SYRIA PROGRAMME

Syria remains one of the most challenging humanitarian emergencies in the world, with ongoing armed conflict resulting in hundreds of thousands of deaths and triggering one of the worst displacement crises of modern times. By 2024, 16.7 million people are in need of emergency health assistance: This is an increase of 4.6 million compared to 2022. In Idlib and Aleppo governorates, where Dünya Doktorları (DDD)/Médecins du Monde (MdM) Türkiye operates, on average 79% of residents are internally displaced persons (IDPs) living in rented accommodation or tents.

The humanitarian situation in Syria has been exacerbated by the devastating February 6 earthquakes in 2023. In Syria, an estimated 2.9 million people were affected by the February earthquakes and more than 300,000 people were forced to flee their homes. The ongoing war in Syria has claimed thousands of lives, displaced more than 10 million people and fueled the largest refugee crisis since the Second World War. The socio-economic impact of the war, including the depletion of economic resources, continued forced displacement and destruction of livelihoods, has had a profound impact on local communities' access to vital/essential services such as health care.

Attacks on civilians trapped in the midst of protracted conflict also cause disabilities, trauma and war-related psychological problems. Around 27% of the Syrian population over 13 years of age are disabled and 50% are in need of mental health and psychosocial support services. The humanitarian situation in northwest Syria has worsened following the escalation of violence between 2019 and 2020.

According to the United Nations Office for the Coordination of Humanitarian Affairs (UNOCHA), nearly 1 million people, 81% of whom are women and children, have been displaced in the region since December 1, 2019. The thre districts of Idlib and Aleppo – Dana, Salqin and Azaz – are home to 56% of the recently internally displaced people. Following the ceasefire on March 6, 2022, the severity of internal displacement has
decreased, but needs have increased as northwestern Syria has become increasingly isolated and dependent on external assistance.

Internally displaced people in the northern part of Aleppo are forced to settle in informal camps, unfinished buildings and open spaces due to the lack of suitable sites for new settlements. In addition, lack of access to clean, safe water and sanitation, bad weather and fuel shortages leading to price increases have led to worsening living conditions for IDPs and host
communities.

In September 2022, a cholera outbreak in aSyria, particularly in the war-torn northern part of the country, added to the suffering of the Syrian people. The cholera outbreak, caused by
contaminated water wells in the region, has once again highlighted the importance of continuously supporting and maintaining critical infrastructure that enables humanitarian corridors and the provision of basic services.

14 years of conflict have severely damaged water and sanitation networks, reducing supply by 40%, while only 52% of hospitals are able to operate under difficult conditions. The  outbreak comes amid a repeatedly reported water crisis, insufficient funding for urgent humanitarian needs, and ongoing armed conflict and threats of new attacks.

The 2022-2023 Humanitarian Response Plan for Syria had only 27% of the required resources. Health funding accounted for only 16.7% of the assistance provided, amounting to $484 million, while nutrition funding amounted to 10.7% at $11 million.

EARTHQUAKE RESPONSE IN SYRIA

The towns of Jinderes and Afrin in northwestern Aleppo and the Harim area of Idlib, where DDD/MdM Türkiye operates, are the areas with the highest concentration of internally displaced persons (IDPs) in northwestern Syria, where on average 79% of the population live in rented houses or tents. On February 6, 2023, these areas were also hit hardest by the earthquake. According to official data, more than 8,000 people lost their lives in these three regions, while most of the town of Jinderes was buried under rubble. Many more were trapped under the rubble as the excavation equipment needed for search and rescue operations got stuck at the border. Another 12,000 people were reported to have suffered earthquake-related injuries.

In the immediate aftermath of the earthquake, DDD/MdM Türkiye provided medical care to those affected by the earthquake through the mobilization of mobile health units and 9 primary health centers in Aleppo and Idlib regions.

DDD/MdM Türkiye provided primary health care, sexual and reproductive health, mental health and psychosocial support services, as well as care at primary health centers and free medicines to people affected by the earthquake. The Earthquake Response Program provided more than 367,000 counseling services to nearly 136,000 people internally displaced by the earthquake.

DDD/MdM Türkiye distributed 30,000 kits in the affected areas of Aleppo and Idlib as a preventive measure to reduce the spread of diseases related to poor hygiene. As part of its emergency response to growing needs in the region, DD/MdM Türkiye also reopened a clinic in Idlib staffed by doctors, nurses, midwives, pharmacists, community health workers and psychologists, enabling it to provide primary health care directly to affected people, either by reaching them directly in camps or through health centers.

As the number of people living in tents has increased due to the devastating earthquake that hit the region, poor and unsanitary living conditions in tent settlements expose children and adults to freezing temperatures in winter and heat waves in summer. In addition, poor ventilation of chimneys in tents and inadequate sanitation in camps are just some of the determinants of poor health. Women, children, the elderly and people with disabilities with integrated health needs are among the most vulnerable to these conditions. These conditions have exacerbated the cholera outbreak in the region, increasing infectious diseases and mortality rates.

ONGOING NEEDS

Demand for integrated medical and protection services remains high in northwest Syria, particularly for vulnerable groups such as children, women, the elderly and people with chronic diseases and disabilities. New camps set up after the earthquake to provide shelter for displaced people are already full as of September 2023.

IDPs living in the town of Jinderes in Afrin district have returned from the countryside, but their homes were damaged, so they often live in new camps set up in the city. People from other parts of Afrin are also moving to Jinderes as new camps have been established in and around the town in anticipation of new services.

In Idlib, the population of IDP camps is increasing as people seek a safer place to live. In addition, problems in accessing basic needs such as clean water and sanitation have led to the spread of infectious diseases such as scabies, lice and cholera in the region, causing many people to suffer from physical and mental health problems.
Gender-based violence was already common in the region. It is exacerbated by the increased displacement caused by the earthquake and disproportionately affects women and children.

Domestic violence, sexual violence, rape, sexual exploitation, abuse and harassment, unaccompanied minors, child abandonment, child labor and early marriage are on the rise in northwest Syria, where DDD/MdM Türkiye operates. Sociocultural factors, and particularly the lack of civilian security services in the area, undermine efforts to support and protect survivors.