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Health Sector Syria - Health Sector Bulletin - December 2024

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SITUATION OVERVIEW

On the early hours of 27 November 2024, a large-scale offensive code-named “Operation Deterrence of Aggression” was launched by Hay’at Tahrir al-Sham or HTS and allied non-state armed groups, from northwest Syria (NWS) against the areas controlled by the government forces in Aleppo, Hama, Idleb governorates. On 8 December 2024 the government of President Bashar Al-Assad was overthrown. A new “caretaker authority” resumed power in the country until the next steps of the government transition.

Since early morning November 27, the overall situation did evolve rapidly with no preliminary developed scenarios or contingency plans to predict it. The expansion of the military offensive since November 29 onwards clearly indicated a direct and indirect impact on health service availability, accessibility and functionality. The number of health facilities affected directly and indirectly was increasing continuously.

As of early morning November 27, 2024, NSAGs/HTS allied factions, launched a significant and coordinated offensive against the GoS positions in western rural Aleppo. The offensive campaign reportedly resulted in the NSAGs capturing more than 30 towns and villages advancing close to Aleppo city. The military activities continued for the next 72 hours. All earlier plans in place on 27-28 November to host displaced people from western rural Aleppo in Aleppo city, including shelters, become irrelevant. Same for all previously contingency plans. Control over Aleppo city put the highest levels of risks on the whole humanitarian operation in and from within Aleppo city. The impact and dimensions were very challenging to estimate. The airport was closed. The situation led to the displacement of thousands of people within the NWS, towards NES, central part of Syria, coastal areas,

The casualties’ figures were unconfirmed and varied widely across media with no official statement by government officials but believed to number in the hundreds. Two key public hospitals in Aleppo city were full of patients, Aleppo University Hospital and Al Razi hospital. A severe lack of HR was initially reported on 30 November. Of concern was the situation around Ibn Khaldoun Mental Health hospital, with 261 patients. Immediate solutions were required to support continuity of care.

As the initial situation evolved around Aleppo governorate, there were not functional public hospitals and/or PHC centers in the affected areas of western rural Aleppo/Idleb. There were some 90 public health facilities in those areas. In Aleppo city which became under the control of NSAG there were 57 public health facilities and another 27 private health facilities. The majority of 27 private hospitals were closed in Aleppo city due to clashes and staff absence.

Immediate de-confliction related mapping of all public health facilities in Aleppo and Idleb rural as well as Aleppo city indicated that 200 public and private health facilities were in the areas of shifting lines of conflict. The health sector reviewed the operational status of all 30 health sector humanitarian organizations inside Aleppo city about suspending their operations from within the city. It was clear that all health sector humanitarian activities out of Aleppo had halted and put on stop. SARC Aleppo received guarantees of safety and security and maintains its operations in the city. Health warehouses were out of access.

At 1600h, 30 November, HTS declared full control of Idlib governorate.

During 5-6 December 2024, following the takeover of Aleppo city, the NSAG forces took control of Hama and Homs governorates and began to move towards Damascus and coastal areas. At the same time the NSAG groups began to advance from the southern governorates to Damascus. In NES, the SDF forces moved against the areas traditionally under the GoS control in Raqqa, Aleppo and Deir-ez-Zoir governorates and gained control of those areas.

All steps and actions by the health sector earlier put in place for Aleppo were replicated for Homs and Hama governorates for the scenario of the necessity of continuity of care.

On 8 December 2024, the HTS and allied NSAG forces entered Damascus city. Civilians and Infrastructure – were not a target. The goal – change of country’ leadership. The situation was evaluated continuously. More information was required on new governance structures and modalities. It was expected that the health governance structure would remain in place. Key public health facilities remained functional in Damascus, while some services being disrupted. Many of the staff stayed back at home. Transportation of patients and staff was a challenge. More information is needed on functionality of private hospitals and labs. Initially multiple health risks were very high and being evaluated based on temporary disruption of essential health services. Sporadic gunfire at multiple locations led to avoidable casualties. The situation as evolved excluded significant clashes in urban areas around and in Damascus. No damage to infrastructure was reported but numerous cases of looting and vandalism. The operational contacts were in place with the key MoH departments and units. All incoming UN missions were suspended as well with placing the reduced operational footprint of UN international staff in Damascus and other hubs with core critical international staff remaining inside Syria.

Developments in the country after 8 December illustrated:

  • Escalation in Deir-ez-Zoir: SDF force advance. High degree of violence.
  • Displacement in different directions: Lattakia/Tartous, Homs, Hama, Damascus/Rural Damascus, 3 NES governorates, from within and outside of Idleb and Aleppo. Expect displaced people to return to Homs, Hama and other locations.
  • The situation in the coastal area was being monitored and assessed closely.
  • Deir-ez-Zoir and Qamishli/Tabqa/Raqqa – Influx within absorptive capacity of present operational partners. New situation around Menbij.
  • Attacks on health or militarization of facilities – throughout the situation since 27 November. Key advocacy messages were in place.
  • Casualties – not known and/or released.
  • Borders remained closed: Jordan, Lebanon. Airports – closed. The supply chain system was temporary suspended.
  • Initially widespread looting, thefts, and insecurity were widely reported. HTS has established a presence in those areas and vowed to protect civilian and public properties.
  • An increase in crime related incidents (theft, looting, kidnapping, robbery, burglary, vandalism, arson, …. etc.), order control units arrived to Damascus where we witnessed indicators of improvement (decrease in celebratory shooting, checkpoints in critical roads. HTS deployed their units to critical governmental facilities, and according to their control and command center the reports of looting have decreased.
  • Watching closely the situation around Tishreen Dam as any damage will impact the areas around.
  • At the same time, during 8 – 11 December 2024 Israel IDF forces began a high scale military operation against all military installations related to former Government of Syria Ministry of Defense. This led to attacks in highly dense urban areas. Urban locations of these facilities have direct and indirect impact on health service delivery.

The “Syrian Transitional Government”, “caretaker authority” was formed. Mr. Mohammed Al-Bashir has been appointed as a new Interim Prime Minister. The appointment of Dr. Maher Hussein Al-Sharaa as the Minister of Health of Syria.

The Humanitarian Action Coordination (HAC) Office - The responsible body for following on the humanitarian intervention from the caretaker authorities within the transitional phase. The HAC will coordinate with the humanitarian community, including L/NNGOs, INGOs, and UN. Already-started projects/ activities are to be continued. New projects including the ones with pending approvals are advised to remain on hold until the related procedures are clarified.

WHO Syria appeal: WHO EMRO | WHO urgent flash appeal for the health emergency response in Syria: US$ 56.4 million for critical needs on multiple fronts | News | Syria site

The outcomes of the IASC Principals ad hoc meeting that took place on 10 December:

  • Activate the IASC Scale-up Protocol for Syria, unlocking agency surge and discretionary funds to boost capacity. [IASC Emergency Directors Group (EDG) being currently consulted].
  • Support a unified coordination structure led by OCHA and deploy senior coordination staff. [OCHA]
  • Amplify advocacy in the region and with all parties to secure access and ensure the safety and security of humanitarian staff. [IASC Principals]
  • Support UNHCR's advocacy to Member States to maintain protections for Syrian asylum seekers and refugees. [IASC Principals]
  • Work with de facto authorities to streamline registration for NGO partners. [Resident Coordinator / Humanitarian Coordinator for Syria]

Dr Hazem Bakleh is appointed as a new SARC President.

On 21 December, SARC and TRC/Turkish Red Crescent signed a cooperation agreement.

RC/HC Syria conducted a donor briefing on the situation in the country in Damascus on 17 December.

The briefing delivered to the Security Council by Mr Tom Fletcher, the Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator, on the humanitarian situation in Syria on 17 December.

18 December, Security Council Press Statement on Situation in Syria.

Secretary-General’s Statement on Syria

Key UN health agencies in Hassakeh conducted an initial coordination meeting with the health authorities of Hassakeh governorate on 18 December.

The Minister of Health of Syria conducted a meeting with a number of NGOs from NWS in Damascus on 17 December. The meeting was well covered in Syria social media. Please check the relevant web sites for key messages.

a.i. WHO Syria Country Representative, Christina Bethke conducted a meeting with the Minister of Health of Syria on 18 December in Damascus.

The Minister of Health of Syria conducted a meeting with a number of NGOs from NWS in Damascus on 23 December.

The Minister of Health of Syria conducted a meeting with DGs, DoH Syria in Damascus on 23 December.

The Minister of Health of Syria conducted a meeting with the representatives of pharma industry in NWS in Damascus on 24 December.

Remarks by Cristina Bethke, WHO Acting Representative to Syria at the UN Press Briefing in Geneva

20 December 2024 - I’m speaking to you from Damascus at a moment of profound significance in Syria’s history. The resilience of the Syrian people is on full display, as is their hope for the future. Over the past 12 days or so, I’ve witnessed both the joy of reunions and returns, as well as the concerns about the uncertainty of what lies ahead.

In the midst of these challenges, WHO remains steadfast—not just in delivering life-saving aid and ensuring healthcare reaches those who need it most, but also in helping Syrians rebuild their lives and recover from years of crisis.

Just yesterday, WHO teams were in Idlib, visiting hospitals that have become lifelines during the recent escalation of conflict. They met with dedicated surgeons who have worked tirelessly, often under attack, to save lives. One surgeon shared with us the words of a patient who walked through their doors: “We finally sleep at night, no longer worrying about being bombarded.”

Our team also met Ahmed, a 64-year-old man who relies on kidney dialysis. Over the past decade, he has been displaced multiple times and has faced enormous uncertainty to access his treatment. Thanks to Bab Al-Hawa Hospital in Idlib, which is supported by WHO, Ahmed has been able to maintain his care. Yet, the funding for this essential service will run out in three months. Ahmed is deeply hopeful, not just for himself but for all Syrians, dreaming of a future where no one has to endure the uncertainty he has lived through.

It is this fragile hope that keeps them going, even as they endure tremendous hardships—sleeping in tents through the bitter cold of winter and the scorching heat of summer. In these conditions, displaced populations, especially those living in camps or informal settlements, are extremely vulnerable. Overcrowded living conditions, food insecurity, and inadequate sanitation are perfect breeding grounds for nutritional deficiencies, respiratory infections and other communicable diseases such as diarrheal disease, as well as lice and scabies, which can lead to long-term health complications.

Many people the team met in Idlib have returned to visit their homes since December 8th, only to find them reduced to rubble. These individuals, displaced multiple times or having returned from Lebanon and Turkey, need support to rebuild their lives. Rebuilding homes is just one part of the solution; they also need access to healthcare and essential services to feel secure and to lay the foundations for recovery.

And in a nation reeling from over a decade of conflict and displacement, mental health and psychosocial services are not just critical—they are lifesaving for families. Our team met Fatima whose two daughters, aged 6 and 10 years, have suffered from sleepless nights, recurring nightmares, and anxiety. Over the past three weeks, they have benefited from psychosocial support services, giving them a sense of stability and hope. But this support must continue. The reality is, even in this historic moment, the humanitarian need remain immense and immediate.

Syria is grappling with one of the largest displacement crises in the world, with 7.4 million people internally displaced before this recent escalation. Over 880,000 have been displaced since then. Among them, 6% are individuals with disabilities who face severe barriers to accessing care.

The health infrastructure is severely strained. In just three weeks, 36 attacks on healthcare have been reported and over half of the country’s hospitals are non-functional.

WHO has launched an appeal to raise $56.4 million to meet these urgent needs over the next six months. This funding will sustain critical health services during this transitional period – including 141 health facilities in northwest Syria at risk of closure in the coming weeks – and support Syria’s long road to recovery.

WHO is doing everything possible to bridge this gap. Our teams are:

  • Facilitating access to healthcare for displaced populations and returnees through referrals to functional facilities and mobile clinics providing basic care, vaccinations, and maternal health services.
  • Integrating mental health support into healthcare facilities, particularly for those affected by trauma.
  • Coordinating referrals between non-functional and operational health facilities and ensuring the safe transportation of patients to specialized hospitals for critical care.

But we cannot do this alone.

  • The resilience of the Syrian people is inspiring, but without immediate international support, their hopes for a peaceful and healthy future are at risk.
  • Everyone my team and I speak to here is hopeful—hopeful for their children, for their homes, and a Syria rebuilt on peace and solidarity. We must help them realize this dream.
  • We call on the international community to act now—your swift action can save lives, restore hope, and help rebuild a nation yearning for stability and peace.

Thank you.