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Syria

OUR COVID-19 RESPONSE IN SYRIA

In northeast Syria, MSF has partnered with local health authorities in a COVID-19 humanitarian taskforce. We are providing training and supporting preparedness measures to help healthcare workers during the crisis. However, MSF believes that the few functional medical facilities in the region could very quickly become overwhelmed with an influx of COVID-19 patients, putting more people at risk.  
  
Our COVID-19 work in northeast Syria is focused on two sites: Al Hassakeh National Hospital and Al Hol camp.   
  
In Al Hassekeh National Hospital we have created a 48-bed isolation ward, which has begun admitting patients. So far we have received four patients with COVID-19 symptoms, three of whom tested positive and one for whom we are still waiting on results. We have introduced surveillance measures, processes for case identification and patient care, patient flow, and triage. We have also trained staff in infection prevention and control and personal protective equipment usage to mitigate over-use. We continue to provide logistical support, including rehabilitating wards to receive COVID-19 patients.  
  
In Al Hol camp, where MSF started providing medical and humanitarian assistance in January 2019, the overcrowded camp now houses around 65,000 people, 94 per cent of whom are women and children. No one is allowed to leave. We continue to run an inpatient therapeutic feeding centre and a wound care program for those who cannot reach the clinics, while also providing water and sanitation support in the camp. We have also started mapping vulnerable people who are more likely to develop severe illnesses as a result of COVID-19 and are sharing targeted health awareness messages and hygiene kits accordingly. We are preparing to reorganise the feeding centre for care of COVID-19 patients if required.  

In late May, MSF flew two charter flights to Iraq, destined for our medical activities and the COVID-19 response in northeast Syria. The flights carried 46 tonnes of essential medical supplies that have since been transferred across the border, as well as 14 MSF staff. The team, made up of medical staff, water and sanitation experts, logisticians and coordination personnel, is quarantining first for 14 days in Erbil.  

Inside Al Hole Camp, Eastern Al-Hasakah Governorate, Northeastern Syria. © MSF

In northwest Syria, more than 1000 COVID-19 tests have been performed so far, all of which have come back negative. In the hospitals and health centres MSF supports, we have reviewed the triage systems and patient flow to ensure fast detection of potential COVID-19 cases and isolation from the rest of the patients.   
  
In Idlib, where MSF assisted with a COVID-19 isolation unit in Idlib National Hospital, the number of patients tested and admitted into the isolation ward at Idlib National Hospital (set up with MSF support) has been decreasing in recent weeks.   
    
After adapting the triage system and implementing social distancing measures, we have resumed our two mobile clinics within the Deir Hassan internal displacement camps in Idlib where we had also distributed hygiene kits to more than 10,000 families. All our distributions of non-food items have been adapted to prevent crowding and to reduce the risk of transmission. For patients with non-communicable, or chronic, diseases, we have resumed our activities in Adana district after they had to be reorganised, and we have added activities outside primary health centres (Al Baraka and Al-Karama) to facilitate distribution of patient’s medications.   
   
In Aleppo, MSF supports two mobile clinics in Afrin district, run by Al Ameen, a local NGO, in five sites in Bulbul area and five other sites in Western Afrin Countryside. In early June our teams performed health promotion activities and distributed soap in 11 unofficial camps in Azaz. For our patients receiving regular care for chronic disease, we have distributed two months’ worth of their medicine to help reduce their movements.  

 

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Right now, Médecins Sans Frontières is providing much needed support and medical care in over 30 countries to counter the COVID-19 pandemic.
 
Our teams are also gearing up to confront potential outbreaks in the hundreds of areas we were already working before the pandemic struck. We are deploying medical staff, sending supplies and applying nearly 50 years of experience fighting epidemics to protect the most vulnerable and save lives.
 
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Hundreds of thousands of Syrian civilians have lost their lives in over 7 years of armed conflict, which began with anti-government protests before escalating into a full-scale civil war.

More than 11 million people have been forced from their homes amongst clashes between supporters of President Bashar al-Assad and those opposed to his rule - as well as jihadist militants from the so-called Islamic State. 

The United Nations has estimated that over 13 million Syrians are in need of immediate humanitarian assistance. An estimated 6.5 million people are internally displaced in Syria, with over 5 million Syrians seeking asylum internationally.

Closed borders, appalling living conditions and limited assistance have compounded their suffering. People fleeing violence live in camps, improvised shelters or with host families.

Violence, attacks on health facilities, the absence of government authorisation and the reneging by armed groups on guarantees of safety for MSF teams have been major obstacles to a more extensive program of medical humanitarian aid in Syria.

 

The conflict in Syria is defined by brutal violence that does not distinguish between civilians and combatants.

Indiscriminate Targeting of Civilians

Siege warfare has been widely used in Syria. Civilian areas have been routinely bombed and deprived of assistance.

Early on, the systematic bombing of civilian areas made it a priority to help treat the wounded. We opened surgical facilities in the north, provided supplies and training to health staff across the country, and set up cross-border trauma care in Jordan. As living conditions deteriorated in the north, we set up a surgical burns unit. 

MSF was one of the only organisations to start providing medical assistance inside Raqqa, through a primary healthcare unit and a stabilisation point. Even as the violence subsided, and residents started to return home, staff saw a sharp increase in the number of patients wounded or killed by booby traps, improvised explosive devices (IEDs), mines and explosive ordnance that littered the city or deliberately left in homes, on agricultural land and along roadsides.

 

Attacks on Medical Staff

MSF has been present in Syria since 2009. Teams continue to provide medical and humanitarian assistance in the country but activities are severely limited by insecurity and constraints on access. Thousands of doctors, nurses, pharmacists and paramedics have been killed, kidnapped, or displaced by violence, leaving a massive gap in medical expertise and experience.

 

In 2017, 11 medical facilities supported by MSF were hit by bombs or shells on 12 occasions in targeted or indiscriminate attacks.

The Syrian government has not granted MSF authorisation to operate in the country despite repeated requests, and our presence in areas outside government control is minimal. Unable to obtain government permission to assist the sick and wounded, we started by supporting underground medical networks.  

Our main programs are in the governorates of Aleppo, Idlib, Raqqa and Hassakeh. In addition to providing medical care, we carry out water and sanitation activities and distribute relief items.

 

Tal Abyad hospital, Raqqa and Ain Isa refugeecamp

Destroyed Health System

Syria’s once fully-functional healthcare system has been devastated as hundreds of medical facilities have been bombed, and medical staff have fled or been killed. Preventable diseases have made a resurgence as common needs go unaddressed. Syrian health staff have been forced to improvise operating theatres and work in deplorable conditions, overwhelmed by the emergencies they face.  

Basic essentials such as medical supplies are restricted amid intense bombing and shelling. Unable to enter these areas, we remotely support medical facilities in besieged areas as necessary.

The consequences of interrupted treatment for chronic diseases such as high blood pressure or diabetes can lead to serious complications. Mobile clinics have increasingly become a central part of our response, to provide preventative care and basic treatment to besieged districts as well as camps in surrounding areas. Since no regular vaccinations have been administered in some areas (such as Aleppo) since 2014, MSF launched a large-scale vaccination campaign.

The bulk of our activity in Syria focuses on the health needs of people with common illnesses, pregnant women, and improving vaccination coverage to prevent childhood diseases.

 

Find out more about Syria