“The children are afraid of houses and buildings,” says Hind, a 36-year-old mother of five in Afrin, in northwest Syria’s Idlib province. “We live in a tent.”
Where can you find refuge when your home is no longer safe? How can you comfort your children when they live in fear of the ground rocking beneath their feet? These are some of the questions in the minds of people in northwestern Syria, a region grappling with the impact of economic crisis and more than a decade of war, compounded by the aftermath of the devastating earthquakes that struck this region and southern Turkey (Türkiye) on February 6, 2023—exactly one year ago.
The disaster left more than 59,000 people dead and caused massive damage to infrastructure, including medical facilities and homes.
“The earthquakes created more poverty, homelessness, and displacement, and caused a decline in people’s living conditions, worsened the economic situation and the functioning of the education system, and caused damage to infrastructure,” says Thomas Balivet, head of mission for Doctors Without Borders/Médecins Sans Frontières (MSF). “In addition, thousands of children lost caregivers or suffered physical injuries and amputations. All of these factors have exacerbated the mental health situation for thousands of people across the region.”
Voices from beneath the rubble
Before last February, many people in northwestern Syria had already been displaced from their homes by more than 10 years of grinding war. In the aftermath of the quakes, they found themselves destitute—without shelter, food, clean water, or other basic essentials.
“We left our hometown in Saraqib, east of Idlib, because of the war and constant shelling, and after years of being displaced and looking for safety, we settled in Afrin, further north,” says Hind. “The house we stayed in had no walls—we hung up blankets for shade and privacy. My husband used to work but we barely had enough to eat. Then the earthquake happened and we lost everything again.”
The first quake, with a magnitude of 7.8, left a swathe of destruction reminiscent of the war damage that already scarred northwestern Syria.
Omar Al-Omar, MSF mental health supervisor in Idlib, remembers the first hours after the earthquake. “At the break of dawn, I went down to Salqin, a town in Idlib province. I saw entire buildings collapsed and turned into rubble. What hurt me the most was hearing the voices of people under the rubble asking for help, while I was unable to provide assistance."
Afterwards, he went to Salqin Hospital, which is co-managed by MSF. "When I entered, I was shocked by the sight of the wounded and corpses in the rooms and corridors of the hospital. I was no longer able to stand—I sat on the ground and burst into tears. In the hospital, we could feel the aftershocks, and every moment large numbers of wounded and injured people entered the hospital. It was a night that will remain engraved in my memory until the last day of my life.”
Even before the quakes struck, the health care system in northwest Syria was struggling, with underfunded medical facilities and limited services. The disaster damaged 55 health facilities, leaving them unable to function fully. As well as medical assistance, people across the region needed toilets, showers, heating systems, winter clothing, generators, blankets, hygiene kits, and cleaning products.
From emergency response to long-term activities
In the hours following the first quake, MSF teams provided emergency medical care and immediately started distributing MSF’s existing stocks of essential relief items. In the following days, MSF sent 40 trucks loaded with medical and non-medical items to the area, including food and shelter materials. Meanwhile, MSF water and sanitation experts constructed toilets and showers for earthquake survivors and provided them with clean drinking water.
“Following the acute phase of the emergency response, our focus shifted toward providing shelter, food, and relief items, and ensuring access to health care as well as water and sanitation services,” says Balivet. “The lack of these basic necessities has had a profound impact on people's mental health.”
One year on, the physical destruction caused by the quakes is less visible than before, but the impact on people’s mental health is stark.
“Since the earthquake, cases of post-traumatic stress disorder (PTSD) and behavioral problems have surged, especially among children,” says Omar. “In addition to panic attacks, there are various types of phobias and psychosomatic symptoms.”
Psychological support for survivors
MSF has provided mental health services to people in northwest Syria since 2013. After the earthquakes, MSF launched a comprehensive mental health initiative as part of its emergency response.
Mobile teams of mental health counselors were deployed to provide psychological first aid, as well as specialist counseling for moderate and high-risk patients in 80 locations across the region. They also ran sessions to help people deal with both their immediate psychological reactions and the emotions that come later. MSF teams provided a total of 8,026 individual mental health consultations in the aftermath of the earthquakes.
“Safe spaces” for women and children
MSF also set up a “safe spaces” program in four locations in northern Aleppo and Idlib provinces, in collaboration with partner organizations, to provide places where women and children could take a moment of respite from the harsh reality outside. These activities are still running, with three additional sites added in Idlib province.
Within these dedicated tents, women and children engage in games and activities such as drawing, taking part in group sessions, or simply sitting down to rest. Whether engaged in quiet contemplation or lively conversation, the women and children in these spaces find a refuge where they can momentarily disconnect from the weight of their troubles and simply breathe.
Some 25,000 women and children have used these safe spaces. MSF teams also referred 1,900 of the women and children to other organizations to receive follow-up treatment for physical or mental health issues.
“When I come inside the safe space, I forget everything, I forget the agony and fear,” says Hind, who frequently visits one of MSF’s safe spaces. “My children come with me and play. We all forget the fear, we all forget what happened after the earthquake.”
Living amidst the rubble left by war and the earthquakes, people in northwest Syria still need clean water, food, shelter, and access to essential health care. "Investment in improving the living conditions of the people of northwest Syria is essential,” says Balivet. “Only by addressing the root causes of suffering can we hope to pave the way toward recovery."