Syria: The earthquakes, six months later

MSF’s ongoing response is focused on rehabilitating facilities, providing essential medical services, and alleviating the hardships endured by displaced people.

An aerial view of white plastic tents stretched out as far as the eye can see.

Syria 2023 © Abd Almajed Alkarh

Six months have passed since the catastrophic earthquakes struck northwestern Syria and Turkey on February 6, leaving in their wake a landscape marred by destruction and despair. 

“The earthquake [brought] a state of panic and fear, a situation we had never experienced before,” said Alaa Abdullah, MSF nursing team supervisor in Idlib. “Although we had faced many incidents such as bombardment on cities and towns in northwestern Syria, this time it was completely different.”  

The aftermath of this catastrophe has imposed severe challenges on an already fragile health care system and has disrupted the lives of huge numbers of people. Across affected areas in northwestern Syria, Doctors Without Borders/Médecins Sans Frontières (MSF) and its partners have been at the forefront of efforts to rehabilitate facilities, provide essential medical services, and alleviate the hardships endured by displaced people in the worst-affected areas, such as Jindiris, Sarmada, Armanaz, Jisr Al Shughur, Al Maland, Harim, and Salqin.

A gray concrete building that was damaged by the earthquake with windows blown in and crumbled balconies.
Fifty-five health facilities across northwest Syria were damaged by the earthquakes. Services were suspended in 15 of them, including in the maternity center supported by MSF in Jindires hospital in Aleppo province. Syria 2023 © Abd Almajed Alkarh
Syria 2023 © Abd Almajed Alkarh

Mohammed Al-Aziz, MSF's Community Health Workers Supervisor in Idlib, underscores the health care needs that remain, "Areas severely impacted face pressing health care and psychological needs, with many grappling with trauma from loss, fear, and injuries. Some families, affected deeply by the quake's challenges, struggle to reintegrate into the community and secure their basic needs."

As the recovery process continues, MSF remains committed to its ongoing efforts. However, earthquake response-related activities have been integrated as part of MSF's regular activities. These efforts focus on extending facilities, recruiting additional medical staff, and providing essential mental health and recreational activities. MSF's response to the aftermath of the earthquake in northwestern Syria encapsulates a comprehensive approach that spans emergency care, rehabilitation, and ongoing support.

More than four men in MSF vests are helping to unload a truck full of tents and winter kits. We only see their backs as they work to pull the equipment off the truck.
MSF staff unload tents and winter kits in Al-Ameen, Syria. 2023 © Rami Alsayed

Ongoing struggles and progress in affected areas

For over a decade, people in northwestern Syria have faced extreme hardships, living in constant search of safety and grappling with economic challenges. The health care situation has been worsened by pre-existing issues, such as underfunded medical facilities and limited services, which require swift and robust action. 

"The earthquake on February 6 exacerbated this suffering, forcing many to leave their permanent homes due to extensive damage,” said Alaa. “This not only affected their living conditions but also led to new health challenges, such as the emergence of skin diseases in displacement camps. Natural disasters leave a lasting, negative imprint on the lives of those affected."  

The Jindaris subdistrict was hit hardest by the earthquakes, with over 1,000 reported deaths and 80 percent of structures affected. However, amidst the ruins, there are signs of progress. The rubble clearance in Jindaris has been successful, setting the stage for reconstruction. Additionally, the establishment of camps for internally displaced people (IDP) in the Afrin subdistrict has provided a semblance of refuge for those uprooted by the disaster. 

Two women medics are conducting an ultrasound on a pregnant patient in a tented medical room.
A man stands over a child that is laying on a hospital bed while a medic examines the child. This is all taking place inside of a tented medical space.

To ensure the continuity of essential services, the MSF team helped a local partner in Jindaris to set up tented wards next to the damaged hospital to offer emergency consultations, pediatrics, and reproductive health services, in addition to assisting births. Over 1,000 patients were treated in this field hospital. Syria 2023 © Abd Almajed Alkarh

In the Idlib and Aleppo areas, MSF has focused on rehabilitating facilitates and also constructed an extension to the Mashad Ruhin facility to accommodate the growing number of displaced people. The facility’s medical staff has been bolstered with the addition of one doctor and one nurse.

MSF's rehabilitation activities

Immediately following the earthquake, MSF launched an emergency response, providing trauma kits and support to hospitals within the first 48 hours. The rehabilitation phase encompassed a range of activities aimed at restoring health care facilities and services. This included continuing support for 15 reception centers, deploying mobile teams across 80 locations, and establishing advanced burn patient locations in Jisr Al Shughur, Andalus Hospital in Sarmada, and Amal Hospital in Daret Ezzeh. MSF's support also extended to Afrin General Hospital, which played a vital role in the response. While progress has been made, MSF's efforts are ongoing. Key health care centers need further rehabilitation, underscoring the ongoing necessity for resources and commitment.

A long line of patients are standing outside of a stone building being directed inside by a medic.
A mother and child are standing by a table full of pharmaceuticals as a medic reaches for something on the table.

In collaboration with a local organization, an MSF team in Jindaris is running a mobile clinic in Hamam camp. In its first month of operation, mobole clinic teams performed 1,550 medical consultations and offered 670 mental health sessions. Syria 2023 © Abd Almajed Alkarh

As the situation shifts, the focus has pivoted to orthopedic care. MSF's support for an orthopedic hospital includes training for orthopedic surgeons and improvements in infection prevention and control protocols. However, impending funding constraints are poised to impact the hospital's operations in the coming weeks.

Collective centers have emerged as focal points of humanitarian aid, providing essential housing for displaced people. However, challenges persist with suboptimal living conditions and inadequate hygiene facilities, testing the resilience of both the people who live in these centers and aid providers.  

The Syrian Ministry of Displacement and Humanitarian Affairs (MDHA) has embarked on a transition strategy, relocating people to housing projects or temporary housing with improved living standards. But  longstanding gaps in specialized health care services persist, hindering access to essential medical care.

Mental health and recreational support

The earthquakes had a considerable impact on the well-being of the community, exacerbating mental health issues. “Cases of maladjustment to the post-earthquake situation have emerged, characterized by increased panic and fear, particularly among children,” said Alaa. “This has led to behavioral problems such as bedwetting, increased aggression, attachment to parents, nightmares, and social isolation.”

A man, woman, and child are sitting outside of a plastic tent on a blanket surrounded by dry dirt.
A displaced family in front of their shelter at Hamam camp in Jindaris. Syria 2023 © Abd Almajed Alkarh/MSF

Acknowledging the psychological toll of the earthquakes, MSF also provides mental health support. We offer mental health services in mobile clinics, which have become an integral part of ongoing activities. Recreational activities that provide psychological relief and support have also been introduced in various collective centers, including Al Nour, Al Sana, Wade Raseef, and Al Kwathar camps. Social workers and lay counselors are engaged in these activities, referring identified cases to MSF mental health teams and other medical services, as well as other organizations that can provide non-medical and social support.

While significant strides have been made, challenges in health care access, living conditions, and specialized services persist in Northwest Syria, underscoring the need for sustained efforts.