After four years, the Syrian war remains as intense as ever and the need for emergency assistance becomes more urgent with each passing day. But the fragmented and shifting front lines, the sheer level of risk, and systematic blockades of international assistance have made it impossible for Doctors Without Borders/Médecins Sans Frontières (MSF) to provide hands-on emergency care in most parts of the country.
Because the needs are massive and still growing, the organization is working with Syrian doctors who have stayed and are determined to operate on wounded people, deliver babies, and provide emergency care to critically ill patients. Over the past three years, MSF has developed a program of large-scale support to underground and improvised health care facilities. MSF supports more than 100 health care structures in government- and in opposition-controlled zones—all locations where it is not possible for MSF teams to be physically present. The program is increasingly focusing on besieged areas, where little or no international aid reaches the doctors.
The blocking of access and bombardment of areas under siege such as Ghouta and parts of Homs and Deraa is causing untold suffering. The military tactic of placing entire communities under siege means doctors struggle to keep any sort of medical activities running and frequently run out of essential drugs and medical supplies.
In northern Homs, for example, approximately 350,000 people have been under siege for more than one year. MSF is supporting eight field hospitals and three medical points in northern Homs. Medical supplies can only reach northern Homs after a perilous journey on dangerous and insecure roads full of checkpoints, where the probability of death, arrest, and confiscation of material is high. Even if it is available, many suppliers do not want to risk selling material like gauze or surgical threads when they know it is going to be sent into northern Homs. Gauze is considered synonymous with war surgery, and often a supplier is not willing to take the risk of being arrested or shut down for supplying a besieged area. "It is precious, dangerous, incriminating," said a doctor supported by MSF in Homs. "There are secret outlets supplying us with gauze."
The field hospitals are providing the full range of services, but do so with severe limitations of equipment and staff. These services are crucial to thousands of civilians because they are trapped with no other options. "We were sending sick children and pregnant women to Homs National Hospital. But many of our patients never came back, so we stopped referring them," the doctor in Homs said.
Almost all of the field hospitals supported by MSF in Homs and elsewhere in Syria have sustained damage from airstrikes and barrel bombs. "We work underground, literally. There are entire hospitals below the earth. The operating theater is underground, as are the laboratory and the post-operative care room. Above ground we only keep patients who are stable and can be moved quickly to the basement when the shelling restarts," the doctor in Homs said.
Today, East Ghouta is the most populous besieged area in Syria, with an estimated population of 800,000 to 1,200,000 people. Starved, bombed, and under siege, the population of East Ghouta is paying a shockingly high price. MSF provides 21 health facilities with up to 60 percent of their medicine and consumables. Earlier this year, one of these field hospitals received 128 patients after a crowded market was bombed. The medical team there was able to save 60 of the casualties, but 68 of their patients died and they used almost their entire stock of emergency room drugs and materials in that one day.
A March 5 bombing on and around a primary school in a rural part of Idlib Governorate is a reminder that the violence is reaching all corners of the country. After the bombing, 50 wounded casualties were treated by the three nearest MSF-supported facilities. Such events are happening with terrible regularity, and the health facilities, in rural as well as urban areas, are struggling to maintain even the most basic medical services.
The following are testimonies from doctors whom MSF supports in Syria: