cases of measles among children in Aleppo, and the discovery of the first case of polio in Syria in 14 years, were early indications of a health system breakdown in the country as a result of the war, which led to mass vaccination campaigns by MSF in northeast Syria.
Medical organisations in the country also started to voice more strongly their difficulties in meeting people’s needs, let alone dealing with mass casualties and acute emergencies. Due to the intensity of fighting in southern Syria, we opened an emergency surgical programme in Ramtha, northern Jordan, near the Syrian border, to treat war-wounded people unable to receive treatment in the 14 field hospitals in Dara’a.
Meanwhile, hundreds of thousands of Syrians were still leaving Syria to seek safety or medical treatment in nearby countries. These nations, experiencing a continuous influx of refugees, started adopting more restrictive border policies. In response, we further expanded the volume of our operations in the region to provide as much assistance as possible to the Syrian people. By the end of 2013, an estimated 1.5 million Syrians were refugees.
Interrupted vaccination campaign
MSF teams launch a measles vaccination campaign at 49 sites in Aleppo but struggle to complete the campaign due to widespread violence.
Increased response in neighbouring countries
Increased response in neighbouring countries: MSF ramps up our medical activities in Lebanon’s Bekaa Valley and starts working in Shatila refugee camp in south Beirut. In Iraq, MSF increases our activities in Domiz refugee camp and sets up new health posts on both sides of the Syrian-Iraqi border.
Patients displaying neurotoxic symptoms
Medical teams in three MSF-supported hospitals in Damascus province admit 3,600 patients displaying neurotoxic symptoms in less than three hours. The use of neurotoxic agents constitutes a violation of international humanitarian law, which absolutely prohibits the use of chemical and biological weapons.
Increased surgical activities in Jordan
MSF opens an emergency surgical programme in the Jordanian town of Ramtha, close to the Syrian border, where we treat hundreds of war-wounded patients from southern Syria.
Medical care to Syrians fleeing violence
In northeast Syria, near the border with Turkey, MSF sets up projects in Kobanê/Ain Al-Arab and Tal Abyad to provide medical services to people fleeing to these areas.
2014: Deadly clashes intensify
In 2014, the war grew increasingly bloody. The UN estimated that 6.5 million people had been internally displaced, while more than three million had fled Syria.
Violence and insecurity, the tightening of sieges and increased shelling, and attacks on health facilities and medical workers, were some of the challenges faced by MSF teams, which prevented them from providing a more extensive programme of medical humanitarian aid.
The abduction of MSF staff in 2014 also led us to stop our activities in areas controlled by the Islamic State (IS) group and to withdraw international staff in northwest Syria. Yet, we still managed to maintain our presence in Syria, opening new projects and increasing our remote support to medical facilities within the country.
Nowhere to go
Hundreds of casualties are reported in the town of Erbin in east Ghouta, a suburb of Damascus, following the bombing of a crowded market. Some 50,000 people have been under siege in east Ghouta for more than two years.
2015: Huge displacement crisis
In 2015, the number of Syrian refugees who had fled the country crossed the four million mark, with thousands attempting dangerous crossings of the Mediterranean Sea, while another six million people were internally displaced within Syria. The conflict had caused the biggest displacement crisis since the Second World War, leaving millions in desperate need of lifesaving humanitarian aid. We increased our activities across the region in response, launching search and rescue operations in the Mediterranean Sea, and supporting people along their journeys to Europe.
With more foreign countries and parties entering the war, 2015 was characterised by extreme violence, affecting the lives of millions of people. Civilian areas were routinely bombed, often in ‘double-tap’ attacks, in which the initial strike is followed by a second strike, targeting rescue teams or the health facility receiving the wounded. There were also numerous reports of attacks resulting in symptoms of exposure to chemical agents. At least 1.5 million people were trapped in besieged areas without access to humanitarian aid, healthcare or medical evacuation.
Within Syria, 2015 marked the year in which MSF supported the highest number of health facilities to date, reaching more than 150 health facilities. However, our support did not prevent these facilities from being directly impacted by the conflict. In 2015, 23 MSF-supported Syrian health staff were killed and 58 were wounded. Furthermore, 63 MSF-supported hospitals and clinics were bombed or shelled on 94 separate occasions in 2015, and 12 of these facilities were completely destroyed.
We gained access to the heavily destroyed city of Kobanê/Ain Al-Arab, after the IS group was forced out by Kurdish forces with the support of coalition forces. We built a hospital in the city, only for it to be destroyed following another intense period of conflict after Kobanê was infiltrated by fighters from the Islamic State group. Despite this, MSF continued to support primary and secondary healthcare in the city.
Returnees lacking access to healthcare
Returnees lacking access to healthcare: After IS left Kobanê, hundreds of people returned there with little to no healthcare services in the area. MSF supported the authorities in rebuilding Kobanê’s health system to increase access to healthcare in the city.
Violence reaches hospitals, yet again
MSF’s supported hospital in Kobanê was destroyed during the conflict between the IS group and the coalition forces, during the IS group’s offensive on the city.
Clashes send more war-wounded to Jordan
More than 65 war-wounded patients – most of them injured by barrel bombs – arrive at the emergency room of Ramtha hospital in northern Jordan in the space of two weeks.
Double-tap attacks target hospitals
Seven people are killed and 47 are injured in a ‘double-tap’ barrel bombing of an MSF-supported hospital in a besieged area of the city of Homs.
2016: A trapped population
In 2016, siege tactics continued, double-tap attacks increased, and intensified bombing and shelling led to the humanitarian crisis inside the country becoming even more dire. By then, many civilian areas had been routinely bombed and deprived of aid. Accessing food and health services were extremely difficult for many people, especially those living in places under siege.
In December, the Syrian government re-took east Aleppo, but not until its residents had lived through the fiercest bombardment of the five-year war. East Aleppo became the epitome of the Syrian conflict, with every atrocity committed in one place: siege warfare; the destruction of multiple hospitals; indiscriminate bombing of civilian areas; and a total disregard for the rules of war. MSF was fully or partially supporting eight hospitals in east Aleppo – all of them were hit by bombs.
Medical facilities, staff and patients continued to be victims of indiscriminate and targeted attacks. In 2016, 32 medical facilities receiving our support were bombed or shelled on 71 separate occasions.
Meanwhile, more of Syria’s neighbouring countries had closed their borders to refugees, leaving many people trapped in areas under siege or stranded at the closed borders. This stranding of people occurred at the Jordanian border, blocking access to lifesaving activities for the war-wounded.
Siege, starvation, and malnutrition
MSF-supported medics in the town of Madaya, where 20,000 people are under siege by Syrian government forces, identify 250 people with severe acute malnutrition, including 10 people in immediate need of lifesaving care.
MSF-supported hospital attacked twice
An MSF-supported hospital in Ma’arat Al-Numan in Idlib province is hit four times in two attacks within a few minutes of each other. Twenty-five people are killed and 11 are wounded including hospital staff, patients, caretakers and visitors.
Airstrike on MSF-supported hospital kills many
At least 55 people, including patients and medical staff, are killed when airstrikes hit the MSF-supported Al-Quds hospital and surrounding area in east Aleppo. The airstrikes initially hit buildings around the hospital, and then the hospital itself as the wounded are transferred there.
Border closures trap thousands in the desert
Some 60,000 people are stuck in extremely harsh conditions close to Jordan’s northeast border, which was closed following a suicide attack that killed seven Jordanian soldiers. In the wake of the attack, MSF was forced to suspend our mobile clinic for Syrians gathered at the Berm – an isolated and inhospitable border area of desert between Jordan and Syria where thousands of Syrians fleeing the conflict were trapped.
2017: A race for territory
A race to secure territory and control emerged as the main geopolitical change of the year. After a major military offensive on Raqqa, the IS group lost control over large areas of territory in the northeast to US-backed Syrian Democratic Forces. MSF treated hundreds of war-wounded people as a result of the intense bombing offensive in Raqqa, as well as those severely injured by booby traps and unexploded ordinances left behind in people’s destroyed homes.
Meanwhile, in the south of the country, the Syrian government began retaking territories in the provinces of Dara’a, Quneitra and Suwayda. These events had major consequences on the lives of hundreds of thousands of people living in these areas due to the heavy shelling.
These changes in dynamics and the balance of power disrupted our activities in some of the areas where we worked. A total of 11 medical facilities that we supported were hit by bombs or shells on 12 occasions in targeted or indiscriminate attacks.
Clashes force Syrians from their homes
Fighting intensifies in southern Syria as opposing forces vie for control of the city of Dara’a. After some 30,000 people flee Dara’a, MSF organises an emergency distribution of essential relief items to the displaced families.
Fighting threatens provision of medical care
During intense fighting in east Ghouta, we are forced to temporarily suspend our medical support to hospitals in the area after armed opposition groups enter the hospitals and obstruct the provision of medical care.
Assisting displaced Syrians
In Raqqa province, MSF teams set up clinics in camps for displaced people and start working in a number of hospitals in the area, including in Manbij, Tal Abyad and Kobanê/Ain Al-Arab, to provide emergency medical care to people fleeing the city of Raqqa.
Increased response to the displaced
Ain Issa camp, north of Raqqa, becomes an official transit camp for displaced people. As arrivals to the camp increase, MSF teams distribute relief items including mattresses, blankets and hygiene kits; set up water and sanitation services; respond to an outbreak of measles; and vaccinate children against common childhood diseases.
Limited options for healthcare
After active fighting subsides in Raqqa, MSF becomes one of the only organisations to provide medical assistance in the city itself, running a primary healthcare unit and a stabilisation point.
2018: Waves of displacement
With intense fighting to gain control over disputed regions, and with the military advances of Syrian government forces, new waves of displaced people began arriving in northwest Syria. These followed surrender terms imposed by the government granting safe passage for fighters and civilians who wanted to be transported to other non-government-controlled areas of the country, most often to Idlib province. Meanwhile in the northeast, people were coming back to ruined towns and cities full of booby traps and landmines.
Between February and April, east Ghouta, in the suburbs of Damascus, witnessed one of the heaviest bombardments since the beginning of the war. Many health facilities were hit and around 2,000 people were killed during the offensive, which ended with the Syrian government taking control of the suburb.
In many places, such as Dara’a, east Ghouta, Hama and Homs, MSF was unable to continue our work and support to medical facilities after these areas were retaken by the Syrian government. At this time, we increased our medical support in the north of the country.
MSF runs out of options
During a government military offensive on besieged east Ghouta, 13 hospitals and clinics supported by MSF are hit and damaged or destroyed in the course of three days, reducing health capacity at a time of critical medical need. As the offensive continues, we lose our ability to support any medical facilities there.
Remnants of war awaiting returnees
As relative calm returns to Hassakeh and Raqqa provinces, people previously displaced by heavy fighting begin returning home, to areas littered with landmines and unexploded remnants of war, and where the health infrastructure has been largely destroyed. MSF teams in Hassakeh and Raqqa treat hundreds of patients wounded by landmines, booby traps and explosive ordnance.
Reviving healthcare in destroyed towns
MSF started rehabilitating parts of Raqqa national hospital, continued to support the paediatric, maternity and surgical wards of Tal Abyad hospital to the north, and supported or administered vaccination campaigns across the Raqqa governorate.
End of activities in central Syria
MSF is forced to end our support to medical facilities in the Homs and Hama regions after they are retaken by Syrian government forces.
End of activities in southwest Syria
MSF is forced to end our support to eight health facilities in the Dara’a and Quneitra regions after government forces retake the areas. MSF teams had provided medical, technical and logistical support to improve access to healthcare for displaced people and local communities.
2019: Military operations in the north
In 2019, the conflict continued, mainly affecting the north of Syria.
In northwest Syria, hundreds of thousands of people were displaced as a consequence of an offensive launched by Syrian government forces and their allies, notably Russia, in Idlib province, the country’s last opposition stronghold. Most newly displaced people headed for areas where no clean water or medical care was available. They had few options, as most areas that were considered relatively safe were already overcrowded and overstretched in terms of humanitarian assistance.
In northeast Syria, MSF scaled up activities as a rapid influx of more than 60,000 displaced people arrived at Al-Hol camp, most of them from the IS group’s last strongholds of Deir ez-Zor governorate. Later that year, the Turkish military, alongside allied Syrian armed opposition groups, launched the ‘Peace Spring’ operation, aimed at clearing the Kurdish People’s Protection Units from a strip of land 30 kilometres long and 440 kilometres wide along the Turkish border.
On top of continuous conflict and displacement, by 2019, Syria was going through its worst economic crisis in years and the Syrian pound reached an all-time low on the black market, making people’s lives even more difficult.
Responding to lack of healthcare
MSF launches a response in Al-Hol camp, initially providing emergency medical care for new arrivals and distributing essential relief items. We soon expand this support to include emergency triage and the construction of water and sanitation facilities.
Responding to the growing needs
Following the launch of Turkish military operations in northern Syria, residents flee towns and villages along the border to escape the heavy shelling. MSF teams try to meet their growing needs for medical care and humanitarian assistance.
Violence forces MSF’s hand
MSF takes the difficult decision to temporarily suspend most of our activities in northeast Syria and evacuate all our international staff from our projects in the region, after the situation becomes increasingly volatile following Turkish military operations. This is despite the fact that the needs of people in the region are still huge.
Syrian refugees in Iraq
As people continue to flee the conflict in northeast Syria, MSF launches medical activities at a site receiving refugees in Iraq close to the border with Syria.
Living conditions in camps worsen
As the Syrian government offensive on Idlib province intensifies, and in response to the growing number of displaced people in the area, MSF increases our activities in the camps, distributing relief items, improving water and sanitation, donating emergency medical supplies, and scaling up its mobile clinics.
2020: Military offensive, economic crisis and global pandemic
2020 started with the continuation of a huge military offensive in northwest Syria, resulting in the displacement of around one million people. Many of them were already displaced within the area and had fled the conflict multiple times in previous months or years.
The COVID-19 pandemic further worsened the already precarious health situation in Syria. Four months after the pandemic was officially declared, the disease made its way into Idlib, with a first case confirmed on 9 July. The first COVID-19 cases were among the medical community and this became a growing concern over the following months. Even prior to the outbreak, human resources were very limited in the health sector, hospitals in the region often having to share medical staff in order to remain open. In that sense, even just a few doctors infected by the virus and temporarily being put out of work could make a huge difference to access to healthcare.
Meanwhile the economic crisis continued, and the record-breaking depreciation of the Syrian pound became a reality for people in Syria, translating into an inability to access basic necessities such as housing, food and healthcare. Refugees in some neighbouring countries were also touched by economic crises in the host countries, such as in Lebanon.
After nine years of war, the Syrian healthcare system was broken, with limited supplies, few medical staff and health facilities that were often closed or no longer functioning.
Thousands displaced at once
In the space of two months (December 2019 and January 2020), nearly 390,000 people flee camps and homes in Idlib to escape daily shelling, aerial bombing and ground offensives.
Civilians bear the brunt
MSF-supported hospitals near the frontlines in Idlib province receive 185 wounded and 18 patients who are dead on arrival as a result of indiscriminate attacks by the Syrian government and its allies on civilian areas.
Harsh winters in harsh settings
MSF distributes more than 300 tons of supplies to help more than 22,000 people keep warm and heat their tents in 21 camps and settlements hosting families displaced by the conflict.
The COVID-19 pandemic looms
As the first death from COVID-19 is reported in northeast Syria, MSF is increasingly concerned that the region is woefully ill-prepared to deal with a pandemic. MSF works with local health authorities and other organisations to prepare for an increase in COVID-19 patients.
COVID-19 threatens the crumbled health system
As numbers of patients with COVID-19 grow in northeast Syria, the pandemic is having a knock-on effect on other health services in a region where some 700,000 people are displaced from their homes. Across the region and in Al-Hol camp, more than 65,000 people, mostly women and children, have been held for nearly two years, since Syrian Democratic Forces took control of the last remaining territory in Syria from the Islamic State group.
COVID-19 hits an open-air prison
Northwest Syria sees a sharp increase in the number of patients with COVID-19, making an already dire situation even more challenging.
March 2021: The current situation
A decade later, the conflict in Syria is not over and people continue to suffer. The war’s effects continue to have a disastrous impact on Syrians across the world. Currently, almost 12 million Syrians - half the pre-war population - are displaced inside and outside Syria.
Some 5.6 million refugees are scattered throughout the world, the majority in Turkey, Lebanon, Jordan, Iraq and Egypt. Around 6.2 million people are internally displaced – the largest number worldwide – most of them living in precarious conditions.
A record 12.4 million Syrians - nearly 60 per cent of the population - are now food insecure, according to alarming national data from the UN World Food Programme (WFP).
In just over one year, an additional 4.5 million Syrians have become food insecure. An economic crisis, job losses as a result of COVID19, and soaring food prices have added to the plight of Syrians who have been displaced and worn down by a decade of conflict.