Northwestern Syria: Hospitals attacked while hundreds of thousands flee the front lines

A child carries blankets distribution by MSF back to his tent. MSF also distributed hygiene kits and winter relief supplies (including blankets, mattresses, and jerrycans) in a camp located in the Jebel Harem area of Northwest Syria. The camp currently hosts about 120 families living in dire conditions.
Syria 2020 © MSF
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January 31, 2020—A military offensive by the Government of Syria and its allies is advancing in southern Idlib governorate, displacing nearly 390,000 people in the last two months, many of whom had fled previously. The humanitarian situation is deteriorating as people are squeezed between the Turkish border and the advancing front lines, and hospitals are under threat from airstrikes and ground forces.

Doctors Without Borders/Médecins Sans Frontières (MSF) has increased its ad-hoc support to medical facilities in recent weeks, providing surgical and first-aid supplies to four hospitals close to the front lines. MSF strongly condemns recent violations of international humanitarian law in the destruction of medical facilities and their use for military purposes.

"Multiple hospitals in northwestern Syria have been hit and either partially or fully destroyed in just a few months,” said Cristian Reynders, MSF project coordinator for northern Idlib. “As the fighting continues, people must go farther to be treated, and the chances that their injuries worsen or that they die is only getting higher. Even if our regularly supported facilities, located farther north in the region, are not receiving patients from areas closer to the front line, there's a clear call for help from the facilities acting as first-line responders."

The Maarat al Numan hospital, one of the largest hospitals in the southern Idlib area, was recently put out of service because of bombing. More recently, on January 29, an armed opposition group stormed the Idlib Central Hospital, a major health facility in the area, where MSF recently donated surgery and first aid kits.

The bombings of medical facilities in the area are happening all the time these days. The hospital that I manage is still standing, but just in the past few weeks, five facilities around us were partially or fully destroyed and went out of service.

A doctor managing a health facility recently supported by MSF

For a few hours, they occupied the facility for military purposes, despite the protests of the medical staff. The same night Ariha hospital was hit by multiple airstrikes, destroying much of the building and its warehouse. Most of the hospital's drugs and supplies and stock of fuel were damaged or lost, and its pharmacy was destroyed, while dozens of people wounded by the bombing were rushed into the facility for treatment.

A doctor managing a health facility recently supported by MSF provided the following account:

"The bombings of medical facilities in the area are happening all the time these days. The hospital that I manage is still standing, but just in the past few weeks, five facilities around us were partially or fully destroyed and went out of service.

"We are completely overwhelmed by the number of patients who would have normally been treated in these hospitals but must now be handled by us instead. The hospital staff can really feel the pressure, both physically, due to the number of patients now having to be treated in our facility, but also mentally. We work nonstop, even until late at night, to operate on and treat all the people coming in, and we see our supplies decreasing drastically, not knowing how or if we'll manage to get more. We also operate in constant fear that we might be the next ones hit.

"What we witness here now is like a human tsunami. People are all trying to flee north, toward the Turkish border, as fast as they can. In the past few days, you could see dozens of thousands of people in their cars. And right now, it takes about three hours to drive 30 kilometers [19 miles] just because everybody is on the road and on the run.

"For the medical staff, the choice is even harder to make in the face of this situation: do we stay to treat the sick and injured, or do we flee as well? My family left a few days ago and I decided to stay behind for now. But I haven't heard from them since then and I am incredibly worried. It feels like we're living through a series of impossible choices."

MSF in Syria

MSF is increasing its assistance to displaced families in Idlib governorate, with the provision of drinking water in camps and the distribution of essential items such as blankets and heating supplies, but the needs are tremendous and only increasing. MSF has prepared an emergency medical stock to support surgeries, medical consultations, and the management of emergency cases in other health facilities.

MSF continues to conduct further assessments in the northern area of Idlib, where tens of thousands of people are in dire conditions.

Across northwestern Syria, MSF teams provide maternal health care, general health care and treatment for noncommunicable diseases (NCDs) through mobile clinics. We distribute relief items and improve water and sanitation systems. We also support regular vaccination activities and support patients who underwent kidney transplants.

Also in northwestern Syria, MSF runs a specialized burns unit that provides surgery, skin grafts, dressings, physiotherapy and psychological support. MSF provides distance-support to primary and secondary health care in several hospitals and clinics around Idlib and Aleppo and has co-management partnerships with three hospitals.

MSF continues some medical programs in Al Hasakeh, Aleppo, and Al Raqqa governorates in northeastern Syria following the suspension of most activities in the region in October 2019.

To ensure independence from political pressures, MSF receives no government funding for its work in Syria.