With millions of people in need of assistance, MSF should be running some of the largest medical programmes in its 44-year history, but it is prevented from doing so.
Violence and insecurity, attacks on health facilities and medical workers, the absence of government authorisation and the reneging by armed groups on guarantees of safety for our teams have been some of the main obstacles to a more extensive programme of medical humanitarian aid.
The war entered its fourth year in 2014, and continued to be defined by brutal violence that does not distinguish between civilians and combatants. An estimated 200,000 people have been killed, and half the population is displaced either within Syria or in neighbouring countries. Entire communities are besieged and cut off from any outside assistance and people are trapped between the ever-shifting frontlines. Thousands of doctors, nurses, pharmacists and paramedics have been killed, kidnapped, or displaced by violence, leaving a massive gap in medical expertise and experience.
On 2 January 2014, ISIS (later renamed Islamic State; IS) abducted 13 MSF staff members. Among them were eight Syrian colleagues who were released after a few hours. The remaining five international staff members were held captive for up to five months. The abduction led to the withdrawal of MSF’s international teams and the closure of health facilities in IS-held areas. MSF closed its field hospital in the mountainous region of Jabal Al-Akrad, in the west of Syria’s Idlib governorate, as well as the two health centres it was running nearby.
MSF runs three health facilities within Aleppo governorate, which has seen some of the most intense fighting, and is one of the main corridors for Syrians attempting to flee the country. One of the hospitals has 28 beds, and offers emergency, maternity and outpatient care. Vaccinations, orthopaedic services and treatment for some chronic diseases are also provided. The team stabilises patients at this hospital before transferring them to other facilities when necessary. From this base, MSF donated drugs and medical supplies to 10 field hospitals, nine first-aid points and three health centres.
A second MSF hospital in the Aleppo area had to be closed in August for security reasons. It provided access to healthcare for adults and children, including surgery for war wounded, trauma cases and burns patients, as well as emergency services, maternity, ante-and postnatal care and outpatient consultations.
On the outskirts of Aleppo, a third MSF hospital has a capacity of 12 beds. At this location teams carried out some 22,000 outpatient consultations, more than 12,300 emergency room consultations, over 500 surgical interventions, and admitted 1,200 patients. Vaccinations, antenatal care and mental health support were available and the hospital has a referral system in place for people who need additional services.
There are extreme shortages due to the war, and the poor-quality fuel that families have to use for stoves and heaters frequently causes explosions, resulting in severe burns. In Idlib governorate MSF runs the only burns unit in northern Syria where people can get the specialist care they need, such as wound cleaning (debridement), dressing changes performed in the operating theatre under anaesthesia, skin grafts and physiotherapy. The 15-bed hospital has an emergency room, and a team offers psychological support to patients. More than 1,800 burns patients came to the facility in 2014 and over 5,800 patients were treated in the emergency room. The team performed more than 3,800 surgical interventions.
In response to reports of several measles cases in a community of some 100,000 internally displaced people along the border with Turkey, MSF conducted a vaccination campaign. More than 11,000 children were vaccinated against measles in camps and villages in August. MSF is continuing routine vaccinations for children under three years old. The absence of routine vaccination schedules as a result of the war has led to a rise in preventable childhood illnesses.
The health centres and hospitals that are still operational in Ar-Raqqah governorate are struggling to maintain supplies, staff numbers and to ensure drugs are stored at the correct temperatures. It is estimated that up to 40,000 people across the governorate have been forced to leave their homes, and this has put additional pressure on local communities who are sheltering them in their houses, in schools and in former health centres. MSF continued to run a basic healthcare clinic in the Tal Abyad referral hospital, and supported a paediatric ward in the facility. Mobile teams provided emergency assistance to the displaced in multiple locations, and also supported routine vaccination activities by health workers in the region. More than 5,200 outpatient consultations were conducted, and 7,000 children were vaccinated against measles before these activities were handed over to the Ministry of Health and the local authorities in May.
Al Hasakah governorate
In northeast Syria, acute shortages of drugs, medical supplies and skilled personnel are having a devastating impact on healthcare. MSF provided staff and supplies to support pre- and post-operative care in a hospital’s trauma ward. A team also assisted in the maternity ward, which MSF rehabilitated and furnished with new equipment. MSF started to run two clinics offering outpatient consultations and mother and child healthcare.
MSF has been running mobile clinics in the region bordering Iraq since 2013. Basic healthcare, with a focus on the health needs of mothers and children, is provided to displaced people and to the host communities on the Syrian side of the border. MSF also conducts routine polio vaccinations campaigns in the area – in October 2013, the first case of polio in Syria in 14 years was reported.
The border with Iraq, which had been closed since September 2013, reopened in one direction in June – allowing people to travel from Iraq to Syria. In August, tens of thousands of Iraqis crossed the border, fleeing violence in Iraq’s Ninewa governorate. MSF teams working on both sides of the border responded to the increase in needs by running mobile clinics and setting up health facilities in transit camps and in camps for displaced people.
Support programmes for Syrian doctors
Despite the increasing access restrictions, MSF doctor-to-doctor networks continued to provide clandestine support to medical facilities run by Syrian doctors in both government- and opposition-controlled areas. These support programmes allow dedicated Syrian medical staff to work, often in extremely hazardous conditions, and bring a minimum level of healthcare to people trapped by the conflict.
MSF has developed a programme of large-scale support to over 100 underground and improvised healthcare facilities at two locations along Syria’s borders and across six governorates, almost half of which are dedicated to besieged areas in the Damascus governorate. The facilities are in both government-held areas and opposition-controlled zones – all locations where it is not possible for MSF teams to be physically present. These programmes are increasingly focused on areas under siege, and supply essential drugs and medical items, distance training and technical support, as well as tailored support such as ambulances in some areas.