Funding cuts in Syria will cause preventable deaths

The end of the WHO-funded medical referral system leaves patients in northeast Syria without access to secondary specialist care.

A line of empty hospital beds in a ward in northeast Syria.

Syria 2021 © Florent Vergnes/MSF

Doctors Without Borders/Médecins Sans Frontières(MSF) calls on donors, especially member countries of the US-led Global Coalition to Defeat ISIS, to increase funding for health care services in Syria

A severe lack of funding has forced the end of operations for a vital World Health Organization (WHO)-funded medical referral system in 11 camps in northeast Syria, including Al-Hol camp. MSF is sounding the alarm that this will lead to a marked increase in the number of preventable deaths. 

This essentially eliminates the possibility for the residents in Al-Hol camp, where MSF works, and from other camps in northeast Syria, to access secondary and specialist health care. 

Allen Murphy, head of MSF mission

In an environment where humanitarian funding has been reduced across the board, WHO has had to make difficult choices, and as of March, referrals for patients requiring specialist or complex care are no longer funded. “This essentially eliminates the possibility for the residents in Al-Hol camp, where MSF works, and from other camps in northeast Syria, to access secondary and specialist health care. It leaves lives hanging in the balance, the majority of them children, sometimes with treatable and preventable diseases, and other times in need of urgent specialist care like surgery,” said Allen Murphy, MSF head of mission. 
 
As of January 2024, 93 percent of the people detained at Al-Hol camp were women and children, with 62 percent under the age of 18, and 43 percent under the age of 12.    

“My daughter has been battling kidney failure since 2023. Despite monthly referrals to Hassakeh hospitals, I was unable to accompany her due to security restrictions. Recently, I received the devastating news that she can no longer be referred to Hassakeh hospitals for treatment, and in just five days, she will run out of medication. Witnessing her suffering is more agonizing than the horror we endure in Al-Hol camp. The feeling of helplessness when a loved one is in pain is truly overwhelming.”—Heba*
Child walking among tents in Syria.
A child runs through the streets of Al-Hol camp.
Syria 2021 © Florent Vergnes/MSF

Little to no options remain for camp residents 

In 2023, MSF directed 1,446 patients to external referrals. At least 22 percent of referrals were declined, either because the necessary services were unavailable, or due to security restrictions. With the most recent round of service cuts there remain little to no options for even life-threatening cases to be referred to a hospital outside camps. 
 
Even before the complete cessation of WHO support for medical referrals, there were an estimated 1,000 patients categorized as ‘cold cases’ (non-emergency, although they may deteriorate into life-threatening emergencies without this treatment) in all 11 camps, including over 800 in Al-Hol alone. These patients need specialized health services only available outside of the camp, including endocrinology, neurology, ENT (ear, nose, and throat), general surgery, ophthalmology surgeries, reconstructive surgeries, gastroenterology, and dermatology. 

“For over five years, I have called Al-Hol camp my home. Despite the immense challenges and hopelessness of life, I persevere to ensure my children receive the love, care, and attention they deserve. Two years ago, my son was diagnosed with a disease that shattered our world. His tiny body endured relentless nasal bleeding and unyielding bouts of vomiting – suffering that eclipsed even the horror we witnessed during the conflict and our time in the camp. It has been two years now since his diagnosis, yet I persistently ask for his urgent treatment. Recently, my son’s suffering intensified as he began experiencing vision disturbances. Although it took over six months for him to be referred to Hassakeh for medical consultation, still no treatment was provided, and my son lost his sight. Our faith in humanity has waned; within the confines of Al-Hol camp, compassion finds no sanctuary.”—Sara* 
Muddy water between tents in northeastern Syria.
A small pond of muddy, stagnant water after two tents due to heavy rains at Al-Hol camp in northeast Syria.
Syria 2023 © MSF
"My daughter was diagnosed with a chronic gastro infection in 2023, a condition that necessitated referral to hospital for essential treatment, as the required medication remains unavailable within the camp. Unfortunately, her last referral, a month ago in March 2024, yielded no relief. She has since exhausted her medications, and her health has deteriorated significantly. Desperate, I pleaded for repatriation to my home country where health care was once accessible, yet my pleas remain unanswered. They tell me my country has abandoned us.”—Reema* 

Urgent need for donors

Given the increasing humanitarian needs in northeast Syria, it is crucial for donors, especially member countries of the US-led Global Coalition to Defeat ISIS, to increase funding for health care services instead of reducing it. This is especially vital for external medical referrals. The capacities of local medical facilities serving as referral centers for Al-Hol camp, and other detention and displacement camps in northeast Syria, must be improved. Immediate funding is necessary to fill current gaps in this system.
 
“More than 40,000 people, the majority of them women and children, remain detained at Al-Hol camp [after coming] from countries including Syria, Iraq, and over 50 others. Many of them have been held there since 2019 and some, who were born there, have never known life beyond the confines of the camp,” added Murphy. 

*Names have been changed for privacy.