The civil war in Syria has claimed thousands of lives, displaced over 10 million people and fueled the worst refugee crisis since World War II. The situation in the country has still been critical after the armed conflict that has been lasting for more than 10 years and recent clashes in northwestern region of the country. Due to this relentless war, a total of 11.7 million people, including nearly 2.7 million ones in northwestern Syria, are in need of various humanitarian aids.
The socio-economic impact of war, including the depletion of economic resources, the continuation of forced displacement movements, and the destruction of livelihoods, has had a profound effect on local communities to access and use vital/essential services such as health care.
Today, 2.7 million people in northwestern Syria need health support.
Epidemics such as measles, acute bloody diarrhea, typhoid fever, and cutaneous leishmaniasis continue to be serious health issues due to certain health risks accompanied by overpopulated refugee camps, poor living and sanitation conditions, and lack of access to necessary vaccination services in unregistered settlements.
Attacks against civilians stuck in the middle of clash environment also result in disability injuries, trauma, and war-related psychological problems. Around 27% of Syrian population above 12 years of age have a disability, while 50% of them needs mental health and psychosocial services.
Humanitarian emergency in northwestern Syria has become much worse after war situation re-erupted in southern Idlib in December 2019. According to the United Nations Office for the Coordination of Humanitarian Affairs (UN OCHA), nearly 1 million people ─ %81 of them are women and children ─ have been displaced in the region since 1st December 2019. Dana, Salqin and Azaz, three sub-districts in Idlib and Aleppo host 56% of recent internally displaced people.
Although the severity of internal displacements has decreased following the ceasefire on March 6, 2020, there is still not enough official data on the repatriations to settlement areas near conflict zones.
In the northern part of the Aleppo Governorate, internally displaced people have had to settle in informal camps, unfinished buildings, and open spaces due to lack of appropriate places for new settlements. Furthermore, the lack of access to clean, palatable water and adequate sanitation, bad weather conditions, and the recent fuel shortage resulting in price hike have led to the deterioration of the living conditions of internally displaced people and the host community.
The common perception in northwestern Syria is that people ignore the warnings and measures against the COVID-19 pandemic. Nevertheless, it is also known that only some refugee/IDP residents in the camps have started to use medical masks and gloves to protect from the spread of the coronavirus.
Rising concerns over the COVID-19 pandemic indicate that all health actors must hold themselves in readiness to respond the potential spread of the pandemic in the region.
DDD has a total of 12 health clinics in the area that the Operation Olive Branch was carried out and in the Idlib De-escalation Zone. Services provided by DDD are as follows:
Healthcare Facilities Supported in the Operation Olive Branch Area
Jindires Clinic: It is a full-time clinic providing primary sexual and reproductive health services.
Afrin Clinic: Like the clinic in Jindires, it is a full-time clinic providing primary sexual and reproductive health services.
Jelmah Clinic: It is a full-time clinic with maternity and delivery units.
Healthcare Facilities Supported in the Idlib De-escalation Zone
DDD has a total of 9 health clinics in the Idlib De-escalation Zone, including 5 full-time clinics located in Qah Refugee Camp, Al-Doaa, Al-Jolan, Dana town and Al-Salam, 2 full-time emergency clinics located in Sarmada and Killi, 2 part-time clinics located in Morek and Deir Hassan camps.
In 2020, Dünya Doktorları (DDD)/Médecins du Monde Turkey (MdM-T) oversaw 17 health facilities, directly operated 12 primary health care clinics (9 in Idlib and 3 in Aleppo). Through its two partners, it supported two health facilities in Idlib and three mobile clinics in Aleppo.
In total, over half-a-million people were serviced across these 17 facilities in 2020.
Primary Health Care:
As the leading health actor in NWS, DDD and its partners provided a comprehensive range of services through a network of 17 health facilities (14 static and 3 mobile clinics) in Aleppo and Idlib governorates. Additionally, DDD ensured provision of targeted specialized and inclusive outreach services to complement the activities provided in the centers in surrounding communities. The comprehensive package of services included treatment for communicable and non-communicable disease, routine vaccination, leishmaniasis, localized outbreaks of disease, and specialized services for people living with disabilities and other functional difficulties.
Sexual and Reproductive Health (SRH)
In 2020, DDD provided antenatal care (ANC) and postnatal care (PNC) services at its health facilities to reduce risks of pregnancy complications and provide positive pregnancy experiences for women in the communities it serves. The region has no SRH hospital equipped to manage deliveries with complications. To support service delivery, DDD launched basic emergency obstetric and newborn care (BEmONC) services at Celmeh PHC in Afrin district, northern Aleppo in September 2020, enhancing the facility’s capacity to conduct deliveries by skilled birth attendants. Strategically positioned in Afrin just north of the Idlib governorate border, an area facing escalating tensions, through the BEmONC site DDD is able to provide 24-hour services to vulnerable communities.
Mental Health and Psychosocial Support Services (MHPSS)
DDD recognizes the need to work on multiple tiers and levels of intervention, developing and providing a more comprehensive and integrated package of mental health psychosocial care that responds to the wider range of needs of conflict-affected populations in Syria. In 2020, DDD reinforced the community-based component of its MHPSS strategy to include community services outside DDD PHC Centers in Idlib, including active engagement with community leaders and families in the local environment (teachers, caregivers, and children) in group counselling sessions, as well as ongoing attempts to engage in emergency response by supporting community resilience and self-care. The rollout of child focused PSS activities conducted in schools in Idlib was observed as good practice, reportedly improving both the psychosocial wellbeing of children as well as providing the opportunity to make necessary referrals to other MHPSS services.
Protection Mainstreaming and Inclusion
Since 2019, DDD has been adapting its health programs to ensure more meaningful access through a protection lens within all PHC, MHPSS and SRH services provided. DDD’s approach aims at preventing and mitigating as well as addressing risks and obstacles in accessing protection services, such as lack of information and limitation of accessing specialized GBV protection services, qualitative SRH service links with GBV protection services. In 2020, DDD increased its capacity to provide referrals to specialized non-medical services, including protection services, by developing a safe referral pathway for identified GBV service providers between SRH and case managers, to ensure vulnerable and at-risk individuals have access to support at any level of service delivery. DDD also conducted renovation of some facilities to ensure they are more accessible to people with physical disabilities.
In 2020, DDD contributed to efforts to combat the COVID-19 pandemic, as it has exacerbated the already fragile situation of populations in the region since the health infrastructure along with human resources available, epidemiological surveillance system and laboratory capacity in NWS are not adequate to respond to such a crisis. As one of the few organizations conducting PCR testing in NWS in 2020, DDD also adapted its procedures in its health facilities to prevent and respond to the risk of COVID-19 transmission:
For PHC and SRH, DDD secured PPE for medical staff, implemented enhanced triage protocols on intake, and moved staff to a two-shift system at all health facilities to reduce potential spread of the virus and observe appropriate social distancing protocols at facilities.
For MHPSS, DDD transitioned to remote MHPSS support to clients in line with WHO guidelines, through hotlines and WhatsApp groups for group sessions, while maintaining in-person sessions for most vulnerable clients. This new modality allowed DDD to extend MHPSS services to those who do not typically come to the health facility, reaching a new demographic of clients.
In 2020, a total of 384,816 people were provided with primary health care consultations, including family planning and sexual reproductive health services in Idlib and Aleppo. DDD was also one of the only NGOs providing COVID-19 testing and support in North West Syria.
A total of 3,746 IDPs were provided with mental health and psychosocial support in Idlib and Aleppo in 2020.
Throughout 2020, a total of 700 vulnerable beneficiaries were referred to relevant and appropriate services through case management approaches to resolve non-medical and protection-related issues in North West Syria.