Shelling, aerial bombing, and ground offensives carried out by the government of Syria and its allies in southern Idlib governorate have resulted in a massive new movement of people fleeing the war zone. Northern Idlib, near the border with Turkey, already hosts around 1.5 million vulnerable displaced people, and according to the United Nations more than 300,000 more have fled their homes since December 1, 2019, mostly from southern Idlib. Having already fled conflict, they now face limited and overcrowded shelter options, cold winter temperatures in the mountains, and an aid response that is straining at the limit of its capacity.
MSF runs four mobile clinics in the region that carry out medical visits to more than 15 camps and informal settlements. The medics perform around 4,500 consultations per month, with around half the patients being children under 15 years old. The most frequent medical complaints are respiratory infections, while the most common pathology for newly arrived patients is psychological trauma. There are also many patients in need of referral for hospital treatment, such as those suffering from war-wounds that have become infected or people with chronic diseases who have gone too long without medication.
Stepping up activities to meet the growing needs
As violence has escalated, several hospitals have been bombed and put out of service, including Maarat al Numan, which is the largest hospital in the southern Idlib area. Other hospitals were evacuated as fighting drew near. Medical facilities located further north are overwhelmed with patients, and MSF has donated medical materials to several hospitals to support their increased activities.
As wave after wave of new families arrive, MSF mobile clinic teams have been expanding their activities to include the distribution of blankets, locally made heating fuel blocks, and other winter necessities, and a water engineering team is digging latrines and increasing access to drinkable water in areas where displaced people are congregating.
MSF teams are also providing medical care in Deir Hassan camp, in Ad Dana district, where displaced people arrived throughout the offensive. The camp consists of several makeshift settlements where more than 11,000 people have arrived in the last three weeks. These newly displaced people received small emergency kits with canned food, but no shelter and no heating devices.
A mother of four explained that she and another family pooled all of the money they had to buy a tent because they could not leave their children without shelter in such cold weather. Other families share tents with relatives, but space is running out and conditions in the camp are dire. In response to the growing numbers of displaced people in Deir Hassan, MSF is running a mobile clinic to provide primary health care.
“There is a lot of sadness and despair in these camps”
Further west in Harem, a mountainous area of northern Idlib, an MSF team distributed winter relief supplies on January 7 to 52 families who had just arrived. They had fled from a displacement camp closer to the front lines—the third or fourth time some of them have had to flee for their lives.
“With more than a million displaced people already in the area, the lack of shelter and near-total reliance on assistance are critical issues,” said Cristian Reynders, MSF project coordinator for northern Idlib. “Sometimes there is no space available for newly arrived families in official camps, and in other camps people are asked to bring their own tent or shelter. There are organizations working to resolve this, but for the moment it is a big issue. On top of that, there are very few opportunities to earn money, and price inflation in the food markets is high, so people get into debt with no hope of repayment, and over time become entirely reliant on assistance.”
With the exception of hospital referrals for critical emergency medical cases, the Turkish border is closed to Syrians. The front lines of the Syrian government offensive are moving steadily and violently north toward the two main motorways that run east-west and north-south through Idlib, squeezing displaced people into an ever-shrinking area. Though there are many organizations working to assist vulnerable people in northern Idlib, the growing needs have stretched this aid capacity to its limits.
“There is a lot of sadness and despair in these camps,” said an MSF logistics manager in the region. “I spoke to a man waiting in turn for a [supply] distribution and asked him about his hopes, his plans. His voice was breaking as he told me his greatest wish is that this will be the last time he and his family need to flee. What can you say in reply to that?”
Across northwest Syria, MSF provides general and maternal health care and treatment for noncommunicable diseases through mobile clinics. We also distribute relief items and work to improve water and sanitation systems, and support regular vaccination activities in two vaccination centers, one hospital, and through mobile clinic services.
MSF also runs a specialized burn unit in the region that provides surgery, skin grafts, dressings, physiotherapy, and psychological support. We also offer distance support to several hospitals and clinics around Idlib and Aleppo, and maintain co-management partnerships with three hospitals.
MSF’s medical programs across Raqqa and Al Hasakeh and Aleppo governorates in northeastern Syria continue, despite having been temporarily reduced or suspended in October 2019. We have progressively restarted some activities in Al Raqqa, Al Hol, Al Roj, and Newroz camps and in Kobane/Ain Al Arab and Tal Kochar/Yaroubiyah, but we have not yet been able to resume supporting the Tal Abyad hospital in northeastern Syria or return to the surrounding area, from which the majority of the population—including medical staff—fled in October.
To ensure independence from political pressures, MSF receives no government funding for its work in Syria.