In the space of two months (December 2019 and January 2020), nearly 390,000 people have fled from their homes or from the camps they had already been displaced to, in order to escape the daily shelling, aerial bombing and ground offensives. The exodus of 150,000 of these people took place in the last two weeks of January only.
While displaced people find themselves squeezed between a closed Turkish border and an advancing frontline, the clear majority of approximately three million people living in northwest Syria are already extremely vulnerable and the continued fighting is only further compromising their chances to survive.
Not only do people have to flee for their lives and sometimes struggle to even find a tent to stay in at overcrowded camps, they are also living all the consequences of the conflict. Access to healthcare, for instance, has become increasingly limited as the frontline continues moving and number of casualties keeps on rising.
“An important number of hospitals in the area have been hit and have been either partially or fully destroyed in northwest Syria in the space of just a few months,” explains Cristian Reynders, MSF project coordinator for northern Idlib.
“What this concretely means is that as the fighting continues, wounded people have less and less chances to even access health facilities. If people must go further to be treated, the chances that their injuries worsen or the probability that they even die is only getting higher.”
In recent weeks, MSF has increased its ad hoc support to multiple facilities closely located to the frontlines, to help them cope with the situation. We provided first aid kits and surgical kits to four hospitals in the past weeks.
“Even if our regularly supported facilities, located further north in the region, are not receiving patients from the areas closer to the frontline, there’s a clear call for help from the facilities acting as first-line responders and we can’t simply ignore it,” continues Cristian Reynders.
The medical and humanitarian situation now is really terrible. The bombings of medical facilities in the area are happening all the time these days.
A doctor managing one of the health facilities in the area
The Maarat al Numan hospital, one of the largest hospital in the southern Idlib area, was recently put out of service because of the bombing.
More recently, on 29 January, an armed opposition group stormed into the Idlib Central Hospital, one of the other major health facility in the area, to which MSF had just donated surgery and first aid kits. For a few hours, they occupied the facility for military purposes, despite the protests of the medical staff.
The same night, at midnight, Ariha hospital was hit by multiple airstrikes, which led to major destruction of the building and its warehouse. Most of the hospital’s drugs and supplies and stock of fuel were damaged or lost and its pharmacy was destroyed, while dozens of wounded injured by the bombings were still rushed into the facility for treatment.
These incursions into and bombings of health facilities and the overall obstruction of healthcare come at a time when lifesaving medical care in Idlib is needed most.
There’s a clear call for help from the facilities acting as first-line responders and we can’t simply ignore it.
Cristian Reynders, MSF project coordinator for northern Idlib
MSF strongly condemn the blatant violations of international humanitarian law in the destruction of medical facilities or their use for military purposes. Hospitals are not only closing one after the other, the health system is constantly under threat, whether coming from the sky or from the ground.
“The medical and humanitarian situation now is really terrible. The bombings of medical facilities in the area are happening all the time these days. The hospital that I manage is still standing, but just in the past few weeks, five facilities around us were partially or fully destroyed and went out of service,” says a doctor managing one of the health facilities in the area that MSF recently provided support to.
“We are completely overwhelmed by the number of patients who would have normally been treated in these hospitals but must now be handled by us instead. The hospital staff can really feel the pressure. Both physically, due to the number of patients now having to be treated in our facility, but also mentally. We work non-stop, even until late at night, to operate on and treat all the people coming in and we see our supplies decreasing drastically, not knowing how or if we’ll manage to get more. We also operate in constant fear that we might be the next ones hit."
MSF has put together an emergency medical stock to support 50 surgeries, the management of 300 emergency cases and a thousand consults in the upcoming weeks, to be able to support other health facilities’ needs. Meanwhile, we continue to conduct further assessments in the northern area of Idlib, where tens of thousands of people have settled and currently live in terrible conditions.
“What we witness here now is like a human tsunami,” adds the director of the hospital. “People are all trying to flee up north, towards the Turkish border, as fast as they can. In the past few days, you could see dozens of thousands of people in their cars. And right now, it takes about 3 hours to drive 30 kilometers just because everybody is on the road and on the run.”
“For the medical staff, the choice is even harder to make in the face of this situation: do we stay to treat the sick and injured, or do we flee as well? My family left a few days ago and I decided to stay behind for now. But I haven’t heard from them since then and I am incredibly worried. It feels like we’re living through a series of impossible choices.”
MSF keeps on stepping up its assistance to newly displaced families as well, with the provision of drinkable water in camps and distributions of essential items such as blankets and heating supplies but the needs are tremendous and only increasing.
 Source: OCHA Situation Report #7: Recent Developments in Northwest Syria (as of 29 January 2020)
Across northwest Syria, MSF teams provide maternal healthcare, general healthcare and treatment for non-communicable diseases (NCDs) through mobile clinics. They distribute relief items and improve water and sanitation systems. They also support regular vaccination activities and support patients who underwent a kidney-transplant.
Also in northwestern Syria, MSF runs a specialised burns unit that provides surgery, skin grafts, dressings, physiotherapy and psychological support. MSF provides distance-support provides support to primary and secondary healthcare in several hospitals and clinics around Idlib and Aleppo and has co-management partnerships with three hospitals.
Some of MSF’s medical programs across Al Hasakeh, Aleppo and Al Raqqa governorates in northeast Syria continue despite having been reduced or suspended in October 2019. To ensure independence from political pressures, MSF receives no government funding for its work in Syria.