More than nine years of conflict have caused unfathomable human suffering in northwest Syria.
Between April 2019 and March 2020, 4 million innocent civilians in Idlib, including 2 million children, were subjected to a relentless bombing campaign, which killed 1,000 people and injured at least 5,000. As a result of the bombing campaign, nearly 1 million Syrians were forced to flee their homes in the span of just three months, further worsening an already dire situation, where 70% of people are in need of humanitarian aid and thousands continue to live outdoor in makeshift housing.Families and children are now facing a grave humanitarian crisis in northwest Syria, as they struggle to access food, water, shelter, sanitation and medical care. Without proper food, housing and sanitation, individuals are extremely vulnerable to illness and disease, including a possible COVID-19 outbreak.In the midst of all these challenges, the first case of COVID-19 in northwest Syria was confirmed on July 9, 2020. As more COVID-19 cases emerge, SAMS medical facilities are taking all necessary precautions to protect staff and patients. In addition to the newly-established SAMS COVID-19 Care Center in Idlib, SAMS has turned both Al-Amal Hospital in Darat Izzat and Salqin Hospital in rural Idlib into specialized COVID-19 care centers. In June, SAMS launched the only hospital in Idlib city specifically designated to treat and isolate suspected cases of COVID-19. We also opened two new facilities in northern Syria: Ali Bajliyah Medical Center, an internal medicine clinic, and a chronic illness treatment center, while also enlarging our hospital in Afrin and expanding our cancer treatment services in Idlib.In light of the pandemic and the ongoing economic turmoil, SAMS also launched the "One Million Loaves" campaign to distribute loaves of bread to vulnerable individuals in northwest Syria. In partnership with the Violet organization, SAMS has already distributed more than 290,000 bundles of bread to those in need. As health needs continue to grow, SAMS heroic medical personnel are working around the clock, delivering an average of 150,000 services per month, free of charge to those in need. In northwest Syria, SAMS supports 12 major hospitals, 13 primary health care centers, 2 mobile clinics, 2 midwifery institutes, a tuberculosis center and a specialized mental health center, and an ambulance system. “When WHO characterized COVID-19 as a global pandemic, SAMS immediately took the necessary precautionary measures such as monitoring and screening all patients and visitors who come to our facilities. For suspected cases, samples are taken for analysis, and individuals are quarantined until the results of the test come back clear,” explained Dr. Jalal Saud, an infection control specialist at the hospital.Tragically, northwest Syria is one of the most at-risk areas for a large-scale COVID-19 epidemic due to its already overburdened and crippled healthcare system and the enormous influx of internally displaced people. In the face of this health emergency, SAMS has launched a robust mechanism to prepare and respond promptly to protect its patients and medical workers in northwest Syria and neighboring countries.At SAMS medical facilities in northwest Syria, we have expanded our infection control measures, community education and staff training, and protocol to address this health emergency. We are coordinating with the Health Cluster, WHO and Early Warning, Alert, and Response Network (EWARN) to mobilize a robust plan of action in the event of a COVID-19 outbreak in the area.As the threat of a COVID-19 outbreak in northwest Syria continues, SAMS medical personnel are working tirelessly to serve every patient in need. To reach an additional 3,000 patients per month, in May, we established the Ali Bajliyah Medical Center in northern Syria, which operates a number of clinics, including pediatric, OBGYN, internal medicine, and dental, as well as a pharmacy and a lab. We also launched an internal medicine clinic at SAMS-supported Ma'arat Al-Masrin Hospital to care for patients with chronic diseases. The treatment of chronic disease is among the urgent health needs of displaced Syrians. On April 14, 2020, SAMS launched a Chronic Illness Treatment Center at Idlib Central Hospital to diagnose and treat chronic diseases, including hypertension, diabetes, cardiovascular and chronic respiratory illnesses, asthma, and hypothyroidism. Additionally, the center provides medical consultations for patients with chronic conditions in need of surgery.
“The need for this clinic is of utmost importance given the large number of displaced patients with chronic illnesses in need of regular follow up and care. In addition to alleviating their suffering, we provide their medications, all free of charge,” said Dr. Mohammad Ismael, an internal pathologist working at Idlib Central.“I’ve suffered from persistent dizziness and vertigo since I was 10 years old, and I’ve also been coughing up phlegm and sometimes blood for a long time. I’m now visiting this clinic for routine check-ups and treatment to manage my condition. I’m extremely grateful,” Juma’a, a 60-year-old patient at our clinic.
In light of the COVID-19 pandemic and in an effort to prevent and contain the spread of the disease, this clinic has taken all necessary precautionary measures, including providing awareness sessions and sensitizing patients on best practices to help with mitigation, as they are at much higher risk of infection than the general population and are the most vulnerable.
More than 10 month of attacks on northwest Syria have devastated the civilian population. On March 5th, airstrikes over rural Idlib caused unfathomable human tragedy. At least 16 adults and children lost their lives in the attacks and others may still be trapped under the rubble of collapsed buildings. As the wounded civilians streamed in after the airstrikes, SAMS medical personnel at Ma’arat Masrin Hospital responded heroically, providing emergency care for 28 survivors.After civilians were attacked on March 3, medical staff at SAMS-supported Ma’arat al-Masrin Hospital and Idlib Central Hospital responded, treating the injured by performing surgeries, resuscitating patients, and providing diagnostic and other services. Idlib Central Hospital received fifteen wounded patients, including three children who were injured during the attacks.
SAMS Dr. Hikmat Al-Khateeb, an orthopedic surgeon at Ma’art Masrin hospital, stated: “One of the hardest moments was when we first started receiving the injured and had to triage each case within a matter of seconds. I felt helpless when I saw a baby boy, no more than 13 days old, who had been killed in the attack. There was nothing we could do for him.”
“In that same instant,” the doctor continued, “a 16-year-old girl came to us with a traumatic vascular injury that had severed the arteries near her collarbone. We immediately took her to surgery with our vascular specialist. That quick action saved her life. After her condition stabilized, we placed her under medical supervision for recovery. It was an indescribable feeling when her parents found out that their daughter was alive.”
Nearly 4 million people, including 2 million children in northwest Syria have been subjected to an agonizing 10-month bombing campaign, which has killed and injured thousands of innocent civilians and forced almost 1 million Syrians to flee. Airstrikes, rocket attacks, heavy artillery barrage, and armored assaults occur nearly daily, except for brief periods of calm. Since April 2019, there have been at least 95 documented attacks on healthcare.On February 25th, SAMS-supported Idlib Central Hospital was directly targeted, injuring four health workers and causing major structural damage to the facility. On the same day, ten schools in Idlib were also attacked. At least 20 civilians died and 80 more were injured, tragically most of whom were children.
As injured children flowed into the hospital after the attacks, SAMS medical personnel worked intensely as they triaged each young patient, all the while subduing their sense of horror and grief. Abdul Monem, one of our staff members who responded after the attack, was petrified when he saw his 5-year-old daughter among the injured. He said, "After we were displaced from the city of Sarmin due to the recent escalation, my family and I sought refuge in Idlib City. I’ve been working here at the Central Hospital for the past 25 days non-nonstop, responding to the overflowing number of injured civilians. Today, I was surprised to see my 5-year-old daughter Naha among them. I was devastated to the point I fell unconscious."Despite the attack, SAMS’ Central Hospital kept its doors open, providing emergency care to the overflowing number of injured civilians as a result of the attacks on schools.The oncology department in Idlib Central Hospital is the only center providing cancer treatment in the area, and was severely damaged, leaving hundreds of vulnerable patients without access to lifesaving care. The hospital provides on average 11,500 services on a monthly basis.As the unfathomable conditions unfold around them, SAMS medical teams are working tirelessly to treat injured and displaced civilians, relocating and resupplying damaged medical facilities and traveling to IDP camps to treat those in need. SAMS is also working with partners to deliver humanitarian aid, including blankets, heaters, heating fuel, hygiene kits and diapers.
On February 17, direct aerial bombardment caused severe material damages to Al Ferdous Hospital and Kinana Hospital, forcing staff to suspend operations and evacuate patients to other medical facilities. The SAMS-supported dialysis center at Al Ferdous Hospital was also forced to suspend operations following the attack, leaving many dialysis patients with no access to life-saving care.The attacks on civilians and civilian infrastructure have resulted in unfathomable human suffering. On February 11, SAMS-supported Al-Atareb Surgical Hospital received 23 injured patients, including a little girl and two patients that had died. On February 10, SAMS-supported Al-Atareb Surgical Hospital received 53 injured civilians, including women and children. Additionally, SAMS' Ma’arat Mesrin hospital received 16 injuries, including two children.
As the bombardment continues, civilians have no choice but to escape quickly, if they are to stay alive. Since December 1, nearly 948,000 innocent civilians have fled to the Turkish border, creating one of the most massive humanitarian crises since World War II. Civilians are seeking shelter in tents, bombed-out buildings or whatever shelter they can find just to survive the freezing temperatures. The majority of those fleeing are women and children, with an estimated 6,500 children arriving into the camps along the Turkish border each day. Harsh winter weather, disease, a lack of shelter, sanitation and medicine continue to threaten the innocent civilians impacted by this crisis.
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Here is what some of our medical personnel are saying about conditions in northwest Syria.
"The pain and sadness that I saw in my patients' eyes are indescribable. A pregnant woman, in particular, came in a state of unconsciousness and in labor. I learned that an airstrike had just killed her husband," said Dr. Ikram Haboosh, OGYN and director of SAMS' Maternity Hospital."I ran out of words. Most of my patients are recently displaced from Saraqib and Ma'arat al-Numan. Our hospital is overflowing, we have no beds, no rooms, and no personnel left to receive this huge number of patients. I felt powerless," she added.
The suffering of Idlib’s civilians is beyond unimaginable. Civilians continue to be subjected to ongoing bombardment and displacement, with nowhere else to go and fewer areas of safety to escape to. Humanitarian conditions in northwest Syria are worsening, as injured and traumatized civilians flee the violence, causing massive waves of displacement into makeshift camps along the Turkish border. The majority of those fleeing are women and children, with some estimating that 6,500 children are entering the camps each day.As the magnitude of this crisis increases, our selfless medical personnel are committed now more than ever to delivering dignified medical care to every patient in need. SAMS President Dr. Mufaddal Hamadeh recently visited 7 SAMS-supported medical facilities in northwestern Syria: Idlib Central Hospital, Avicenna Specialty Hospital, Idlib Maternity Hospital, Al-Atareb Surgical Hospital, Al-Atareb Maternity and Childhood Hospital, and Qah Maternity.
“I met with our tireless medical staff, who are working diligently to provide medical services to patients in need and to alleviate their suffering. It was an opportunity for me to hear about the current medical situation as a result of the ongoing escalation. At SAMS we always strive to address the needs of our staff and beneficiaries alike and will continue as best we can to support their invaluable work,” said Dr. Hamadeh, who is originally from Idlib. It’s been an emotional trip to go back after all these years to see his hometown and its residents live in austere conditions under continued bombing and in displacement.
The escalation in northwest Syria has taken a devastating toll on civilians. On January 15, northwest Syria came under heavy bombardment, killing at least 20 people and injuring over 65, many of who were children. SAMS medical personnel in Idlib treated over 40 injured civilians, including 15 children, many of whom were in critical condition."We received large numbers of injuries and most of them were severely injured. The hospital was overflowing, and we had to manage with what we had. We used the waiting room as an emergency room that was managed by nurses from Ma’arat Al-Numan Hospital- which recently stopped its operations due to heavy bombing,” said SAMS Dr. Abd al-Rahman.
Syrians who fled their homes continue to be deeply affected by the violence. 9-year-old Aisha was displaced along with her family from the rural village of Al-Fatira in southern Idlib, seeking safety and escaping from bombing. Aisha arrived at our medical facility, suffering from cyanosis, a pathological condition that is characterized by a bluish discoloration of the skin.“We visited the health center in Kourine, where they told us — after running some tests — that she had a deficiency of platelets in her blood. She was then transferred to the hospital, where she remained for 15 days before returning home,” said her mother.
As the bombardment continues, thousands of families are seeking shelter in make-shift camps along the Turkish border. Dr. Mustafa Obeidan, a SAMS mobile clinic physician, spoke with us about the illnesses people suffer from in the camps: “Infections of all sorts are widespread, with respiratory illnesses being particularly common, in addition to urinary infections resulting from unsanitary water. Children are often more vulnerable than others to catching these illnesses.”Mohammed, a resident of the settlement said: “All five of my children got sick. We went to the clinic, where the doctor examined them and gave them the medicine and care they needed.” He added: “We settled here only a short while ago, right around when the clinic was making its first visit. It came at the perfect time, too, as my children were ill and needed medical attention.”The mobile clinic’s staff worked diligently throughout their visit to al-Manhal settlement, providing as many services as they could. Mervet is a community health worker with the clinic. “We searched for cases of malnutrition among children and pregnant women in the settlement, and provided the appropriate medication and hygiene supplies for the children.”
Mobile clinics are among the most important medical facilities available in Syria, and people in need rely heavily on their capabilities. These mobile clinics are yet another way SAMS is striving to support unique approaches to serving the Syrian people — especially the displaced.
Since December 16, the aerial and artillery bombardment of civilian infrastructure in northwest Syria has intensified dramatically, endangering the lives of nearly 4 million innocent civilians As the military assault escalated, dozens of Syrians were killed and hundreds more were injured. So far in December, SAMS medical personnel have treated over 700 injured civilians, including many children. Salem, 26, lost three of her children and was severely injured in an attack on her hometown of Al-Bara. SAMS Dr. Abdullah Homaidi, director of the Al-Zerba Health Center and Salem’s brother-in-law said: “My brother’s house was targeted and hit directly by three back-to-back airstrikes. He and his wife Salem, injured in the attacks, lost their children: five-year-old Jenna, three-year-old Safaa, and one-and-a-half-year old Mohammed. Salem was in her first trimester when the attack happened and lost her unborn child. First responders worked for two hours to evacuate my brother and his wife from the devastated remains of the house. Both of them had sustained severe injuries all over their bodies. My brother was taken to one of the border hospitals for treatment to his spinal cord.”
Salem received the treatment she needed, however, her life has been forever changed. Tragically, losing her three young children and her unborn child as well has had an immense psychological distress on her and caused her irreparable damage. The ongoing escalation in northwestern Syria has torn families apart and made it impossible for them to continue to live normal lives after suffering such heartbreaking and unfathomable loss.
Due to intensity of the airstrikes, on December 23, SAMS was forced to suspend its operations in both major hospitals in the city of Ma’arat al-Numan, Al Salam Maternity Hospital and Al-M’ara National Hospital, and evacuate both the staff and patients. SAMS supports 34 medical facilities in northwest Syria, including 11 major hospitals, and ambulance system, 14 primary health care centers, four mobile clinics, a dialysis unit a rehabilitation center, two nursing schools, and a mental health & psychosocial support center.
"When the planes start flying near the hospital, we don’t know what to do. It’s our responsibility to protect the infants in the incubators and the children in the pediatric wing and take them down to the lower floors. At the same time, we also have to protect ourselves from getting hurt.” – Sabah Misto, a nurse working at SAMS-supported Al-Atareb Maternity & Pediatric Hospital.
As the attacks continue, tens of thousands have fled to safer areas near the Turkish border in a matter of days. According to reports from the United Nations, more than 235,000 civilians have been displaced between December 12 and 25, 2019. Displacement is exacerbating the vulnerability of those in acute need as winter approaches and aid deliveries are few and far in between. Many displaced individuals have fled with very few possessions and do not have adequate protection from the cold, nor access to food, clean water and sanitation.
The suffering of these vulnerable civilians is immense and inescapable with a long and dismal winter ahead. Mohammed, a resident of Al-Muthana camp, describes the hardships of daily life in the camp as winter sets in: “Because of the cold and muddy conditions, the majority of the people here are suffering from respiratory infections or neurological conditions.” Getting around the camp presents a huge problem. Every day, more than one person falls down.” Children often lose their shoes in the mud, further intensifying the freezing conditions and limited mobility.
Sabiha, a 43-year-old woman residing in the settlement, suffers from cancer, in addition to having lost her home and livelihood. “I need so many expensive medications,” she says. “We’ve been displaced several times at this point, which makes everything more difficult.”
Here is what SAMS is doing to address this crisis:
Establishing an emergency response mechanism to monitor events on the ground in northwestern Syria on a 24/7 basis.
Working around the clock to treat the influx of injured and displaced patients at medical facilities including Mobile Medical Clinics.
Procuring medications and medical supplies for healthcare facilities.
Reinforcing, resupplying and relocating medical facilities, as conditions permit.
Deploying Mobile Medical Clinics in strategic locations to serve waves of displaced populations.
Working closely with partners to provide humanitarian aid, including blankets, food baskets, hygiene kits, diapers, heaters and heating fuel to thousands of IDPs.
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