Though the intensity of the fighting has decreased since the ceasefire signed in March 2020, some 2.7 million people remain displaced and live in precarious conditions. In 2021, civilian areas and infrastructure, including medical facilities, came under direct fire and thousands of people were killed, wounded or displaced.
To address the medical needs in Idlib and Aleppo governorates, where the health care system remains very fragile, we supported eight hospitals, including the only specialized burns unit in the area. We also ran mobile clinics and supported health centers to provide care to displaced people living in camps. Our services included obstetric care, treatment for infectious and chronic diseases, as well as skin conditions related to the poor living conditions, such as scabies and leishmaniasis. We also started offering mental health support to people deeply traumatized by over a decade of conflict.
In the camps, our teams worked to improve water supply and sanitation facilities, for example building latrine blocks and providing commodes for people with disabilities, and distributed hygiene kits and relief items, such as blankets and heating materials, to help people cope with the cold winter weather. We also ran community-based surveillance in the camps to facilitate early detection of medical and humanitarian needs.
Although the number of people in need of assistance grew in 2021, humanitarian funding continued to fall, and MSF received an increasing number of requests to support hospitals and health centers facing frequent shortages of essential medicines and medical supplies. To cover critical gaps in care, we expanded our sexual and reproductive health services and our water, sanitation, and hygiene activities.
The already enormous needs in the region were exacerbated by the COVID-19 pandemic in 2021, as northwest Syria experienced its most severe wave of infections to date. We reopened our isolation centers in Idlib governorate and community treatment centers in Afrin and Al-Bab, in Aleppo governorate. We also supported a COVID-19 pediatric unit, implemented home-based care for patients not needing hospitalization, and distributed COVID-19 prevention kits in the camps (containing masks, hygiene materials, and information about the virus). Efforts to contain the virus were hindered by the low vaccination rate – only 3 percent of the total population were fully covered by the end of 2021. In response, we deployed health promotion teams to spread messages about the safety and efficacity of COVID-19 vaccines.
The population of northeast Syria have continued to suffer from the compounding effects of 11 years of conflict, with displacement, insecurity, an economic crisis, and inhibited access to basic services creating a range of humanitarian needs across the region. For example, the Alouk water station suffered repeated interruptions leading to episodic water shortages for up to one million people in Hassakeh Governorate.
MSF has responded across Hassakeh, Aleppo and Raqqa Governorates to the persistent and emerging humanitarian needs in the region. Throughout the year, we supported a large primary health care center in Raqqa to provide emergency, outpatient, and non-communicable diseases (NCD) care. We also supported the local health authorities to provide routine vaccinations to women and children in 12 locations in Kobane / Ain al Arab and across Aleppo Governorate.
In Tal-Abyad and Ras Al-Ain, we partnered with local organizations to re-establish routine immunization services and conducted a measles vaccination campaign.
In June, we responded to a rise in the number of malnourished children by setting up an in-patient therapeutic feeding center (ITFC) in Raqqa, alongside our outpatient center. In August, we started providing primary health care and treatment for tuberculosis (TB) for adolescent detainees in a detention center in Hassakeh city. And in September, we started to support a new clinic treating NCDs in the southern neighborhoods of Hassakeh city.
Al Hol camp, in Hassakeh, continues to be an unsafe place for people to live. The camp, which hosts around 57,000 people, mostly women and children, saw repeated violent incidents throughout 2021. This led to the deaths of many camp residents, including one MSF staff member in January, as well as repeated interruptions to the provision of humanitarian assistance.
MSF has provided primary health care, treatment for non-communicable diseases, COVID-19 care, mental health support, and water and sanitation services in the camp across 2021. In September, we closed our inpatient therapeutic feeding center due to a very small number of patients, and re-oriented our assistance to NCD care through a new clinic that opened in October. Over 2021, we delivered in average over 600,000 liters of water per day to the camp and worked to ensure continued access to sanitation facilities. Despite these efforts, access to adequate and sufficient water and sanitation facilities remain major problems in the camp.
In 2021, there were also multiple waves of COVID-19 across northeast Syria. MSF supported the Qamishli laboratory, the only PCR testing facility in the region, with essential testing materials to try to avoid critical ruptures. In collaboration with local partners, MSF cared for people with suspected or confirmed COVID-19 in treatment centers in both Hassakeh and Raqqa, and donated medical supplies to health facilities across the region to help them respond to COVID-19.