Reflections on a decade of war in Syria

Arwa Damon:

Welcome and thank you so much for joining us in this discussion: Reflections on a Decade of War in Syria. My name is Arwa Damon. I am your moderator today. I am a senior international correspondent based in Istanbul and I am also the co-founder and president of the charity INARA that focuses on filling in the gaps for impacted children who are unable to access the medical care that they need. That some of you might know Doctors Without Borders by its French name Médecins Sans Frontières or MSF. And that's how you'll be hearing us refer to it today, as MSF.

Now, we are going to be talking about the last 10 years of war in Syria, and I was recently in the province actually for the 10 year anniversary. Although hardly anyone there will call it an anniversary, more of a grim, very grim milestone. Now in Idlib at the moment there is a tenuous ceasefire that has been holding for about a year now. And there is this sense amongst many people that when the bombs stop falling, somehow the humanitarian need all of a sudden evaporates. It does not. And what really struck me most that trip and I've been reporting on Syria for the last decade, was that people stopped asking us, "Why doesn't the world care about what's happening?" Or, "Why is this happening to us?" They don't ask that question anymore. And we used to hear at all the time, and it's almost as if for the population there they realize at this stage that it's futile.

Syria has destroyed too many lives for us to begin to even be able to count. It's shredded families, either through death or displacement. Hundreds of medical facilities have been targeted and hit and bombed by the Syrian government, by regime fighter jets and helicopters. The war has decimated significant parts of serious infrastructure and its previously functional and relatively advanced healthcare system. Almost 12 million Syrians have been forced to flee their homes and some are displaced internally. Others are living as refugees in neighboring countries. They face incredibly precarious conditions, economic and stability. In other words, they can't find work. Food insecurity. In other words, they don't have enough money to put regular meals on the table. Very few Syrians who you meet, who are living as refugee families in neighboring countries can actually feed their children three meals a day. There's also a lack of access to basic services, especially now, of course, everything has been greatly aggravated by the COVID-19 pandemic. And you know, I also hear people say throughout the course of my reporting, viewers who are watching the story that we put out saying, "It's too complicated." And they use that as if it's something of a justification to be able to turn away.

And I want to thank everyone who's joining us today for not being those people. For listening, wanting to learn more about what's been happening in Syria. And I also want to thank MSF for their continued efforts to respond to the humanitarian crisis there. Now, as I was saying in this discussion, we will be reflecting on the past 10 years. How the war has shaped and changed Syria and the lives of so many. And also look beyond the terminology of war and humanitarian work and show what it really means, what it really looks like, what it really feels like. MSF and others continue to respond to the humanitarian crisis in Syria by donating medical supplies, setting up hospitals and clinics, providing remote support to medical facilities and networks of doctors in areas that cannot be directly accessed. And today we're joined by some experts who will reflect on the past 10 years of war in Syria and on MSF's response there.

But before we continue, I have a little bit of housekeeping to take care of. So this discussion will run for about 90 minutes, wherever you're joining from today, you can submit questions for our panelists. If you're watching on live stream, YouTube live, Facebook live, or Twitch, I don't even know what Twitch is. You can send questions in the comments or live chat section, and our team members will send them to me. We will be prioritizing questions directly related to today's discussion. And there are also live captions for this event. You can view them on a separate URL, or you can watch them on YouTube where you can click on the button that says CC in the YouTube player to turn them on. You know, these are really good instructions. Like this is what I would actually do here if I was watching this. We'll add the links to both those options in the chat. Now, onto our panelists.

We have with us, Dr. Chenery Lim, who's a medical coordinator for MSF in Northwest Syria. Joel Ghazi, field coordinator for MSF in Northwest Syria. Will Turner, head of emergency operations for MSF in Northeast Syria, and Dr. Aula Abbara, consultant in infectious diseases at Imperial College in London and the co-chair of the Syria public health network.

Now, if you're wondering why it's split into Northwest and Northeast, it's because Syria today is not a unified country. It's actually a patchwork. You have the bulk of the territory more or less, which is controlled at the moment by the Syrian regime, the government of Bashar al-Assad in Damascus. Then you have the Northeast, which is controlled by the Kurds. And then you have the Northwest, which is partly controlled by what remains of Syria's rebel forces, and then partly under the control of Turkey. So to start with you, Joel, as I was saying, you know, today, Syria is not this one unified country and your work is focusing in the Northwest in Idlib that I was just talking about in my introduction. Can you share a little bit more about what the dynamics are like there and what kinds of challenges you're facing?

Joel Ghazi:

Yes, of course. Thank you everyone. Thank you everyone for being here. So as you were mentioning, I've been working on Idlib for the past almost 10 months and the area of Idlib for what we'll be mentioning as the Northwest is today home to 3 million people. So you already have to imagine that among pre-war Syria, Idlib was not one of the most populous provinces. It was maximum maybe home to a million people. Today, Idlib is home to 3 million people. Out of this 3 million, half of them are displaced. So we're talking about an area with 50% of its population are displaced people living in precarious situation, living in tents for the big part. And a lot of these people it's not their first displacement. You know, for a lot of us, we- and this is really something important. We will have to communicate on Idlib and on Syria broadly.

Most of the people in Syria have been displaced multiple times. And the reality of Idlib and its population today is that most of the people that have been displaced four, five, six, and even seven times, a lot of these people have had to flee from the, let's say their first place to another place where they have family. They've witnessed war so on and so on and so on. And so this story has been going on for 10 years. And the reality today is that the people in Idlib have been displaced multiple times. Half of them are displaced in Idlib. A lot of them face the wrath of nature I would say. We witness it every year. Sadly, I've been on Idlib on and off for the past four years. Every winter, when there is a heavy rain for two days, camps are flooded. There are two meters of water. People lose their tents, their livelihoods, whatever let's say they were able to flee with.

So when we are talking about Syria, of course it's quite broad, but for my part, when it comes to just Idlib, this is really the situation. It's an area that we hear about in the news on and off. So sometimes we hear about an increase in the conflict, for example, a year ago. A bit more than a year and a half ago, actually, when we heard there was a big military offensive and this caused a million more displaced within Idlib. However, even if when we don't hear about Idlib, it's an area that is in active conflict. There is every day bombing somewhere in the area that affects some part of these 3 million people. So this is the reality. And in really brief terms, I would say about the area, and this is the reality of where MSF today has parts of its operation.

Arwa Damon:

Yeah. And just to kind of add to your description. So when Joel's talking about people being repeatedly displaced in Idlib, a lot of the fighting lately, again, there was this ceasefire that's been in place, but it was focused on this one province and what each military offensive did each round of bombing did was take this population and crush it up into an ever shrinking chunk of territory. And the thing is, from this one last chunk of territory, there is nowhere for people to flee to. And that is why each time there is another bombing offensive, there is panic because they can't cross into Turkey and they can't go back into regime areas. They're quite simply too afraid to, and now to kind of illustrate how many times people end up fleeing and how, when you're working within the humanitarian sector and trying to set up healthcare clinics, we have this two-minute video where we'll hear from Mustafa who is one of MSF's health center directors. And he and his family were on the move, fleeing violence from 2011 to 2016. And along the way at every single point, when they thought that they finally reached relative safety, he and his colleagues would try to set up makeshift medical centers along the way.

So Joel, we're talking about how you're providing this remote medical support. I mean, how does that even work when people who are part of your operation on the ground are constantly on the move like this?

Joel Ghazi:

So, that's a very big question to answer. So the point of it is that the way MSF has been working in Syria has changed depending on the situation. So in some areas where there was a relative safety, we were able to set up, let's say, proper hospitals or more regular operations, but in cases like Dr. Mustafa, who is someone who's had to move all the time, what MSF did and what we're still doing - I was myself with Dr. Mustafa on the phone last week - is that there are doctors and medical staff among the Syrian population that themselves take the initiative to set up a health center, field hospitals, et cetera.

And in that case, what we tried to do is we reach out to them. Actually, we've been reaching out and developing these networks for almost a decade now, and we support them. So for me, from my point, I think, I've been doing this for some years. It was quite difficult to explain this some years ago. The irony of it is that it became a bit easier last year, because a lot of people have shifted to what we call remote work or work from home. This has been in my case and several of my colleagues, our reality for six years. So we, we do Skypes, we do WhatsApp, we do calls, we get videos, we get pictures of things. All sorts of- the way the technology of both, we tried to evolve and use many of it.

So this has been the reality of several of our colleagues. And we tried as best as we can to channel support these doctors. So, I'm not going to bore you with some of the things that I don't clearly know a lot about and other details, but for me, two important points. We supported these doctors with all of the running costs of the center. We give them medication, et cetera. But personally, after all these years, two things stand out. First of all is the ability- the fact that we were able in many cases to provide some technical medical input, a lot of these doctors, because many of them, when the war started, they had to abort their studies. They couldn't finish their studies. They had to work in things they never studied even before. So, in many cases they were put in situation, they were receiving wounded, there was war, and it wasn't their specialty.

The ability to speak to an experienced surgeon, even remotely was very helpful. For me this is the first point. The second point is that as you saw, a lot of them- I don't like to see them because that's not the way I view it as also victims of this war, because they have been despite being victims, they're also providers of services and of relief. And the ability- the fact that we were talking with them and just sometimes, honestly, no amount of training or things we can do can prepare us. But sometimes we're just being there for them, talking to them, asking them about their families. Sometimes they're talking to us, asking us about things and we stay until the dead of night. And for me, these are the two things I remember when we were talking about remote support and staff supporting facilities. Yes, it's all of the package, but it's the technical support to doctors who need it. And it's also a certain show of solidarity over humanity. And of just being there with a certain person who you're calling even remotely, never seen him or her, but you just checking, they have a way of also expressing, talking about some things. So I'm not sure I answered your question.

Arwa Damon:

It creates a special kind of bond. I mean, one that's really hard to put into words. And, you know, to highlight your point of this technical support that you're talking about, you know, I remember reporting on a story where an ophthalmologist was trying to do a complicated brain surgery to save somebody's life, and literally had Skyped in on his phone to an expert who was guiding his scalpel as best as he could, where the electricity was out. So another colleague of theirs with holding up his cell phone to shine a little bit of light from the cell phone camera. I mean, when we think about what the medical staff inside have had to go through, it's extraordinary.

And so speaking about Syria and how every region right now today is quite different if we move on to the Northeast. So the Northeast is an area that is predominantly controlled by Syria's Kurds. It's an area that did not necessarily see that much fighting by the regime, but it's an area whose fighters, who are the Kurdish fighting force known as the YPG, ended up being the bulk of the force that ended up pushing ISIS out of certain areas in Syria that they controlled, backed of course by the US and other coalition allies. And so, Will, you're the emergency coordinator in this area. How do you describe kind of what your work there looks like? And obviously it's quite different to the dynamics in the Northwest.

Will Turner:

Yeah, thanks. On the one hand, yes it is quite different because of the political dynamic and the presence of different armed actors there. But in terms of the humanitarian impact, I think you can draw parallels with the situation across the country and particularly the Northwest, With the population suffering from this decade of turmoil. And that has gone through various phases from the early phase of the uprising and the escalation of conflict with then huge numbers of people moving out of the country, being displaced, separated from their families, trying to seek shelter, and really then MSF trying to scale up massively activities to try and respond to the needs, both inside Syria, but also in neighboring countries, such as Turkey, Lebanon, Iraq, Jordan. And then of course, further afield in Europe as huge numbers were risking their lives trying to reach safety, including crossing the Mediterranean and Eastern Europe.

And then during the next phase of very intense and heavy conflict, of course, hundreds of thousands of people lost their lives, were severely injured, and with very little ability to seek safety all the more hampered when borders started to close from 2015 onwards, when particularly the Turkey border, which had provided a safe haven for many Syrians - over 3 million - that option then started to become unviable. And as you said earlier, people are now being trapped. There's always been huge limitations in the amount of humanitarian support and, and medical assessment assistance. There was already a weak infrastructure in the country. Many health facilities, and the medical mission was targeted by armed actors. So people were not able to access health care safely. Many health facilities were destroyed, and many staff, including healthcare workers in MSF-supported facilities, lost their lives, particularly in 2015 when 23 MSF-supported staff lost their lives tragically.

But this is been a trend that we've seen throughout the conflict. These different phases of crisis after the other. And now in the latter years, the years of hardship just continue with the economic situation being particularly difficult. People are becoming more food insecure. We have colleagues and patients who are having two meals a day rather than three. And then put on top of that the COVID pandemic in the Northeast, there's a drought, which is impacting on water availability, the possibility for agriculture to take place, et cetera. And what you see is that people are going through these phases of crisis and each time just facing yet more uncertainty about what the future holds and often a sense of hopelessness about the future.

Arwa Damon:

And obviously Dr. Chen, the medical needs are wide and diverse, but in terms of what you're actually seeing with patients that you're seeing, what is the biggest challenge that they're facing today versus say, for example, what they were facing when the fighting was at its most intense?

Dr. Chenery Lim:

Yeah. So, when you asked me this question, it's a little bit to me a little bit tricky, because I don't know how do I start to explain a little bit the complexity of what is happening. If you listened to what Joel is saying, if you listen to what Will is saying, the conflict never stop. This is an area where it is a protracted conflict. That means the conflict is happening all the time. And if you look at it, if you translate it to health, it's a little bit also that health is also moved by factored up. It's cause and effect. Conflict is happening. We don't hear it in the news it doesn't mean it's not happening. Our facility is receiving trauma patients for example, every week. We are still seeing this, but it's not being highlighted. You know, as what Joel is saying, we actually have to monitor health scenarios by season because it's so different that our response also has to be adaptable to what is happening per season. So for example, this winter, it was the harshest winter that the Northern part of Syria actually experienced were in. We had to really run after building improvising the tent for the people. To make sure that they have enough warm clothes because then we will see now again the increase rise in frostbite, increase rise in hypothermia. This summer for example, our team is preparing for heat stroke because of the lack of access to water. You're talking about basic needs. You're talking about access to clean, drinking water wherein these are things that are supposed to be free. These are things that you're supposed to be given to you for a fee and it's not free inside.

So it's a little bit this basic health care that is actually not there. But sometimes we also forget, because the thing is, is that when you talk about health people only think about the physical one because it's something that you see. So it's something that is like, okay you are hurt? That's there. You're in pain? But what you don't see is actually the not physical one that people are suffering. I can talk about this from our staff, as you mentioned before, these people has been displaced multiple times.

Our staff, our healthcare service providers, are also victims of this displacement. Our healthcare providers everyday go to our hospital serving their own people. The resiliency of our staff in treating all of these children for supplies coming into our facility. Suffering from minor illnesses for example and you actually don't really see, and you don't really feel but they are also victims themselves. For them to actually provide this services to our beneficiaries is already very, very good. I cannot say that the resiliency of this people is really admirable.

Definitely for me, basic access to healthcare is definitely the number one that we always need to think about. This area relies a lot on humanitarian assistance. Northwest as an area is stateless. There's no government. There is no proper health department that takes care of its people. These people rely on humanitarian assistance from us, from people. So definitely for me, it's very important that we continue to support because as I said it's a protracted country. I definitely would advocate for the renewal of this UN resolution cross-border because it will affect a lot of the lives of these people inside. Thank you.

Arwa Damon:

A lot of people might not know what this UN resolution is and what the hold up is. Aula if you could actually address that, and clarify a little bit, and also talk about how important it is for these humanitarian corridors to remain open. Because again as we've all highlighted, the bombs might not be falling in the same intensity as they were that does not mean that the need has decreased.

Dr. Aula Abbara:

Cool, thank you very much and thank you very much to my colleagues for highlighting some of the issues across the country.

So the UN Security Resolution on cross-border aid is actually really pertinent at the moment because it's up for renewal in July. So the background to this resolution was that early in the conflict the provision of healthcare in humanitarian aid was criminalized by the Syrian Government. So there are many Syrian healthcare workers that have been imprisoned, tortured or forced to flee as a direct result of this criminalization of healthcare for people considered to be opposing the Syrian Government. And this has affected thousands of healthcare workers and it's been a big driver of the exodus of healthcare workers the way we've seen, through no fault of their own.

And so what happened with international pressure, and this was a positive step, was that in 2014 the first UN Security Council Resolution on cross-border aid was established and it allowed for four humanitarian corridors, so four borders. Two in the Northwest so Bab alHawa and Bab al-Salama one in the South and one in the Northeast and the other will be a border crossing. What this allowed was humanitarian actors based where they be in Jordan, Turkey or elsewhere to be able to support the health and humanitarian profession and areas mostly outside of government control. The reason this was essential is because very early on it became clear that the flow of aid through the government was not going to reach everyone equitably, across all areas, based on humanitarian need not based on political affiliation or corruption or anything else that could occur.

Every year it was up for annual renewal and this was always a very tense time for all the humanitarian organizations, including Médecins Sans Frontières. But many of the Syrian organizations that are providing humanitarian care in the Northwest, the Northeast and then previously in the South of the country before it was taken over by the Syrian Government, of course Eastern Ghouta so Damascus suburbs swelled before it was taken by the Syrian Government.

What happened in January 2020 was devastating. There was the closure of Yaroubiyah border-crossing which served the Northeast of the country. So then we hear from Will and the rest of the team about the situation in the Northeast, just before a pandemic, it's had devastating consequences in terms of the ability to respond, not only to the normal health and humanitarian needs in that area which are dire. So that area if you remember, was already underserved before the onset of the Syrian Conflict, it was neglected. It didn't have the same investment of Damascus, Aleppo and elsewhere and so that happened in the Northeast. And what became very clear when provisions were provided to the Syrian Government to respond to COVID, whether it be training, PCR machines, PPE, anything else that would support the health system in the Northeast that simply wasn't reaching the people that needed it in the Northeast, in the way that it was intended by the international community. This has been devastating to the Northeast.

If we now go to the Northwest, where depending on how you define the Northwest, there's about 4.17 million people and thankfully it's the areas under Turkish control. As we heard from Joel these are people living between the closed Turkish border of one side, the lines between opposition control and government control on the other side the closure of Bab alSalama Hospital last year.

And in July there was very high threat that Bab al-Hawa border-crossing is going to be closed and this is going to cut off more than 4 million people and we have more than 50% to 75% of those people are already internally displaced. Many of the IDPs themselves are women and children. That's more than 70-80% are women and children and they have very high humanitarian needs. We're seeing all the normal things diarrheal infections, uncontrolled cases of COVID-19, but also severe acute malnutrition. Which is, in Syria before the conflict, wasn't something that we were seeing and that's not withstanding those who've been affected by the conflict; the elderly, those with non-communicable diseases, those with chronic conditions and of course those with disabilities. We don't know the number of disabled people in Syria, we estimate. I've heard everything from one million to two million but we are talking vast numbers of people whose lives have been devastated by the conflict.

And so that's why I asked everyone who's listening to this call to, that really advocates, and all the humanitarian actors, in any way that we can, we must be advocating for Bab al-Hawa border-crossing to remain open. The consequences, should it close, are going to be devastating. In a country of conflict where we've seen the worst of the humanitarian crises that in our generation, I can't believe I'm saying this, but it could even be worse than we could possibly imagine if it weren't renewed.

Arwa Damon:

And this does very much, and correct me if I'm wrong, but it is the politicization and the weaponization of humanitarian assistance with little to no regard for the people, the civilians, that will be impacted by it.

Dr. Aula Abbara:

Absolutely, that's very nicely said Arwa. So I was reflecting on this earlier and I'm Syrian, albeit with the privileges of someone who's grown up in the UK, and it's very clear for me that very few people who have power in Syria, and I'm going to use that broadly across the country, care very much for civilians in any part of the country. I do think however, it's important to highlight that when we look at the balance of morbidity/mortality. Attacks on healthcare. Attacks on healthcare workers. So I'm sure everyone is aware that more than 930 healthcare workers have been killed in this conflict, and in the last few years, more than half a million people have been killed in this conflict of a pre-war population of around 21 million. So these are devastating numbers but more than 90% have been by the Syrian Government. And so for me it's always been very difficult when I talked to international actors and they say: "But aid must flow through the Syrian government. We must work with the Syrian Government aid. They couldn't equitably provide aid across the country."

Whereas in fact we know that's not the case. There's been some excellent work from Human Rights Watch, Physicians for Human Rights and others. Where they examine the situation for example, for returnees so people who may have been displaced once again and have to go back to certain areas, they don't get the same level of healthcare access.

And actually now we're talking about COVID-19 if we look at vaccination, I'd be very surprised if they had the same access to vaccination or any other services. Water is an important one. I really liked what Chen said about, I'm a clinician and Chen's a clinician, we tend to think of health in a one dimensional way but health is about everything. It's about water and infrastructure which in itself has been weaponized. And we know that from Alouk Water Station in the Northeast which has often deprived 400-500 thousand, already desperate, people of water in this political interplay that has occurred through the conflict. Leaving children, other vulnerable people at risk of death and suffering from entirely treatable conditions. So in our whole camp it's not infrequent that we hear of children who've died of diarrheal illnesses when of course water healthcare should be a human right.

Arwa Damon:

And it seems probably among one of the more disturbing causes of death within this context. I mean all causes of death are disturbing but these kinds of illnesses that are so treatable and yet end up devastating so many families that are already dealing with these compounded traumas. I just want to also briefly remind everybody who's watching that you can submit your questions to the panel in the chat on the various mediums that you are watching on. And to that effect we do have some questions that are beginning to come in, this one is quite appropriate on the heels of what we were talking about, given that Syria has been a war zone without a frontline and without rules. So Joel I'll send this your way first. This is from Cole on Instagram, thank you Cole: "What precautions does MSF take when working in countries that are at war?"

Joel Ghazi:

Well it's a broad question but if we bring it back specifically to Syria, in terms of precautions, I think the risk analysis from the beginning has been a risk of bombing. I think a lot of our colleagues just talked about it. But if I'm asked about Syria what's the biggest plight also that health worker have faced with at the moment it's not the only one, it's far from being the only one, but that's the biggest one. So in terms of precautions in many cases, I mean we've had to support facilities were underground minus two, minus three people have had to dig other parts of the building that were above ground. I had to fill them with sandbags. I mean people tried everything.

This is why I think it's important also to be honest, in our case, we send myself managed facilities and supported facilities and it's not the same thing. When we say managed facility we mostly try to place these facilities close to the border because we think it's safe from bombing to some extent. When we say we support facilities, these are facilities set up by Syrians for Syrians in their towns, and in that case we try to recommend some things. But at the end of the day they will set up their facility. A lot of them are not with us anymore, it's hard to say, but they tried as best as they could and at the end of the day, there is no amount of sufficient protection you can do when there's so much sophisticated weapon be being used.

Arwa Damon:

And I think it's worth reminding everyone who's watching right now that medical facilities were often hit, at times deliberately targeted, by both the Syrian regime and the Russians. This is despite the fact that at one point in time the coordinates of some of these locations were shared with the United Nations, intending to keep them safe and yet they were bombed anyways.

Providing medical assistance in areas that were under rebel control was considered to be a crime. A lot of these clinics that we talk about, all these medical facilities that we talk about, they were actually underground. They were hidden in secret locations. You could not disclose where they were. For us as the media, oftentimes when we went to try to film there, we were told no it's just too risky and we completely respect that or we would have to go in, and then that only film once we were inside the facility. It's kind of mind blowing to think that just trying to save someone's life would make you a target but that was just the reality of what people there were facing. To that effect, Joel I wanted to ask you another question that might be a bit difficult but how many of the doctors and medical staff, who you've known over the years working in Syria, are still with us?

Joel Ghazi:

I don't have the broader numbers for all the country I can only talk about the few, or the ones that in the project, in my experience worked with. I think I tried to forget the exact number but if memory serves maybe a third or 40% of, and again this is my case, I mean the teams and the smaller projects I was in around 40% of the medical staff in general. So we're talking doctors, nurses, pharmacists, and so on technicians are not with us today anymore. I have covered around six years and a half of work with MSF on Syria and during those six years a good 30-40% of the staff we've supported are not with us anymore today, if memory serves right again.

Arwa Damon:

I'm sorry. It's hard but it is sadly the reality for Syria. I remember the beginning of the revolution and the demonstrations, as the media, we would all have our lists of activists we were in touch with in different parts of the country and then as this wore on that list just got shorter and shorter and shorter as people either died or they would disappear into detention facilities. And so every aspect of working in this environment is very difficult. Will how do you handle some of the challenges? I imagine it must be quite difficult to have operation staff located on the other side of a border. And what are some of the challenges you're facing right now in providing cross-border aid?

Will Turner:

Well there's quite a few challenges but I think what keeps me up at night is the fact that in Syria, for MSF, is that we have not been able to negotiate access with all actors and namely the Syrian Government to be able to work in all areas of the country, to respond to the needs of the population across the country.

So we have been working predominantly in the Northwest and in the Northeast and other opposition held areas during the evolution of the conflict. With that our teams and medical and humanitarian staff are at risk of being seen as working for a terrorist organization in the eyes of the government. And therefore the risks that might entail for them in the future are quite considerable. That is a challenge that our teams have to live with and our teams have family members across the country they might need to travel to government held areas to seek healthcare. For example, there is the need to travel to Damascus to try and receive some specialist care because the specialist care cancer treatment for example is just not available in large parts of the country. And then that becomes a significant barrier because in crossing lines into government held areas they might get detained and questioned and that could have severe consequences for them in the future. So this is a reality now and also for the future.

And so our teams are taking great risks as well to provide assistance to their community. We as MSF want to stand in solidarity with them and the population and that's why we tried to find different ways as MSF throughout this conflict to continue to provide assistance when we weren't able to access areas because we weren't able to negotiate with certain groups or that we felt it was too insecure. Then we try to find ways to support by providing medical supplies and financial support to pay for salaries to allow Syrian health care workers to continue to provide assistance to their community. And then as the conditions have let's say improved and somewhat allowed MSF to work inside the country, for example in the Northeast we are able to run full medical activities in certain parts, but it is incredibly difficult environment because our staff are they're living through the crisis as well. And we also have to support and be compassionate to them.

I just want to share a story of actually a close colleague of mine who works with us in Amsterdam, a Syrian colleague, just to highlight a bit the indirect tragedy of the impact of the Syrian war. So he actually left Syria when the conflict started soon after the uprising and actually started to work in Turkey with MSF. During that time it became very difficult for him to continue to support his family and his grandfather was unable to receive cancer treatment any more because the border closed with Turkey. His grandfather and grandmother both died. He eventually came to the Netherlands and was able to start working with us in the Netherlands and in 2018, his father was at home and working on the roof and tragically fell off the roof and landed on his head and severe brain injury. Now this was in the Northeast, in a place called Qamishli, and despite their best attempts to try and access a health. There was just no health facility they could take care of his father. They were driving from one facility to the other and there was no bed space. Eventually they found a private facility where they managed to pay to get a bed after several hours of driving around in the back of a vehicle.

Now after a day or two at bed became available, unfortunately when somebody else came and to try and receive some adequate health care in the end, that was not enough, and sadly he died. And it's this kind of situation that is so tragic that Syrians are living through many different aspects of a difficult situation of being separated from loved ones, not being able to provide support, not being able to travel, to see family, and the lack of basic health care and services. Which, is having such a devastating impact on people's lives.

Arwa Damon:

Yeah, I think thank you for sharing that story. I think a lot of people, when they hear about humanitarian and medical assistance in conflict zones, they just think response to violence, which of course is a big part of it. But then it's also all of these other aspects of healthcare and how, when the medical infrastructure gets decimated, it's not just about being unable to provide for people that need emergency treatment, because they've been injured in violence. It's also being able to provide these kinds of basic services just to save people's lives. We have another question, which kind of relates to this. This is from Karen on Instagram and Dr. Chen, maybe you can address this. How has the medical work in Syria changed over this 10 year period?

Dr. Chenery Lim:

How did the change? So I think, this war started, as you said, a lot of it started and an emergency we’re in. You always respond...

Arwa Damon:

I think we might be having some audio problems with Dr. Chen's audio. Yeah, sorry. We seem to have lost Dr. Chen's audio. Well, I mean, it's not a zoom dispassion if something doesn't go wrong. Hopefully Dr. Chan, we can figure out how to get your audio back and then we'll return to that question. Meanwhile, I have another one from Julia, who's watching on livestream, Aula maybe you can answer this one. Has there been any research done into building bomb resistant health centers into Syria?

Dr. Aula Abbara:

That's a very interesting question. I wouldn't describe it as research, and it ties into what Chen was just speaking of, was addressing. What's been devastating about this conflict is actually hospitals are among the most dangerous places for people to be. People might be dreadfully unwell, but doctors will try and turn them around really quickly and discharge them before that perhaps ready. Patients don't like going into hospitals. They avoid them at all costs. And that's because like Cara was saying the deconfliction mechanism. So the mechanism by which the coordinates of hospitals and health care facilities were shared with the international community, quite possibly led directly to them being targeted. As a result of this over the last few years, increasingly, health facilities have been built underground, pretty much all health facilities, especially the ones that were existing or built new were being reinforced.

So you would have heard of some of the underground or cave hospitals. Now, if anyone's not watched a phenomenal film called The Cave, starring Amani Ballour, which was up for an Oscar nomination, I think it was early this year or last year, you must watch it, because she quite beautifully shows us how devastating it is to run a hospital underground. She was working in Rif, Damascus suburb, so Rif-Dimashq in those areas. In terms of actual research about it, I'm happy for my colleagues to correct me. I don't think there has been, but in terms of the humanitarian practice, particularly by a number of the Syrian humanitarian organizations, the Syrian American Medical Society being one of them, there's been reinforcement and changes in the way we structure our health facilities and we enforced them, which is an incredibly sad thing to say. And certainly not something that we should ever accept to be normal.

Arwa Damon:

No, it's not. And it's kind of been this, whole effort of how far underground can we go? And then the bombs that fall get bigger and more powerful. I think we have Dr. Chen back now, sorry that we lost you. It happens you're in Beirut and Beirut's and electricity and internet are spotty at best. I can attest to that myself, but on a more serious note, we were talking about how you'd sort of seen the Syrian medical landscape changing over the last 10 years.

Dr. Chenery Lim:

Yeah. So basically, I mean, from what I saw during the last couple of years is that a lot of this change from a lot of the emergency mode to being a more of a slightly stable one. And it's very adaptable to the needs of our beneficiaries also. So sometimes we adopt on, for example, having a mobile clinic that is providing primary health care services to being, having a facility that only serve, for example, maternal and child health services, because that is what is needed in the area. So for example, if I look at it on the facility that you are so that we are co-managing now, we are the only one that is providing a comprehensive emergency maternal obstetric and newborn care. That means we're the only one that's providing cesarean section for a population of more than 200,000 people.

So imagine that every day, this is the only thing that our physicians and our doctors are doing. So it's a little bit of this adaptation to the needs of what we actually are seeing on the ground. So this is how it's evolving now, because now we have the response to the specific needs of the population. This is like, what all I say, and Joel is saying is that majority of the people there are women and children, a lot of the men we lost during the conflict. And now with this economic crisis, we are also seeing a lot more of underage pregnancy. So these are things now that we are trying to focus on a lot.

Arwa Damon:

Oh yeah, of course, jump right in.

Joel Ghazi:

And just jump on parts of this question on the evolution of healthcare. I think one important point is the fragmentation of it. And doctors, correct me if I'm wrong. But what we saw is with the heightened insecurity when we're talking about the hospital, most people imagine a hospital. So you have several departments, you have different wings and everything. What we have had in many areas of Syria Damascus, the South end today, the North is that services were divided. So basically what people understand as being a hospital today in Syria is actually five different places and five different locations. And each has a different specialty. This has caused a lot of problems in terms of management of coordination and also issues for the patients. In many cases, patients needed different types of specialties or service. And this is not what we have today because of insecurity. What Syrian doctors for the big point decided to do is to just separate and not put all the eggs in the same basket for fear of bombing has increased a lot in the past.

Dr. Chenery Lim:

And I think this is a little bit, the other stability of what we are seeing in a lot of the health services is I think it has to do in partly on the insecurity that you are seeing, but also party on what is really the actual needs that the people have. Of course, as much as you can, you want it to provide all the necessary services, but in some cases it's also not just possible because then the human resources are sometimes a problem. Or if sometimes the materials you need to make sure that it's spread evenly to everybody. So it's this adaptability that we have to be aware of.

Arwa Damon:

Oh, there's been a lot of adaptation throughout the course of the last 10 years. That's for sure. We have another question from Lynn. Who's watching on livestream and Aula maybe you can answer this one. There have been multiple calls to end sanctions. How are sanctions affecting the civilian population?

Dr. Aula Abbara:

That's a very difficult and loaded question. I'm going to say your honest answers. We probably don't know. I know that there are now people looking into it because we need facts. Obviously, trends are an emotive issue. And depending on who you speak to, you're going to get a different opinion as to how much sanctions are affecting the population. I would urge caution and some of the messaging that's coming out, she listened to the steering government. And those that work closely with the government, they'll say the sanctions are affecting the Syrian government's ability to support the COVID-19 pandemic and supports health and humanitarian care. But I would say we need to tread very carefully of that narrative. And the reason is sanctions are that with the exception. So the things relating to helping humanitarian who can, should not. And I can't say for certain or not, but they should not be sanctioned.

So anything that's needed for health care needs to come into the country and should be able to do. So in terms of what is it that's making the health and humanitarian care across the country. So I don't know. I think you alluded to this more than 80% of Syria's population are living in poverty, and I'm going to call it object poverty because the COVID-19 pandemic has devastated the economy. Now what happened in Lebanon with the Beirut blast has had an adverse effect on the Syrian economy as well, and its effects and the collapse of the Lebanese economy in terms of the impact on the banking infrastructure and all these that I don't understand because I'm a clinician has had a negative impact on the average Syrian civilian inside the country. Who's just trying to survive, make a living and have enough food on the table for their children.

So do I think sanctions are the reason that health and humanitarian care across Syria, but particularly in the Northeast and the Northwest and some other areas of deprivation. Do I think sanctions are the reason that's the case? I think we'd be very hard pressed to say that for certain, while we ignore, as you quite nicely described it, it's the weaponization of health and humanitarian care, the politicization of the provision for the everyday needs of the civilians in Syria.

Arwa Damon:

And to follow up, actually, Lynn has another question, which I think leads on quite nicely, but it's a bit of a tricky one. The Syrian government now controls over three quarters of Syrian territory. What is the condition of healthcare in these areas? And I can just say from a journalism perspective and a journalist perspective, it is extraordinarily difficult for us to get accurate verified information from areas under regime control. The government, rarely if ever responds to any of our queries. And a lot of people who we talk to in these areas are terrified of speaking out, even if it is about a condition, but snippets that we've heard are of life getting significantly more difficult with hospitals, really beginning to feel the strain of the COVID-19 pandemic, with the economy receiving will blow after blow people, having to queue up for bread and fuel. I'm going to just throw this out there to all of you. If any of you have any insights on what's happening in regime areas.

Dr. Aula Abbara:

May I just add to this because I've still got some family there, and in the last few months we've had a number of deaths based on COVID and from other conditions in areas that are now under government control, including a cousin, who's my age, who's got metastatic breast cancer. I'm trying to support her, she's got young children and trying to talk to about what she needs. She lives. I'm not going to give many details. Actually she lives in one particular area and has to travel baring in mind. This is a dreadfully unwell lady with metastatic cancer for two hours each way for every appointment, as much as we've discussed just before. So she might need to go to an oncologist and then to her surgeon, then to get some blood tests then to get x-rays. And this lady who's having to travel across the country for women is actually possible to travel in some ways across the country.

But as we know for men, particularly young men that puts them at great risk. In terms of health care, in areas under government control. I think it's always important for us who might be familiar with the Northeast or the Northwest to be reminded just how awful the conditions are in areas under government control.

The COVID-19 pandemic has shown us exactly how awful the cases of COVID-19 started in government areas before they did in the Northwest and the Northeast, and where out of control. So we don't know the exact numbers because that was vast under testing, under reporting and threats against healthcare workers for daring to say, we're seeing all these patients with COVID-19 as an aside for healthcare workers themselves, their salaries might be two or $300, which is simply not enough to live. So they're doing more than one job to make ends meet. And that's a fantastic way for them to go other than devastating for them personally, it's a very good way to transmit COVID-19 among patients when you don't have enough PPE or IPC.

We don't know exactly how many Syrian doctors in areas under government control have died from what we presume of COVID-19, but we're talking dozens of doctors in a country where we already don't have enough doctors across all areas of Syria, particularly in some parts. Specialist services that adversely affected hospitals and some under resource, not just in terms of staff, but also in terms of simple things that we might take for granted as we respond to a pandemic and the hospitals themselves.

So if you're a Syrian with COVID-19, I've spoken to friends with relatives who had COVID-19 in these areas, and they just did not want to go to the hospital because you might go that there may not be enough oxygen. There may not be enough treatment and actually transmission within these hospitals, can't say for certain, but we're presuming to be very high with insufficient access to different medical treatments, but also highest specialty care. So things like intensive care, should you need it? I'm going to stop there and I'm sure Joel will have more insights as well about the areas under government control.

Arwa Damon:

Will, Joel did either of you want to jump in on that one?

Joel Ghazi:

Well, to be honest with you, I think that there's an important point to clarify. We've been from my side, Dr. Chen, we're talking a lot about the Northwest and the Northeast, because this is where UNICEF operation have been taking place since in the past 10 years. And we do not currently have any operations on the government side, but it's not for lack of trying. You talked about how difficult it is for journalists to get permission. But what I can tell you from several colleagues of mine that I know is that UNICEF has been also trying to get a registration since 2012 from Damascus. And it has been since 2012 refused. So today some people might look and say, okay, UNICEF you are not talking about what's happening in the area. What's the situation there? Simply because we don't have operations. We talk from my point through welfare, Dr. Chen, others of our colleagues about the areas where we work, where we have projects, where we have worked in the past 10 years, all of our attempts have been unsuccessful in registering with Damascus.

And hence we have been unable to work on that side. I have some information about how the situation is there, but this is a more of a personal thing because I also from the Damascus and I still have some family there like Dr. Rola, but from the UNICEF side, this is the reality suddenly and it's not from lack of trying. I'm not a doctor medical background. So I cannot be as precise as doctoral, but I mean, everything, what she said is true. We have received information that a lot of doctors are threatened just and forbidden to just mention COVID. And even some of the people I know, and the staff they're working in hospitals in the onset of the pandemic would prevented to even wear masks because this was like this would spread panic.

That's what they were told then. And I mean, just receiving this kind of information from people you know, it's hard to believe. How can you ask doctors to go to the good hospitals, not to wear masks because they shouldn't spread panic. This is the last point. I think that adds on healthcare is essentially because it has affected the government areas.

The North, Northeast, the Northwest is that in the past year alone, Syria has witnessed an economic crisis, like never before the pound has crumbled to an extent in one year, more than it did in the past nine, nine years. What we saw in the last, let's say 14 months is worse than what happened since 2000, between 2011 and 19, in terms of purchasing power of people, in terms of what their salary allows them to buy. And this affects greatly healthcare because the people start prioritizing things differently. Like, okay, the old grandfather in the family would say, don't get this medication for me, get food for the children. I've heard people say that, I've heard people who were forced to make these choices. So when we're talking about health care, we cannot forgo the economic crisis that has hit all of the country.

I'll leave it at that. Because other than that, I'll be talking about things like I don't understand a lot.

Arwa Damon:

It has serious, not for a lack of complex problems. And there is one of these problems that I actually am quite interested to hear all of your thoughts on and have our viewers listen about, because I think this is one of the most perhaps unique and controversial places on earth. And it's a camp that's called Al Hol, that is in the countries Northeast. And basically to sum it up Al Hol is mostly made up of women and children. And these are what we refer to as the last families of the Caliphate. So as the last battles were happening against the Islamic States, the last batch of women and children, and a couple of men to leave from there were literally rounded up and placed in this camp. And I'm very loosely calling it a camp because it's much more like an open air prison.

And to go there, in many ways is to sort of step into a mini version of the Caliphate, but one that is being run by women. And I don't say that to mean that everybody there actually believes in the ideology of the Islamic state, actually, most of them do not. But it is so lawless and so neglected that the women who came out of ISIS's last territory, who were the true believers. I've managed to implement a version of that inside this area. Will, I mean, I've covered it, but you obviously know it a lot better than I do. Can you talk a bit about the situation in and fall and what kind of services you're providing to this population and also why it's so important that these people who are there not be rejected and ignored.

Will Turner:

Yeah, thanks. I think our whole camp represents a stain on the global conscience. And the reason for that is as you said, at the end of 2018 and the beginning of 2019. Tens of thousands of women and children were bused up to our whole camp in horrendous conditions. People were dying in the back of trucks as they were traveling up and arrived in complete chaos at our whole camp. Now, the conditions in the camp have been dire since the beginning that have been gradual improvements in some areas, but still today, there's significant issues with the provision of health care. There's a lack of access to services and people who need specialized care are unable to receive that. The water and sanitation situation is awful. You walk around the camp and there's open sewage flowing around and small children playing in the dirt.

And it's not a safe environment for children. As you said, that's two-thirds of that camp is made up of children. Now, the tragedy aside the actual conditions in that camp, the unsafe conditions, is the fact that there is no hope for those people, those children, for the future. There's very little interest or seeming motivation of the authorities, and the countries who have their citizens in that camp. And just to mention that in an area of that camp, there's up to 10,000 foreign nationals being held in even more area of the camp, where people will have even less access to health care and held in even more constrained conditions. And they are made up of from dozens of countries around the world.

Countries are not taking their responsibility to find long-term solutions for them. People are languishing in this camp, and it's very uncertain what the future holds. But just to bring it back to the impact of the conditions of the camp. What that actually means is, for example, you might have a mother who brings a patient to one of our facilities. We had recently a three-year-old boy who, as so commonly in camp settings, was injured after a fuel burner got knocked over, and he got severe burns. This happened at nighttime because there's no possibility of having health care available in the annex. At night, the mother had to wait all through the night without any health care and was waiting at 8AM for when our teams arrived to be able to receive medical care.

We provided immediate medical care. The child needed to be referred to a specialist facility to a burns unit. Well, there isn't a burns unit in Northeast Syria, of course, but we were able to negotiate and you have to negotiate with the security actor, a nonmedical security actor for a patient to be referred out of the camp. So the child is referred to Hasakah National Hospital, where they have limited capacity to deal with such a case.

The mother is not allowed to travel with her boy as so often is the case. The caretaker or the mother is not allowed to be with the patient. They don't hear anything back. The mother comes to us to try and get information. We tried to find out days later. We get in touch with the hospital and tragically, the child died then because of the nature of the camp. The boy was not able to come back to the camp to be at least reunited with the mother for a funeral. And the boy had to be buried, with the mother never getting to say her farewells or be present. And the boy was buried in a nearby undefined town.

And this is just one example, just to highlight the horrendous situation that faced the population of that camp and the severe limitations of all people's ability to receive adequate health care and be treated in a dignified and humane way.

Arwa Damon:

That's a horrible, horrible story, but I'm glad. Thank you for sharing it, because I think we need to hear all of this and we can't sigh or turn away from what's really happening in these situations. And to speak just a bit more about Al-Hol and you talking about it being a dark stain. The situation in the camp there is, to put it a bit more bluntly, that none of the countries who have foreign nationals there want to reclaim their foreign nationals because they claim that they might potentially be of concern to their own national security. And so instead they prefer to keep them dumped inside Syria in these horrendous conditions. And then you also have the bulk of the camp, which is mostly Syrians and Iraqis, many of whom are not being released to go back to wherever it is that they're originally from.

Many of them actually ended up dragged into a caliphate and do not hold these fundamentalist beliefs. And what's especially important for people to also recognize is that the longer these conditions are allowed to fester, the more hatred is going to grow. And that is not the children's fault because all they're seeing in that camp, is the fact that they've been completely discarded, side-lined, don't have access to a proper education, live in these decrepit situations. And so who is going to step in and actually change the narrative and the balance of their psyche, which actually kind of leads me to something else that is well worth talking about that another of the viewers brought up and that's mental health. So Dr. Chen, this is from Brenda on livestream: "To what extent, and in what ways is MSF addressing the mental health needs of Syrian refugees and what are the major challenges in meeting those needs?"

Dr. Chenery Lim:

So for us in our facility now, we started to have mental health activities. Also, we do it in two phases. In one, we have what they call the psychosocial support system. We do psychosocial education, more on life skills, resiliency, adaptability, and all of this. And then we have a small cohort we're in, we cheat a little bit more on this post-traumatic stress disorder, the depression, the anxiety, and all of this. Because mental health, as a topic is very wide and very varied in its sense. So you're talking about, for example, what Will was saying a little bit. So this is a little bit the case that we are seeing. Imagine when we were children, when you want to draw a house, you always have two shapes. It's a triangle, and it's a square.

If you look at it in the psyche of a child inside Syria, living in IDP camps, you only see always one shape. And that is a triangle. When you were drawing a house before, you always have trees, you always have these clouds, whatever you put the windows. The thing that you will see if you compare it in the mind of a Syrian child, living in an IDP camp is rubbles, stones. A lot of other triangles in the area, a lot of the sticks that you are seeing is them fetching water. This is the norm that they are living with every day. For them, there is no concept of what is play. This is something that we have to introduce to them, playtime. What is it?

We have to teach them how to be a child. So this is a little bit on what we do when we do all of the psychosocial support, because I think this is what is needed, because you always have a portion of these people that will develop all this post-traumatic stress. But majority of what you will need are a lot of these psychosocial skills, psychosocial educations. So just adjusting to the norms.

Arwa Damon:

When we talk about kids though, we're not also just talking about one trauma, and I think that's important for people to be aware of. They weren't just displaced once. Many of them see one act of violence. We're talking about compounded trauma.

Dr. Chenery Lim:

And this is why you always have to always teach them. What is it that is normal, because you have to understand that all of the students are on cards. Their life is always, "I have to be ready”, or “I have to be detached”. How do you make that bond? Because they've lost so much. So it's very difficult to go through all of this sessions, what we call them, display therapy group, this group sessions. It's not easy. But yeah, we have a bit of the system in place.

Arwa Damon:

This conversation just reminded me of a 13-year-old girl who I met on my last trip into Syria. So she's 13, obviously war started when she was three and her father had disappeared detained. She had lost her leg in a bombing. And I asked her, "Did she dream of a life without war?" And she kind of looked at me blankly. And then I said, "Can you imagine a life without war?" And she shook her head. And to me, it just spoke volumes that she couldn't even imagine or dream of a life without war, because she literally had no clue what that looked like.

And this is such an ongoing and unpredictable conflict. And I want to ask this question to all of you and it's a tough one and it's a broad one, but what does the future hold? You can't even say, how do people begin to rebuild their lives after 10 years of war? Because for so many of them, their life is just so uncertain, but what comes next for MSF and the others providing healthcare and support. And Joel, I'll start with you on this one.

Joel Ghazi:

I don't know what's going to happen. And even after working all these years with several colleagues, we said that when a big event happened in Syria, like a big displacement, a big massacre or something, well, we said it cannot get any worse. And the reality is that each year it was getting worse. So now when you ask me this after six, seven years, I don't know. I really don't know, but what I know is that independently of what happens and then independently of what might happen, whether it's worse or not is for me to, and not just for not just me and MSF and for other colleagues, but also for others to continue doing what we are doing. Because this keeps hope alive. I have spoken with several doctors right after their hospital was bombed, the ones who survived. And honestly, I still cannot understand that if even today we were more dwelling on it than they were.

They were focusing on like, okay, we found another place, actually, we're going to set up here and we're going to set up there. And I sometimes was speechless. We didn't know what to say. I was trying to see what happened, who save, who needs something? And they were already focusing on, okay, how can we resume the service? The ones who survive this attack, how can we resume and give again and continue to give, continue if you will.

This is, this is me. I mean, I call it a kind of human resistance. It's this humanity that allows you to resist and to continue throughout all of this. And we have seen it. I have seen it. And I think that it doesn't just belong to them or to me. And I think it's all of us who took part in any way we did, whether it's from a foyer with a post, with information, with talking to someone. Everything in this counts. And this solidarity has to be claimed by all of us and continued. And hopefully with that in mind, and if that continues, then maybe we have a brighter future. But then again, I continued that, but at the same time, I don't dare to hope. That's my answer from this question.

Arwa Damon:

Aula, your thoughts?

Dr. Aula Abbara:

I think this is a difficult thing to answer. And certainly, one to answer with any optimism, what will happen next? I'm very sad to say is that the health and humanitarian situation, poverty levels, and the devastation to the health system will continue to have its effect. And if the UN Security Council resolution on cross border aid doesn't get renewed in July, there's a humanitarian catastrophe, worse than anything we've seen, even with the escalation of finance at the end of 2019, early 2020 in Northwest Syria than we can possibly imagine. But what is it that we should do? So for those of us like myself who sit outside of Syria or anyone else in the international community, we must always stand in solidarity with Syrian civilians in Syria and healthcare workers in any way that we possibly can. And that's whether with donations, whether with support in terms of education and quite simply in solidarity, because they do feel forgotten.

And it's really important for us never to forget the sacrifices that they have made and continue to make. Because remember, so many of them could have left, but they haven't. And they work in the most unimaginable of circumstances. In terms of the health and humanitarian sector. Remember this is a vastly underfunded response. So all of us must do everything we can.

I'm always surprised because people say, Syria is out of the news to me, it's never around us with the news, but I can understand why with the trends in prep. So people like yourself, Arwa, who do brilliant work, highlighting the needs. We mustn't just go on to the next humanitarian disaster, which you must always be highlighting the situation in the Northeast and the Northwest even now in government-controlled areas because humanitarian situation is dire and we must continue to allow health and humanitarian aid to be provided by humanitarian organizations. I won't go into the politics of it, but it's needless to say that it's a politicized situation where many humanitarian organizations that do excellent work, cannot register in government controlled areas. So if they start to lose access in areas outside of government control, that's going to be devastating for the people who remain in those areas.

Arwa Damon:

Will?

Will Turner:

Yeah, I think there's been a lot of pertinent points made. I think the Syrian conflict is so hard to predict and has been so hard to predict. It's been a proxy war. There's been geopolitical power players involved, which make it so hard to know how things will go in the future. But those States, the US, Russia, the government of Syria, Iran, et cetera, they have a responsibility to ensure that services and health care are provided. And let's not forget that, for example, in the Northeast, that the area that the Kurdish authorities are supported by the coalition, which is predominantly made up of the US. And there has been significant destruction in the Northeast, all facilities as a result of coalition bombing. And there needs to be huge investment to rebuild cities such as Raqqah, such as the region of Deir ez-Zor, to allow people to rebuild their lives.

And that takes a commitment of resources and funding in order to be able to do that. And that's going to be so important that humanitarian assistance for the short-term for more immediate needs is provided from the international community, from international organizations, such as MSF, but also media. And longer-term Syria will need to rebuild, and that's going to take a long time. And that needs a commitment of the international community. The Syrians have shown remarkable resilience to go through a decade of war, but it is so important that we stand shoulder-to-shoulder, that we also, as MSF continue to do whatever we can to support them. And as I said to make sure that we share the stories, give the voice to Syrians, to make sure that the world doesn't forget. And we don't risk that the Syria conflict becomes fatigued. And we need to keep the plight of spirits on the map and show our support to them.

Arwa Damon:

Dr. Chen, your thoughts?

Dr. Chenery Lim:

I think a lot has been said about what it is for me. I just want to say one thing. If the people of Syria doesn't give hope and I hope the international community and us don't give up our hope for them also. So let's continue to support them. And I think this is just the message that I wanted to give, because I think all the panelists give a lot of their views about meeting their needs and all of these things. Thanks.

Arwa Damon:

And just to add on to everything that you've all been saying, I think the stories that you're sharing about how you yourselves, how everyone who, on the ground is still fighting. Even if they're fighting every day for survival, they're still fighting, they're still struggling. And so even if this conversation can seem very thick and deep and helpless and hopeless, the important thing to realize is that it's not, and we need to keep talking about it and we need to keep fighting for the civilian population. As a journalist, we realized a long time ago that no reporting out of Syria, was really going to shift the needle. And yet, for those of us that keep reporting on Syria, it's because we refuse to allow global apathy to demoralize us into silence. And I think it's something that sort of extends over to the humanitarian and medical sectors as well, just because of problems seems insurmountable, does not mean that we should turn away.

And the beautiful stories you hear from people on the ground, even if they're heartbreaking are why it's so important because if Syrians were just given a chance, the country that they could build for themselves would be spectacular. And it's all of our responsibility to try to help them to do that. Unfortunately, that's all the time that we have, this went by very quickly. Thank you, Chen, Joel, Will, and Aula for such a fascinating conversation. And thank you all of you for taking the time to be with us today. It's been a pleasure being your host. Apologies if we did not get to your question, but please stay in touch. Not with me. You can, of course, that's fine. Stay in touch. Stay connected with MSF. You can email the team at event.rsvp@newyork.msf.org. For more information, you can also visit the website. For the US, it's doctorswithoutborders.org. And the international site is msf.org. And you can also follow MSF on Facebook, Twitter, and Instagram and beyond. Goodbye, and thank you so much for joining us.