The extreme violence perpetrated against civilians during six years of war in Syria shows no sign of abating.
Civilian areas have been routinely bombed and deprived of assistance. Access to food and healthcare remains extremely poor, especially in places under siege. Many hospitals are facing critical shortages of supplies and staff, as so many health workers have fled or been killed. Well over half of the Syrian population have been forced from their homes by the conflict. Many others remain trapped in areas that are under siege or stranded at the closed borders of neighbouring countries. Medical facilities, staff and patients have been victims of indiscriminate and targeted attacks. In 2016, 32 medical facilities receiving support from MSF were bombed or shelled on 71 separate occasions.
MSF’s direct presence is significantly constrained despite the immense needs. The Syrian government has not granted MSF authorisation to operate in the country, and insecurity has limited MSF’s ability to provide assistance in opposition-controlled areas.
MSF still directly operates four health facilities and three mobile clinics in Syria. It has partnerships with five facilities (one in Idlib, in the northwest and four in the northeast) and endeavours to provide the best possible support to 73 health facilities countrywide in areas where teams can’t be physically present.
Humanitarian aid in northern Syria is significantly inadequate. After six-and-a-half years of war, closed borders, and limited health services, the public health situation is precarious. Essential systems such as drinking water and waste systems are often disrupted. Most children aged five and below have never been vaccinated, and MSF is seeing many cases of preventable diseases in its clinics.
Mental health needs are significant. Many families have lost loved ones due to the war and insecurity prevails. Public hospitals are slowly starting up again but have been severely damaged by the war in many places.
Raqqa and northern Syria
Sick and injured civilians in besieged Raqqa city face major difficulties in obtaining urgent lifesaving medical care due to the ongoing battle to control the city that started in June 2017. According to the United Nations, almost 25,000 people are still trapped in Raqqa. MSF teams are seeing fewer than expected numbers of war-wounded in Kobanê/Ain al-Arab and Tal Abyad hospitals. The number of people arriving in Ain-Issa camp from the Raqqa area decreased in July and August.
Areas that come out of the frontlines are usually contaminated with mines, unexploded ordnance and booby traps, which are used by warring parties to deliberately target civilians returning to their homes after the end of the hostilities, or trying to flee home to safer areas. The US-led coalition and other warring parties are responsible for unexploded ordnance contamination due to airstrikes against the Islamic State (IS) group.
The impact on civilians has been devastating, killing and injuring returnees, the displaced and refugees, and hampering the resumption of essential services, including medical services.
Support to medical facilities
The 73 medical structures MSF supports are located across Syria, including in Aleppo, Idlib, Hama, Homs, Dara’a and Rural Damascus governorates. They range from small rural health posts to hospitals in urban areas.
MSF works in close collaboration with Syrian medical networks, and mostly runs its programmes from neighbouring countries. The programmes consist of: donations of essential drugs and medical and relief equipment and material; distance and face-to-face training; technical, medical and logistics/supply advice for medics and medical support teams inside Syria; support for ambulance services; and financial support to cover the facilities’ running costs.
Support is based on needs and the capacity of other organisations or agencies to assist these facilities or medical networks. The medical data reported from these facilities cannot be fully attributed to MSF as, although several facilities are 100 per cent MSF-supported, many have multiple sources of assistance.
MSF regularly supports around 30 health facilities in Idlib, Aleppo and Hama governorates and a further three facilities in the south of the country. Around 45 facilities in the besieged areas of northern Homs Governorate, East Ghouta and Rural Damascus governorate receive support.
In the first half of 2017, MSF-supported facilities provided more than 1.5 million outpatient consultations, more than 30,000 surgical operations and more than 150,000 emergency room consultations. More than 55,000 patients were admitted for treatment.
MSF’s support programme is heavily focused on besieged areas, where the medical situation is particularly dire. Many medical facilities have come under such consistent bombardment or shelling that their infrastructure has been catastrophically damaged. The services are usually moved to other buildings, or even basements, to provide some level of protection if they are bombed again.
Over the past five years, many medical staff have been killed or wounded, leaving a chronic shortage of well-trained medical personnel. The very few humanitarian convoys that have been allowed into some of these areas often have essential medical items removed, which further reduces the medical services that can be offered to these communities. And when patients are severely wounded or sick, medical authorisation for evacuations to properly equipped hospitals is often denied. The few medical evacuations that are permitted can take days or weeks to negotiate and organise. Even when the bombardments by the besieging forces are suspended, violence between opposition groups in the besieged area can wreak havoc on the population and on the health facilities.
International humanitarian law should be respected
MSF reiterates its call to all warring parties to allow the unhindered delivery of life-saving humanitarian aid – including impartial medical care – and enable the population to access the remaining functional health structures.
According to the World Health Organization, by December 2016, 46 per cent of Syrian hospitals were reported to be damaged. MSF-supported facilities have been bombed or shelled many times: 32 structures on 71 occasions in 2016, and 63 facilities during 94 attacks in 2015.
Warring parties and countries involved in the conflict should ensure the protection of civilians, including health workers and their patients. They must do more to make sure that international humanitarian law, and the United Nations Security Council resolutions they unanimously committed to, are upheld. Attacks on medical facilities must stop.
MSF specifically asks Syria’s neighbour countries to allow the cross-border evacuation of severely ill and wounded patients, and give a safe passage to people seeking refuge and protection.
Year MSF first worked in the country: 2009.
|Relief kits distributed||5,300|
|No. staff in 2016||455|
|Expenditure 2016||€39.4 million|
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