Syria: Escalating conflict in Idlib is causing more deaths, injuries, and massive displacement

An MSF mobile clinic triage nurse checks the blood pressure of a woman who was recently displaced by conflict in northwest Syria.
Syria 2019 © MSF
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NEW YORK, JULY 31, 2019—Bombing and shelling of Syria’s southern Idlib and northern Hama governorates in the northwest part of the country has forced more than 450,000 people to flee north towards the Turkish border in the past three months and has led to increasing numbers of casualties, with hundreds of deaths and thousands of injuries, according to multiple reports. The violence has escalated over the past month, leading to more people killed or wounded than at any time so far this year. Many of those who have fled their homes because of the violence are living in appalling conditions and remain in need of humanitarian assistance.

Medical teams at hospitals in the area that are supported by the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) have faced mass-casualty influxes—when 10 or more wounded arrive at once—on multiple occasions over recent weeks. Earlier this month, an MSF-supported hospital received more than 35 wounded from airstrikes in just 48 hours. Another facility receiving MSF support treated 50 casualties that same week.

“Patients, their caretakers and hospital staff are all struggling psychologically,” said the director of a hospital in the area*. “When planes fly over the hospital, they are extremely scared—some leave the building out of fear it will be hit. We often have to empty the hospital, worried that something could happen. There are days when we have to go to the safe room multiple times because planes are flying overhead. But no matter how many times we have to interrupt our work, we try to keep the emergency room open—we put all our efforts into this. Some hospitals in the area serve tens of thousands of people. We have no choice but to be there for them when something happens.”

The military offensive was launched by Syrian government forces and their allies in late-April, within an existing “de-escalation zone.” Civilian infrastructure—including medical facilities, schools, markets, and camps for displaced people—has been hit and damaged in the offensive. One MSF-supported hospital has been damaged by bombing, while other MSF-supported facilities have had to partially interrupt their services multiple times over recent weeks for fear of being hit, further reducing health services for people in the region.

The escalation in violence has forced 450,000 people to leave their homes, adding to the previous displacements of hundreds of thousands of people to and within Idlib governorate. Most of the newly displaced people have headed for densely-populated areas and are now living in tents or out in the open under olive trees, in need of food, water, and medical care.

MSF has been distributing essential relief items and drinking water to the newly displaced people over recent months, as well as installing latrines, both in existing camps and in newly formed settlements. But the displaced people need much more support than is currently available.

“What we’re facing now are hundreds of thousands of displaced people living in appalling conditions,” said Lorena Bilbao, operations coordinator for MSF’s programs in Syria. “Many of the settlements are very overcrowded, their infrastructure is inadequate, and living conditions are unhygienic, posing a severe risk of disease outbreaks. If people do not have clean water to drink, we can expect more patients with dehydration, diarrhea, and waterborne diseases in the coming weeks. This will lead to a further deterioration of what is already a critical situation.”

MSF has scaled up its mobile clinic activities, which include maternal health care, general health care, vaccination services, and treatment for non-communicable diseases (NCDs). MSF has also reinforced its support to medical facilities by donating medications to health centers and first aid kits and surgical kits to hospitals, and by supporting referral systems in the area. MSF will continue to provide vital humanitarian aid to people displaced or wounded by the military offensive.

We provide support to primary and secondary health care in several hospitals and clinics around Idlib and Aleppo with services including outpatient and inpatient departments, emergency rooms, intensive care units, operating theaters, blood banks, maternity wards, vaccination centers, treatment for NCDs, and treatment for thalassemia, all in coordination with local authorities.

MSF’s activities in Syria do not include working in government-controlled areas since our requests for permission to access these areas to date have been refused. To ensure independence from political pressures, MSF receives no government funding for its work in Syria.

*Name withheld for security reasons.