Australian Robert Onus is coordinating Médecins Sans Frontières' medical humanitarian response to the crisis in Raqqa, Syria.
Médecins Sans Frontières is working in Tal Abyad hospital supporting trauma care, surgical services and the overall running of the hospital in partnership with the local health authorities. We have eight ambulances providing referral services around Raqqa city for anyone who is injured or who needs emergency medical care to access secondary healthcare facilities that we support in Kobane, Menbij, or Tal Abyad. We also have an advanced medical point in Hazima, north of Raqqa city, for those patients in the northern Raqqa country side who need emergency medical care and we have five vaccination teams working across the governorate. We are also supporting a primary health care clinic and a vaccination team in Ain Issa camp treating displaced people from Raqqa.
What are the main challenges facing the population fleeing Raqqa?
As Raqqa city is besieged we have very little information about what is happening inside the city. We know there are injured people, we know there are people in need of medical care but due to the intensity of the conflict we are unable to access those patients and there are no safe passages for these people to exit the city.
War related injured patients that we are treating tell us that there are still a large number of sick and war wounded trapped inside Raqqa city with very limited access to medical care and very few possibilities to get out of the city. We are extremely concerned about the wellbeing of those who are left behind without sufficient access to healthcare.
On the other hand, many people from around Raqqa are returning to their villages, but still face the residual impact of the conflict. The villages and towns are littered with explosive remnants of war including improvised explosive devices, booby traps and unexploded ordinances. We are receiving many patients in our ambulances and hospitals who are suffering from blast injuries and gunshot wounds. The vast majority of these patients are civilians who have been injured either in the midst of the conflict or in its aftermath when they return home.
Is there a clear pathway for the wounded to leave Raqqa?
The city of Raqqa is a warzone, there is a very clear frontline and it is very difficult for civilians to cross that frontline. Some are able to cross at night, or perhaps they can use smugglers to leave the city but there is certainly no organised or coordinated way to medically evacuate injured or other sick people from the city. Unfortunately, the people that we can access with our services are only the ones that could reach us.
For example, in Tal Abyad hospital we received a patient who lost seven family members. He had shrapnel in his chest and arrived with his daughter and his wounded mother, who was trapped for 15 hours underneath the rubble of a building that collapsed from an airstrike before they could access basic medical care and later fled the city.
The patient explained that despite their wounds they had to be smuggled out of the city with a group of 40 other people. They slept in the bushes for a night and had to follow the dogs to avoid mines - the threat of being shot at by snipers from both sides was always looming. After they managed to escape the city they were moved from one camp to another and they only managed to reach Tal Abyad hospital 10 days after they were originally wounded.
What are the kinds of wounds that Médecins Sans Frontières is currently seeing in the patients it is receiving?
We see two types of cases coming out of Raqqa, the first are the acute trauma cases from people injured from the fighting in the city who require immediate medical care, the second are those people trapped on the other side of the frontline. They are able to access rudimentary medical care inside the city and then only after some days or weeks are they able to find a way to cross the frontlines and reach our hospitals for secondary health care.
What are the challenges facing Médecins Sans Frontières in working in Raqqa?
The biggest challenge facing Médecins Sans Frontières in Raqqa is related to access. We know that there is still a sizeable civilian population inside the city, between 30,000 and 50,000 according to the UN. However, we cannot access this population and they most probably cannot access medical care inside the city. For those who can cross the frontline to reach our ambulances, it takes them sometimes hours or days to bring a patient to the hospital. That’s an incredibly long time for someone who has been injured or who is in need for emergency medical care.
Why is Médecins Sans Frontières working in Raqqa?
After six years of war the scale of unmet medical needs is only increasing. At the same time there are only a handful of organisations working in the region to provide humanitarian relief and medical care. When these two pieces of the puzzle are put together the result is a major deficit in the medical care available for an incredibly vulnerable population. Emergency medical care, surgery, primary healthcare and vaccinations: all of these services are effectively non-existent for the people in Raqqa and as humanitarians we feel it is our imperative to respond.
Why can’t Médecins Sans Frontières work closer to the frontline?
At the moment we have our ambulances and our teams as close as they can safely be to the frontlines. Unfortunately, the rules of war and international humanitarian law have not always been respected in the Syrian conflict. We can’t ignore this fact. Without that protected status, medical professionals are extremely vulnerable to attack, which at the end of the day makes it more difficult to work in areas close to the active conflict. All of this results in greater suffering for the patients.
The threat to medical professionals is not only close to the frontlines. Our teams are working in newly accessible areas that have been retaken from ISIS. We are finding large numbers of improvised explosive devices (IEDs) in these towns that are preventing people from returning to their normal lives. For example, In Hazima, north of Raqqa city, our teams restarted vaccination services this week but we have been forced to put this on hold as the vaccination site, a local school, was found to be contaminated with mines and booby traps.