Syria

A 13-year-long civil war has left a record 14.6 million people need humanitarian assistance in Syria. It is the country with the largest number of internally displaced people in the world, with 6.9 million people displaced, most of whom are women and children. Many have been displaced repeatedly and live in precarious conditions. 

MSF operates in Syria where we can, but ongoing insecurity and access constraints continue to severely limit our ability to provide humanitarian assistance that matches the scale of the needs. Our repeated requests for permission to operate in areas controlled by the Syrian Government have not been granted. 

In areas where access could be negotiated, such as northwest and northeast Syria, we run and support hospitals and health centres, and we provide healthcare through mobile clinics.

What we're seeing in Syria

We see people in the camps suffering from poor living conditions and an overall lack of humanitarian assistance, mental health support or access to vaccinations. Supporting hospitals, basic healthcare centres and mobile clinics in displacement camps are also a central part of our response. Due to the poor living conditions in the region, injuries from domestic accidents are also frequent. We run a specialised surgical burns unit in northwest Syria to respond to such injuries.

What used to be a functional health system in Syria has been devastated by the conflict. Hundreds of medical facilities have been bombed, medical staff have been killed, detained or have fled, and supplies are lacking. Syrian health staff have been forced to improvise operating theatres and work in deplorable conditions, overwhelmed by emergencies. Over the past decade, we have not only dealt with mass casualties and acute emergencies but also the resurgence of preventable diseases.

An estimated 6.9 million people remain internally displaced in Syria. Most people who have fled violence live in camps, improvised shelters or with host families. The 11 years of conflict, the COVID-19 pandemic and a severe economic crisis have further aggravated their vulnerability. Most people living in displacement camps have suffered from repeated displacement. Many suffer poor living conditions, psychological trauma and a lack of access to medical care. In some of these camps, we provide healthcare and mental health support through mobile clinics as well as water, sanitation and hygiene (WASH) services.

As the conflict escalated in the early years of the Syrian war, so did the crackdown on medical assistance for people in areas that were not under the control of the Syrian Government. In areas we can’t access, we have tried to maintain a system of distance support to medical facilities and networks of medics. Over the years, we supported underground medical networks. 

Given the volatility of the Syrian context, our teams are ready to respond to various emergencies, from mass casualties to displacement and outbreaks. Throughout the years, we have diversified our activities in the country, from trauma care, vaccination campaigns, maternity care and mental health support.

MSF Activities in Syria in 2023

In Syria, MSF provides vital healthcare to displaced people living in extremely vulnerable conditions. In 2023, we also responded to the devastating earthquakes that shook the country’s northwest.

Northern Syria has been severely affected by nearly 13 years of conflict. The people living in this area, including refugees and displaced people, face daily challenges in accessing essential healthcare and clean water. The declining economy and the destruction of critical civilian infrastructure, including water, electricity and oil supplies, in airstrikes aggravated the situation during 2023. The conflict and chronic underfunding have eroded the healthcare system; it remains fragile, and its capacity to respond to persistent outbreaks of communicable diseases is insufficient.

Northwest Syria

The northwest corner of the country was dealt yet another devastating blow in February, when it was hit by catastrophic earthquakes, exacerbating the already dire humanitarian situation. Furthermore, by the end of 2023, Idlib was witnessing its most intense military escalation in years, causing people who have been displaced for more than a decade to flee once again.

In this region, we focused on delivering critical medical and humanitarian assistance to the communities in Idlib and Aleppo governorates. Our teams co-managed or supported six hospitals, offering a comprehensive range of specialist services, including maternal and paediatric care, vaccinations, surgery, mental health support, and treatment for chronic diseases and skin conditions, as well as health promotion. In addition, we run a burns facility, where our multidisciplinary approach comprises surgery, mental health services, physiotherapy and palliative care.

MSF also runs or supports 12 general healthcare centres, with a particular emphasis on sexual and reproductive health and community health promotion, and has 11 mobile clinics across the region, which deliver essential medical services to displaced people in remote and inaccessible areas.

Our other outreach activities include managing two clinics for non-communicable diseases (NCDs), facilitating patient referrals through ambulances, and delivering crucial water, sanitation and hygiene services in more than 100 camps. Community-based health surveillance ensures a timely response to emerging health threats, while capacity-building initiatives empower local healthcare workers with essential skills and knowledge.

Emergency responses and earthquake relief

Powerful earthquakes hit the south of Türkiye and northwest Syria in February 2023, resulting in over 59,000 deaths and many more injuries, as well as massive damage to infrastructure, including homes and medical facilities.

Following the disaster, our teams launched a swift emergency response, distributing trauma kits, rehabilitating healthcare facilities and sending mobile teams to affected areas. Mental health support was also a key component of our response. We set up a ‘safe spaces’ programme in four locations in northern Aleppo and Idlib, in collaboration with partner organisations, to provide places where women and children could take a moment of respite from the harsh reality outside.

Our teams brought in over 40 trucks of medical and essential items, including hygiene kits, shelters and blankets, for people in northwest Syria, and made several donations of goods and equipment, including two consignments of medical kits and other relief items to the Syrian Arab Red Crescent, for distribution in areas where we do not have a presence. Our hospital in Atmeh, which usually specialises in caring for people with severe burns, made numerous donations of medical and non-medical equipment to 30 hospitals in the region. We also sent medical equipment to around 10 hospitals in Bab Al-Hawa, Darat Izza, Idlib and Atarib, among other locations.

As the recovery process is still ongoing, we have integrated our emergency response into our regular activities. Throughout 2023, our teams responded to other emergencies, such as mass-casualty incidents and disease outbreaks, including a surge of cholera cases early in the year.

Northeast Syria

The healthcare system in northeast Syria is almost totally reliant on international support. Reductions in this support have resulted in decreased provision of medical and humanitarian assistance to people who are already living in extremely vulnerable circumstances.

MSF supports general healthcare clinics in the region, offering care for patients with NCDs, as well as mental health and psychological support programmes, inpatient and outpatient feeding units, and an emergency room.

In addition, our teams frequently respond to outbreaks of measles and cholera, and maintain capacity to manage other emergencies.

We also run a reverse osmosis water purification plant to supply safe drinking water for people living in Al-Hol camp, which currently hosts over 40,000 people, more than 93 per cent of whom are women and children. People continue to live in inhumane conditions, with little access to water, sanitation or healthcare. Five years after its expansion, the camp remains an open-air place of detention, an ambiguous legal space where people are arbitrarily and indefinitely deprived of their liberty.

MSF continues to draw attention to the immense unmet needs and vulnerability of people in Al-Hol, and urgently calls for increased international support and a long-term solution to the situation in the camp and others in the region.