MEDECINS SANS FRONTIERES SINIR TANIMAYAN DOKTORLAR

SYRIA CRISIS ACTIVITY REPORT 2016

www.msf.org www.sinirtanimayandoktorlar.org INtroductıon CONTENTS INTRODUCTION 1 INTRODUCTION

4 TURKEY AND ACTIVITIES

4 SYRIA CRISIS Médecins Sans Frontières MSF was founded in 1971 as a Our actions are guided by medical non-profit, self-governed organisa- ethics and humanitarian principles 6 ACTIVITIES IN TURKEY (MSF) is an international, tion with the belief that all people such as independence, neutrality independent, medical should have access to healthcare and impartiality. Strong commitment 8 ACTIVITIES IN SYRIA humanitarian organisation regardless of gender, race, religion, of MSF to humanitarian principles creed or political affiliation, and that relies substantially on our individual 16 MSF-SUPPORTED HOSPITALS IN SYRIA that delivers emergency aid people’s medical needs outweigh and private donors that make MSF to people affected by armed respect for national boundaries. MSF independent from interests of fund conflict, epidemics, natural is a worldwide movement fuelled by providers; thereby MSF is a move- 35,000 health professionals, logis- ment oriented by needs of vulner- disasters and exclusion tical and administrative staff –most able people. MSF has almost 6 million from healthcare. MSF offers of whom are hired locally – who work donors providing 92% of its income assistance to people based on programmes in some 69 countries which reached about 1,5 billion euros on need, irrespective of race, worldwide, with a shared commit- in 2015. Besides MSF rejects the idea ment to the Médecins Sans Frontières that poverty-stricken people deserve religion, gender or political Charter and principles. third-rate medical care and strives to affiliation. provide high-quality care to patients. © MSF

www.msf.org www.sinirtanimayandoktorlar.org [email protected]

MSFTurkiye

MSF_Turkiye Cover Photoı Nine-year-old Abdul Hadi is hugged by his older brother in a hospital ward in besieged east Aleppo. Abdul Hadi was injured by a bomb MSF_Turkiye Mahmoud Abdel-rahman/MSF blast while playing outside his home. He sustained head injuries, has lost his memory and can no longer feed himself. Medical staff say he needs a CT scan, but there is no such equipment available in east Aleppo, and he cannot be referred elsewhere for specialised MSF Turkiye care because all roads leading out of the city are blocked. 2ND EDITION: MARCH 2017

Syria Crisis Activity Report 2016 1 INtroductıon INtroductıon

Simultaneously, and with equal vigour, MSF continuously seeks to improve the organisation's own practices. Over © MSF the years, MSF has received many prestigious awards in recognition of its medical humanitarian work. In 1999, MSF received the Nobel Peace Prize. MSF's interventions involve medical teams addressing the most urgent health needs of people in crisis without geographical priorities and limitations. Our teams conduct independent eval- uations to determine medical needs MSF CHARTER before deciding to open a programme. We analyse what assistance we can Médecins Sans Frontières (MSF) is a private, international association. The association is made up mainly of doctors potentially bring, and we regularly ques- and health sector workers and is also open to all other professions which might help in achieving its aims. All of its tion the pertinence of our presence or members agree to honour the following principles. absence. We retain continuous and direct control over the management and • MSF provides assistance to populations in distress, to victims of navtural or man-made disasters and to victims of armed delivery of our assistance for the dura- conflict. They do so irrespective of race, religion, creed or political convictions. tion of our activities, some of which are • MSF observes neutrality and impartiality in the name of universal medical ethics and the right to humanitarian assistance primary and mental healthcare support; and claims full and unhindered freedom in the exercise of its functions. emergency and surgical interven- • Members undertake to respect their professional code of ethics and maintain complete independence from all political, tions; vaccination campaigns; building, managing nutritional and health centers; economic or religious powers. An inflatable operating theatre is erected inside this MSF makeshift hospital in Syria (a • As volunteers, members understand the risks and dangers of the missions they carry out and make no claim for them- providing water and sanitation services; converted chicken farm) as it is an efficient way to maintain a sterile environment. selves or their assigns for any form of compensation other than that which the association might be able to afford them. and provision of humanitarian aid items and shelter. patients had been transferred, was Not only the population encircled The conflict that Syrians are going then targeted in a third strike. This in besieged areas, but virtually all through, the endless violence and clearly illustrates the intentional nature remaining population is imprisoned

© MSF misery that they are suffering are heart- of the strategy and its brutality towards inside a country, whose borders are breaking for the entire world. MSF is the civilians and emergency services closed or restricted, is also suffering struggling to help Syrian patients and on the ground. Other dozens of from conflict. Turkey, Jordan, Iraq and displaced people survive under very medical staff have been killed. Medical Lebanon have made immense efforts difficult conditions. Despite our efforts, facilities have been systematically to assist Syrian refugees, hosting access to the affected population has targeted and destroyed. almost 5 million Syrians. However, been severely restricted by numerous Patients risk their lives daily by seeking hundreds of thousands continue to challenges. In the 7th year of war, attention in the medical facilities. seek refuge abroad. Externalization of international humanitarian law is disre- Health system in Syria is agonising. borders to prevent movement of refu- spected by all warring parties in the Services and care that should be gees from Syria or blocking humani- conflict. Humanitarian aid is not a polit- provided and available is missing, tarian aid into Syria cannot be accept- ical tool that can be used at various causing enormous suffering and making able while the extreme violence is levels by states and actors involved in it difficult to measure mortality as some exercised on the ground. The political the conflict. MSF reiterates its call to conditions become mortal when not interests and bureaucratic obstacles warring actors to allow access to Syria treated and the patients remain trapped by states and actors made the delivery to provide medical assistance to the in the camps or in their houses. of aid and medical care to Syrian victims of the war. nearly impossible. The current hopes Furthermore, millions are displaced for a solution or a relaxation from the Medical professionals paid a terrible from their homes and confined in hostilities which would allow access to toll trying to provide assistance to provisional settlements and camps the population are dim. people in need. Tragically, we witness for displaced populations in awful that medical facilities have turned into living conditions and not even spared In these pages, MSF shows a summary targets by warring parties too. from the violence. Thousands are also of the activities developed by the An airstrike against the Maarat trapped in besieged areas, without teams, with a distinctive recognition by al-Numan Hospital in the morning of access to food, medicines, unable to those colleagues working inside Syria, 16 February 2016 killed 25 people, seek a safe place and systematically who are risking their lives to serve their including one MSF colleague and targeted by different parties. Access communities and deliver the medical The MSF-supported hospital in Ma’arat Al Numan was attacked and destroyed on Monday 15th Feb. At least seven people were killed, injuring 11 more. Once first responders care and humanitarian aid that is so and at least eight are missing, presumed dead. The 30-bed hospital had 54 staff, two operating theatres, an outpatient department to those areas has been systematically and an emergency room. The outpatient department treated around 1,500 people a month, the ER carried out an average of 1,100 had arrived to deal with the first strike, jeopardized while trapped populations much needed by the Syrians. consultations a month, and around 140 operations a month, mainly orthopaedic and general surgery, were carried out in the operating a second one followed. A hospital, have been used by the warring parties. theatres. a short distance away, to which the

2 Doctors Without Borders Syria Crisis Activity Report 2016 3 TURKEY AND SYRIA ACTIVITIES TURKEY AND SYRIA ACTIVITIES

TURKEY AND SYRIA © MSF ACTIVITIES

SYRIA CRISIS

The Syrian conflict that Amidst the brutality of the Syrian Even those people who manage to conflict, violence against medical facil- flee the front lines or besieged areas began in 2011 has created ities, staff and patients has become and reach the border find it increas- the biggest displacement horrifyingly routine. In 2016 alone, 81 ingly difficult or even impossible to An MSF doctor and a child in control examination in , Syria. crisis since the Second medical facilities have been damaged seek refuge abroad. Border restrictions World War, and millions of or destroyed in Azaz and Aleppo and closures force people to return districts, some repeatedly. This follows to the places in Syria they fled, or to people are in desperate need 94 attacks on MSF-supported facili- camp out in provisional settlements Following the Islamic State (IS) group’s MSF is running 6 health structures Apart from the assistance delivered of lifesaving humanitarian ties in 2015, which killed 81 healthcare with no facilities or resources, at risk of abduction and release of MSF staff inside Syria, out of which 2 in Aleppo inside Syria, MSF is also providing aid. Some 4.9 million people staff. violence, disease and hunger. in 2014, and the impossibility of and are managed and supported support to Syrian refugees settled in obtaining the necessary guarantees from Turkey. Despite obstacles, MSF surrounding countries like Jordan, Attacks, and the ever-present threat Since 2011, MSF has been supporting have fled the country and an from IS leadership that MSF patients has developed medical programs Lebanon, Iraq and Turkey. Although of attacks, not only deny the popula- a growing number of medical struc- estimated 6.6 million have and staff will not be taken or harmed, aiming at supporting on-going health- MSF wishes to develop new proj- tion access to medical facilities, but tures in some of the most conflict-af- the decision was taken to withdraw care activities and medical networks ects in Turkey in 2017, maintaining been internally displaced also affect the scope and effectiveness fected areas of Syria, and in areas from IS-controlled areas. MSF’s activ- inside Syria and continues its support and enhancing its projects in Syria is as government troops and of the medical care that still can be where MSF does not have direct ities have consequently been limited programme to some 150 healthcare of utter importance so as to prevent provided. access to patients. A partic- opposition forces battle to regions controlled by opposition facilities run by Syrian doctors, with further displacements and loss of lives ular emphasis has been placed on for power and control of The humanitarian system is still groups, or restricted to cross-frontline a particular focus on besieged areas, by meeting medical and humanitarian supporting facilities and medical teams failing to Syrian people. Assistance, and cross-border support to medical providing technical advice, medical needs of the local population within territory. in areas under siege. including access to food and medical networks. supplies, salaries and fuel, and helps their own country. In this six years of war, Syrians have supplies, remains appallingly insuffi- The Syrian government continues to rebuild damaged buildings. Medical suffered immeasurably and the cient. The pervasive daily reality for deny repeated requests by MSF to and humanitarian support projects complex war has been character- many people in Syria is one of fear, access government-controlled areas. within Syria not only support health ised by extreme violence: civilian areas deprivation, and a struggle to survive. In a country where we should be structures and primary healthcare have been routinely bombed – often in In many parts of the country access running some of our largest medical centers, but also Advanced Medical “double-tap” attacks in which the initial to medical care is dire due to a crum- programmes, the opportunities to Points, ambulance networks and dial- strike is followed by a second on rescue bling health system. Many hospitals reach people and to respond in a ysis centers. teams or on the healthcare facility face critical supply shortages, and timely manner to the enormous needs receiving the wounded; and there have there are ever-diminishing numbers of remains extremely limited. This is a been attacks resulting in symptoms of health workers, as medics have fled or forceful reminder of how access to exposure to chemical agents. been killed. From the beginning of the medical care and humanitarian aid At least 1.5 million people are still conflict medical staff and medical facil- is by and large not respected and is trapped in besieged areas without ities have been targeted. directly targeted by those involved access to humanitarian aid, healthcare in the conflict and used for political or medical evacuation. purposes.

4 Doctors Without Borders Syria Crisis Activity Report 2016 5 TURKEY AND SYRIA ACTIVITIES TURKEY AND SYRIA ACTIVITIES

Main Expenses 2016*

Subcontracted Services 1% 2016 in Numbers Purchase of Transport 5% Medical Items When we work in contexts where there are many parties to a 40% General and ACTIVITIES IN TURKEY conflict and humanitarian assistance is at risk of abuse, we Running Costs rely solely on private donations to fund our activities. This 8% helps to ensure operational independence and flexibility, and Purchase of Médecins Sans Frontières Kilis provision of primary healthcare services to act based on the needs of the population. Non-medical at the camp’s clinic, provide psychoso- Items 11% (MSF) has been active in In Kilis, MSF supported the activities The use of MSF funds is tightly controlled and the audited of Citizens’ Assembly (hCa), a local cial care with activities for children and financial reports of all our national offices are publicly avail- Turkey during different NGO providing primary healthcare adults, and supply water and sanita- able. The audited MSF International Financial Report, which natural disasters and the and psychosocial support services to tion amenities and non-food items for is available online at http://www.msf.org/en/international- ensuing humanitarian crises, Syrian refugees in its clinic. In 2016, the refugees inside the camp. In the financial-reports, provides a transparent global overview of meantime, MSF teams also helped the some of which were Erzincan 2,927 individual and 990 family coun- MSF’s work. It defines the different categories of income selling consultations were condu- construction of a Child Friendly Space and expenditure and shows how funds are raised and spent. (1992), Marmara (1999) and within the transit camp and assisted the cted by 10 community mental health In order to be able to access and assist Syrian people in distribution of hygiene kits, blankets, (2011) Van earthquakes, workers, while 1,354 individuals and need, as well as to protect impartialityof our medical aid, mattresses and kitchen utensils in the Staff Costs since early nineties as an ad 810 families received psychotherapy MSF does not accept funds from governments or other outskirts of Akçakale town for the most 35% consultations. 2,868 psycho-education parties who are directly involved in the Syria Crisis. Instead, hoc emergency support. vulnerable communities living outside group sessions were also performed we use the donations of private individuals for the funding of camps. In 2016, 47,559 individuals parti- In June 2015, MSF was granted autho- by 4 psychologists. Sexual and gender- our projects in Syria risation by the Turkish authorities to based violence-related submissions cipated in 6,646 psychosocial support * The “Main Expenses 2016” graph covering the annual expenses of one carry out medical and humanitarian dramatically increased in 2016 and sessions conducted by both STL and of the MSF teams is a representative one which explains how MSF teams allocate their budgets in the Syria Crisis. activities for the growing number of reached up to 123, a figure that is IBC. Through Metider, MSF supported refugees in the country. MSF’s autho- higher than the total number of the last a team of outreach workers to work risation to work in the country has three years. All of these patients rece- with the target communities in raising expired in June 2016 with a pending ived psychological support. Although awareness on services, identifying key renewal since then. the recurring rocket attacks from Syria health issues and referring individuals instigated a noticeable reduction in the to relevant services. MSF also helped In 2016, MSF continued to provide number of submissions to the clinic, train outreach workers on health-related financial and technical support to © Anna Surinyach hCA also conducted 32,775 primary topics, such as pregnancy and birth Turkish civil society organizations health consultations and 15,919 labo- monitoring, infant feeding, common working on the Syrian - Turkish border, ratory tests for Syrian refugees throu- infectious diseases, domestic violence, Kilis, Gaziantep and Şanlıurfa, namely ghout the year. sexually transmitted diseases, the Support to Life, International Blue importance of vaccination, etc. Crescent Relief And Development Şanlıurfa Foundation, Metider). In Şanlıurfa, MSF worked in colla- Gaziantep boration with Support to Life (STL), In Gaziantep, MSF provided medical International Blue Crescent Relief and treatment to Syrian refugees in colla- Development Foundation (IBC) and boration with Physicians Across Metider to support their ongoing mental Continents (PAC) in the Voluntary health services and outreach activities Health Center for People under for Syrian refugees. In STL’s commu- Temporary Protection. The Polyclinic nity center in Şanlıurfa, 1,341 indivi- offered free paediatric and sexual/ dual and 69 group counselling sessions reproductive health (SRH) consulta- were conducted for Syrian refugees as tions to women and children, through a part of its mental health and psycho- specialized team of Syrian and Arabic- social support (MHPSS) activities. speaking medical staff. Due to changes Throughout the year, MSF provided in its operational strategy, MSF ended financial and technical support to its activities in the polyclinic in April IBC’s MHPSS program in Akçakale 2016. After the closure of the project, Community Centre, which hosted 2,554 the ex-MSF patients continued their individual and 41 group counselling treatment in a different Syrian medical consultations. Until its closure in May facility in Gaziantep, equally receiving 2016, MSF had also been supporting free of charge consultations. Between January and April 2016, MSF team Akçakale transit camp through part- , 18 years old, was shot by a sniper in Aleppo, and now she cannot walk. She tries to start a new life as a refugee in Kilis nership with IBC and in cooperation provided SRH consultations to more (Turkey), where she is receiving psychological support from MSF. with Akçakale Municipality to assist the than 2,500 women.

6 Doctors Without Borders Syria Crisis Activity Report 2016 7 TURKEY AND SYRIA ACTIVITIES TURKEY AND SYRIA ACTIVITIES

Consultations

6000 ACTIVITIES IN SYRIA 000 000

Aleppo Outpatient Department (OPD): 2 paedi- Inpatient Department (IPD): 8 specialist 000 atricians and 3 doctors working in the doctors work in the emergency service Azaz: Al Salamah Hospital 2000 OPD provide inclusive medical scre- and the IPD, which has 9 female, 9 In Azaz district, close to the Turkish umer o consultation ening for malnutrition to all children male and 9 paediatric bed capacity, 1000 border, Médecins Sans Frontières under the age of 5 and therapeutic as well as a 2-bed isolation room. In (MSF) runs a 34-bed hospital in Al 0 feeding support to those who are in 2016, 2,489 patients were admitted to Salamah to offer free-of-charge and April ay une uly arch Auust need. In addition to specialized healt- the IPD, 25% of whom (620) consisted anuary eruary ctoer quality health services to an estimate Septemer ovemer Decemer hcare support for patients with chro- of children under the age of 5. The of 400,000 people in the region, provi- onths nical diseases like hypertension most frequent type of diseases in the ding treatment to internally displaced and diabetes, the hospital staff also IPD were gastric/intestinal ulcer, lower 1 yrs old 1 yrs old people (IDPs) and the war-wounded ! provides vaccination and immunization respiratory tract infection and uninten- with its 85 medical and para-medical support against rat bites, tetanus and tional physical injuries in 2016. Due to staff. The hospital, which also procures Consultations various diseases. approaching frontlines and the growing necessary medications to patients, security gap in the first half of the year, 160 has an emergency room and also In 2016, the medical staff in the the hospital’s capacity was decreased, 10 offers a wide range of services inclu- hospital conducted 46,337 outpatient only to provide emergency services 120 ding outpatient and inpatient consulta- consultations in total, 35% of which between April - June 2016. While the 100 tions, surgical care, and maternity and (16,730) consisted of paediatric consul- treatment rate of the IPD services was 0 additional support services (pharmacy, tations for children under the age of 15. 60

80%, complex cases were referred umer o patients laboratory, X-ray, etc). In addition, MSF The most frequent type of diseases in to other health facilities that would 0 teams refer patients to other structures the OPD were related to upper respira- provide better healthcare in the region in Azaz district or in Turkey, if they tory tract infections and nonbloody diar- 20 or in Turkey. cannot be treated in the MSF hospital. rhea, which was not only prevalent with 0

April ay une uly children but also with adults in 2016. arch Auust anuary eruary ctoer Septemer ovemer Decemer onths

yrs old yrs old ! © MSF

MSF'S SALAMAH HOSPITAL 6 YEARS AZAZ DISTRICT, NEAR THE FRONTLINE OF WAR IN In 2016 46,337 26,091 SYRIA outpatient emergency MSF'S WORK consultations room IN ALEPPO treatments GOVERNORATE 2,489 1,933 inpatient surgical (NORTH) consultations procedures

578 deliveries

In the first half of 2016, Al Salamah hospital was forced to limit its capacity when frontlines came too close, since June 2016 it has reopened only for emergency cases and surgeries.

8 Doctors Without Borders Syria Crisis Activity Report 2016 9 TURKEY AND SYRIA ACTIVITIES TURKEY AND SYRIA ACTIVITIES

Aleppo City and Rural Areas Assessment of IDPs and Emergency of experienced medical and non-me- MSF’s assessment and support Interventions: MSF’s Aleppo team dical international staff, MSF provides program in Aleppo, which started in closely monitors population move- capacity building trainings to Syrian Emergency Room Consultations by Case 2013, continued with the distribution ments in Syria and provides effective health workers who aim to employ of aid, as well as water and sanitation emergency medical and humanita- highest quality medical standards to Non-trauma services through regular and emer- rian aid when other aid or non-gover- highest number of patients. Surgical Condition gency technical, financial and logistical nmental organizations fail to meet the Immunization and Vaccination: 6% support to hospitals and other health needs of IDPs. MSF teams not only Trauma Injury Every year, thousands of people die offer emergency medical interventions 16% facilities in the region, especially in the from vaccine preventable diseases. first half of 2016. In accordance with in cooperation with MSF’s Al Salamah Immune enhancing vaccinations are the humanitarian situation in Aleppo in hospital staff, but also help distribute of utter importance for MSF when it the second half of the year, the prog- non-food items (NFI). It’s important to comes to medical interventions and ram’s operations focused on besieged clearly state that although MSF is first public health. During the second Gynaecology and Maternity Services 000 East Aleppo in order to better meet the and foremost a medical aid organisa- half of 2016, MSF started to imple- needs of Syrian population. tion, MSF teams also procure distribu- ment a basic immunization program in 000 Regular Medical Donations: MSF tion of humanitarian aid materials at Azaz district, especially for pregnant made regular medication and medical times when other organisations fail to women and children under the age of 6000 equipment donations to more than act on time or during large-scale popu- 5. Throughout the year, 8,514 people lation movements, such as the one in were vaccinated (6,693 children under 000 25 hospitals, health centers, first-aid centers, blood centers and ambulance Azaz during the first half of 2016 as a 5 and 1,821 women). result of heightened clashes between services in Aleppo, as well as 1 health Following the emergence of measles 000 the warring parties. From February to center and 1 blood center in Azaz for a cases in 2015, MSF also supported June, MSF teams distributed hygiene Paediatric period of 3 months. The total amount the implementation of a ring vaccina- 000 kits, tents, blankets and other NFIs to Patients of donations in this period was 160 tion campaign in the area east of the 7,767 families. 22% Medical tonnes. In the second half of the year, Euphrates River in northeastern part 2000 Pathology these regular donations were cana- Water and Sanitation: With the incre- 56% of Aleppo governorate. 2,784 children asing number of IDPs fleeing the mili- 1000 lized to health facilities in East Aleppo. were rapidly vaccinated for measles Nevertheless, the inability to access to tary offensive in the region and upon in communities that are suffering from the growing need for hygiene and 0 the besieged areas prevented medical the consequences of war and ground Antenatal Care ostnatal Care amily lannin Deliveries aid to reach where it was needed clean water, MSF implemented water offensives. Local health-response most. During the siege, MSF teams and sanitation services in irregular teams simultaneously conducted an managed to deliver and transport 75% shelters, such as waste management emergency food distribution and scre- of 3-month regular medical aid to East and supply of clean water, in order to ened all children who passed through Surgical Interventions: In 2016, 17% of teams immediately referred them to hospital staff provided family planning Aleppo. ! improve life conditions of the IDPs and the vaccination campaign for acute those patients who applied to emer- other structures in Azaz district or (FP) support and general consultations Emergency Donations: In line with prevent the spread of contagious dise- malnutrition. gency services consisted of trauma for women. ases. in Turkey in close collaboration with the needs, MSF also provides ad The vaccination program continued cases, most of which required emer- authorized health facilities in Syria. In In 2016, our specialized staff condu- hoc medical, technical, logistical and Referral System Support: Since refer- in Tal Abyadand Ayn-Al Arab in 2016. gency surgical interventions. 4 general 2016, there have been 747 referrals in cted 7,238 ANC, 730 PNC and 2,608 FP biomedical donations to medical faci- rals are of critical importance for our In Tal Abyad, MSF team provided surgeons, 4 orthopaedic surgery speci- total, 27% of which consisted of refer- consultations in Al Salamah hospital. lities, such as for use in emergency patients to get access to medical more than 26,037 doses of vaccines alists and 4 nurses handled emer- rals to Turkey. Heart conditions and Throughout the year, all pregnant situations like massive influxes of services, MSF teams working in Aleppo and 21,226 in Ayn al-Arab which gency surgical interventions and elec- trauma cases that required internal patients received prophylactic and casualties, destruction of buildings or Support Program helped repair the included BCG, Hep B, Birth dose, tive surgeries that aimed to improve fracture treatment were prevalent in curative treatment, including tetanus suspension of services as a result of ambulances and procure the necessary DTwP+Hib+Hep B, Oral Polio Vaccine, the living conditions of our patients. In these referrals to Turkey. MSF aims to vaccine, as well as prenatal and ante- bombing or shelling, etc. For instance, life-saving medical equipment in order Measles, IPV, MMR, and in the mean- 2016, 1,933 surgical operations were keep referrals at a minimum level and natal health training, while all newborns in coordination with other aid organisa- to maintain the referral system. time 3,042 doses of tetanus toxoid conducted in total, 31% of which were conduct necessary treatments within were vaccinated against diseases tions, MSF instantaneously assessed Capacity Building Trainings: Many (TT) vaccines in total were delivered in emergency interventions and 69% its own capacity, while covering all (such as tuberculosis, measles, hepa- the needs of and provided emer- qualified medical and paramedical Ayn-Al Arab (1,202 doses for pregnant were elective surgeries. diagnoses, medical examinations and titis, etc.) in line with Syrian Healthcare gency donations for 11 hospitals in professionals have left Syria because women, 1,804 for 15-45 years of age, treatment costs required by the health Emergency Services: Al Salamah Protocol. In 2016, MSF staff assisted in Idlib and West Aleppo which received of the ongoing war. Those who stayed, 36 for the wounded). In Tal Abyad, total facility which the patients are trans- hospital has been very important for 578 deliveries. high number of patients following the on the other hand, continued to work number of doses of TT vaccines were ferred to. In 2016, all paediatric cases its strategic position to provide health- Laboratory Services: The lab staff in evacuation of local people from the under precarious conditions with 1,414 (668 doses for pregnant women, that were referred to other health faci- care to local people and the IDPs in the the hospital performs basic blood, besieged city of Aleppo. higher work-load but a huge shortage 622 for 15-45 years of age, 124 for the lities were monitored and followed up Azaz region, especially during the first hepatitis and biochemical tests and of resources. Through the assistance wounded). by MSF teams until their discharge half of the year when admissions to conducts analyses of these tests. emergency services increased due to from hospitals. Shuttles: MSF’s transportation vehicles approaching frontlines. In 2016, 26,091 Gynaecology and Maternity Services: work routinely as shuttles in between patients applied to emergency services With due regard to female patients’ IDP camps in the region and the department. privacy, the department provides hospital in order to facilitate access medical care in a separate section with Referrals: When patients with highly to healthcare for local people and the 5-bed capacity. In addition to prenatal critical health conditions could not be IDPs. treated in Al Salamah hospital, MSF (PNC) and antenatal care (ANC),

10 Doctors Without Borders Syria Crisis Activity Report 2016 11 TURKEY AND SYRIA ACTIVITIES TURKEY AND SYRIA ACTIVITIES

Tal Abyad community members who are 5 years Idlib, Hama, Homs In Tal Abyad MSF has continued to and older and with 109 follow up Through a doctor-to-doctor network

support Tal Abyad healthcare faci- consultations, the hospital was able to and a team of other health workers, © MSF lity with activities such as OPD, ER give services to 10,047 outpatients in Médecins Sans Frontières (MSF) has consultations and vaccination in order total. organized and supplied drugs, medical to improve the population access Ayn al-Arab equipment and non-food items to more to healthcare. In 2016, 30 referrals than 25 healthcare facilities in Idlib, In Ayn-Al Arab, to improve the popu- were conducted, 1,975 new outpa- Hama and Homs*. During 2016 MSF lation access to healthcare, MSF has tient consultations were given to the teams focused on technical support, continued to support nearly 10 healt- community members who are younger developing medical trainings as mass hcare facilities* with services such as than the age of 5, 7,963 new outpa- casualty training, malnutrition, vacci- IPD, OPD, ER consultations, radiology, tient consultations were given to the nation and infection and prevention blood transfusion, vaccination, as well control. From the beginning of the as supporting a Social Activity Center year, MSF teams established a partner- for Mental Health activities by Syrian ship agreement with Qunaya Hospital nationals staff and supported by an Summary of Healthcare Facilities in Ayn al-Arab (Idlib) taking care of the hospital needs international team in Northern Syria. Transport of MSF supplies, consisted of medicine and consumables, to get to one of the 120000 covering 100% in collaboration with 11022 the hospital director. Since early 2016 North Homs besieged areas. * Supported healthcare facilities in Ayn-al Arab are: Community Center Health Post: Mistanur MSF has expanded the activities with a 100000 rimary ealthcare acilities Primary Health Center, Emergency Room of mobile clinic in 6 camps in Harim dist- Atmeh Surgical Burn Hospital In 2016, the IPD received 500 admis- Ayn al-Arab Hospital, Khanik Health Post, rict (Idlib) and started EPI activities in Atmeh project in Idlib opened in June sions, while 3,382 consultations were Qunaya Health Post, Tel Ghazal Health Post, Reproductive ealthcare acilities Qunaya and Darkosh hospitals. conducted in the ER and 3,033 major 0000 Girik Health Post, Abu Qalqal Health Center, 2012 as a trauma center for indivi- Jalabiya Health Center In 2016 MSF expanded regular EPI duals wounded in the Syrian conflict. surgeries and 1,176 minor surge- activities in with As a consequence of the conflict front- ries were performed in the operating 60000 53,341 total vaccinations. 49,381 of lines’ shifting and the opening of other theatre. In addition to these services, the total vaccinations were provided trauma centers in the region, the faci- 11,895 BCG, 5,179 Hepatitis B at birth, lity now serves as a specialized burn 32,303 Penta, 17,147 MMR, 19,867 0000 in Qunaya hospital which is fully supported by MSF. In February 2016 surgical hospital. PCV and 31,636 Polio doses were it was the first center where EPI was The hospital admits patients from IDP administered in accordance with the 20000 re-established. A second EPI center camps, as well as hospitals throughout EPI program. The number of direct 1020 beneficiaries of Atmeh hospital in 2016 1 1 was re-established in hospital Idlib, North Hama, West and South in May 2016. was 160,154. 0 Aleppo. Emergency non-burn patients Consultations Reerrals that require further definitive inpatient * Hama Central Hospital, Ain Al Bayda Hospital, treatment are stabilized in the ER and Mellis Hospital, Salkeen Hospital, Al Qunaya referred to nearby hospitals in either Hospital, Al Tamanaa MP, Mestreeha MP, Al Syria or Turkey. Due to Atmeh’s proxi- Kastan MP, Bashiriya MP, Mishmisham MP (Idlib). Ibn Sina/Kars Ibn-Wardan Hospital, mity to IDPs camps, the project also

© MSF Mobile Clinic (East Hama), Kalaat Al Madeek includes outreach activities performing MP (Hama). Al Rastan Hospital, Al Zaafaranah health education and routine vaccina- Hospital, Talbiseh Hospital, Ter Maallah Hospital, Kafr Laha hospital, Al Ghanto tion in the Atmeh camps and surroun- Hospital, Tal Dahab, Taldaw, Al Taeba, Deir ding villages. Baalbe, Ez Eddine and ICU (Homs).

1200000 1121

1000000 Summary of Medical Data for Idlib, Hama and North Homs 00000

600000

00000

201 200000 02 660 61 1226 12 112 0

D MSF scaled-up support to local health authorities in northern Syria, who implemented a ring vaccination campaign in June, 2016 D Deliveries Reerrals north east of Aleppo governorate. 2,784 children were rapidly vaccinated for measles in communities that are suffering from the R atients ynaecoloy AC C rauma Cases consequences of war and ground offensive. ajor Sureries inor Sureries

12 Doctors Without Borders Syria Crisis Activity Report 2016 13 TURKEY AND SYRIA ACTIVITIES TURKEY AND SYRIA ACTIVITIES

Major IPD Conditions Admitted in Idlib, Hama, Homs in 2016

Other Surgical Cases 01 13% Non-war Injuries 25%

Vaccination in Idlib Governorate in 2016 Gynecology/ Obstetrics 17%

600

War Injuries Medical Cases 22% 23% 1 66 26 261 2162 Harim Mobile Clinic Medical cases comprised 23% of major IPD admissions; they mainly include 10 The influx of IDPs in Idlib governo- severe high pressure, food poisoning or other poisonings, severe hypoglycemia, rate led MSF to put in place a medical strokes and shocks, etc.) emergency response team in form of organized mobile clinics in Harim/ camps. The objective of the April ay une uly arch Auust mobile clinic was to provide free, eruary ctoer Septemer ovemer Decemer accessible basic primary healthcare to ! internally displaced population in the Qunaya Hospital two sub-districts. Qunaya Hospital is fully supported by Due to the fact that most IDPs live in MSF, working in partnership with the an integrated setting in the villages director of the hospital. with host community by default, the A total of 105,168 outpatient consulta- 160000 host population in vicinity is part of the tions (OPD) were conducted in Qunaya beneficiaries. This mobile clinic has hospital in 2016. Major pathologies been running since April 2016. 10000 Top 5 Acute OPD Morbidities in Idlib, Hama, Homs in 2016 include chronic diseases like hyper- 1620 A total of 12.099 consultations were tension and Diabetes, followed by provided in the period of Apr-Dec 2016 respiratory tract infections and urinary 120000 by the mobile clinic team. 7% (875) of! tract infections. A total of 12,011 were these consultations include pregnancy treated in Qunaya hospital in 2016. related services for antenatal or post- 15% (1,838) of these inpatient admis- 100000 natal care. sions (IPD) were related to war injures.

0000 12 120000 1016 100000 60000 Summary of Medical Data for Qunaya Hospital 61 0000 0000 60000

0000 20000 1 20000 12011 11 26 60 02 01 10 2 0 0 pper Repiratory ower Respritory yphoid ever S Skin Disease D ract nection ract nection D Deliveries Reerrals R atients AC C rauma Cases Upper and lower respiratory tract infections comprise 18% of total consultations in OPD. ajor Sureries inor Sureries

! 14 Doctors Without Borders Syria Crisis Activity Report 2016 15 TURKEY AND SYRIA ACTIVITIES TURKEY AND SYRIA ACTIVITIES © MSF

MSF-SUPPORTED HOSPITALS IN SYRIA

Médecins Sans Frontières Hospitals fully supported by MSF: Harim, Salqin, Al Saleh Hastanesi, Al Salamah MSF hospital, Qunaya Darkush (Al Rahma), Al-Atareb, (MSF) supported 150 health hospital, Al-Manssora, Anadan, Qobtan Baghdad Hospital (Tawwama), Kafar facilities all across Syria Eljabal, Sham Ambulance (based in Hamra, Alfardos Hospital (Daret Ezzah), in 2016. The figure varies Kafra Hamra), Idlib City, Al-latamnah, Maret Al-Misrin, , depending on the access to Tal Krsyan, Babila (dialysis center), (Alhekmah Hospital), Sarjeh, Kafar Al-Rami, , Qirata Zeta, Hizaren, Tarmala, Takad PHC, facilities and MSF’s ability Hospitals partially supported by MSF: Arinbe to deliver supplies, as well Azaz Ahly, Azaz Maternity, Marea as on the conflict dynamics General, Thawret Al Karama, Al Bayan, affecting the medical Al Daqaq, Bahdad, Zarzour, Omar, Al facilities, such as attacks. Quds, Hanano, Al Zahra, , Al Fardous, Al Hikma, Al Reh Almorsala, The list below comprises Atmeh Charity, Bab Al Hawa, only of the hospitals, Hospitalization House Atimeh, Ibn-Al- teams and health facilities Haitham Oftalmologic, Idlib Central, supported from Turkey in Thawret Al Karama, Ibn Sina, Madiq Castle (Kalate Madiq), Ein El-Bayda, North Syria. © MSF

MSF´s Al Salamah hospital in Azaz district in northern Syria includes an ER, an operating theatre, outpatient and inpatient services, including maternity care. It is the largest directly run MSF facility still inside Syria.

800+ HUMAN MSF staff and 142 cargoes RESOURCES volunteers 625 Syrian, with 2.083 AND SUPPLY 76 Turkish metric tons of citizens supplies - 2016 with a value of 6,9 million NORTH SYRIA 33 euros international AND TURKEY staff from 71 nationalities

Atmeh is a 15-bed hospital with operating theatre, IPD and emergency room (ER), providing surgery, skin grafts, dressings, In this report, only activities driven from Turkey or Northern Syria are represented. To know more, please check Syria Crisis physiotherapy and psychological support. Updates by MSF.

16 Doctors Without Borders Syria Crisis Activity Report 2016 17 www.msf.org www.sinirtanimayandoktorlar.org [email protected]

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