Smoke billows over shelled and destroyed buildings in the Saif al Dawle district of Aleppo. 2nd October 2012.

March 2016 will mark the start of the sixth year of conflict in Syria, and the humanitarian and medical toll of the violence remains appalling.

Millions of people are on the run, displaced in their own country, or seeking refuge abroad. Millions more are trapped in communities that are under siege or hemmed in by the closed borders of neighbouring countries, already overwhelmed by the numbers of Syrians seeking protection and increasingly restricting access to new arrivals.

Meanwhile the level of violence inside the country shows no signs of diminishing, in some regions even increasing. Death and injury remain a daily reality.

The following was reported to us by a doctor in a suburb of Damascus, Syria.

"I graduated in 1995 and opened up a clinic on October 10th, 1995. In 2001, I became specialized in urology. There were around 40,000 residents in the area before ‘the events’ [Syrian uprising 2011]. Now, the population here, including the displaced, is currently around 15,000 individuals.

I work in mainly two clinics. One experienced numerous strikes, and it was closed down and we transferred to the second makeshift clinic, which was also hit a lot. The last strike against this second clinic was in September 28, 2015. Four people were killed, including a friend of mine who was the director. It was very violent, that strike.

We have rebuilt the clinic as we usually do. We’re still lacking the physiotherapy room and the out-patient department is currently just a big room divided between genders, yet the clinic still provides all types of medical services, starting from emergencies, out-patient rooms, surgeries, laboratories, to x-rays, physiotherapy. It is an essential clinic for the Ghouta area.

Patients are afraid to come because of the strikes. They always tell me not to take them to the clinics; they would rather go to centres (smaller health posts) because clinics and hospitals in the area are more likely to be targeted.

Information about MSF-supported facilities in the Damascus region of Syria

One of the patients might be a family member

You see all types of casualties. Just today, as patients were coming in, they were telling me how much I’ve grown in these times; I responded that this is because of the injuries I’ve seen. Because you see patients who lost a leg, their head’s decapitated, their hand cut off.

In the future, the doctors in areas like Ghouta will be considered the most famous in the world because of the extraordinary things they had to do. Because of the limited number of doctors in East Ghouta, and especially in any of the besieged areas, any doctor remaining is forced to play multiple roles. I am a urologist and a gynecologist, I’ve done more than 200 C-section surgeries, I’ve done general surgeries, and I’m a pediatrician. I have to do everything.

The hardest moment we face is the fact that when patients are brought in, you have this strange sensation that one of the patients might be a family member. More than that, you see a patient, who you’ve only spoken to five or 10 minutes earlier, brought in without a face or head. This is truly the hardest moment for me.

Map of Syria

The worst of times

It is a bit better today, but the years of 2013-2015 were the worst of times. The situation regarding resources has been improving for the last four months because of the easing of the blockade and aid arrived around 10 days ago with about 53 kilos of goods allocated for each family – the breakdown is like so: 15 kilo flour, 10 kilo rice, four kilo burghul, five kilo sugar, six kilo chickpeas, and a kilo of spaghetti. There were also some medical supplies. This was brought in by the Syrian Red Crescent.

Before this convoy a kilo of sugar was 1,000 Syrian pounds (£3.7). A kilo of bread reached up to 1,000 – 1,200 Syrian pounds (£3.70 – £4.50). Now, bread, for example, is priced at 300-350 Syrian pounds (£1.10 – £1.30). There’s food, there’s fruit! Fruit! Last year, I remember, I had bought four oranges for 3,000 Syrian pounds (£11.11) for my children.

There are still limited medical supplies, but not as bad as before. You can say that we’ve currently reserved about 50-60 percent of our needed medical supplies. Two years ago, in comparison, medicine was 2,000 – 2,500 Syrian pounds, (£7.40 – £9.25) now it is 900 Syrian pounds (£3.33).

Double-tap airstrikes

They simply want to violence to stop

Yet in the context of this war, it is still very bad. There are always planes, always injuries, casualties, dead.

Everyone is fatigued with the fear and deaths. People all wanted freedoms, wanted the revolution to persist, but now they have reached a point where they simply want the violence to stop. Everyday someone says goodbye to their relative.

Every day there was fear. I was one of the few people who would go out in my car to other areas to work in makeshift clinics. Every time I go out, I would pray because I’m not sure I’ll return to my children. Yet for the past five to six days now, I’m not afraid to go out. This is the first time, in three years, that I feel safe and unafraid from a strike.

Still, we hear the sounds of gunfire. Nearby, there are battles raging and getting closer. The cessation of violence actually does not exist, but it did decrease violence.

You can say the level of violence is around 15 to 20 percent from what it was. People are still afraid of what will happen after the cessation of violence ends, especially given that a day before the cessation of violence came into effect, we had around 50 strikes onto Ghouta. It was as if the people bombing us wanted to say a brief goodbye. We are worried that once the cessation ends, the response is going to be harsh.

Find out more about MSF's work in Syria

Mass casualty events

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