Three years of extremely violent war have ripped apart towns, villages, hospitals, clinics – everything that Syrians relied on for their existence. Throughout the country, families that can are fleeing from one place of refuge to the next, each time with fewer belongings and more fear. The entire country is in a state of medical crisis, with the worst-affected areas experiencing extreme suffering. And the crisis extends beyond Syria to the surrounding countries where more than two million refugees are struggling to survive.

Gunshot wounds, bomb blasts and shrapnel injuries make for a long medical case list in Syria. But maternal health, vaccinations, burns, chronic diseases that turn deadly if medication is neglected – all these add to the waiting list of urgent requirements that are not being met. Millions of Syrians are reliant on the limited medical assistance that can be provided at makeshift facilities in basements and private houses.

Inside Syria

Since June 2012 MSF has been providing healthcare in parts of northern Syria where needs were identified and where it was possible to set up makeshift hospitals and clinics. To date the medical teams have provided more than 140,000 consultations, many of them for trauma wounds and life-threatening chronic diseases. Nearly 7,000 surgical procedures have been performed and more than 1,900 women have been assisted with safe deliveries.

But the war makes providing assistance extremely challenging. The intensity and volatility of the conflict is a huge obstacle to reaching the people in need. On the evening of 2 January 2014, while on assignment to provide medical care to Syrians suffering from the war, five staff members were taken from an MSF house in northern Syria. MSF continues to put all its efforts towards securing their safe return.

The hospital and the two clinics in the area of the incident are currently suspended. However, because the needs are so overwhelming, we continue to maintain medical activities in five makeshift hospitals and clinics in Syria. Our programme of supporting Syrian medical networks also continues. We are providing medical supplies and technical support to 50 hospitals and 80 health centres across seven governorates, covering opposition-controlled, government-controlled and contested areas. Because we are working in an intense war environment, we constantly reevaluate our projects and activities in the light of the security challenges.

MSF activities inside Syria (to end January 2014):

• ER consultations – 49,083
• Out-patient consultations – 94,389
• Surgical procedures – 6,895
• Maternity deliveries – 1,962
• Emergency measles vaccination campaign – 75,000 children (April to June 2013)

Syrian refugees

More than two million Syrian refugees are registered or awaiting registration in countries neighbouring Syria, but the actual number could be much higher. Compared to Syria, there is much better access and security in the surrounding countries, but the resources of these countries are stretched to the limit, and gaps in health services continue to expand while the needs of refugees show no signs of diminishing.

In Iraq there are more than 210,000 Syrian refugees. MSF is providing outpatient health services, mental health consultations and water and sanitation services in several locations for refugees in Iraq, notably in Domeez and Kawargosk camps, and also in transit and refugee camps located in Dohuk and Erbil governorates. On average, MSF teams provide around 3,000 consultations per week in Iraq.

In Jordan there are more than 575,000 Syrian refugees, the majority living outside the refugee camps. MSF’s project in Zaatari camp closed in 2013 as other organisations had the capacity to manage the health needs. Meanwhile an MSF assessment showed that needs for mother and child healthcare were a major concern for refugees living outside the refugee camps, particularly in Irbid governorate in the north of the country. In November 2013, MSF started a new programme providing maternal health, neonatology and paediatric services; by the end of January the team had provided 1,753 antenatal consultations and assisted 303 safe deliveries.

MSF’s emergency surgical project inside the Ministry of Health hospital in Ramtha, next to the Syrian border, continues to be extremely busy – more than 540 lifesaving surgeries have been provided for war-wounded patients coming from Syria. Often patients arrive with severe abdominal, chest and orthopaedic injuries, and require multiple amputations.

In Amman, MSF operates a reconstructive surgery project providing complex orthopaedic, maxillofacial and plastic surgery for victims of violence. While some patients come from elsewhere in the region, most are from Syria. Physiotherapy, psychosocial support and postoperative care are also provided as necessary.

In Lebanon there are more than 990,000 Syrian refugees. Growing medical gaps for refugees include access to secondary healthcare, safe deliveries in a hospital environment, and medication for chronic diseases. MSF is assisting refugees through general medical consultations including treatment of acute and chronic diseases, immunisations, reproductive healthcare and mental healthcare, as well as distributing relief items. MSF’s main activities are in the Bekaa valley, where the organisation runs four clinics; in Tripoli, northern Lebanon, where MSF supports two hospitals and two clinics; and in Saida and Shatila, where the majority of Palestinians from Syria have gathered.

MSF activities for Syrian refugees (to end January 2014):

• Iraq: total consultations (including mental health) – 173,030
• Jordan: ER, maternal health and outpatient consultations – 22,914
• Jordan: surgical procedures – 956
• Lebanon: total consultations (including mental health and reproductive health) – 119,813