The Syrian conflict that began in 2011 has created the biggest displacement crisis since the Second World War, and millions of people are in desperate need of lifesaving humanitarian aid.
MSF in Syria 2015
Some 4.3 million people have fled the country and an estimated 6.6 million have been internally displaced as government troops, opposition forces and insurgent groups battle for power and control of territory.
The complex war has been characterised by extreme violence: civilian areas have been routinely bombed – often in ‘double-tap‘ attacks in which the initial strike is followed by a second on rescue teams or on the healthcare facility receiving the wounded; and there have been attacks resulting in symptoms of exposure to chemical agents.
At least 1.5 million people are still trapped in besieged areas without access to humanitarian aid, healthcare or medical evacuation.
The Syrian government continues to deny repeated requests by Médecins Sans Frontières/Doctors Without Borders (MSF) to access government-controlled areas. In a country where we should be running some of our largest medical programmes, the opportunities to reach people and to respond in a timely manner to the enormous needs remains extremely limited.
This is a forceful reminder of how access to medical care is by and large not respected and is in many cases directly targeted by those involved in the conflict and used for political purposes.
Following the Islamic State (IS) group’s abduction and release of MSF staff in 2014, and the impossibility of obtaining the necessary guarantees from IS leadership that MSF patients and staff will not be taken or harmed, the difficult decision was taken to withdraw from IS-controlled areas.
MSF’s activities have consequently been limited to regions controlled by opposition forces, or restricted to cross‐frontline and cross‐border support to medical networks.
MSF's Al Salamah hospital in Azaz district in northern Syria includes an ER, an operating theatre,outpatient and inpatient services - including maternity care. It is the largest directly run MSF facility still inside Syria, managed by nearly 150 Syrian staff. Azaz district has seen new waves of displaced people arrive in recent months, and now an estimated 100,000 people are trapped in the area between shifting frontlines and the closed Turkish border. MSF teams travel out to displaced persons camps and surrounding areas to bring back patients, and MSF also provides distributions of emergency relief items. © Mahmoud Abdel-rahman/MSF #MSF #DoctorsWithoutBorders #Syria #Syrians #Hospital
A man who brought his sister to an MSF field hospital
“We heard the sound of explosions… I told my sister to move and find shelter, as it was close. She was behind me, about five metres. A bomb landed near her. She was covered in rubble. I shouted: “Are you hurt, sister?” She replied: “Yes, I am!” I ran towards her and saw that shrapnel had hit her face. Blood was coming out of her neck … We shouted for a car. Thankfully there was one nearby. We took her to the hospital, where they stopped the bleeding. Her situation is stable now.
If there were no hospital, she’d have died. We need medical care. In my sister’s case, she needs doctors, care, drugs. As you know, we have nothing here. We need support in medication, doctors, ambulances capable of transporting patients immediately, everything.”
An MSF-supported hospital director describes the horror of a mass-casualty influx in northwest Syria.
“The planes circled above us in the late afternoon and we waited. Would we become casualties? Would we become numbers?
“At around 3pm we heard a deafening sound as a result of three rockets exploding in a town nearby. A town overwhelmed, desperate locals living alongside many displaced people from other areas in Syria…
“There was blood everywhere, but we were running out of blood bags. Men and women donated their own blood to strangers.
“With the descent of night it became impossible to find people alive under the rubble. We will continue to find dead bodies in the next few days.
“As a medical team, the only choice we have is to replenish our supplies, gather our hopes, and prepare for the next tragedy.”
Hover over the image below for an interactive guide to MSF in Syria
MSF’s work in Syria: 2015
In 2015, MSF continued to operate six medical facilities in different locations across northern Syria and saw an increase in the number of people with medical complications caused by delayed medical care, and in infections and deaths due to shortages of antibiotics.
MSF also increased its support programme to around 70 healthcare facilities run by Syrian doctors, with a particular focus on besieged areas. MSF provides technical advice, medical supplies, salaries and fuel, and helps rebuild damaged buildings. MSF also gives ad hoc support such as medical donations to around 80 other medical facilities in emergency situations, for example massive influxes of casualties. No MSF staff are present in these supported facilities.
During 2015, 23 MSF-supported Syrian health staff were killed and 58 wounded. Furthermore, 63 MSF-supported hospitals and clinics were bombed or shelled on 94 separate occasions in 2015; 12 of these facilities were completely destroyed.
The situation deteriorated significantly in Aleppo city in 2015, with targeted attacks on civilian infrastructure such as markets, water supplies and health facilities throughout the year. The intensification of the conflict in Hama and Idlib forced thousands of families to flee to Aleppo governorate.
MSF staff at the 28-bed MSF-run hospital in Azaz district conducted over 32,500 outpatient and 17,000 emergency consultations, and performed 1,200 surgical interventions. The teams also saw 6,000 patients for antenatal, postnatal and family planning consultations and delivered 409 babies.
MSF received reports of attacks on nine health facilities around Aleppo in May, including six hospitals – one was the MSF-supported al Sakhour hospital in Aleppo city, which was forced to suspend activities after being bombed at least twice on consecutive days.
In June, MSF had to close its field hospital in Maskan due to ongoing insecurity – the hospital had performed 5,834 outpatient and 2,495 emergency consultations, and assisted 51 deliveries.
Fighting between armed groups intensified in north east Syria in 2015. MSF worked in a maternity hospital in the area, where 1,559 births were assisted, including 393 caesarean sections. Regular medical equipment and supplies were also donated
MSF continued to run the Atmeh burns unit in Idlib, where over 6,800 medical consultations and 5,500 surgical interventions were conducted, and 3,100 patients were enrolled for mental health services. More than 7,000 children were vaccinated against measles and over 3,500 newborns against hepatitis B.
Besieged areas in Homs and Damascus governorates
More than a million people in opposition-controlled neighbourhoods have been under military siege in Damascus and Homs governorates, plus several hundreds of thousands more in Deir ez-Zor and other areas where MSF has not been able to organise support activities.
On average, more than 300,000 patient consultations were carried out per month in MSF-supported health facilities in besieged areas.
MSF provided medical donations, relief items and technical support to six hospitals and health posts across Dara’a governorate, helping Syrian medical networks undertake 118,000 outpatient consultations, admit 5,800 patients for care and assist more than 2,000 deliveries.
These hospitals also treated more than 8,000 victims of violence.
Documentation of the war-wounded
A report compiled by MSF and released in early 2016 showed that 154,647 war-wounded patients were received in 2015 in MSF-supported hospitals and clinics in north west, west and central Syria (Aleppo, Homs, Hama, Idlib, Lattakia and Damascus governorates), and 7,009 war-dead were documented.
Women and children accounted for 30 to 40 per cent of the victims. In 10 documented mass-casualty influxes, such as after the bombings of schools or playgrounds, between 60 and 90 per cent of the victims were women and children.
Find out more in our 2014 International Activity Report.
At the end of 2015, MSF had 494 staff working in Syria. MSF first began working in the country in 1999.