Interview with Katrin Kisswani, who headed MSF activities in northern Syria for two months.

We’ve been working mainly in the Jabal Al-Akkrad region, in the north of Idlib governorate, which is fairly mountainous and close to the border with Turkey. While some of these areas haven’t suffered the same frequency and intensity of fighting as areas further inland, the situation remains extremely volatile and dangerous. 

Rocket and helicopter attacks

Certain villages here are coming under attack on an almost daily basis from rockets and helicopters that drop drums full of explosive and metallic devices. The impact of the attacks is devastating for the local population, shrapnel wounds and crush wounds from collapsing houses. 
It’s a beautiful area, and on bright days you have a clear blue sky with a stunning view of the mountains. But the beauty is always short-lived, as a clear day means the helicopters are bound to come. There were days when several drums were dropped in the centre of populated villages and we received several wounded, including children and women, at our field hospital. One was dead on arrival, several needed surgery, there were internal injuries and one old woman needed had to have her foot amputated due to the severity of her shrapnel wound. 

The helicopters provoke panic

Even when they don’t drop bombs, the fear these helicopters generate causes a lot of injuries. People hear the helicopters and panic, and you have traffic accidents, motorbikes hitting cars and walls. One time we treated a child who was on the roof of his house when the helicopters came. He was so frightened he jumped off the roof, falling several metres to the ground. He was brought to us with concussion and breathing difficulties, but thankfully, we were able to treat him successfully.

The wounded arrive in waves

Often during clashes or attacks, patients will arrive in waves and it’s unclear whether it is the start of a mass casualty event – if there will be more coming and how many - or if things will slow down. You’re then faced with difficult choices. Do you start surgery on a wounded patient and hope that nobody with more severe injuries arrives? Or do you put the patient on hold a bit and prepare for another wave that might not actually arrive? Getting clear information about what is going on is tricky. This is what we’re faced with and it’s always a difficult balancing act. But that’s the nature of providing emergency care in such a context. 
The conflict is a constant source of fear and anxiety for people. We are assisting a lot of displaced people who have fled more intense areas of conflict and, for them, normal life – having food, fuel and water available, sending children to school, having a stable view of the future – has stopped. There are children with depression who are unable to eat or sleep and people struggling with the basics. We’ve been able to distribute blankets, hygiene materials and jerry cans for collecting water, and we’ve been carrying out mobile clinics.

A collapsed healthcare system

A lot of the time we’re dealing with basic healthcare issues and chronic diseases – high blood pressure, heart disease, asthma, diabetes and the like – people’s conditions are deteriorating because the healthcare system in Syria has essentially collapsed. We had a cancer patient who was supposed to be receiving chemotherapy.  He came to us in a terminal stage and all we could offer was pain relief. There are also massive problems with maternal healthcare. Pregnant women basically have nowhere to go and are forced to give birth at home if they’re lucky enough to find a midwife or a traditional birth attendant. These cases are growing and we are assisting normal deliveries as well as carrying out caesarean section when needed. 
In case of certain emergencies or conditions we can’t treat, we refer patients to hospitals in Turkey and help to arrange transportation. That can be very complicated.  

MSF is needed

MSF started activities in Syria by focusing on the war wounded and, obviously, that is still a big part of what we’re doing. But the country has been suffering this conflict for two years now and in that time the health system has virtually disappeared in many areas, leaving people in need of the most basic healthcare. Increasingly, we’re providing that in the areas where we work, but the needs are huge. MSF is needed here. We have a lot to do.