Intense fighting, including air strikes and ground shelling, has dramatically intensified in northern Syria since mid-December 2017, fueling one of the largest displacements of people since the war began. The increased violence, concentrated in areas of northeastern Hama, southern Aleppo, and southern Idlib governorates, is taking a profound toll on a population already suffering from nearly seven years of conflict.
Tens of thousands of families have fled north towards the Turkish border, where they are living in overcrowded tents or makeshift shelters in frigid winter conditions.
Abu Mustafa, a 37-year-old father of six from Elhos district in the southern Aleppo countryside, arrived in Sarmada, a town near the Turkish border, with next to nothing. "I fled my village with my wife and six sons and twenty other families who are also relatives," he said. "The heavy shelling and airstrikes have had a huge impact. Three hundred and sixty small villages have been abandoned because residents have fled." He and 20 other families pooled their money to rent a small piece of farmland for roughly $1,000 per month.
"We had no other option. We needed somewhere to sleep," said Mustafa. The families built makeshift shelters using iron pillars and covered them with blankets and plastic bags. There are no floors, and the damp dirt under the tent is covered with frost. "The cold seeps through everywhere," he said.
Heartbreaking words from Um Sultan, 60, who fled Ras El Ein. Tens of thousands of Syrian families have fled north towards the Turkish border, where many are living in overcrowded tents. pic.twitter.com/Z7K3EWoKpm— Doctors w/o Borders (@MSF_USA) January 24, 2018
"The journey here was like traveling through death."
Families who left their homes endured a harrowing journey. "We fled from Ras El Ein [in Idlib] because of the shelling and death," said 60-year-old Um Sultan, who is now living with her family in Hazano, in the countryside of Idlib province. "The journey here was like traveling through death. The road was crowded with cars, with warplanes in the sky and air strikes all around us. My son crashed his car because he was speeding so fast, out of fear."
Many of these families left home with very little or nothing. Others carried their belongings piled high on trucks and tractors, salvaging farm equipment, appliances, or other valuables that they can later sell to survive. They say the mass displacement has left a number of villages virtually abandoned. "I hope we can return home soon," said Sultan. "We have many children: eight sons, three daughters, and about twenty grandchildren. Our family has twelve houses that we left behind. There is nothing is better than returning back home."
Formal camps in the area have swelled beyond capacity, leaving most internally displaced people to seek refuge in 160 makeshift settlements spread out over a large area. They live in improvised tents with as many as three or four families in each. Most of the families average six members.
In these informal camps, there is limited access to basic shelter, sanitation, food, water, and medical care. The wet, cold weather and overcrowded camps threaten to contribute to a further deterioration of conditions at a time when many humanitarian actors are scaling back operations inside Syria.
Dr. Mohammed Yaakoup, a Doctors Without Borders/Médecins Sans Frontières (MSF) mobile medical team member, recently visited Al-Rahman camp, near the Turkish border. Forty-four newly displaced families had recently arrived there, joining 70 families were already in the camp. The ballooning population is putting significant strain on the limited facilities.
Attending to Needs
"The medical situation is really difficult," said Yaakoup. "Respiratory tract infections are very common. Some families have been traveling for one week before arriving here, camping by the side of the road in the open air. Many patients with chronic diseases haven’t taken their medication for a month. We had numerous cases of patients with diabetes and high blood pressure. Children had not been vaccinated for years."
The doctor is providing some 45 consultations per day, and a midwife on the team is seeing around 15 people per day.
MSF teams are also distributing hygiene and winter supply kits, including blankets and insulated sleeping bags. So far, kits have been distributed to more than 1,000 families. MSF is providing additional support, including donations of medical supplies, to boost the capacity of some key health care facilities and emergency referral centers in the area. MSF also supports ambulance services through the provision of fuel and maintenance.
In the coming weeks, MSF teams will expand the vaccination outreach program and coordinate with other organizations to more efficiently continue the distribution of relief kits to those in urgent need.
Meanwhile, the air strikes persist, forcing those who have been driven from their homes to flee yet again.
"One of the settlements that we visited was attacked several days later," said Zuhair Kanjou, MSF project manager for north Syria. "People were forced to move again. The shelters where they live are not suitable for people. They flood with rain and are full of mud. The situation is miserable."
MSF directly operates five health facilities and three mobile clinics in northern Syria and partners with five facilities. It also provides distance support to around 50 health facilities countrywide in areas where teams cannot be directly present. No MSF staff are present in supported facilities.
MSF’s activities in Syria do not include areas controlled by the Islamic State group since no assurances about safety and impartiality have been obtained from their leadership. MSF cannot work in government-controlled areas since requests for permission have not been granted. In order to ensure independence from political pressure, MSF receives no government funding for its work in Syria.