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Inspired by the Arab Spring demonstrations that swept through North Africa and the Middle East, similar anti-government protests started in southern Syria in March 2011. The government responded to the protests with force and the situation deteriorated rapidly. Over the four years since then, the conflict has grown more complex, entrenched and divisive and the situation for those people living in Syria is critical.

With multiple, shifting fronts, besieged populations cut off from essential aid and a myriad of armed groups, Syria was one of the most difficult countries in which Médecins Sans Frontières (MSF) tried to work in 2014. Several projects were forced to close and international staff were withdrawn, subsequently making it even more difficult for MSF to reach patients. Syria has recently been referred to as the world’s worst humanitarian crisis.


By the start of 2014, MSF had a significant and well-established presence in the north of the country in areas not controlled by the government. It had not been easy to set up these facilities, but by working with networks of dedicated Syrians, MSF was able to gradually expand its operations. With six MSF-run hospitals, six clinics, several mobile clinics and around 60 international staff members working alongside hundreds of Syrian colleagues, teams were able to treat a substantial number of patients in Idlib and Aleppo governorates.

All this changed in January, however, when 13 of MSF’s staff were abducted by the group who call themselves the Islamic State (IS). This occurred despite written and verbal security guarantees from local members. Eight Syrian staff were released shortly after being taken, but five international MSF colleagues were held for up to five months. This significantly altered the way MSF operated inside northern Syria and led to a considerable reduction in activities. Since security guarantees from high-level IS group leaders were not forthcoming, MSF made the difficult decision to stop all activities in IS-controlled areas, but continued to operate facilities in non-government areas outside the control of IS. MSF was unable to open any medical projects in areas under government control in 2014, but continued to operate three hospitals in the north, a specialist burns unit in Idlib and two other hospitals in Aleppo, all staffed by Syrian colleagues. In addition, MSF was able to run two facilities in the northeast of Syria.


Aleppo is Syria’s second-largest city but years of war have brought its health system to its knees, and thousands of medical workers have fled or been killed. Throughout 2014, the facilities in the city run by Syrian staff and managed at a distance by MSF international teams continued to provide a wide range of medical services to the trapped population amid a dramatically worsening humanitarian situation. These included treatment for the devastating injuries caused by barrel bombs: unguided high-explosive devices that are filled with scrap metal and then dropped from helicopters or airplanes. As the bombs cannot accurately target military installations, civilians often fall victim to them.

The appalling toll on health is not just a result of traumatic injuries caused by the fighting, however, but also of the lack of access to basic healthcare and treatment for chronic diseases such as diabetes. Women are forced to give birth in deplorable conditions, and many people are suffering the severe mental health repercussions of living in a conflict zone for years.

As elsewhere in the country though, the needs of the population greatly outstripped what was offered by MSF and other humanitarian organisations working in the area. And to make matters worse, in July, at least six hospitals in Aleppo – including one run by MSF – were bombed and either destroyed or damaged.


Since the beginning of the conflict, MSF has donated equipment to support medical networks which continue to operate in extremely difficult situations throughout Syria; this can be as simple as gauze for wounds, or as complex as full kits of drugs and materials for operating theatres, including devices needed for orthopaedic surgery.

Over time this support work has expanded and now provides supplies to more than 100 field hospitals, health posts and clinics – facilities that without MSF help would struggle to offer essential medical services.

The support provided by MSF is particularly valuable in areas that are besieged by government forces – places where, for up to two years, there has been a blockade on certain goods. Although clearly useful this support falls far short, however, of the needs that MSF knows exist.

Throughout 2014, MSF should have been running major projects in Syria, but with no security guarantees for staff and no access to areas controlled by the government, this simply was not possible. Increased and direct hands-on assistance will only be viable when the many armed groups, both government and opposition, show the political willingness to respect and allow independent medical humanitarian action. This willingness was not forthcoming in 2014, resulting in intolerable levels of suffering for the Syrian people.

For more on MSF’s work in Syria in 2014, click here.

Dr S – a young surgeon working in an MSF-supported hospital in the east of Damascus

Three years of non-stop surgery under tough circumstances – I have maxed out. I’ve had enough of scenes of misery. I was on the phone recently with my surgery professor and he said: “Regardless of the operating conditions, your work during these three years matches my whole 30 years’ experience as a doctor. You have reached retirement in just three years.” And indeed, every moment of every day I feel I have had enough, but we have no other choice. People here need us. They are in desperate need of all kinds of medical care, from the most simple to the most complicated. We cannot add another reason for the deterioration of this already disastrous situation. Today, I am almost certain that, when the war is over, I will quit medicine. Any human being would make that decision after living through what I have lived through. I look forward to the end of this war. It has to stop, one day. Then, I can choose what to do. Only then will we be truly alive again.