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Despair and displacement in wintry northwest Syria
Since December 2019, more than 300,000 people have been forced to flee amid escalating violence
Intense military offensives by the Government of Syria and its allies in southern Idlib, involving shelling, aerial bombing and ground offensives, have resulted in a massive new movement of people trying to escape the war zone.
The northern part of Idlib, near the Turkish border, already hosted around 1.5 million vulnerable people.
According to the UN, another 300,000 people, mostly from southern Idlib, have fled their homes since 1 December 2019.
"They say the planes bomb when the skies are clear, so they prefer days that are cold, cloudy and rainy. The weather forecast for the next few days is sunny..."
They are frightened, uprooted and vulnerable. Overcrowding, limited shelter options, cold winter temperatures in the mountains and an aid response that is being pushed to its limits mean their situation is particularly difficult.
“We hear some disturbing things when out on our mobile clinics,” explains one of the MSF logistics managers.
“Despite the winter temperatures, people tell us that they fear the sun; they consider it a bad sign. They say the planes bomb when the skies are clear, so they prefer days that are cold, cloudy and rainy. The weather forecast for the next few days is sunny...”
Health system under strain
As the violence has escalated, several hospitals have been bombed and put out of service. This includes Maarat al Numan hospital, the largest in the southern Idlib area.
Other facilities were evacuated as the hostilities drew closer. Health services further north are overwhelmed and MSF has donated medical supplies to several hospitals to support their increased activities.
As wave after wave of new families have arrived, MSF mobile clinic teams have expanded their activities to include the distribution of blankets, locally-made heating fuel blocks, and other winter necessities.
A water engineering team is digging latrines in areas, where there are concentrations of newly-arrived families, as well as increasing the quantities of drinkable water being provided.
Camp conditions "dire"
Our teams providing medical care in Deir Hassan camp, in Ad Dana district, saw displaced people arriving throughout the offensive.
“They say the journey was very difficult,” says Ahmed, an MSF nurse.
“They left everything and escaped when some volunteers found a vehicle for them. Some other families left at night but people didn’t use car lights so accidents happened on the roads.”
Deir Hassan camp consists of several makeshift settlements where more than 11,000 people arrived over the last three weeks.
These newly displaced people received only a small emergency food kit with canned food, but no shelter or heating devices.
A mother-of-four explained that her family, together with another family of six, pooled all the money they had to buy a tent because they could not leave their children without shelter in such cold weather.
Some families share tents with relatives but these quickly become very crowded. Overall, the conditions remain dire.
In response to the rapid increase in numbers at Deir Hassan camp, MSF is running a second mobile clinic to provide primary healthcare.
Sadness and despair
Earlier this week, MSF distributed winter relief supplies to 52 families who had arrived in the district of Harem, a mountainous area of northern Idlib, from a camp closer to the frontlines.
For some of the families, this was the third or fourth time they had been forced to flee for their lives.
"With more than a million displaced people already in the area, the lack of shelter and near-total reliance on assistance are critical issues"
“With more than a million displaced people already in the area, the lack of shelter and near-total reliance on assistance are critical issues,” says Cristian Reynders, MSF project coordinator for northern Idlib.
“Sometimes there is no space available for newly arrived families in official camps, and in other camps, people are asked to bring their own tent or shelter. There are organisations working to resolve this but for the moment it is a big issue.
“On top of that, there are very few opportunities to earn and price inflation in the food markets is high, so people get into debt with no hope of repayment and over time become entirely reliant on assistance.”
“There is a lot of sadness and despair in these camps,” continues the MSF logistics manager.
“I spoke to a man waiting in turn for a distribution (of aid) and asked him about his hopes, his plans. His voice was breaking as he told me his greatest wish is that this will be the last time he and his family need to flee. What can you say in reply to that?”
What MSF is doing to help
In the northern part of Idlib governorate, MSF runs four mobile clinics that visit more than 15 camps and informal settlements.
Our medics perform about 4,500 consultations a month and half their patients are children under 15-years-old.
The most frequent medical complaints are respiratory infections, while the major concern among newly-arrived patients is psychological trauma.
There are also many patients needing hospital referrals for complex needs such as war wounds that have become infected or chronic diseases that have been left untreated.
Trapped between war zones
The Turkish border is closed to Syrians except for hospital referrals for some critical emergency medical cases.
The frontlines of the Syrian government offensive are moving steadily and violently north towards the two main motorways that run east to west and north to south through Idlib.
This is pushing communities of displaced people into an ever-shrinking area as the previous offensive, conducted between April and August by the Syrian army and its allies, resulted in massive displacements.
There are many organisations working to help in northern Idlib, but the huge numbers of displaced people are stretching the current response to its limits.
The need for emergency assistance in Idlib remains as high as ever.