Eleven years after the beginning of the conflict in Syria, the humanitarian situation remains dire. Hostilities are still unresolved, resulting in 14.6 million people currently in need. Almost 7 million people have been internally displaced, while 6.7 million Syrians fled the country searching for refuge. The situation has worsened due to human and climate factors such as reduced access to water and energy, while lack of crops, coupled with the devaluation of the Syrian currency, have left 90% population under the poverty line.

A total of US$ 4.4 billion were requested to finance the Syria Humanitarian Response Plan (HRP) 2022-2023, but only 8.1% has been covered so far.

Financing for humanitarian health needs requires urgent action

Currently, 12 million people in Syria are in health need, with 8 million in acute health need. Almost half of them – 44% – are children or young adolescents. Non- Communicable Diseases (NCDs) account for 45% of the registered mortality.

Conflict-related damage and dysfunction, and severe resource shortfalls have left the health system, throughout the country, unable to respond to the health needs of the population. In 2021, only 56% of Primary Health Care (PHC) facilities and 63% of hospitals were fully functional.

Barely 2.1% of the resources required for the health sector in Syria has been provided, leaving a funding gap of US$ 582 million.

In the regions where Médecins du Monde (MDM) France, Spain and Turkey work, the health situation continues to be critical and lack of funding will only make it worse.

In North West Syria (NWS) only 426 health facilities are functional, serving 4.4 million people of which 3.1 million are in need of health assistance. One of the areas where this shortage impacts particularly in, is sexual and reproductive health care.

The situation is not any better in North East Syria (NES), where similar problems were compounded by the 2021 Euphrates River crisis which resulted in an outbreak of waterborne diseases and Leishmaniasis which affected 7 % of the population.

While in Southern Syria, the limited number of functional health facilities and of human and other resources, have left local communities with no option but to go to private clinics, charging high fees, beyond the reach of most people. Out-of-pocket payments for health have meant that many people cannot access the health system or run into financial hardship when using health services.

Finally, the COVID-19 pandemic continues to be a serious concern in the country, with figures on the rise, NWS had 5,386 new cases in March 2022 totalling 102,884 cases and 2,459 deaths. While in NES as of April 2, there have been 38,522 cases, and 1,645 deaths.

MDM urges all donors, but particularly the EU Institutions and its Member States to renew their commitment with the Syrian population by increasing their funding to the different humanitarian actors responding to people’s needs in the whole country and particularly, to critical sectors such as health, grossly underfunded.

Urgent need to integrate a nutrition response

Food and nutrition assistance is considered the most pressing need by 71% of Syrian heads of households, while 12.4 million people experience food insecurity, and 1.3 million face severe food insecurity. It is estimated that 5.5 million people are in need of nutrition services, one out of three under 17 years old. There are 873,095 people in nutrition severe need, while 2.4 million people are in extreme need and 2.1 million in catastrophic need. It is expected that the number of people in need of nutrition services will continue to increase in 2023. The most vulnerable groups are mothers and children between 0 and 59 months (6 years), 3.8 million children are suffering from chronic and acute malnutrition.

In NWS, malnutrition rates are lower in relation to the whole of Syria. However, one million people are deemed at risk of food insecurity. In April 2019, the last SMART survey conducted in Idlib and rural Aleppo, reported stunting rates among children aged 6-59 months of around 19.3%.
We urge all donors, but particularly the EU Institutions and its Member States to provide adequate funding to the nutrition sector. The effects of malnutrition in childhood are irreversible, a response can no longer be delayed.

In NES, 15% of children under 5 years are chronically malnourished and 5% are acutely malnourished. Further to this, the Global Acute Malnutrition Rate raised from 1.7% in 2020 to 4. 7% in 2021.

The financial coverage for the Nutrition component of the Humanitarian Response Plan remains extremely low – 1%; at least US$ 124 million are immediately needed.

We urge all donors, but particularly the EU Institutions and its Member States to provide adequate funding to the nutrition sector. The effects of malnutrition in childhood are irreversible, a response can no longer be delayed.

Attacks targeting humanitarian assistance in health remains a critical challenge

The UN Security Council Resolution 2286 (2016) condemns “acts of violence, attacks and threats against the wounded and sick, medical personnel and humanitarian personnel exclusively engaged in medical duties, their means of transport and equipment, as well as hospitals and other medical facilities […]”.

Nonetheless, medical facilities in Syria continue to be targets of ongoing hostilities. During the first trimester of 2022, three attacks were directed towards health facilities and personnel. Two of these attacks impacted on medical infrastructure, and all three of them affected either patients or personnel. As a result, two health care providers were killed. Attacks on healthcare are on the rise, particularly in southern-Syria and the total number of attacks reported in 2021 exceeds recorded figures in 2020.

Rehabilitation work of health facilities remains inadequate. According to data collected in early 2022, only three health facilities where refurbished or rehabilitated in Northwest Syria

  • International Humanitarian Law and Humanitarian principles should be respected by states and all parties to the conflict.
  • We call on EU members states to fulfil their obligation to respect and ensure respect for International Humanitarian Law as stated by common Article 1 to the Geneva Conventions.
  • Thus, we call on the UN system and EU Members States to press the government of Syria to fully investigate and prosecute all attacks against health personnel and facilities to ensure accountability.
  • EU members states should make use of universal jurisdiction in case of absence of meaningful action.

MDM´s work in Syria

MDM started its activities in 2008, providing Primary Health Care services in Aleppo governorate in partnership with the Syrian Arab Red Crescent (SARC), before the beginning of the conflict. With the outbreak of hostilities, MDM adapted its response to better address the needs of the Syrian population.

During the eleven years of the Syrian conflict, MDM has engaged in numerous medical humanitarian activities aimed at assisting those suffering from the war. The complexity of the conflict – with numerous actors, limited access, direct attacks on healthcare personnel and facilities, and massive needs – has resulted in an equally complex response. MDM implements activities directly or through partnerships with local actors in North West, North East and South Syria and in nearby countries with Syrian refugees.

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