In 2022, we ran programmes in northwest and northeast Syria, where access and the security situation permitted. Our teams provided a wide range of medical services, including trauma and wound care, maternal and child health, treatment for chronic diseases and sexual violence, mental health support and protection-related activities, through both fixed and mobile facilities.   

In July, the last remaining humanitarian border crossing point into Syria, Bab Al-Hawa, came under threat of closure after the renewal of its continuing operation was vetoed at the UN Security Council. Authorisation was eventually renewed for six months only, demonstrating the fragility of humanitarian access into Syria, which is still dependent on political decisions, and not solely on the humanitarian needs of the millions of people displaced in the region.  

In September, sewage contamination in the Euphrates River and a severe water shortage were contributing factors to the first cholera outbreak in the country in 15 years, which was declared in Aleppo governorate and rapidly spread to other parts of northern Syria. 

Northwest Syria   

At the end of 2022, there were around 4.4 million people residing in northwest Syria, with roughly 2.8 million being internally displaced. Their already precarious living conditions continue to deteriorate due to the ongoing conflict, the worsening economic situation and rising prices. As a result, they are losing hope for the future, which is in turn taking a toll on their mental health. Humanitarian needs therefore remain extremely high, especially regarding medical care, water and sanitation, food and shelter, yet aid to the area has decreased.  

This situation has been compounded by the additional barriers of active frontlines, restrictions on access and supply flow issues, which affect MSF’s ability to respond. For this reason, we have developed a network of partners with whom we work to deliver care where it is most needed. 

To address the medical needs in Idlib and Aleppo governorates, where the healthcare system remains fragile, MSF co-manages and offers technical support to seven hospitals. In addition, we run the only specialised burns facility in the area. We also operate mobile clinics and support general healthcare centres to provide care to people living in camps.   

Our services include surgery, wound care and treatment for burns, obstetric and paediatric healthcare, treatment for infections and chronic diseases, as well as skin conditions related to poor living conditions, such as scabies and leishmaniasis, mental health support, health promotion and routine vaccinations.   

In displacement camps, our teams worked to improve water supply and sanitation facilities by building latrine blocks and distributing commodes for people with disabilities. We also provided hygiene kits and relief items, such as blankets and heating materials, to help residents cope with the cold winter weather. We additionally run community-based surveillance in the camps, to facilitate early detection of medical and humanitarian needs.  

Following the declaration of the cholera outbreak in September, our teams set up and managed cholera treatment centres and rehydration points, and organised patient referrals. We also improved water and sanitation facilities, mainly in displacement camps, and conducted individual and group health promotion sessions.   

Northeast Syria   

Likewise in the northeast of the country, MSF is responding to the immense humanitarian needs caused by conflict and the economic crisis, assisting both displaced people and host communities who have very limited access to basic services.   

Throughout the year, we supported a large basic healthcare centre in Raqqa governorate, offering emergency care, outpatient consultations, and treatment for non-communicable diseases (NCDs). We responded to a rise in the number of malnourished children by setting up an inpatient therapeutic feeding centre in Raqqa, alongside our outpatient centre. We also supported the local health authorities to administer routine vaccinations to women and children in 12 locations in Kobanê/Ain Al-Arab. In 2022, we handed over the vaccination programme to the local authorities, but we continued our donations during the year.   

In Tal Abyad and Ras Al-Ain, we collaborated with local organisations to re-establish routine immunisation services and conducted a measles, polio and pentavalent vaccination campaign. In addition, we provided treatment for leishmaniasis, technical training, and donations of medical supplies to health facilities. 

In the southern and northern neighbourhoods of Hassakeh city, we supported two clinics with treatment for NCDs. In Al-Hol camp, in Hassakeh, over 53,000 detained people – the majority of them children – continue to languish in unsafe and unsanitary conditions. There were numerous violent incidents in the camp in 2022, resulting in the deaths of several residents, as well as repeated interruptions to the provision of humanitarian assistance. 

In Al-Hol, MSF offers basic healthcare, treatment for NCDs, and mental health support. Despite our efforts to improve water and sanitation services in the camp, there is still a lack of adequate facilities. Water quality and supply remain an issue in northeast Syria. Since the summer, in mid-2022, there have been prolonged disruptions at Alouk water station, leaving it essentially non-operational for up to a million people in Hassakeh governorate. Our teams are monitoring the situation and will intervene where possible. 

During the year, we responded to several outbreaks of diseases, including COVID-19, meningitis and severe acute respiratory infections. When a cholera outbreak was declared in Raqqa and Deir ez-Zor governorates, we launched a response in partnership with the local health authorities, opening a treatment centre in Raqqa and oral rehydration points in Hassakeh, providing treatment for patients with suspected cholera and dehydration, and referring patients with severe dehydration to other facilities. In addition, we sent extra staff to the area, including community health workers, and worked with other local organisations to improve water and sanitation, by chlorinating water trucks, ensuring the quality of water supply, and supporting water treatment stations with chlorination processes.