Can you describe Al-Hol camp?
Al-Hol camp, in Hassakeh province, close to the border with Iraq, is the largest camp in northeast Syria. Today, some 65,400 people are being held there—most of them since the final battles between the Islamic State (IS) group and Syrian Democratic Forces in early 2019. More than 90 percent of the camp’s residents are women and children; two-thirds of them are under the age of 18.
Al-Hol is a “closed camp”, meaning that people cannot move freely in and out. Surrounded by barbed wire fences, the camp is highly secure, its entrances heavily guarded by security forces. The camp is massively overcrowded, with an average of seven people squeezed into modest-sized tents. In some places, multiple families are crammed into communal spaces.
Restrictions on people’s movements, already strict before COVID-19, have been further tightened as a result of the pandemic. For many people it is impossible to leave the camp, even for short periods of time.
Most of the camp’s inhabitants, those of Syrian or Iraqi origin, live in the main camp. Then there is the “Annex”. In this separate and even more highly secured area, nearly 10,000 third-country nationals languish, almost entirely neglected by the world. Some governments and humanitarian agencies have been reluctant to provide services in the Annex because of the perceived affiliations of those who are held there.
What health care is available in Al-Hol camp?
At the moment, there is almost no health care available, as many health facilities have closed as a result of the knock-on effects of COVID-19. The consequences are devastating. In just one week in August, seven children died—all under the age of five. We heard horrific reports of their mothers going from clinic to clinic in a desperate search for somewhere that was open.
In May, there were 24 primary health care clinics in the camp; by early August there were just 15. At present, just five of these clinics are operational, including MSF’s clinic in the Annex. Since we were able to reopen it in late July, we have seen more than 1,000 patients. Across the camp we also run a tent-based wound care program for people who cannot reach clinics. There are three field hospitals, but none are currently fully functional. Until last week there was no emergency medical care available in the main camp. Thankfully, some limited services have been able to restart. But it’s not clear how long this can be sustained, given the high rates of infection among health staff.
Referrals for more critical cases are possible, but these can be complicated and can take a long time to organize. As COVID-19 impacts health care across the region, the options for referrals are likely to reduce.
There is an ongoing outbreak of diarrhea. Young children are particularly vulnerable, and many become malnourished as a result. In our therapeutic feeding centers, nearly 80 percent of our patients under the age of five have acute watery diarrhea. Admissions to our inpatient therapeutic feeding center increased 71 percent in July; in addition we saw 157 children with malnutrition as outpatients. Clean water and hygiene are absolute priorities, all the more so in the blazing summer heat. In July, we delivered 15.2 million liters of chlorinated water and treated a further 69.3 million liters for others to distribute.
Is there a risk of a COVID-19 outbreak in Al-Hol?
We have just heard about the first confirmed case of COVID-19 among Al-Hol residents. We are worried about what will happen next.
Al-Hol camp is not well prepared for an outbreak of COVID-19. An isolation facility has been built, but it isn’t ready for use. It doesn’t have enough trained staff, and it lacks basic water and hygiene infrastructure and adequate infection prevention and control measures. There are also problems with medicines and medical equipment, including oxygen support. It is hardly surprising that when people with suspected COVID-19 were identified in the camp, they were reluctant to go there.
Our teams have identified 1,900 people across the camp who will be particularly vulnerable to COVID-19, many of whom have non-communicable diseases, such as diabetes, hypertension, asthma, or heart conditions. We are doing everything we can to provide them with the medicines they need, as well as with soap and other essential items. This is especially important as they can’t go out to buy these things themselves.
MSF has been working to provide targeted health awareness messages about how to stop COVID-19 from spreading—but it is challenging to ask people living so closely packed together to take impossible measures, such as physical distancing.
Should there be more humanitarian assistance?
Yes. This requires a collective effort. As MSF, we are trying to meet as many of the people’s needs as we can, and to support the work of other organizations. But, far more attention and commitments are needed. Areas such as the Annex have been all but abandoned by the world. Regardless of people’s perceived affiliations, access to medical and humanitarian assistance are basic rights.
As well as our work in Al-Hol and the broader COVID-19 response in northeast Syria, we continue to support free access to primary and secondary health care in Raqqa and vaccination activities in Kobane/Ayn Al Arab. We also continue to assess the health and humanitarian needs of people living in remote, socially or economically excluded areas, informal settlements, and other camps.