Hospitals in Idlib are overwhelmed, under-resourced and lacking in essential life-saving equipment and medicines to treat even basic illnesses such as flu and diarrhoea, warns Islamic Relief as the crisis in Syria enters its tenth year.

The conditions are so awful that aid workers from Islamic Relief fear that mass homelessness, chronic illnesses such as heart disease and diabetes as well as infections such as pneumonia combined with conflict related trauma injuries will bring the health system to its knees. 

To make matters worse, fears are growing that the shattered health system would not be able to cope with a possible outbreak of the coronavirus and that hundreds of thousands of displaced people would be especially vulnerable to the disease. 

Ahmed Mahmoud Islamic Relief’s Syria Country Director, said: “The situation in Idlib is dire, people are exhausted, hungry and afraid. The health system has been shattered by the violence and mass displacement and it is already struggling to cope. We’re very concerned that if the coronavirus reaches Idlib this humanitarian catastrophe will only get worse. 

“There are already mass shortages of beds, ventilators, medicine and proper equipment. People’s immune systems have been systematically worn down by the violence and years of malnutrition and poverty. With so many people crowded into squalid and unhygienic camps – the conditions are rife for an outbreak that we simply do not have the resources to handle.”  

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Eyewitness accounts from Islamic Relief aid workers, and supported doctors and nurses in Idlib paint a grim picture of the humanitarian suffering following intense and indiscriminate fighting that began in early December. Since then up to 1 million people have fled their homes, tens of thousands more endure miserable conditions out in the open and at least 500 civilians have been killed. 

In one harrowing case, Mohammad, a male nurse working at an Islamic Relief hospital in Idlib said he was unaware that he was treating his own dying brother due to his injuries.

“The ugliest thing I have ever experienced, is when a badly-injured patient came in and because of the airstrike his face was covered in dust and smoke.

"Only when I started providing first aid, did I realise it was my brother. I tried to remain calm and be professional to help him but shortly after he died. I was numb I didn’t know what to do, where to go,” he said in a video testimony filmed by Islamic Relief. 

“Then a woman started screaming ‘for God’s sake please help us’ and I told myself I will have to mourn my brother later.” 

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Ahmed Mahmoud, Islamic Relief’s Syria Country Director said: “The civilian population in Idlib – as well as medical and aid workers – have been systematically terrorised and have found themselves pummelled constantly since December. 

“The recent ceasefire cannot reverse the critical damage done over the last nine years – it just risks sweeping the crisis under the carpet and allowing people to forget about Syria once again, even though the needs are huge and growing.” 

“We’re seeing women and children waiting outside hospitals, in the cold, as people struggle to cope. In some places patient numbers have tripled in a month. The system has been brought to the very brink of collapse.” 

Health facilities targeted and bombed

Dr Ishan, a cardiologist working at a major hospital in Idlib supported by Islamic Relief, said that the recent attacks have made many people too scared to access medical care. 

“The hospital has been attacked several times. Earlier this month, several bombs exploded about 30 metres from the hospital, which broke the windows and doors. I believe the hospital was targeted as the bombs exploded so close to the hospital and in quick succession. Some patients with acute coronary syndrome were too scared to come to hospitals as they are being targeted.”

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Islamic Relief is one of the biggest providers of medical assistance in Idlib, offering support to 80 health facilities, paying the salaries of more than 150 medical staff and operating four Emergency Mobile Health Units, a fleet of trucks that have been converted to surgical operating rooms that are in high demand whenever bombs start to fly. 

But the support is simply not enough, and Dr Ishan warns that more people will die needlessly unless the situation changes. “We get lots of heads injuries, but we don’t have a CT scan or a neurological surgeon. As a cardiologist it’s hard as a lot of the cardiovascular equipment that I need is not available. We urgently need more assistance – the system is under unimaginable strain.

“Even infections such as pneumonia, flu and diarrhoea – deadly for the very young and old where living conditions are dire – often go untreated because of a lack of essential medicine.

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Mahmoud said: “In nine years, we’ve never seen this many displaced in so little time and the consequences of this are going to be felt for years to come. Families are now living in a rocky mountain area and ramshackle camps that are not fit for people. They are attaching plastic sheets to two rocks for shelter. Some are still sleeping in the open. They have nowhere to return to. They’re exhausted, scared and hungry and feel the world has abandoned them.

“What the people of Idlib need most is a permanent and enduring end to the war as well as access to sustained humanitarian assistance including food, water, shelter, medical care and education for the children.”

While Islamic Relief has long tried to provide mental health and psychosocial support, the devastation has forced operations to shift to provision of basic supplies such as food, water and shelter.

In the current wave of displacement Islamic Relief has provided food to more than 220,000 people.

Tents, blankets, mattresses and plastic sheets were provided to more than 10,000 people. But much more needs to be done.

Last year, Islamic Relief reached more than two million people in the north-west although their teams forecast that the needs will be even larger in 2020.