The international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) released a report today highlighting the deteriorating situation for the approximately 53,000 people—most of them children—left to languish in Al-Hol camp, northeastern Syria. People in Al-Hol are indefinitely and arbitrarily detained in the camp, in unsafe and unsanitary conditions with limited access to medical care.
“Al-Hol is effectively a massive outdoor prison,” said Martine Flokstra, MSF’s Syria operations manager. “The majority [of people there] are children, many of whom were born there, robbed of their childhoods, and condemned to a life exposed to violence and exploitation, with no education, limited medical support, and no hope in sight.”
The report, Between two fires: Danger and desperation in Syria’s Al-Hol camp, highlights the challenges MSF faces providing medical care in the camp and the impact of harsh conditions on the safety, security, dignity, and access to humanitarian aid for people living there.
Sixty-four percent of the camp’s population are children, and half are younger than 12. In 2021, 35 percent of all people who died in Al-Hol in 2021 were children under the age of 16. This included children who died after being hit by trucks, succumbing to burn injuries, or drowning in pools of dirty water that are scattered around the camp.
Al-Hol camp is divided into the Main Camp, housing Syrian and Iraqi nationals, and the Annex, housing approximately 11,000 foreign nationals from about 60 countries. The effectiveness and impartiality of medical aid in Al-Hol have been compromised by the prison-like conditions in the camp, MSF said.
MSF’s teams—who provide care in both the Main camp and the Annex—often struggle to facilitate external medical referrals for patients who require additional medical care. For people living in the Annex, referrals require prior approval from the security forces and the camp administration—leaving the final decision for medical referral to the discretion of people who are not medically trained. This has led to delays in lifesaving treatment.
In addition, patients, including children as young as 2 years old, are accompanied by an armed escort for the duration of an external referral, and patients referred from the Annex are not allowed to be accompanied by a caregiver. “For children and their caregivers in Al-Hol, if they can access medical care, it is often a terrifying ordeal,” said Flokstra.
In February 2021, a seven-year-old boy was rushed to MSF’s clinic in Al-Hol with second-degree burns across his face and arms. Lifesaving medical care was no more than an hour drive away from the camp, yet it took two days for his transfer to be approved by camp authorities. He died on the way to the hospital under armed guard, in pain and separated from his mother, who was not allowed to leave the camp.
A few months later, a five-year-old boy was hit by a truck and rushed to the same clinic. MSF staff recommended he be referred to the hospital for emergency surgery immediately. But it took hours for his transfer to be approved and he died on the way to the hospital, alone.
Al-hol was designed to provide safe, temporary accommodation and humanitarian services to civilians displaced by the conflict in Syria and Iraq. However, the nature and purpose of Al-Hol has long deviated and grown increasingly into an unsafe and unsanitary open-air prison after people were moved there from Islamic State (IS) controlled territories in December 2018.
“Members of the Global Coalition against IS, as well as other countries whose nationals remain held in Al-Hol and other detention facilities and camps in Northeast Syria, have failed their citizens,” said Flokstra. “They must take responsibility and identify alternative solutions for the people detained in the camp. Instead, they have delayed or simply refused to repatriate their citizens, in some cases going as far as to strip them of their citizenship, rendering them stateless.”
Forced to live in a violent and dangerous environment, people in Al-Hol are exposed to constant physical and psychological trauma and fear. MSF teams working in Al-Hol regularly witness acts of violence and exploitation towards people in the camp. In 2021, the leading cause of mortality in Al-Hol was crime-related death, which accounted for 38 percent of all deaths in the camp. Between January and August 2022, there were 34 reported murders in the camp.
There are no formal legal policies and practices in place to govern the detention of people in Al-Hol. This leaves them vulnerable to violent abuse by the security forces who are not held accountable for their actions.
The practice of forcibly separating young boys from their caregivers has become routine in the Annex. Boys who look older than 11 years old are regularly arrested by security forces during patrols and separated from their caregivers. “Mostly I worry about my nine-year-old boy and that the security forces will take him when he gets older,” said a camp resident. “There are a lot [of mothers] whose boys were taken off to prison by the security forces when they turned 11 or 12, and they cry every day.”
“Despite the violent and unsafe conditions in Al-Hol, and more than three years after more than 50,000 people were moved there, insufficient progress is being made to close the camp,” said Flokstra. “There are still no long-term alternatives to end this arbitrary and indefinite detention. The longer people are kept in Al-Hol, the worse it gets, leaving a new generation vulnerable to exploitation and without any prospect of a childhood free from violence.”
“In one word, what we are living through here is horrible,” said a camp resident. “We are in Al-Hol because they promised us freedom, they promised us good conditions . . . I was pregnant and I had five children, so I decided to leave Baghuz. Now I regret having left . . . If I’d known, I would have preferred to die than come here.”
MSF began working in Al-Hol in January 2019. In the main camp our teams run a clinic for patients with non-communicable diseases and provide home-based medical services to people who are unable to walk to a health facility. Our teams also run mobile clinics in the Annex and provide outpatient consultations, women’s health services, and mental health support in the Service Area adjacent to the Annex. MSF also provides emergency water trucking to areas of the Main Camp and supply water to the Annex and one of the most densely populated sections of the Main Camp, which houses more than 20,000 people.