February 09, 2018

On February 8, a health center partially supported by Doctors Without Borders/ Médecins Sans Frontières (MSF) in Mishmishan, in northwestern Syria’s Idlib region, was hit by an airstrike that killed six people and wounded 17. This follows an earlier incident, on January 29, when two airstrikes hit an MSF-supported hospital in Saraqab district, also in Idlib, killing five people.

Intense fighting and airstrikes in northern Syria have escalated since December, resulting in one of the largest population displacements seen since the beginning of the conflict. In the south of Idlib, Syrian government forces and their allies are fighting against armed opposition groups. Behind the front lines, in central and northern Idlib, aerial bombing is hitting civilian infrastructure, including medical facilities, deepening the crisis for people attempting to flee the violence and find safety. Tens of thousands of newly displaced families have been trying to find space among the hundreds of thousands of displaced people already crowded into northern Idlib governorate. Many have no tents and are frightened, cold, and vulnerable to the spread of disease.

Omar Ahmed Abenza, MSF head of mission for northwestern Syria, provides an overview of the situation today in Idlib:

Yesterday a health center in Mishmishan, in northwestern Syria’s Idlib region, was hit by an airstrike. This is another step towards disaster in this troubled zone. Once again, this bombing is completely outrageous and cannot be tolerated. It is a sad but undeniable fact that civilian areas – and specifically health care facilities –  are being hit in northwestern Syria. Airstrikes, although used regularly during the seven-year-long conflict, are currently at an intensity that should be a wake-up call.

MSF was supporting the vaccination activities of the health center in Mishmishan. In the second half of 2017, that team vaccinated more than 10,000 children there. This service is now shattered. The area of the health center where the vaccination activity took place was badly damaged, destroying the stock of vaccines and the fridges required to keep the vaccines cold.

Given the massive numbers of families fleeing to this area from the conflict raging further south and east, there were many vulnerable displaced people who did not necessarily know about the vaccination services in the health center. That is why MSF supported a vaccination team to start some outreach activities. The morning the health center was bombed [in Mishmishan], the vaccination team was out in nearby villages. Their lives, and the lives of parents and children who would have been queuing for vaccinations at the health center, may have been saved by that lucky coincidence.

That is no consolation for the six people killed by the strike, all patients or caregivers. And it is no consolation for the 17 people wounded, among them three medics from the health center. We send our deepest condolences to the friends and families of those killed, and we wish a safe recovery to those who were wounded.

This situation also raises the question of where will the wounded be treated.

Read More: Syria: “Medical Facilities Are Paying an Extremely Heavy Price” Amid Intensified Airstrikes on Idlib

There is a terrible knock-on effect each time a medical facility is bombed. For example, managers of the referral hospital nearby at Qunaya, to which MSF is providing a comprehensive package of support, were made extremely and understandably nervous by what happened at Mishmishan. In order to minimize the exposure of medics and patients in case they too would be bombed, the Qunaya hospital management reduced services, sent non-critical patients home, and kept a skeleton team running the Emergency Room and the operating theater, but nothing else for the moment.

This domino effect ripples out in waves each time there is a strike on a hospital or clinic. The result is more people in greater need with fewer health services open and available. The circle is certainly vicious. Those facilities that remain open are so overwhelmed that consultations are rushed, errors in diagnosis can be made, referral options for more critical cases are harder to arrange or may be impossible. And so more people become more seriously sick and have a greater need for more advanced medical care, which is becoming ever more constrained.

Our mobile clinic teams see this as they move around the settlements of displaced families, sheltering in the cold, crowded into tents, sometimes having travelled dozens of miles barefoot to get away from fighting or the threat of bombing. Among the most prevalent medical conditions are respiratory tract infections and chronic diseases, such as diabetes and hypertension. Without access to care, these conditions can worsen, and, in the case of chronic diseases, become eventually life-threatening. The MSF mobile clinic team can treat the patients they find, but there are hundreds of thousands of displaced people spread across northern Idlib, and not all people can get to see a doctor or nurse.

An already bad situation is in the process of getting much worse. The requirement to avoid hitting civilian areas and civilian infrastructure, such as medical facilities, is the first step to avoid a catastrophe.

MSF was one of several organizations supporting the Mishmishan health center with donations of medical supplies and medicines, however no MSF staff were on the ground in this facility. In December 2017 another organization took over general donation support for the Mishmishan health center and MSF changed to focus specifically on supporting the facility’s vaccination services, training and paying incentives to vaccination staff, equipping the vaccination center, and providing vaccines. Elsewhere in the Idlib region, MSF has three mobile clinic teams with MSF staff on the ground, and ad hoc distribution teams providing winter-survival and hygiene kits to displaced people. MSF also has a full-support partnership agreement with Qunaya hospital and provides varying levels of distance-support to other Syrian hospitals and health centers in the region.

Read More: Syria: Families Displaced by Fighting Struggle for Survival in Winter Cold

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