No way out SYRIA, 10 YEARS OF WAR

Part One

BOMBED

Syrian families displaced in Idlib province live in precarious conditions. The last opposition stronghold, Idlib is regularly the target of airstrikes launched by Syria’s government and its Russian ally. Left with nothing, most of the displaced shelter in insalubrious camps where Médecins Sans Frontières/Doctors Without Borders (MSF) provides assistance.

Advances of Syrian government forces between April 2019 and May 2020

Advances of Syrian government forces between April 2019 and May 2020

At the end of April 2019, Syrian military launches an offensive in the north of Hama. In late August, the fighting and advancing troops oblige 300,000 people to displace to the north of Idlib province.

Despite Russia announcing a unilateral ceasefire, another offensive is launched between December 2019 and March 2020, forcing an additional one million people in Idlib and Aleppo Governorates to flee, the biggest population displacement in Syria in ten years of war. Most of them are sheltering in over 1,000 informal camps that have few basic services, particularly in Dana, one of Idlib’s most densely populated districts. There are now 300 health facilities in Idlib and Aleppo, compared to almost 600 before the war.

Mustafa Ajaj runs a healthcare facility in Deir Hassan camp in Idlib. Mustafa, who’s from Anadan in Aleppo province, has been displaced six times. He’s just one of the people forced to flee the offensive in February 2020. A father of five, he has witnessed relentless and targeted attacks on medical workers and facilities since the beginning of the war.

In 2012, Syria’s government adopts a law criminalising medical activities in opposition-held areas. The destruction of health facilities deprives the population of vital services, and patients found in them are threatened. Many people won’t attend them for fear of being bombed, arrested or tortured.

Although unauthorised by the Syrian government to provide medical aid in the country, MSF decides to work in opposition-held areas. In 2012, two hospitals are established in Idlib province and a third in Aleppo. In June, a trauma surgery unit is set up in a house in Atmeh.

To protect themselves from the repeated attacks on medical facilities, the team from Jabal Al-Akrad hospital work in a cave and then a farmhouse turned into an emergency department with an operating theatre. Practicing clandestine medicine, away from the airstrikes, has become commonplace.

In 2012, MSF deploys cross-border operations to deliver tons of medicines and medical supplies to health centres in Aleppo, Damascus, Deraa, Hama and Homs provinces. In February, after months of fighting between rebel and loyalist armies, Homs is subjected to several weeks of heavy bombing.

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Journalist and humanitarian aid worker Tarek Baderkhan was born in Homs 29 years ago. When his hometown falls to the Syrian army, the young man escapes and is evacuated by bus to the countryside north of the city : he weighs just 45 kilos and his body bears the marks of shrapnel wounds. © Omar Hajj Khaddour

Listen to Tarek's story below ⬇

Like Tarek, Abu Alaa comes from Homs neighbourhood Al Khalidiya. Both participated in the protests that erupted in 2011. 60-year old Abu Alaa and his family have been displaced, first to eastern Ghouta and then Idlib. ©Abdul Majeed Al Karh

Listen to Abu Alaa's story below ⬇

^{In 2015, MSF counts 94 airstrikes and rocket attacks on 63 health facilities it supports. 12 wipe out their targets, and kill or wound 81 of the medical staff. The figures are all the more alarming, given that the number of centres MSF supports represents only a fraction of Syria’s health facilities.}

^{In 2015, 30 to 40% of the victims of violence treated in health centres MSF supports are women and children, a clear indication that civilian areas are constant targets of airstrikes and attacks.}

On 15 February 2016, Syrian forces and their Russian allies bomb MSF supported hospital in Maarat Al Numan in Idlib. Four rockets hit the hospital in two separate attacks launched within minutes of each other, leaving 25 people dead and 11 wounded. It’s the third time the hospital has been targeted since the start of the war. This ‘double-tap’ attack strategy has been documented in other airstrikes on Syrian medical facilities. It consists in targeting them a second time, when the first responders are already on the scene tending to the victims of the first strike.

On 15 February, Doctor Mazen Al Saud arrives 15 minutes late at Maarat Al Numan hospital. The orthopaedic surgeon and graduate of Aleppo University has chosen to work with his friends and neighbours in his hometown.

© Abdul Majeed Al Qareh

© Abdul Majeed Al Qareh

On the way, he hears over his walkie-talkie that there’s been an airstrike and realises the hospital’s been hit.

Listen to Doctor Mazen Al Saud's story below ⬇

Part Two

PERSECUTED

Over these 10 years of war, Syria’s civilian population has faced extreme levels of violence, and none of the forces involved in the conflict—the Syrian government and its allies, but also the Islamic State group (IS) and the US-led international coalition—show them any pity.

In early 2013, more camps are set up in Idlib province to provide shelter to the growing numbers of people fleeing the airstrikes and fighting. MSF’s teams are still in Atmeh, treating patients with serious burn injuries inflicted by the bombs or substandard fuel used in cramped, hazardous camps.

Throughout the year, MSF donates on average three tons of supplies and equipment a day to a network of 40 hospitals and 60 clinics in seven Syrian provinces. The health system is collapsing in opposition-held areas, which still receive little humanitarian aid. The imbalance is striking: government-controlled zones receive almost all the international aid, while insurgent areas are left to fend for themselves. Syrians living in them grapple with food shortages and water and electricity cuts, as in eastern Ghouta on the outskirts of capital city Damascus where, in summer 2012, fighting breaks out.

A year later, rebel fighters in several towns—Douma in Ghouta, but also Daraya and Yarmouk— are surrounded. On 21 August 2013, the Syrian government launches airstrikes and alleged chemical attacks occur on Ghouta. During the morning, in less than three hours, three of the hospitals MSF supports treat 3,600 patients showing symptoms of exposure to a toxic agent. 355 die. Estimates of the fatalities range from 300 to 2,000.

A couple of years later, on 16 March 2015, helicopters drop several barrels of asphyxiating gas near opposition-held town Sarmin in Idlib. According to information received from Syrian doctors in the town’s hospital MSF supports, their patients’ symptoms suggest the presence of chlorine. Six people die and 70 are poisoned. In April 2017, MSF detects yet again symptoms consistent with exposure to nerve agents, such as sarin gas (retracted pupils, muscle spasms and involuntary defecation) in eight victims transported to Bab Al Hawa hospital during the attack on Khan Sheikhoun, a town near Idlib.

Before the war, Imad Youssef was a construction worker. The 55 year-old, who’s from Zamalka in eastern Ghouta, is unemployed and lives in Kafr Takharim near Idlib.

Traumatised by Hama Massacre ordered by President Hafez al-Assad in February 1982, Imad joins the protests in March 2011. The father of four remembers what happened in Ghouta during the night of 21 August 2013.

Listen to Imad Youssef's story below⬇

Meanwhile, on the other side of the country, the Islamic State group has reigned over Raqqa since seizing the city in March 2013. Raqqa’s inhabitants witness the rise of IS in Syria, until now confined to Iraq.

MSF secures guarantees of protection from IS to continue to treat people in Qabassin in Aleppo province, under the group’s control. However, the aid organisation soon realises that relations are deteriorating and its safety is no longer assured. In January 2014, following the kidnap by IS of five MSF staff, the international teams leave the region and medical assistance is organised from neighbouring countries.

In Raqqa, the civilian population has been living under the yoke of IS for four years.

In June 2017, the Syrian Democratic Forces (SDF) backed by the US-led international coalition air force launch a military offensive on Raqqa.

In the whole of June, MSF teams working in Kobanî/Ain al Arab hospital—a two and a half hour drive from Raqqa—treat just 64 war-wounded patients. Most arrive from the bombed suburbs, not the centre of the city. The majority have been wounded by landmines during their escape. The contrast between the violence of the offensive on a limited, surrounded area, and the few wounded casualties they treat is manifest. Groups of civilians manage to get out, but 30,000 to 50,000 are still inside. Cornered, IS’s fighters use the inhabitants as human shields. They’re grouped together in the old town where most of the fighting is concentrated.

The coalition launches intense airstrikes on the city, making no distinction between combatants and ordinary citizens and no plans for evacuating the civilians. An investigation by Amnesty International and Airwars later reveals the scale of the civilian fatalities: over 1,600 people are killed by coalition bombs during the offensive on Raqqa.

Trapped, every day Raqqa’s inhabitants endure IS’s summary executions and the coalition’s indiscriminate airstrikes. Those who do manage to survive are considered pro-IS and risk indefinite imprisonment without trial.

Aged about 40, Khalaf al Malla was a sports teacher in the town. In the early hours of 22 September 2014, as the men in black come to arrest him, he flees his home, barefoot and in his pyjamas.

On the road to Tabqa a sign reminds him he’s leaving his hometown: Raqqa thanks you for your visit. He goes to Saraqeb in Idlib, and then spends 12 months in Turkey. He returns to southwest Syria in October 2015.

Listen to Khalaf al Malla's story below ⬇

Fatima Al Ali lost three of her six children in the war. Before Islamic State arrived, she lived on working in the fields around Raqqa. But she had to stop. For months she doesn’t leave her home in al Daraiya, a neighbourhood west of the city centre. This area is among the worst affected by the coalition airstrikes.

After several attempts, she manages to escape and stays a while in Ain Issa refugee camp where MSF provides assistance. She then goes to Armanaz, a town in Idlib province near the Turkish border.

Listen to Fatima Al Ali's story below ⬇

Part Three

BESIEGED

In 2015, the large number of people reported to have starved to death in Madaya, a besieged city in the Damascus region, is a harrowing indication of the horrendous consequences for civilians trapped by military strategies designed to prolong the sieges. Between October and December 2015, not one medical or food convoy is allowed into the city. The critically ill aren’t authorised for evacuation to a hospital, even when they’re at risk of dying. In besieged towns and cities the fighting rages on, leaving their inhabitants no respite.

On 27 April 2016, at the height of the Syrian government’s offensive on opposition-held east Aleppo, the district around Al Quds hospital comes under a deluge of fire. Ain Jalout school opposite is bombed in the evening. After the first strike, medical staff from Al Quds treat and transport the wounded to the hospital. Not long after, a second strike hits the house below where personnel from the hospital live.

A few minutes later, the emergency room entrance is bombed in a third strike, and after another five minutes, a fourth destroys the two top floors. The health facility has been treating large numbers of casualties wounded in five airstrikes on east Aleppo earlier in the day. 55 people are killed, and over 80 wounded.

The area’s health facilities are bombed every day for the next four days. In all, 14 medical facilities are hit in east Aleppo in April 2016. From July on, successive sieges prevent the city’s inhabitants from fleeing.

During the summer, the eight hospitals still open in east Aleppo sustain damage in airstrikes and shelling at least once. Four are hit several times—proof of the Syrian government's relentless attacks on rebel-held east Aleppo. The last medical aid convoy MSF teams manage to get through to the hospitals is in August. During the following months of uninterrupted siege, doctors trapped in Aleppo tell them about the shortages, their wish to be evacuated, their fear of the bombing, but also reprisals for accepting to deliver medical assistance in the area. The Syrian government and Russia announce the setting up of "humanitarian corridors" to enable the population to leave. However, afraid for their lives, few are ready to take the risk, particularly as several armed opposition groups prevent civilians from using them.

Part of the city is surrounded by government forces, and cut off from supply routes.

Men pull a child from the rubble of a collapsed building in Aleppo neighbourhood Al-Kalasa. April 2016.© Ameer al-Halbi

A little girl plays on the roof of a car in Aleppo. 2016.© Ameer al-Halbi

People evacuate children after airstrike on Aleppo district Salihin. September 2016.© Ameer al-Halbi

A boy works in a repair shop to support his family, 2015.© Ameer al-Halbi

Rescue workers scan the sky. Aleppo, 2016.© Ameer al-Halbi

250,000 people trapped inside the city struggle to survive. Ali Hajj Jasem is forced to evacuate by bus when the siege is lifted. An office worker who used to work in real estate, he’s displaced with his wife and six children to Khan al Arsal, 10 kilometres from Aleppo.

Three years later, in January 2020, they’re forced again to flee the fighting. They arrive in the town of Idlib, where they now still live.

Listen to Ali Hajj Jasem's story below ⬇

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Under siege since 2013, people in eastern Ghouta—a rebel stronghold since the start of the war—are also in a desperate situation. They’re bombed every day, and starving because no food gets through. The world’s TV stations broadcast images of starving children and adults, and the United Nations, accusing Damascus of intentionally starving the population, condemns the "use of starvation as a weapon of war".

In early February 2018, the bombardment in eastern Ghouta is particularly deadly. Between 18 February and the morning of 21 February, ten health facilities that MSF supports and eight it helps with emergency medical supplies report 1,285 wounded casualties and 237 fatalities. In just three days, a total of 13 hospitals and clinics receiving regular or intermittent support from MSF are damaged or destroyed.

Deliveries of essential supplies to medical facilities fall sharply. The Syrian army systematically prohibits and removes anaesthetic drugs from the few UN and Red Cross convoys permitted to enter the enclave where 400,000 people still live.

Surrounded by collapsed buildings, a local Jobar resident rides his bike carrying a jerrican of water. Damascus, March 2016.© Sameer al Doumy

Originally from Kafr Batna in Ghouta, Anas Al Kharboutli is wounded in rocket fire in 2016 and his brother is killed in an airstrike. The rest of his family flee abroad. The 29 year-old photographer covers the siege of eastern Ghouta up until Syrian army tanks are 100 metres from his house.

He just has time to grab his laptop and camera before escaping to Ein Tarma and then Jobar. In March, he’s finally forced to leave Ghouta for Idlib.

Listen to Anas Al Kharboutli's story below ⬇

Part Four

ABANDONED

During years of war and displacements, Syrians fleeing the violence find themselves crowded into already overpopulated Idlib province hemmed in to the north by the Turkish border.

Each displacement and resettlement plunges them into greater hardship, and the economic crisis that hits the country in 2020 exacerbates their situation. In less than 12 months, the Syrian pound has lost 98% of its value against the US dollar. This is due to the crisis in Lebanon and devaluation of the Iraqi dinar, further compounded by the effects of the US-imposed sanctions and Covid-19 pandemic.

They’re still exposed to airstrikes, particularly during the Syrian government’s military offensives, even when they live in clearly identified displaced persons camps. On 20 November 2019, a missile destroys part of Qah camp set up in 2012 and sheltering 4,000 refugees. According to Idlib’s Health Department, 12 people, 8 of them children, are killed in the attack and 58 others wounded. Many families pack up for the umpteenth time and move to camps nearer the Turkish border. Qah’s maternity department is also damaged in the attack.

Living conditions are disastrous in the northwest of the country. In a region where 2.8 million people already depend on humanitarian aid for their basic needs—food, water, shelter, health care and education— every new military attack, every economic crisis affects directly a population left shattered by ten years of war and countless displacements.

Over 12 million people, more than half the population, have been displaced by the war in Syria. Among them, 5.6 million have taken refuge in other countries, primarily Turkey, Lebanon and Jordan, and Europe.

Amani Al Ali lives in her hometown Idlib. Even during the worst of the airstrikes, she refused to flee and stayed with her disabled mother. The two women live in the family home, but most of their relatives have left.

She sells her drawings to the international press and enjoys teaching her nieces and nephews painting. She would have preferred the revolution to start in the 1980s, as they would already be rebuilding the country.

Listen to Amani Al Ali's story below⬇