In July, the last remaining humanitarian border crossing point into Syria, Bab Al-Hawa, came under threat of closure after the renewal of its continuing operation was vetoed at the UN Security Council. Authorization was eventually renewed for six months only, demonstrating the fragility of humanitarian access into Syria, which is still dependent on political decisions, and not solely on the humanitarian needs of the millions of people displaced in the region.
In September, sewage contamination in the Euphrates River and a severe water shortage were contributing factors to the first cholera outbreak in the country in 15 years, which was declared in Aleppo governorate and rapidly spread to other parts of northern Syria.
In the wake of the catastrophic earthquakes that jolted both Türkiye and Syria in 2023, MSF has been at the forefront of emergency responses. MSF medical teams were among the first to arrive on the scene in Syria, offering assistance just hours after the disaster occurred. We initiated an urgent medical response, equipping hospitals with trauma kits within the initial 48 hours, and are part of the rehabilitation efforts to restore the health infrastructure.
This included sustained support to 15 reception centers and the inception of advanced burn care facilities in Jisr Al Shughur, Sarmada—Andalus Hospital, and Daret Ezzeh—Amal Hospital. Mobile medical teams were rolled out across 80 sites, and collaborated with Afreen General Hospital.
From February to April 2023, MSF conducted 198,477 medical consultations spanning mobile clinics, established clinics, and hospitals, distributed 110,835 relief items, including a significant number of tents and blankets, and extended care to 14,028 wound victims. We also conducted 8,026 mental health consultations, supported 36 hospitals and 10 Primary Health Centers (PHCs), launched 14 emergency mobile clinics in addition to the pre-existing 11, provided 367,607 bread units, served 16,800 hot meals. Our teams also undertook water, sanitation, and hygiene operations in 100 refugee camps.
While these accomplishments mark significant progress, several key health institutions remain in the revitalization phase. This highlights the sustained demand for resources and the continuous dedication required in this region. Furthermore, MSF expanded its outreach beyond its usual operational zones. We made two significant donations of medical and logistical kits to the Syrian Arab Red Crescent (SARC).
At the end of 2022, there were around 4.4 million people residing in northwest Syria, with roughly 2.8 million internally displaced. Their already precarious living conditions continue to deteriorate due to the ongoing conflict, the worsening economic situation, and rising prices. As a result, Syrians are losing hope for the future, which is in turn taking a toll on their mental health. Humanitarian needs remain extremely high, especially regarding medical care, water and sanitation, food, and shelter—yet aid to the area has decreased.
This situation has been compounded by the additional barriers of active frontlines, restrictions on access, and supply flow issues, which affect MSF’s ability to respond. For this reason, we have developed a network of partners with whom we work to deliver care where it is most needed.
To address the medical needs in Idlib and Aleppo governorates, where the health care system remains fragile, MSF co-manages and offers technical support to seven hospitals. In addition, we run the only specialized burns facility in the area. We also operate mobile clinics and support general health care centers to provide care to people living in camps.
Our services include surgery, wound care, treatment for burns, obstetric and pediatric health care, treatment for infections and chronic diseases, as well as skin conditions related to poor living conditions, such as scabies and leishmaniasis. We also provide mental health support, health promotion, and routine vaccinations.
In displacement camps, our teams worked to improve water supply and sanitation facilities by building latrine blocks and distributing commodes for people with disabilities. We also provided hygiene kits and relief items, such as blankets and heating materials, to help residents cope with the cold winter weather. We additionally run community-health monitoring in the camps, to facilitate early detection of medical and humanitarian needs.
Following the declaration of a cholera outbreak in September, our teams set up and managed cholera treatment centers and rehydration points, and organized patient referrals. We also improved water and sanitation facilities, mainly in displacement camps, and conducted individual and group health promotion sessions.
Likewise in the northeast of the country, MSF is responding to immense humanitarian needs caused by conflict and the economic crisis, assisting both displaced people and host communities who have very limited access to basic services.
Throughout the year, we supported a large basic health care center in Raqqa governorate, offering emergency care, outpatient consultations, and treatment for non-communicable diseases (NCDs). We responded to a rise in the number of malnourished children by setting up an inpatient therapeutic feeding center in Raqqa alongside our outpatient center. We also supported local health authorities in administering routine vaccinations to women and children in 12 locations in Kobanê/Ain Al-Arab. In 2022, we handed over the vaccination program to local authorities, but we continued our donations during the year.
In Tal Abyad and Ras Al-Ain, we collaborated with local organizations to re-establish routine immunization services and conducted a measles, polio, and pentavalent vaccination campaign. In addition, we provided treatment for leishmaniasis, technical training, and donations of medical supplies to health facilities.
In the southern and northern neighborhoods of Hassakeh city, we supported two clinics with treatment for NCDs. In Al-Hol camp in Hassakeh, over 53,000 detained people—the majority of them children—continue to languish in unsafe and unsanitary conditions. There were numerous violent incidents in the camp in 2022, resulting in the deaths of several residents, as well as repeated interruptions to the provision of humanitarian assistance.
In Al-Hol, MSF offers basic health care, treatment for NCDs, and mental health support. Despite our efforts to improve water and sanitation services in the camp, there is still a lack of adequate facilities. Water quality and supply remain an issue in northeast Syria. Since the summer of 2022, there have been prolonged disruptions at Alouk water station, leaving it essentially non-operational for up to a million people in Hassakeh governorate. Our teams are monitoring the situation and will intervene where possible.
During the year, we responded to several outbreaks of diseases, including COVID-19, meningitis, and severe acute respiratory infections. When a cholera outbreak was declared in Raqqa and Deir ez-Zor governorates, we launched a response in partnership with the local health authorities, opening a treatment center in Raqqa and oral rehydration points in Hassakeh to provide treatment for patients with suspected cholera and dehydration and refer patients with severe dehydration to other facilities. In addition, we sent extra staff to the area, including community health workers, and worked with other local organizations to improve water and sanitation by chlorinating water trucks, ensuring the quality of water supply, and supporting water treatment stations with chlorination processes.