As part of the COVID-19 humanitarian taskforce chaired by the local health authorities, MSF contributes to the coordination of the COVID-19 response in northeast Syria. MSF works alongside the Kurdish Red Crescent to provide medical care to people with suspected and confirmed COVID-19 at the only dedicated COVID-19 hospital in Washokani, near Hassakeh city.
In Washokani, both those discharged from care and those who can self-isolate at home with mild illness are supported with hygiene material and health education. We identify vulnerable people in their household, offer self-protection advice, follow up with their household contacts, and review their health status at regular intervals for a month.
We increased our support in Raqqa with a focus on protecting health care workers, improving IPC in primary and secondary health care facilities, improving triage and care for suspect patients requiring inpatient care while they await test results, and sharing lessons learned from our Washokani response with Raqqa health organizations. PCR testing remains limited in the region with no supply pipelines secured at the moment. The average number of tests per day has declined to a very low level, making it difficult to determine the scale of the outbreak.
Across Al Hol camp, our teams continue to follow up with the 1,900 people who have been identified as particularly vulnerable to developing severe symptoms if they contract COVID-19, and support them based on individual needs. Many of the identified people have noncommunicable diseases, such as diabetes, hypertension, asthma, or heart conditions.
In northwest Syria, MSF continues to provide care for patients with moderate and severe symptoms in Idlib national hospital’s 30-bed COVID-19 treatment center. We are working in three recently opened COVID-19 treatment centers in the regions, with capacities of 31 beds, 34 beds in Afrin, and 28 beds in Al-Bab. In the centers, we treat patients with mild, moderate, and severe symptoms, providing oxygen support to those patients who need it. In the camps where we work in northwest Syria, our teams are still spreading awareness messages about COVID-19 and distributing hygiene kits to the families.
\In Syria, civilian areas and infrastructure, including medical facilities, came under direct fire again in 2019. Thousands of people were killed or wounded, and many more driven from their homes.
Doctors Without Borders/Médecins Sans Frontières (MSF) continued to operate in Syria but our activities were limited by insecurity and access constraints. In areas where access could be negotiated, our teams ran or supported hospitals and health centers and provided health care in displacement camps, following independent evaluations to determine medical needs. In areas where no direct presence was possible, we maintained our distance support, comprising donations of medicines, medical equipment, and relief items; remote training of medical staff; technical medical advice; and financial assistance to cover facilities’ running costs. Learn how you can best help in Syria and other countries.
In northwest Syria, hundreds of thousands of people were displaced as a consequence of the offensive launched by the Syrian government forces and their allies, notably Russia, in Idlib province, the last opposition stronghold, in April 2019. Most newly displaced people headed for densely populated areas where no clean water or medical care was available. They had few options, as most areas that were considered relatively safe were overcrowded and overstretched in terms of humanitarian assistance.
Schools, hospitals, markets, and camps for internally displaced people were also hit and damaged during the offensive. On multiple occasions, most notably in August and from late October, medical teams at MSF-supported hospitals had to deal with mass-casualty influxes, with 10 or more wounded people arriving at once. Some MSF-supported hospitals were damaged by bombing, while others had to reduce or suspend their services, for fear of being hit.
We supported basic and specialist health care in several hospitals and clinics in Idlib and Aleppo governorates, in areas such as outpatient and inpatient departments, emergency rooms, operating theaters, and maternity wards, in coordination with local partners or health center managers. We also continued our co-management partnerships with three reference hospitals, which entail developing medical strategies and protocols with the hospital directors, supporting all services, donating drugs and other medical supplies, and covering the running costs (including salaries).
In Atmeh, we run a specialized burns unit, offering surgery, skin grafts, dressings, physiotherapy, and psychological support. An average of 150 procedures per month were performed in 2019, and severe or complex cases were referred to Turkey by ambulance. We also maintained our support for the key departments in Al-Salama hospital in Azaz, an area hosting a large and increasing displaced population.
In addition, we supported vaccination programs in health facilities, conducted vaccination campaigns in and around the camps, and assisted with lifesaving medication and follow-up for almost 100 patients in Idlib who had received kidney transplants.
In response to the influx of displaced people in Idlib, we increased our activities in the camps, scaling up our distributions of relief items─such as hygiene kits and mattresses─as well as our improvements to water and sanitation systems and donations of emergency medical material. Following the intensification of the military offensive, we also scaled up the mobile clinics we had been running in displacement settlements, delivering general health care, maternal health services and treatment for non-communicable diseases. Please donate to support our work in Syria and other countries around the world now.
In January, we launched a large emergency response in Al-Hol camp in Hassakeh governorate. The camp’s population of approximately 10,000 swelled after the arrival of 60,000 more displaced people. The camp is made up of 94 percent women and children, who arrived from the Islamic State group’s last stronghold of Deir ez-Zor. In a highly politicized and militarized setting, we started by donating relief items and providing emergency care at the reception area of the camp, and then opened a comprehensive health care facility offering around-the-clock emergency care and an inpatient nutrition center. We began community-based surveillance, camp-wide water and sanitation activities, a tent-based wound care program for those who could not reach the clinics, and referrals to an MSF surgical facility in Tal Tamer. We opened another primary health care center in the ‘Annex’ as well as water and sanitation activities in an area of the camp where foreigners are held.
The situation changed significantly in northeast Syria in October, with the sudden relocation of the US-led coalition forces further east. The Turkish military, alongside allied Syrian armed opposition groups, launched their ‘Peace Spring’ operation, aimed at clearing the Kurdish People's Protection Units from a strip of land over 18 miles long and 273 miles wide along the Turkish border. As a result, we had to suspend some projects and temporarily evacuate international staff to Iraq, and relocate some national teams to other parts of northeast Syria.
In Ain Issa camp, Raqqa governorate, teams provided general health care, vaccinations, mental health services, and water and sanitation activities until October, when the camp closed and its residents fled because of the fighting and insecurity. We then started supporting the local health authority hospital in Ain Issa with donations of medical supplies, before withdrawing due to insecurity. Comprehensive medical activities including thalassemia treatment for more than 280 patients were also suspended in Tal Abyad hospital after Turkish backed groups took control of the area. Our program in the hospital closed towards the end of the year, as we were unable to negotiate the resumption of our activities with the newly installed authorities.
In Raqqa city, we continued to run a general health care center offering emergency care, outpatient consultations, mental health support, and vaccinations. At Raqqa National Hospital, MSF completed a large rehabilitation of the facility, then set up and supported emergency, inpatient and post-operative care, general and orthopedic surgery and radiology, as well as the blood bank and laboratory. We continue to support these activities at the hospital with regular donations of medical supplies and financial assistance for health workers.
We maintained our support for the maternity hospital in Kobanê/Ain Al-Arab, in Aleppo governorate, with provision of medical supplies and financial support to health workers. We continued to support routine vaccination programs (EPI) in 12 locations across the district and donated relief items to displaced families from Tal Abyad and Afrin.
Following the temporary evacuation of our international colleagues, we were also forced to suspend our activities in Tel Kocher in Hassakeh governorate, where we run a general health care center serving a vulnerable Arab community, offering pediatrics, services for pregnant women and patients with chronic pathologies. From November, we gradually resumed some medical activities and started to deploy mobile clinics to assist displaced people in Newroz camp.
In October, our teams distributed relief items to displaced people living in camps, schools, or with families and friends in Tal Tamer, Hassakeh, and Newroz camp. We donated hygiene kits, blankets, and multi-purpose tents. In Tel Kocher, we provided hygiene kits and blankets to victims of floods and donated 1,000 blankets and a tent for triage to Hassakeh National Hospital during a mass casualty response.
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