Syria: Latest MSF Updates
- Escalation of Conflict in Azaz District Could Have Dire Consequences
- Providing Aid to the Displaced Close to Front Lines
- Voice From The Field: "Tens Of Thousands" Newly Displaced In Syria
- MSF-Supported Hospital Hit by Airstrikes in Southern Syria
- Starvation Continues In Madaya
MSF and the Syrian Crisis
What was already a dismal situation for millions trapped by conflict in Syria at the beginning of 2015 deteriorated further throughout the year, pushing hundreds of thousands of people to make the hard decision to make a dangerous and sometimes deadly crossing into Europe.
The scale of death, injury, and displacement from the conflict that began following the Arab Spring protests of 2011 is unimaginable. The United Nations estimated in August 2015 that over 250,000 people had been killed, but other monitoring groups put the death toll much higher. An estimated four and a half million people have fled outside the country, with the vast majority fleeing to Lebanon, Turkey, Jordan, and Iraq. Hundreds of thousands of people are living in besieged areas inside the country, with extremely limited access to health care.
With massive unmet needs inside Syria, Doctors Without Borders/Médecins Sans Frontières (MSF) should be running some of the biggest operations in its history, but the scale of the violence and the fast moving nature of the conflict mean that MSF's work inside Syria is limited. Following the abduction and release of MSF staff in 2014, the extremely difficult decision was taken to close projects and stop support activities in areas controlled by the Islamic State (IS) group. MSF has sought high-level assurances from the leadership of the IS group that staff and patients will not be harmed, but these assurances have not been forthcoming, which means that large swathes of the country—and the people living there—are out of our reach. To date, MSF has also been unable to receive permission from the government of Syria to work in areas it controls, again meaning millions of people are out of reach of hands-on assistance from any external aid provider.
Despite these significant constraints, MSF continues to operate medical facilities inside Syria, as well as directly supporting more than 150 medical structures throughout the country.Throughout 2015, activities in neighboring countries have been scaled up and additional projects have been opened, but the needs remain enormous.
MSF in Syria
The impact of the conflict in Aleppo Governorate in the northwest of Syria is severe, and the situation has deteriorated significantly through 2015. The population in this northern governorate lives with indiscriminate violence as well as the deliberate targeting of what remains of the all-but-destroyed health system. Massive displacements affect large segments of the population and Aleppo is one of the main corridors for Syrians attempting to flee the war.
A 27-bed MSF hospital run by Syrian staff in the region offers a wide range of services including outpatient and inpatient consultations, emergency room, surgical care, and maternity. In addition the MSF team provides mental health care, and can refer patients to other structures if they cannot be treated in the MSF hospital.
January to August 2015 statistics for Aleppo Hospital
- 23,010 outpatient consultations
- 1,069 inpatient consultations
- 11,251 emergency room treatments
- 900 surgeries
Ayn Al Arab / Kobane canton
Inside this area in northern Syria MSF has worked alongside the Kobane Health Administration since March 2015 to re-establish basic health facilities; provide outpatient health services, with 11,800 consultations through September; re-establish vaccination services; and create psychological support programs. In August MSF supported the local health authorities in providing measles vaccinations and vitamin A for 5,776 children.
In this governorate, also in the northwest of Syria, MSF runs a 15-bed burn unit, staffed by Syrian nationals and supported by an international team in southern Turkey. The facility began as a trauma center, but as specific needs for specialized burn treatment were identified, it focused on this work. Burn patients needing skin grafts, frequent dressings, and/or physiotherapy are treated in this center, as are emergency cases in a small emergency room. In addition, MSF runs activities for people living in camps for Internally displaced people (IDPs) in the area, which host more than 100,000 people. Services offered to these IDPs include disease surveillance and routine vaccinations.
Hasakah, in northeast Syria, is home to a sizable share of Syria’s Kurdish minority, and for almost a year clashes between various armed groups have been on the rise. The border with Iraq has been closed since the end of September 2013, and since June 2014 it has been open only for Syrian returnees from Iraq.
In this governorate, MSF runs several medical centers that offer primary health care services with a particular focus on mother and child care, as well as chronic diseases. These services are offered to both IDPs and people from the host communities. Between January and June, MSF provided 18,618 consultations in the clinics it runs and in the maternity clinic supported by MSF there were 571 deliveries and 196 Caesarean sections performed in the same period. Mental health services are also offered here, and MSF has also distributed water, meals, hygiene kits, and blankets to people in camps who had been forced to flee violence.
Remote Support to Medical Facilities Nationwide
Since 2011, MSF has been supporting a growing number of medical structures in government-held and opposition-controlled areas throughout Syria, with a particular emphasis on structures in areas under siege. By October 2015 MSF was actively supporting more than 150 medical structures, which vary from small rural health posts to full hospitals in urban areas. The supported structures are throughout the country, including in Idlib, Aleppo, Homs, Hama, rural Damascus, and in Deraa in the south. Developed in close collaboration with Syrian medical networks and run from neighboring countries, the support projects run by MSF consist of donations of essential medical equipment and relief material, distance training for staff trapped inside Syria, as well as support for ambulance services.
MSF in Neighboring Countries
Turkey hosts more than a million refugees who fled the conflict in Syria. MSF was authorized in June 2015 to work with refugees from the Syrian crisis. In Kilis, a town on the southern border with Syria, the number of refugees (107,000) is higher than that of the host population (90,000). From January to August 2015, MSF provided counseling to 2,075 people and performed 22,860 outpatient department consultations. In Sanliurfa Province, MSF works in partnership with two Turkish NGOs to provide ongoing mental health services and responded to refugee influxes from Kobane and Tal Abyad with food and hygiene kit distributions, along with water and sanitation infrastructure in camps.
Jordan is host to around 629,000 registered refugees, and a roughly equal number are estimated to be living in the country unregistered. Access to free health care for refugees living outside the camps in Jordan stopped in October 2014, creating further difficulties for these people. To support the health burden created by these large numbers, MSF has established a number of health projects that provide surgery, work on non-communicable diseases, maternal and child health, and mental health.
In August 2015, the Reconstructive Surgery Project in Amman moved into a new renovated structure in the capital city. The move to the new hospital is intended to improve the quality of the medical services offered to patients in the structure. The project was established in 2006 to offer orthopedic, maxillofacial, and plastic surgery, as well as physiotherapy and psychosocial support to victims of violence in the region. As the conflict in neighboring Syria escalated, the number of Syrian patients increased to the point that more than 50 percent of the patients in the hospital are Syrian. Since it began nine years ago, the hospital has admitted more than 3,700 cases and conducted 8,238 surgeries.
"I see the MSF Reconstructive Surgery Project as a very unique project. Its mission goes beyond the physical care of war victims as it aims to improve the quality of their lives as much as possible. This project provides a comprehensive package of psychological care and rehabilitation, allowing the patients to reintegrate into their societies after their treatment. Moving into a new hospital is a significant step in the life of this project. It will facilitate MSF’s mission to improve the quality of the medical services, which we will provide to patients in the coming years. This new facility will also open new horizons, allowing us to add new surgical specialties, not to mention the possibility to develop a healthy work environment and improve our disinfection policies.”
—Dr. Rasheed Fakhri, Surgical Coordinator
For the last two years, the Emergency Surgical Program inside the Al Ramtha Government Hospital has been offering lifesaving trauma surgery for patients injured in the Syrian conflict. Just five kilometers from the Syrian border, the project has seen more than 1,850 Syrian war-wounded patients arrive in its two operating theaters. Around 75 percent of these patients were suffering from polytrauma resulting from blast injuries and more than 2,900 surgical interventions have been performed on the 864 patients admitted into to the surgical program run by MSF in the hospital. Around 90 percent of all war-wounded patients who come across the border from Syria into Jordan are initially seen in the MSF project in Al Ramtha.
As the trauma surgery project in Al Ramtha grew, MSF established a post-operative care facility in Zaatari refugee camp. The unit now has 40 beds and offers post-injury treatment as well as mental health activities and physical therapy sessions. Between January and September 2015, 133 patients received medical treatment at the facility and around 400 psychosocial support sessions were conducted.
Following assessments In 2013, MSF established a maternal and child health care project in this northern town, close to the border with Syria. The catchment area is home to tens of thousands of Syrian refugees living outside the refugee camps who have difficulty accessing the care they need. Needs for maternal and child care increased at the end of 2014, when Jordanian authorities announced that all Syrian refugees, whether registered or not, would have to pay for Ministry of Health services. In the first quarter of 2015, the project was upgraded to be able to manage complicated deliveries and provide Caesarean sections as well as an intensive care unit.
MSF also has two clinics in Irbid Governorate treating noncommunicable diseases with Syrian patients and vulnerable Jordanians. The first clinic, operated in partnership with the Jordanian Ministry of Health, opened in December 2014 and the second, run with the Arabian Medical Relief Society, a local NGO, opened in April 2015. The majority of patients in both clinics are treated for hypertension, diabetes, and asthma. By the end of September 2015, there were 2,893 patients under treatment in the two clinics.
The situation in Lebanon remains highly volatile. The refugee influx is putting considerable strain on public services and exacerbating tensions in the country. Since December 2014, measures put in place by the government—such as the limitation of entrance in Lebanon for refugees—have reduced the number of new refugees arriving in the country. As of May 6, 2015, the UNHCR suspended new registrations of refugees in Lebanon, in line with a request by the Lebanese government. Accordingly, individuals awaiting registration are no longer included in the official figures for refugees in Lebanon. Moreover, the costly measures put in place by the Lebanese government for the renewal of documents for refugees keep many Syrian refugees from renewing their documents. With such measures the number of non-documented refugees in Lebanon is only likely to increase.
Living conditions are precarious, with increasing numbers of refugees residing in unsuitable shelters. The main health concerns are access to primary and secondary health care, safe deliveries, and chronic disease medications.
From January to June 2015, MSF provided 126,048 primary health care consultations for Syrian refugees in Lebanon, compared to 194,427 for the whole of 2014 and 96,320 for the whole of 2013.
In the Bekaa Valley, where the majority of refugees have settled, MSF began primary health care provision in March 2012. This includes treatment of acute consultations, chronic diseases, and a comprehensive reproductive health package, through four clinics in Hermel, Arsal, Baalbek, and Majdal Anjar. Those services are provided for Syrian refugees irrespective of registration, as well as vulnerable Lebanese. In addition to the reproductive health package offered in the four clinics, mental health support as well as health promotion services are offered. MSF also runs weekly sessions specifically for girls and women, where they can see a female doctor and midwife, as well as women-only sessions where women-specific health issues are discussed.
Tripoli, North Lebanon, also hosts a large number of Syrian refugees. MSF has worked in Dar al-Zahraa Hospital since February 2012, providing basic health care, treatment for chronic diseases, and a comprehensive reproductive health package for Syrian refugees and vulnerable Lebanese.
MSF has also been working in Al-Zahraa dispensary in Jabal Mohsen District since November 2012 and Al-Dawa dispensary in Bab al-Tabbaneh District since April 2013, providing primary health care, including treatment for acute diseases and reproductive health. In Jabal Mohsen, MSF provides support for light surgery to stabilize patients while waiting for transfers to a hospital during outbreaks of violence.
In April 2015, MSF opened a new clinic in Abde, north of Tripoli. The clinic provides primary health care, including acute, non-communicable diseases, and sexual and reproductive health. It also offers mental health and health promotion activities, as well as vaccinations.
Since September 2013, MSF has been working in Beirut’s Shatila camp, where Palestinian refugees have gathered, focusing on primary health care, chronic diseases, and mental health services. The team has also set up a system for supporting patients with emergency surgical needs, referring them to two hospitals with which MSF has agreements. The project is intended primarily for Syrian refugees, but is open to Palestinians who have fled from Syria and other residents of the camp. The focus is on unregistered refugees who are not eligible for official assistance, or for registered refugees with emergency surgical needs that fall outside the UNHCR’s shortlist of eligible injuries. Recently, the clinic has been expanded to meet the ever-growing needs on the ground. Furthermore, a women’s health center was established in January 2015, providing various maternity care services for vulnerable women in Lebanon. The center performs more than 100 deliveries per month. In total, more than 4,000 patients are seen monthly.
In Southern Lebanon, MSF is running mobile clinics that provide primary health care, care for pregnant women, and chronic disease and mental health support for refugees in three locations (Chebaa, Marjayoun, and Klayaa). The medical services are provided for Syrian refugees and Lebanese communities in the area.
Palestinian Refugees from Syria
Before the March 2011 uprising began, Syria was home to approximately 500,000 Palestinian refugees, some of whom were born and raised in the country. Palestinian refugee camps inside Syria, including in Aleppo, Daraa, and the Yarmouk camp in south Damascus, have come under attack and siege, resulting in numerous civilian fatalities and injuries. By April 2014 over 3,070 Palestinians from Syria had registered in Lebanon with UNRWA and 13,836 had sought support from UNRWA in Jordan.
In Lebanon, MSF has provided mental health services for Palestinian refugees and vulnerable populations residing in Ein-al-Helweh camp, near Saida, and surrounding areas since April 2011. In June 2015, the project was handed over to UNRWA.
Since June 2013, primary health care consultations were also provided at Human Call Hospital in Ein-al-Helweh camp for Syrian refugees and Palestinian refugees from Syria and Palestinians already living in the camp.
MSF also foresees further expansion to the Burj al-Barajneh refugee camp.
The Kurdish Region (KRG) of Iraq has been hosting the vast majority of the 251,499 Syrian refugees currently in Iraq (UNHCR, July 2015), but with the current turmoil in Iraq, the burden on KRG is increasingly high. In light of the overwhelming crisis affecting Iraq today, some international humanitarian organizations are scaling down their assistance to Syrian refugees in the country.
Over the past year, the spread of violence across Iraq has led some Syrian refugees to return to Syria, while tens of thousands Iraqis crossed into Syria in August 2014 before entering back into safer areas in Iraq.
Since May 2012, MSF has been the main organization providing health services to Syrian refugees in Domiz refugee camp, including primary health care, sexual and reproductive health care, care for chronic diseases, and mental health assistance. MSF also offers emergency services and referrals to Dohuk hospital. Initially set up for 27,000 people, the camp currently houses approximately 41,000 Syrian refugees (UNHCR, June 2015). From January to June 2015, MSF medical teams carried out 63,314 consultations, including primary health care and maternal health care. On August 4, 2014, MSF opened a maternity unit and oversaw the delivery of the first child there. Since the opening of the facility a year ago there have been on average 100 deliveries per month. From January to June 2015 there were 660 deliveries in the MSF maternity facility.
MSF provides mental health services in two refugee camps in Erbil governorate: Kawargosk camp and Darashakran camp.
Syrians Fleeing to Europe
The ongoing conflict has left hundreds of thousands of Syrians prepared to risk their lives to seek refuge in Europe. Initially, the main routes were through Egypt, Libya, and Turkey, and finally by boat to Greece and Italy. Now, new overland routes have also opened. Many of the people making these dangerous journeys are Syrian, and the welcome they find in Europe can be bitterly hostile.
MSF's Work in the Mediterranean
In 2015, MSF operated three search-and-rescue ships in the Mediterranean:
Bourbon Argos: From May 9 to December 30, 2015, the Bourbon Argos rescued thousands of people in distress. As winter conditions have reduced the number of people crossing the central Mediterranean, MSF has gauged that there are currently enough assets to deal with existing needs during the winter season.
Dignity I: Launched on June 13, 2015, Dignity I had a crew of 18 people, which included medical staff. The 50 meter-long vessel had the capacity to carry 300 people to land.
MY Phoenix: From May 2 to September 23, 2015, MSF had a team of six people providing post-rescue care on board the Phoenix, a search and rescue vessel run by MOAS (Migrant Offshore Aid Station) and funded 50 percent by MSF. The medical care provided ranged from primary care to resuscitation and advanced life support. MSF is no longer working on the MY Phoenix. On September 22, MOAS informed MSF that they would cease operations in the Mediterranean Sea. As a result, MSF is no longer in partnership with MOAS.
In 2015 MSF teams on board three ships patrolling the Mediterranean Sea assisted over 23,000 people in distress either through direct rescues (20,129) or by transfer from or to other vessels, and took part in 120 separate rescue interventions, disembarking safely in Italy more than 80 times. Data from theBourbon Argos show that 4,424 rescued people were in need of medical care, 355 were suffering from a serious health condition and 140 were pregnant women.
MSF has been working with fishermen in Zarzis, Tunisia, to offer training in search and rescue.
MSF is working in the first reception center in Pozzallo (Ragusa Province, Sicily) in collaboration with the Ministry of Health to provide medical services to migrants, asylum-seekers, and refugees from the time they arrive and during their stay in the center. MSF also provides mental health care support to people living in reception centers in Ragusa province.
MSF is providing medical care and distributing relief items to migrants arriving in the Dodecanese islands as well as on Lesbos and at the Idomeni border crossing to Macedonia.
Since the beginning of this year, MSF teams in Greece have witnessed a marked increase of arrivals in the Greek islands. The vast majority of the people arriving in Greece come from Syria, Afghanistan, and Iraq.
MSF is providing medical consultations and mental health support and distributing relief items on Lesbos. MSF also works on improving water and sanitation in the Kara Tepe and Moria camps and ensures cleaning services. MSF is also offering transportation via buses to new arrivals so they do not need to walk the seven kilometer distance from arrival points on the north coast to the registration center in Mitilini.
In Idomeni, close to the border with FYROM (Former Yugoslav Republic of Macedonia), MSF is running mobile clinics and distributing relief items for those who first arrive in Greece to continue crossing the Balkans to go to northern Europe.
In Athens, in October 2014 MSF launched a project offering medical rehabilitation to asylum-seekers and migrants who have been victims of torture, in collaboration with two Greek organizations (the Greek Council for Refugees and Syneirmos/Babel). So far, the MSF team has received a total of 140 patients.
MSF teams have been providing medical and mental health care and distributing relief items such as hygiene kits, food, survival items, tents, blankets, and raincoats to people crossing through Serbia since late 2014.
MSF is working in Croatia, in a transit camp near the border with Serbia (at about 15 kilometers from Tovarnik) where refugees spend about a day before being transferred to Hungary. In the camp, which hosts around 5,000 people daily, MSF has opened a clinic.
In late 2013, Doctors Without Borders/Médecins Sans Frontières (MSF) sent teams to MSF projects in Iraq, Lebanon, and Jordan on the same day to record the work we are doing with Syrians, to experience the situation through the eyes of staff members trying to provide desperately needed assistance. The goal was to chronicle “a day in the life” of this brutal, relentless conflict, to collect imagery and narratives that might foster a deeper understanding of the reach of this war. More at reachofwar.msf.org.
As the bitter conflict in Syria continues, people are suffering immensely, not only from the direct consequences of war but also from having to leave their homes and belongings, and having their regular lives and medical treatments interrupted.
According to recent estimates, more than 120,000 people had been killed through the end of 2013 and more than six million have either been displaced within Syria or driven out of the country.
MSF has established programs inside Syria and in neighboring countries to tend to those affected.