Hospitals in Idlib are overwhelmed, under-resourced and lacking in essential life-saving equipment and medicines to treat even basic illnesses such as flu and diarrhoea, warns Islamic Relief as the crisis in Syria enters its tenth year.
The conditions are so awful that aid workers from Islamic Relief fear that mass homelessness, chronic illnesses such as heart disease and diabetes as well as infections such as pneumonia combined with conflict related trauma injuries will bring the health system to its knees.
To make matters worse, fears are growing that the shattered health system would not be able to cope with a possible outbreak of the coronavirus and that hundreds of thousands of displaced people would be especially vulnerable to the disease.
Ahmed Mahmoud* Islamic Relief’s Syria Country Director, said: “The situation in Idlib is dire, people are exhausted, hungry and afraid. The health system has been shattered by the violence and mass displacement and it is already struggling to cope. We’re very concerned that if the coronavirus reaches Idlib this humanitarian catastrophe will only get worse.
“There are already mass shortages of beds, ventilators, medicine and proper equipment. People’s immune systems have been systematically worn down by the violence and years of malnutrition and poverty. With so many people crowded into squalid and unhygienic camps – the conditions are rife for an outbreak that we simply do not have the resources to handle.”
Eyewitness accounts from Islamic Relief aid workers, and supported doctors and nurses in Idlib paint a grim picture of the humanitarian suffering following intense and indiscriminate fighting that began in early December. Since then up to 1 million people have fled their homes, tens of thousands more endure miserable conditions out in the open and at least 500 civilians have been killed.
While the ceasefire in hostilities announced by Turkey and Russia in early March has brought a short-term reprieve for the millions of civilians caught in the Idlib conflict, Islamic Relief fears it won’t ease the humanitarian situation for the people on the ground – hundreds of thousands of whom are unable to return and are now trapped in a tiny parcel of land close to the Turkey border.
Islamic Relief has been told by its staff and partner agencies on the ground:
- More than 84 hospitals and medical facilities were damaged, destroyed or forced to close their doors due to violence or mass shortages of staff or supplies since 1 Dec, 2019
- This includes 18 hospitals and medical centres supported by Islamic Relief hit since 1 Dec
- Up to 90 percent of the remaining health centres in Idlib lack drugs to treat chronic diseases
- Violence as well as shortages of fuel and medicine delayed 106,000 medical outpatient consultations, led to 11,000 trauma patients not being seen and caused the suspension of 2,000 major surgeries during the month of Feb
- There is a very high level of miscarriages due to vitamin deficiency, nutritious food and parental care
- In one hospital, there have been 15 amputations in the past month as a result of shelling and landmines
- Patients with diabetes are having their limbs amputated because of infected wounds
- At one hospital patient numbers have rocketed from 5,000 to 9,000 per month
- Children flinch at motorbike engines, mistaking it for bombing, suggesting they might be suffering PTSD-like symptoms.
In one harrowing case, Mohammad, a male nurse working at an Islamic Relief hospital in Idlib said he was unaware that he was treating his own dying brother due to his injuries.
“The ugliest thing I have ever experienced, is when a badly-injured patient came in and because of the airstrike his face was covered in dust and smoke. Only when I started providing first aid, did I realise it was my brother. I tried to remain calm and be professional to help him but shortly after he died. I was numb I didn’t know what to do, where to go,” he said in a video testimony filmed by Islamic Relief.
“Then a woman started screaming ‘for God’s sake please help us’ and I told myself I will have to mourn my brother later.”
Ahmed Mahmoud,* Islamic Relief’s Syria Country Director said: “The civilian population in Idlib – as well as medical and aid workers – have been systematically terrorised and have found themselves pummelled constantly since December.
“The recent ceasefire cannot reverse the critical damage done over the last nine years – it just risks sweeping the crisis under the carpet and allowing people to forget about Syria once again, even though the needs are huge and growing.”
“We’re seeing women and children waiting outside in the cold outside hospitals as people struggle to cope. In some places patient numbers have tripled in a month. The system has been brought to the very brink of collapse.”
Health facilities targeted and bombed
Dr Ishan, a cardiologist working at a major hospital in Idlib supported by Islamic Relief, said that the recent attacks have made many people too scared to access medical care.
“The hospital has been attacked several times. Earlier this month, several bombs exploded about 30 metres from the hospital, which broke the windows and doors. I believe the hospital was targeted as the bombs exploded so close to the hospital and in quick succession. Some patients with acute coronary syndrome were too scared to come to hospitals as they are being targeted.”
Islamic Relief is one of the biggest providers of medical assistance in Idlib, offering support to 80 health facilities, paying the salaries of more than 150 medical staff and operating four Emergency Mobile Health Units, a fleet of trucks that have been converted to surgical operating rooms that are in high demand whenever bombs start to fly.
But the support is simply not enough, and Dr Ishan warns that more people will die needlessly unless the situation changes. “We get lots of heads injuries, but we don’t have a CT scan or a neurological surgeon. As a cardiologist it’s hard as a lot of the cardiovascular equipment that I need is not available. We urgently need more assistance – the system is under unimaginable strain.
“Even infections such as pneumonia, flu and diarrhoea – deadly for the very young and old where living conditions are dire – often go untreated because of a lack of essential medicine.
“Recently a father came in with his young daughter who was suffering from hypothermia, but it was too late to save her, and she died. Living out in cold camps is killing people. I can’t even begin to describe how I felt when the girl died,” said Dr Ishan.
Mahmoud said: “In nine years, we’ve never seen this many displaced in so little time and the consequences of this are going to be felt for years to come. Families are now living in a rocky mountain area and ramshackle camps that are not fit for people. They are attaching plastic sheets to two rocks for shelter. Some are still sleeping in the open. They have nowhere to return to. They’re exhausted, scared and hungry and feel the world has abandoned them.
“There are so many illnesses that could have been avoided but people can’t afford food, let alone antibiotics. Our staff are seeing a big increase in the number of patients with diabetes who have had their limbs amputated. They don’t feel their wounds and they heal a lot slower or get infected and then have to be amputated.”
“The makeshift camps are filled with a truly alarming number of widows and children. They are grieving and emotionally exhausted by everything that’s happened. People are telling us on a daily basis that they cannot take any more – that all that is left is to wait for death.”
While Islamic Relief has long tried to provide mental health and psychosocial support, the devastation has forced operations to shift to provision of basic supplies such as food, water and shelter. In the current wave of displacement we have provided food to more than 220,000 people and tents and blankets, mattresses and plastic sheets to more than 10,000 people, but much more needs to be done. Last year, we reached more than two million people in the north-west although our teams forecast the needs will be even larger in 2020.
“Once dignified people, they’re fleeing for their lives, elderly men describe having to crawling on their hands and knees in the mud to make it to safety and leaving all they have ever known behind in fear. This is not living – this is a mass stay of execution for millions of people.
“What the people of Idlib need most is a permanent and enduring end to the war as well as access to sustained humanitarian assistance including food, water, shelter, medical care and education for the children.”
Islamic Relief is calling on the international community to:
- Ensure that the implementation of the truce agreement in Idlib, where two million adults and one million children live, is maintained and an end to current hostilities is reached
- Monitor the ceasefire conditions to avoid further displacement
- Ensure that the almost one million people forced to flee their homes in the last few months have adequate access to food, shelter, healthcare and education
- Urge all parties to the conflict to end the deliberate targeting of civilians
- Increase humanitarian funding for the crisis in Syria. The UN recently stated that it still needs $371 million to deal with the growing humanitarian crisis, with only $129 million of its requested $500 million for a revised plan committed to date.
Notes to Editor
Islamic Relief has worked in Syria since the onset of the crisis and in 2019 was a lifeline for over 2.3 million vulnerable people in the country. Spending more than £30 million on humanitarian programming in the country, our assistance includes:
- Providing tents, plastic sheets, blankets and mattresses to thousands of newly displaced families.
- Providing food, as well as supporting several bakeries, to ensure that people have food to eat.
- Providing seeds, tools, fertiliser, and livestock to support the income and the access to food for the affected population.
- Supporting over 80 health facilities. These include primary and secondary health centres, women’s and gynaecology hospitals, children’s hospitals, mobile emergency units and dialysis centres.
- Providing clean drinking water and vital sanitation facilities to combat the spread of disease.
- Repairing damaged schools and building temporary classrooms, mainly in IDP camps, as well as providing salaries and training for teachers and counselling and school equipment and clothing for school children.
Video footage and photos are available at the following links.
Syria Material 1: https://www.irdigital.org/?c=17324&k=eb1fddfd6a Password: syria1interviews
Syria Material 2: https://www.irdigital.org/?c=17327&k=e7681b2ea2 Password: syria2footage
Syria Material 3: https://www.irdigital.org/?c=17326&k=712f22d76c Password: syria3photos
For more information and interviews inside Syria, please contact:
Louise Orton, firstname.lastname@example.org or call +44 7939 141 764