The Reach of War: A Day in the Life of the Syrian Conflict

Arsal, Bekaa Valley, Lebanon. November 6, 2013. Syrian refugees being treated at a MSF clinic in the village of Arsal, in Lebanon's Bekaa Valley. (Photo by Moises Saman/MAGNUM)
Moises Saman/Magnum
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As the day begins, surgeons in two different towns in Jordan start their rounds, visiting with one grievously wounded patient after another, knowing more will soon be on the way. In Lebanon’s Bekaa Valley, doctors, nurses, social workers, and midwives begin calling in the mothers, fathers, and children already assembled outside four different clinics. In northern Iraq, a doctor—a refugee himself—walks briskly towards the cries and clamors of new patients who have likewise found themselves far from home, with no sense of when they might return. And inside Syria, where the war that has altered the lives of all these people continues without pause and without mercy, medical teams renew their efforts to do what they can to address even a fraction of the needs they see day after day….

Now into its fourth year, the war in Syria has killed more than 190,000 people and driven upwards of 9 million people from their homes—more than 3 million who’ve fled the country, and more than 6.5 million who are displaced inside its borders.

As astonishing as the numbers are, the human scope of the conflict is still hard to convey. Like an explosion, the force of which radiates outwardly from its point of impact, or a disease that spreads far beyond the initial point of infection, the reach of Syria’s war is visible in many places at once. Day after day, it ruthlessly shapes the lives of Syrians inside the country and across, even beyond, an arc of Middle Eastern nations. With no solution in sight, there’s every reason to believe it will continue to do so.

For those in the war’s grip, there are rare instances that could pass for normalcy—a family breakfast, a soccer match, a break for a cup of tea—but they offer only brief escapes before the search for safety, shelter, healing, or a moment’s relief resumes. Doctors Without Borders/Médecins Sans Frontières (MSF) sees much of this through the prism of medical needs and has been working with Syrians in and around their country since soon after the war broke out, providing hun­dreds of thousands of patient consultations, conducting thousands of surgeries, and delivering thousands of babies, amongst other activities.

That said, like many organizations, MSF has struggled to explain the breadth of the situation, because snapshots of any one group of people in any one place can only relate so much. Therefore, in late 2013, we sent teams to MSF projects in Iraq, Lebanon, and Jordan on the same day to record the work we are doing with Syrians, to experience the situation through the eyes of staff members trying to provide desperately needed assistance. The goal was to chronicle “a day in the life” of this brutal, relentless conflict, to collect imagery and narratives that might foster a deeper understanding of the reach of this war.

“There’s a lack of humanity with respect to Syria because when we talk about Syria, we always talk about figures,” says Dr. Joanne Liu, MSF’s international president. “We always say, in Syria, one in three people are displaced. Or there are 2.8 million refugees outside Syria. But to the normal person, what does that mean? Nobody understands that on a daily basis, kids cannot go to their schools unless parents want to put them at risk of getting hit by a barrel bomb. Children in refugee camps cannot have shelter that is proper to go through winter. A woman cannot deliver in a safe environment, or a child is suffering from a preventable disease.”

In Syria and beyond, the challenges are manifold, the needs im­mense. “What we are trying to do is attend to the patients we can reach in the surrounding countries and hopefully inside the country,” says Dr. Liu. “The other thing we can do as an organization is bring awareness of what’s going on.”

MSF teams in the field are always aware that there is much more that could be done—that so many needs are going unaddressed—and that there are numerous steps parties to the conflict and their allies, along with humanitarian organizations themselves, could take to en­able the delivery of more humanitarian aid to those who need it most.

This project is part of the effort to do more, to see and share more of what’s happening in Syria and to Syrians now in neighboring countries, every day, all at once.

Syria: Relentless Conflict, Radiating Outwards

MSF began working in Syria soon after the war started, first supporting medical facilities with donations of drugs and supplies, then establish­ing independent facilities in areas where it could be done. From the outset, MSF sought approval from the government in Damascus to work in Syria, but with none forthcoming, teams set up projects in op­position-held areas, primarily in the country’s northern border regions.

Given the ferocity of the fighting and the collapse of the once-capable Syrian medical system, the needs have been innumerable, but finding the space to work has been a challenge from the beginning, as health workers and facilities have themselves been targeted frequently. Nonetheless, MSF has been running makeshift hospitals and health centers across northern Syria, where and when it was possible to do so, since June 2012.

At various points, our staff set up field hospitals in a private home, a chicken farm, even a cave. Personnel and resources were mobilized from numerous countries—Syria in particular, because Syrians make up the vast majority of staff in these projects—in order to address at least some of the medical consequences of the war. What’s more, MSF has supported some 50 hospitals and 80 health centers managed by Syrian medical networks as well, donating supplies and materials.

From the outset, however, working in Syria required MSF to go to great lengths to find locations where our teams and our patients would be safe. It has also meant repeatedly explaining to all parties to the conflict that our staff provides impartial, independent, privately funded medical care to all who need it, without regard for religious, political, or military affiliation. This has not always been successful.

At first, the most visible and obvious priorities were wounds directly related to the fighting: shrapnel injuries, gunshot wounds, burns caused by bombs. As time passed, people lost access to medications for treat­able diseases such as hypertension and diabetes. Children lost protec­tions against communicable diseases like measles and even polio. And women facing complicated pregnancies and deliveries lost the ability to call on qualified medical professionals for the assistance they needed.

MSF adapted its programs accordingly. All told, through May 2014, MSF teams in Syria had conducted more than 7,000 surgeries, 54,000 emergency room interventions, and 88,000 outpatient consultations. In addition to responding to mass casualty events, of which there have been many, MSF medical teams have also offered services ranging from primary health to maternal to chronic disease care. They have assisted with more than 2,000 deliveries and carried out vaccination campaigns when conditions allowed.

The ever-changing security situation continues to proscribe our ability to provide care as widely as we’d like, however. Going forward, MSF will try to further adapt or expand our programs inside Syria when and where possible to reach the greatest number of patients. And our teams will also continue to run programs outside of the country to tend to those who fled war’s onslaught—only to encounter a whole new set of challenges.

Arsal, Bekaa Valley, Lebanon. November 6, 2013. Syrian refugees being treated at a MSF clinic in the village of Arsal, in Lebanon's Bekaa Valley. (Photo by Moises Saman/MAGNUM)
Moises Saman/Magnum