MEDECINS SANS FRONTIERES SINIR TANIMAYAN DOKTORLAR
SYRIA CRISIS ACTIVITY REPORT 2016
www.msf.org www.sinirtanimayandoktorlar.org INtroductıon CONTENTS INTRODUCTION 1 INTRODUCTION
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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
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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 Atme, 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 Idlib 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.
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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- Salwah, 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.
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