Thomas Lauvin is a doctor just back from a mission in Aleppo governorate in Syria, where Médecins Sans Frontières (MSF) runs a hospital with an operating theatre, a maternity ward, an emergency room and an outpatient department. Thomas was coordinating the assistance MSF is providing to Syrian doctors and volunteers in the region.

Is the health system functional in eastern Aleppo region?

The health system’s collapse is clearly visible. Three or four months ago, people thought that the situation wasn’t so bad. They said they only needed specialised equipment like ultrasound machines and scanners. At the end of May, supplies of medications and medical supplies from Damascus stopped arriving, but they were persuaded that the problem was temporary. Now the discourse has changed, and they’re saying that they don’t have even the most basic of medicines, and things like gloves and compressors.

I was going regularly to the cities of Al Bab and to Manbij in the east of Aleppo region, each of which has a district hospital. The district hospital in Al Bab has a capacity of 220 beds, but nothing works anymore except for the dialysis service and the paediatric service, which opened up again at the end of October with MSF support. Staff were still present in the hospital, but a lack of medical supplies and medications meant that the facility couldn’t run. We provided the hospital with medications, medical supplies, and money for fuel for the generator, and we installed heating for the winter. As a result the paediatric service was able to reopen after more than a year, and could start treating children again.

In the district hospital in Manbij, which has a capacity of 250 beds, the emergency department, the outpatient department and the paediatric department are more or less functional in spite of a lack of supplies. A bomb fell in the courtyard of the hospital at the beginning of October, doing material damage and blowing out all the windows. Thankfully no one was wounded or killed, and since then, people have been able to return to get care.

Patients would leave the hospital with a prescription, but they’d have no guarantee of finding the medication or treatment they need as hospitals are no longer receiving any medicines or medical supplies. We have made a donation of medicines to the hospital to Manbij to help solve this problem.

In order for those district hospitals to really get up and running, we would need to increase our involvement and send a team of international staff there. Given the size of these hospitals, it would be an enormous undertaking, and unfortunately, with the security situation being what it is, we just aren’t in a position to carry it out.

How do the medical staff manage to do its work?

Though many doctors and nurses have left Syria, there are still quite a number of them in the country, and they still work to the extent that they are able. They are paid a salary by Damascus, but to get it, they have to go to into the area of Aleppo that’s held by government forces. There is only one route that is authorised for travel from the rebel-held areas and there are snipers present along the route. Every month, these medical professionals risk their lives to go and collect their pay. A doctor’s salary can vary between 100 and 200 dollars a month depending on the exchange rate, but still, it’s vital to these people.

How is MSF providing humanitarian aid to doctors and medical structures?

One of the two different kinds of assistance we’re offering provide concerns the treatment of wounded. In Al Safira district in the southeast of Aleppo, MSF is supporting a group of about 30 Syrian volunteers. These are either medical professionals or people who have learned to treat people over the past year. Coordinated by a medical doctor, this group cares for injured people in secondary health posts close to the front lines, which are close enough for people to get there quickly but far enough away not to be too exposed. They are constantly adapting to a very changeable situation: they set up where they can and they move when they have to. They moved Al Safira medical post when it was targeted in bombings, evacuated again when the army took over the city, and then reopened it in less than 24 hours at a site a few kilometres away.

As well as medical training and advice, MSF is providing this group of medical volunteers with medicines and medical supplies. We are also donating fuel for their ambulances, as they hadn’t previously been able to afford it, and of course we treat the patients they refer to us at the MSF hospital.

The other kind of assistance we’re offering concerns the indirect victims of the conflict. We donate basic medicines to health centres so that they can carry out medical consultations, treat chronic illnesses like diabetes, epilepsy, and hypertension, and so that they can treat children. We also carry out regular donations of medicines to a number of health centres in the districts of El Bab and Manbij so that displaced people and the most vulnerable are cared for.

We’re supporting a medical group in the city of Manbij that aims to vaccinate the area’s children. A dozen young volunteers started vaccinating people in June, and we have just ramped up our assistance to them. We’re providing vaccines prescribed by the national vaccination programme, and have also been donating fuel for their vehicles so that they can reach children in remote, rural areas.

Are there many displaced people in this region?

In the eastern part of Aleppo region, the situation is very concerning for displaced people. At the end of September, the capacity of the area to host any more displaced people was stretched. More than 200,000 displaced people have been registered in the Manbij area alone, effectively doubling the population.

At the end of October between 15,000 and 20,000 families left Al Safira district, which was being heavily bombed. Many of these people had already fled bombings in the south of Al Safira, then fled for the second time when Al Safira was bombed. They’ve had to run away in many cases without anything but the clothes on their backs. Many have fled northward and settled in the countryside, fearful of being in towns where the risk of attack is higher. Families are now living in buildings that were once used to raise chickens – structures made out of corrugated iron and a dirt floor, with no latrines. Up to 25 families may be living in these structures at a time, and the sanitary conditions are awful. Other families have movde into unfinished homes, in apartments without doors or windows. Sometimes, up to 10 families share one apartment. But most families are in the fields, living under makeshift shelters made out of canvas bags or jute, or piled into tents, if they’re lucky.

MSF and the few other humanitarian organisations in this area are trying to help these people by giving them tents, blankets, jerry cans, hygiene kits. But the needs are huge, and the absence of the traditional humanitarian actors in the opposition-held areas makes the task very difficult.