Syria: When there are no healthcare options left

"WHO funding shortfalls mean that by the end of March, referrals for patients requiring specialist or complex care are no longer funded," says Allen Murphy, MSF Head of Mission. "This decision shows how the WHO has to make tough choices in an environment where humanitarian funding is being reduced across the board.

"This funding cut essentially eliminates the possibility for the population in Al-Hol camp, where MSF works, and from other camps in Northeast Syria, to access secondary and specialist healthcare. It leaves lives hanging in the balance, the majority of them children aged 12 or younger, left to languish, sometimes with treatable and preventable diseases, and other times in need of urgent specialist care like surgery or treatment for burns."

In 2023, MSF directed 1,446 patients to external referrals. However, at least 22 per cent of referrals were declined, either because the necessary services were unavailable, or due to security restrictions. Now, since the most recent round of service cuts, there are little to no options for even life-threatening cases to be referred to a hospital outside camps anymore.

As of January 2024, 93 per cent of the people detained at Al Hol camp are women and children, with 62 per cent under the age of 18, and 43 per cent under the age of 12.   

Even before the complete cessation of WHO support for medical referrals, there were an estimated 1,000 patients categorised as ‘cold cases’ (non-emergency, although they may deteriorate into life-threatening emergencies without this treatment) in all 11 camps, including over 800 in Al-Hol alone. 

These patients need specialised health services only available outside of the camp. These conditions include endocrinology, neurology, ENT, general surgery, ophthalmology surgeries, reconstructive surgeries, gastroenterology and skin diseases.

More than 40,000 people, the majority of them women and children, remain detained at Al Hol camp from countries including Syria, Iraq and over 50 others. Many of them have been held there since 2019 and some, who were born there, have never known life beyond the confines of the camp.

“Given the increasing humanitarian needs in Northeast Syria, it is crucial for donors, especially Member countries of the Global Coalition to fight ISIS, led by the US, to increase funding for healthcare services instead of reducing it," says Murphy. "This is especially vital for external medical referrals."

"The capacities of local medical facilities serving as referral centers for Al-Hol camp, and other detention and IDP camps in northeast Syria, must be improved. Immediate funding is necessary to fill current gaps in this system."