Since the 2011 protests in Syria, medics treating the wounded have been persecuted by the government and forced to develop underground networks. As the conflict escalated, so did the crackdown on medical assistance for people in opposition-held areas. Unable to obtain government authorisation to aid the sick and wounded, we started by supporting underground medical networks and entered northern Syria to provide medical care in an area largely cut-off from official assistance channels.

What used to be a fully functional health system has been devastated. Hundreds of medical facilities have been bombed, many medical staff have been killed or have fled, and supplies are lacking. We've seen the resurgence of preventable diseases, and inadequate services to meet common needs, let alone deal with mass casualties and acute emergencies. Syrian health staff have been forced to improvise operating theatres and work in deplorable conditions, overwhelmed by the emergencies they face.

The bulk of our activity in Syria focuses on the health needs of people with common illnesses, pregnant women, and improving vaccination coverage to prevent childhood diseases. We see many people with chronic diseases such as high blood pressure or diabetes, where lack of treatment can lead to serious complications. Mobile clinics have increasingly become a central part of our response, and mental health needs are also significant, as many families have lost loved ones and insecurity prevails.

Early on, the systematic bombing of civilian areas made it a priority to help treat the wounded. We opened surgical facilities in the north, provided supplies and training to health staff across the country, and set up cross-border trauma care in Jordan. As living conditions deteriorated in the north, producing more injuries from domestic accidents, we set up a surgical burns unit.

An estimated 6.2 million people remained internally displaced in Syria at the end of 2018. Closed borders, appalling living conditions and limited assistance have compounded their suffering. People fleeing violence live in camps, improvised shelters or with host families. Our main programmes are in the governorates of Aleppo, Idlib, Raqqa and Hassakeh. In addition to providing medical care, we carry out water and sanitation activities and distribute relief items, also in the south of Syria.

Siege warfare has been widely used in Syria, at its most extreme in the town of Madaya, where men, women and children have starved to death. Basic essentials such as medical supplies are restricted amid intense bombing and shelling. Even medical evacuations of sick children are often denied. Unable to enter these areas, we remotely supported medical facilities in besieged areas. One-by-one, the areas have been taken over by the military and there are now very few still under siege.