Civilian areas have been routinely bombed and deprived of assistance, and access to healthcare remains extremely poor in many areas. We operate in Syria where we can, but ongoing insecurity and access constraints – the Syrian government has not granted MSF authorisation to operate in the country – severely limit our activities and hamper our ability to provide humanitarian assistance that matches the scale of the needs.
In areas where access could be negotiated and where we have assurances about our staff safety, we run or support hospitals and health centres, and provide healthcare in displacement camps. In areas where no international presence is possible, we maintain a system of distance support, consisting of donations of medicines, medical equipment and relief items; remote training of medical staff; technical medical advice and financial assistance to cover facilities’ running costs.
MSF activities in Idlib, northwest Syria
The governorate of Idlib currently hosts hundreds of thousands displaced Syrians. Many are living in informal camps that lack almost all services and are seriously overcrowded. MSF’s mobile clinics visit some of these camps on a weekly basis, to provide essential medical services such as vaccinations and primary healthcare consultations. We also conduct water and sanitation activities to improve the living conditions in the camps, and organise distributions of essential relief items.
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.Learn more
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 remain internally displaced in Syria. 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 between 2015 and 2017, where men, women and children have starved to death. Basic essentials such as medical supplies have been restricted amid intense bombing and shelling. Even medical evacuations of sick children have often been 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.