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.
Our teams are currently responding to the coronavirus COVID-19 pandemic in the country.
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.
Our activities in 2020 in Syria
Data and information from the International Activity Report 2020.
MSF continues to operate in Syria but our activities are limited by insecurity and access constraints. In areas where access could be negotiated, our teams ran or supported hospitals and health centres, and provided healthcare in displacement camps. Where no direct presence was possible, we maintained our distance support, comprising donations of medicines, medical equipment and relief items; remote training of medical staff; technical medical advice; and financial assistance to cover health facilities’ running costs.
The huge military offensive in northwest Syria, led by the Syrian government and its allies, continued into 2020, resulting in the displacement of almost one million people, many of whom were already far from their homes, having fled the conflict multiple times. In response, our teams quickly scaled up distributions of essential items (such as soap, kitchen utensils, blankets and heating materials) and water supply in the camps where they had gathered.
On multiple occasions, medical teams at MSF-supported hospitals had to deal with mass casualty influxes, with 10 or more wounded people arriving at once. Some MSF-supported hospitals were damaged by bombing, while others had to reduce their services, for fear of being hit. Although the intensity of the fighting decreased after the signing of the latest ceasefire in March, more than half the people in the region remain displaced and live in precarious conditions.
The already enormous needs in northwest Syria were exacerbated by the COVID-19 pandemic. From its onset, our priority was to continue our regular activities, while ensuring the safety of our patients, staff and facilities. To assist the response, we donated protective personal equipment (PPE), set up triage systems in hospitals we support or co-manage, and ran isolation and treatment centres.
Prevention was another focus of activities, especially in camps for displaced people, where physical distancing is not an option and there is limited access to soap and water. We distributed hygiene kits and spread awareness messages about COVID-19, and, as winter approached, gave out kits containing warm clothes, tarpaulins, mattresses, heating materials, blankets and tents to thousands of displaced families. We also installed latrines and distributed drinkable water in the camps.
In addition to our COVID-19 activities, we maintained our support for basic and specialist healthcare in several hospitals and clinics across the northwest. We also boosted vaccination coverage by supporting programmes and conducting campaigns in and around the camps. In Idlib, we provided lifesaving medication and follow-up for almost 100 patients who had received kidney transplants, and continued to run a specialised burns unit in Atmeh.
The Turkish military intervention, alongside allied Syrian armed opposition groups, had a severe impact on the people of northeast Syria. Many were killed, wounded or displaced as a result of this escalation in violence, and MSF had to evacuate teams from several projects.
Many health facilities have ceased to function in the northeast, and those that remain open are unable to respond to all the needs. The closure of Al-Yarubiyah border crossing point (which was part of the UN cross-border aid mechanism for Syria) in July further compounded the dire healthcare situation, as it prevented vital assistance from reaching the country from Iraq.
More than 700,000 people are estimated to be internally displaced in northeast Syria. The majority of them are significantly dependent on humanitarian assistance and live in overcrowded and unsafe conditions, with poor access to water and sanitation, and low vaccination coverage.
At the beginning of 2020, we handed over activities at a general healthcare clinic we supported in Tel Kocher to the local health authorities. We continue to run an inpatient nutrition centre and a tent-based wound care programme in Al-Hol camp. According to the UN, the overcrowded camp now houses some 62,000 people. They are Syrians, Iraqis or third country nationals, and are contained in the camp by local security forces. Eighty per cent of them are women and children, and most were displaced from the Islamic State group's last stronghold in Deir ez-Zor governorate.
In July, we opened another clinic in the camp, providing general healthcare, including a stabilisation room for emergency cases. In addition, we conducted hygiene and health promotion activities and work to improve water and sanitation.
MSF also supports Raqqa national hospital and Mishlab health centre with medical supplies and salary incentives, and assists local health authorities with routine vaccinations across 12 locations in Kobanê/Ain Al-Arab. In the cold winter months, our teams distributed blankets, mattresses and floor mats to 2,300 internally displaced families.
Since the start of the COVID-19 pandemic, MSF has been part of the humanitarian taskforce, chaired by the local health authorities, in northeast Syria. We provided support to Hassakeh national hospital by introducing surveillance measures, improving the identification and management of patients with the virus, setting up patient flow, triage processes and infection prevention and control measures, and conducting training on how to use PPE.
We also established a 48-bed isolation ward inside the facility. Later in 2020, we handed over these activities to the local health authorities and started supporting another COVID-19 treatment centre in Washokani, outside Hassakeh town. Meanwhile, our teams identified and supported measures to protect 1,900 people in Al-Hol camp who were particularly vulnerable to COVID-19, such as patients with diabetes, hypertension, asthma or heart conditions.
During the year, in response to continuing issues with water supply in Hassakeh province, MSF trucked in water to Al-Hol and other camps for displaced people, as well as nine neighbourhoods in Hassakeh city.
At the end of the year, we continued to carry out assessments in the region, looking at the health and humanitarian needs of people living in remote, socially and economically excluded areas, informal settlements and camps.
*United Nations Office for the Coordination of Humanitarian Affairs - UNOCHA