Humanitarian aid organizations continue response efforts, but those on the ground say it will be a long-term effort to recovery. Data scientists and information managers have used data analysis to track mobility patterns, understand current needs, map damage to buildings and health infrastructure, and effectively share information.

Crisis Ready, a collaboration between Direct Relief and the Harvard Data Science Initiative, hosted Data in Crisis: Responding to the Earthquakes in Turkey and Syria at Harvard on March 3 with over 200 online participants and many others in person.

The nearly two-hour conversation centered on how crisis response organizations have used novel data sources and methods to support Turkey and Syria. The presenters shared their organization’s response models, how to make ethical and effective use of data, and key takeaways from the disaster so far. While open data has helped to determine where people are going and their current needs, scientists say they still expect a drastic undercount of the displaced population as first responders and families continue to look for residents.

The in-person and Zoom event included internationally known speakers: Dr. Andrew Schroeder, Vice President of Research and Analysis at Direct Relief and Co-Director of CrisisReady; Dr. Caroline Buckee, Co-Director of CrisisReady and Professor of Epidemiology at Harvard University; Dr. Abdulfatah Elshaar, Chairman of the Syrian Medical Society and Internal Medicine Physician at Sturdy Memorial Hospital; Ozge Acar, Technical Coordinator at NeedsMap Social Cooperative; Dr. Samer Attar, a medical volunteer at the Syrian American Medical Society and orthopedist at Northwestern Memorial Hospital; Nathaniel Raymond, lecturer at Yale University in the Humanitarian Research Lab; and Can Unen of OpenStreetMap (HOTOSM).

Schroeder opened the event and shared that over 217,000 structures have been destroyed or deemed unsafe, including 520,000 housing units. Across the globe, digital volunteers have mapped buildings and their degree of damage in the earthquake area. Unen from HOTOSM explained to meeting viewers how precision mapping and open information sharing with international response agencies have been beneficial to saving lives.

With millions displaced, medical supports remain the top reported need: antibiotics, access to chronic disease medications, acute trauma support for search and rescue, and support for the displaced staff of medical organizations.

Attar, who volunteered as a surgeon in Syria, said being on the ground changes one’s perspective. There were limited resources that required doctors to make critical triage decisions. He said that they treated two to three patients on the same bed or even on the floor–most of whom had body parts that had been crushed by shattered buildings.

The surgeon said it was a sobering experience and one where he felt like his contributions were “barely making a dent.” Attar said that doctors performed dozens of surgeries per day, but many more people still need critical medical care.

“There wasn’t a lot of heavy machinery, so we would find people digging through the rubble trying to find relatives, or whoever they could find, using their hands or whatever they could find to dig them out,” Attar said.

Dr. Elshaar, also from SAMS, shared that the situation in Syria is one of the worst humanitarian crises in history, given the dire circumstances of Covid-19, the Russian and Ukraine war, the spread of cholera in Syria, and now the earthquake. He shared that hospitals and clinics have been targeted over the past 12 years of civil war in the country, making access to care more difficult.

The SAMS doctor shared an assessment of immediate needs: wound care, amputations and prosthetics, and medication for diabetes, hypertension, cancer, maternal/pediatric health, cholera treatment, and mental health trauma.

Though the situation in Turkey remains dire, access to data is increasing. Mobility data from Data for Good at Meta, analyzed by organizations like CrisisReady, show that population density is shifting away from highly impacted areas in Syria and Turkey. Survivors of the earthquakes are moving to less impacted areas of the country, including large cities like Ankara and Istanbul and rural areas with less damage. However, it’s unclear what housing will be available to them long term. Many are staying in a range of temporary and ad hoc shelters.

Dr. Buckee shared that institutional challenges are often greater than data challenges for epidemiologists trying to model the spread of infectious diseases like cholera and arboviruses.

She shared that having preexisting partnerships before disaster responses is key and that following simple models during a disaster will reap success in determining which populations are at risk, where displaced people may relocate, and identifying the medium to the long-term impact of infectious and non-communicable diseases. The simpler the models, the better for quick and efficient decision-making.

Some said they use social media to track movement, but real-time information gaps persist.

Social media also plays a key role in mapping the landscape of needs at scale. Projects on digital platforms like NeedsMap are at the center of efforts to report where individuals may need food, shelter, and medical care. They can also highlight where the capacity exists to meet those needs.

While helpful, Raymond reminded the crowd that information must be treated with high degrees of care for both individual privacy and community protection. Data can make an enormous impact on disaster response, but the responsibility exists to ensure that vulnerable populations aren’t exposed to further risk.

Dr. Andrew Schroeder contributed to this story.

The post Follow the Data: CrisisReady Shares Emergency Response Models for Turkey-Syria Earthquakes appeared first on Direct Relief.

The 6,800-pound shipment was trucked from Adana, Turkey, and transported into Syria, and contains more than 64,000 defined daily doses of requested antibiotics for infection treatment and other essential medicines.

Tuesday’s shipments are the latest to arrive in Syria, and Direct Relief currently has 22.5 tons of emergency medicines and supplies valued at $4.5M that is ready for shipment, en route or has arrived in the region. In addition to the Syrian American Medical Society, Direct Relief is also shipping medical support to the Independent Doctors’ Association and Syria Relief and Development, all of which support medical efforts in the country.
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In the week since the initial quake, Direct Relief has disbursed $1.52 million in immediate emergency grant funding to enable and sustain the emergency response operations of seven local healthcare and search and rescue groups working across Turkey and northwestern Syria.

The death toll from the 7.8-magnitude earthquake that struck Turkey and Syria in the early hours on February 6 has now exceeded 40,000, and the head of the United Nations relief effort on the ground, Martin Griffiths, stated publicly that this total will likely double or more.

More than 24,000 buildings have been damaged or destroyed in the affected areas, and 8,400 of these structures have collapsed. In northwestern Syria 7,400 buildings have been damaged or destroyed, including 57 hospitals and primary health facilities damaged, and 1,700 of that total have collapsed.

Major concerns include emergency medical and surgical supplies for hospitals, disease outbreaks due to numbers of displaced people without shelter and access to proper water, sanitation and hygiene facilities, and winterization needs, including for medical shelters.

After 12 years of conflict and an ongoing cholera outbreak, 4.1 million Syrians in the northwest already relied on some level of humanitarian assistance before the earthquake, with recent events overwhelming the capacity of local health facilities.

The UN estimated that almost 9 million people have been affected by the earthquake across Syria, and the Syrian American Medical Society has reported that many people are now exposed to the winter weather, lacking adequate shelter and that they are preparing for surges in communicable diseases and potentially cold-induced injuries.

“This shocking event in such an already devastated region has refocused the world’s attention on Syria, but the truth is the humanitarian situation in Syria was desperate and unsustainable even before the earthquake,” SAMS wrote in a statement on its website last week. “A series of challenges to the health sector: dwindling access, COVID-19 and a cholera outbreak across Syria all degraded a humanitarian environment, and these challenges are now exacerbated by this shocking natural disaster.”

SAMS had called on the United Nations to reopen all border crossings into northwest Syria to increase the flow of aid in response to the earthquake’s sweeping impacts. Direct Relief is supporting SAMS and other organizations primarily operational around northwestern Syria, in the catchment areas of Aleppo, Idleb, Lattakia, Hama governorates.

“In the coming weeks, Northwest Syria and those impacted in Turkey will need a level of aid unprecedented in the last few years of the conflict,” SAMS stated.

The post Essential Medicines Arrive in Syria, Post-Earthquake appeared first on Direct Relief.

Cholera is a bacterial infection, most often contracted from contaminated water, that leads to diarrhea and dehydration. It can be fatal if left untreated. Syria’s outbreak comes amid outbreaks of the disease in Iraq and Lebanon. Cholera outbreaks are also occurring in Haiti, the Horn of Africa, and Yemen.  

There is evidence to suggest that the outbreak in Syria is slowing, with the top five most-impacted governates, which are all the north of the country, seeing declines ranging from -28% to -5% from October 23 to 29 compared to October 30 to November 5.

Though case counts are trending down, suspected cases have now been reported in all 14 governates of Syria, and there have been no fundamental changes to underlying conditions in the country related to the spread of cholera, especially access to clean water sources in refugee camps and the ongoing armed conflict, which limits population movement.

In the northwest part of the country, including the governates of Aleppo and Idlib, there have been 11,405 suspected cases and 12 cholera-associated deaths, according to OCHA. Of the confirmed and suspected cases, more than half have been children under five years old, according to data provided by the Syrian American Medical Society (SAMS), a nonprofit whose members have been responding to the humanitarian crisis in Syria, including the cholera outbreak in the northwest and eastern parts of the country.

72% of people who are suspected of having contracted the disease live in refugee camps created by the nation’s civil war, which has lasted more than a decade. More than 6.9 million people are still displaced within Syria, and the war has resulted in a total of more than 13 million refugees, including those internally displaced people, according to UNHCR.

“The basic issue in northwest Syria is access to clean water. In all things related to water, there is a very big gap in Syria. In addition, there are a lot of camps and a continuing war. We have a lot of problems with that. Another issue is awareness of the disease and how to reduce the chances of getting it, in general,” said Dr. Reem Enderun Yonso, a senior health and nutrition officer who has been overseeing the nonprofit’s response to the cholera outbreak.

“With authority, as a health body, you can face any outbreak, but in Syria, we don’t have anything at all. Every year is not like the last year. The war in Ukraine has taken money from Syria. After 10 years, people live in camps, they don’t have any hygiene. They don’t have clean water, they don’t have a house. They drink from anywhere. For children, they treat them in the house. Many times, the case gets worse, and then they go to the hospital, and it’s too late,” she said.

SAMS has been trying to address these problems with a multifaceted approach that combines treatment facilities and door-to-door, or as Yonso said about refugee camps, “tent-to-tent” community education campaigns.

Following World Health Organization and Doctors Without Borders guidelines, SAMS has helped set up a multi-tiered care system in parts of the Idlib and Aleppo governates. This includes oral rehydration points, which are often one-room tents placed near communities with suspected and confirmed cases where healthcare workers prepare and administer oral rehydration salts to patients.

If the patients do not improve, they can go to a cholera treatment center or its smaller equivalent, a cholera treatment unit. These facilities, which function as dedicated clinics for cholera patients, offer more treatment options, such as intravenous fluids and medication. Ambulances with intravenous fluids are also being used.

SAMS has also organized community health worker (CHW) teams. These teams go to areas impacted by the outbreak to gather data, such as suspected cases, and share information about the disease, including how to prevent and combat it.

To ascertain whether or not a person has contracted cholera, Yonso said CHWs ask if anyone has had diarrhea and exhibited additional symptoms of illness. Then, they will share information about treatment options, such as oral rehydration points. CHWs also educate people about general hygiene, with a focus on handwashing, and ways to treat water, such as by boiling it or adding purification tablets.

A report from SAMS identified several key challenges currently facing those trying to end the outbreak in Syria. Some of these include many patients who refuse to give samples,  hesitancy to be admitted to the hospital, and patients, especially women, who check themselves out of the hospital due to the embarrassment of using the toilet frequently. Some doctors have also been refusing treatment to children due to their belief that only a pediatrician should treat children.

Logistically, the war has made it difficult for many patients to access care centers, water being trucked in by the private sector has been hard to monitor, and there is a general shortage of medicines and medical supplies.

“We already faced Covid for two years, so all of our health system is overloaded. After three months of a Covid lull, there’s a Covid increase, more deaths, and now we’re facing cholera and Covid with limited funds and supplies,” Yonso said, adding that fears of a potential closure of the border with Turkey in the new year are an ongoing concern, particularly since obtaining supplies from Damascus is very slow and unreliable.

As another fraught winter sets in, Yonso said many people had expressed an awful kind of fatigue.

“People don’t know what to be afraid from, Covid, cholera, the regime… even if I talk about cholera, they say, ‘Okay, we die from every cause.’ They don’t take it seriously,” she said.  

Direct Relief has responded to the current cholera outbreak in the region by shipping more than $440,000 worth of medicines, oral rehydration salts, and medical supplies to SAMS, with more on the way. Cholera treatment support has also been shipped to hospitals in Lebanon and Haiti caring for patients with cholera. Direct Relief’s cholera treatment kit contains sodium lactate solution, oral rehydration salts, antibiotics, medical supplies to administer medications, and PPE, and is designed to serve approximately 280 patients.

Since 2010, Direct Relief has shipped over $190 million worth of humanitarian aid to Syria, including over 80.5 million doses of medicine.

The post ‘We Die From Every Cause.’ Cholera Hits Syria appeared first on Direct Relief.

They’re “the ones camping on the roads and the ones camping under olive trees [who] are using blankets to create a tent – not even plastic sheets,” said Dr. Hamadeh, president of the Syrian American Medical Society (SAMS).

By contrast, many of those who arrived earlier in the region have put concrete blocks around themselves, or added tin or plastic roofs to ad hoc structures.

More than 900,000 people – perhaps as many as 1 million – have poured into the region since December 1, fleeing a new outbreak of conflict as the Syrian government attempts to retake the Idlib governate. Approximately 80% are women and children.

Numerous humanitarian groups, including SAMS, are on the ground providing help to partners in the area. Nonetheless, there aren’t enough healthcare facilities – or doctors, or medicines – to serve the new arrivals, many of them needing emergency care, medication for chronic disease, a safe place to deliver babies, and treatment for trauma and other mental health issues related to the conflict.

Pre-conflict, Syria had a relatively strong health system and had seen significant improvements in figures like life expectancy and infant and maternal mortality. Children were normally vaccinated.

Idlib and nearby Aleppo, in Syria’s northwest, had a combined 550 health facilities, according to Dr. Alaa Abou Zeid, a WHO emergency health coordinator for the region.

Conflict cut that number in half. “The health system in the northwest was already decimated in the period before the last escalation of conflict,” Dr. Abou Zeid said.

Then, since December 1, an additional 74 health facilities were forced to shut or suspend services. Dr. Abou Zeid estimates that 11,000 patients with conflict-related injuries have been unable to receive urgently needed care.

A major shift

Idlib had already experienced a major population shift before the most recent, cataclysmic development in the years-long conflict.

Before the fighting started, it had had a population of about 1.5 million. During the conflict, even before the recent arrival of hundreds of thousands, its population more than doubled, reaching somewhere between 3 and 4 million, according to WHO spokesperson Hedinn Halldorsson.

The sheer number of newly displaced people “makes it different and more dire as well,” he said. “it puts a lot of pressures on the already strained health services.”

Some health facilities have been attacked – part of a long-running offensive strategy that has drawn international condemnation. Others have fallen into the hands of military forces. Still others have closed as their patient population has fled, leaving whole cities empty.

An ever-changing crisis

In addition, said Karl Blanchet, a professor and co-director of the Health in Humanitarian Crises Center at the London School of Hygiene and Tropical Medicine, it’s hard to offer people reliable information about what’s open and where. A combination of official and informal networks are used to tell people which health facilities are open and safe.

“If you are too transparent, then [the health facilities] become targets,” he said. “It’s happening in a very ad hoc manner.”

That danger, too, means that people are less likely to seek medical care. “If people know that health facilities do get attacked, it definitely doesn’t encourage them to seek health care,” Blanchet said.

Complicating matters, said Halldorsson, is the fact that, for many of the displaced, this isn’t the first time they’re fleeing. “These are people who have been displaced multiple times, so the more you are displaced the more depleted your resources are,” he said.

First and foremost, what’s needed is shelter and basic supplies. Large numbers of the displaced are sleeping in the open in temperatures that have improved but are still frigid at night.

“We are seeing a major spike in children’s deaths due to hypothermia and cold exposure,” said Dr. Hamadeh, citing the example of a father who carried his toddler 5 kilometers to the nearest hospital in freezing conditions, only to find out she had already died.

The ever-changing situation also makes it difficult to know exactly what’s needed on the ground. “It’s highly complex there to have a sense of where to operate and what to do. The needs are huge,” Blanchet said.

“Normal life”

However, at least one thing is clear: “The current health needs are unprecedented,” said Dr. Abou Zaid.

Many have been injured by conflict, making emergency care a priority. “In emergency care, you’ve got one crucial variable: It’s time. It’s about being fast,” Blanchet explained. “Many of [the displaced] won’t get access to emergency care in time. The scale is too large.”

Dr. Abou Zaid also expressed concern about the “high presence of non-communicable diseases,” such as diabetes, hypertension, and cancer, that are going untreated. The rough conditions are increasing the risk of respiratory infections, especially for children and the elderly.

And Dr. Abou Zaid said infectious diseases – like measles – are a risk for children, many of whom have gone without vaccinations. The UN has warned of the potential for an outbreak of a disease like the measles.

Not everyone agrees about the severity of the situation. Debarati Guha-Sapir is the director of the Center for Research on the Epidemiology of Disasters and a professor at Brussels’s University of Louvain School of Public Health. “Syrians are a population that have had a good and high standard of health status,” she said. “There are still people with a very decent level of health conditions and vaccination coverage.”

While Syria’s conflict has certainly created greatly increased emergency health needs and other needs, she said, “it’s more of an acute problem.”

The conflict itself, she said, is a greater threat to Syrians – especially children, whom Dr. Guha-Sapir said are disproportionately likely to be killed by bombings – than the public health situation.

Emergency care is greatly needed, she explained, but she was less concerned about issues like infectious disease outbreaks than she was about other humanitarian crises, like that of South Sudan, in which many fled at “absolutely desperate levels of survival.” For example, “if there were to be a major measles outbreak in Syria, I would be very much surprised. Even in the northwest,” she said.

But Blanchet stressed the importance of addressing all different facets of health care. “Health is actually very comprehensive, so if you miss one aspect, it’s going to have some reflecting effect,” he said.

Failing to prevent violence and trauma will create a strain on mental health services, for example. Leaving chronic conditions untreated creates emergencies. When emergency care can’t be provided, infections become more common.

And sources stressed the extraordinary mental health needs of the displaced, many of whom have lost family members and experienced conflict firsthand. Some mental health providers are currently practicing in northwestern Syria, but the demand far outweighs the available treatment.

“There are huge mental health issues that need to be addressed today and that will need to be addressed in the future,” Halldorsson said.

“Mental health is always the last one to be provided. It’s never been on the top of the agenda,” Blanchet said, explaining that while there’s plenty of awareness around the issue, it’s simply too dangerous to send in additional mental health providers.

Dr. Hamadeh recalls meeting a nine-year-old boy, injured from shrapnel, in an Idlib hospital, hours after losing five of his siblings. The boy, he said, seemed completely without emotion.

“I just realized that these guys are totally numb. Loss has become normal life,” he said. “These are all stories that happen to them every day.”

Direct Relief has maintained a strong presence in the region since the Syrian conflict began in 2011, providing 53 shipments and over $118 million in donations, including equipping people in displacement camps with tents and basic supplies. In response to recent developments in the conflict, the organization is preparing to ship a range of medicines, supplies, and hygiene items this week. 

The post Syria’s Newly Displaced Strain a Health System Already in Crisis appeared first on Direct Relief.

You probably wouldn’t think of birth control pills.

And you wouldn’t be alone. “The humanitarian health response has focused on food, water, shelter, and primary health care,” said Sara Casey, a professor of population and family health at the Columbia University Medical Center.

However, that kind of thinking leaves gaps in women’s health care that can sometimes prove fatal.

“Fifteen percent of pregnant women experience life-threatening complications,” Casey explained.

In addition, women in the midst of a humanitarian conflict are less likely to have reliable access to birth control than women who aren’t. They’re more likely to experience unwanted pregnancies and unsafe abortions.

“People don’t stop having sex once they’re displaced, but a lot of people don’t want to be pregnant or have children when they’re in this unstable situation,” Casey said. “It makes it more difficult for a woman to flee.”

Women in conflict are also vulnerable to sexual and gender-based violence, including rape and intimate partner violence. And in patriarchal societies where women are less empowered, a woman who experiences violence may be less likely to seek help.

Women struggling to feed themselves or their families are in danger of turning to transactional sex, increasing the risk of unwanted pregnancies and sexually transmitted disease. To provide for very young women or protect them from other forms of gender-based violence, a family may urge a young daughter to marry early.

If a woman is pregnant, the list of dangers goes on. A lack of access to healthy food places an unborn infant at risk. Younger mothers may be at higher risk of complications – a January 2019 report by the Syrian American Medical Society, known as SAMS, found that young mothers made up a disproportionately high number of C-sections at a facility in southern Syria.

In Syria, conflict has been ongoing since 2011. 6.5 million people are displaced within the country itself, and even more are refugees.

Among one population of Syrian refugees, Foster found, rates of early marriage – itself considered a form of gender-based violence – had doubled.

Dr. Ikram Haboosh, a Syrian obstetrician, heads a maternal and pediatric hospital in Idlib, which has frequently been the object of airstrikes. For her patients “displacement has resulted in a sharp increase in risk of morbidity and mortality among children, projecting significantly higher rates of underweight and premature births,” she wrote in an email to Direct Relief.

And in a conflict in which hospitals and health workers are regularly the targets of bombing, labor can become more dangerous. Dr. Haboosh described an incident from about eight months ago: The area around her hospital came under fire, and expectant mothers and children urgently needed to be evacuated.

The hospital emptied out. Dr. Haboosh, however, couldn’t leave immediately. She was in the middle of performing a C-section. An while she managed to deliver the infant safely, she credits the stress with causing her own miscarriage that day.

Even in less dramatic circumstances, it’s increasingly difficult to provide health care. “For all doctors in every specialty, there is a shortage in staff, in medications, and in medical equipment and supplies,” Dr. Haboosh said. “We’re constantly suffering from this shortage and are often prevented from receiving patients as a result.”

Because of the shortage of doctors, midwives have frequently been forced to fill the gap, taking on greater responsibility during deliveries.

Direct Relief is working to help fill the gaps in sexual and reproductive health care in Syria.

Direct Relief has supplied 59 full midwife kits, and 12 replenishment kits, to the Syrian American Medical Society, a long-term partner. SAMS supports and provides health care throughout Syria and in a wide variety of refugee settings.

Midwives will use the kits during deliveries in Syrian hospitals. “As [midwives] have taken on greater responsibilities in normal delivery, their skills, experience, and qualification have likewise improved from before” the conflict, Dr. Haboosh said.

The post Birth Amid Bombings: How Syria’s War Punishes Women appeared first on Direct Relief.

The lack of a U.S. military presence has meant a new humanitarian crisis in the region, as thousands of Kurds have fled, in an attempt to escape Turkish bombing campaigns and militias aligned with the neighboring state.

According to Kurdistan Save The Children’s Sara Rashid, who has spent 6 years in Iraq with the NGO, the capacity for health care providers to treat impacted individuals has been drastically reduced, at a time when these latest refugees remain in need of food and medicines.

“Some facilities (in northeastern Syria) are still working, but their stock has completely run out. They have stressed the need for medical equipment, supplies, and medications,” Rashid told Direct Relief from Sulaymaniyah in the Kurdistan Region of Iraq. “And blood. They need a lot of blood.”

Adding to the humanitarian relief challenge is the relative lack of aid groups on the ground during this latest round of violence.

“Usually you have a crisis, and you have everyone on the ground, such as UN agencies, and you get everyone helping. Here, the service provision for the impacted area is completely lacking,” said Rashid, who added that coordinating the delivery of supplies with the few partners they do have, such as the Kurdish Red Crescent, is extremely difficult due to the constantly shifting battlefields.

“We’re trying to fill in what the UN does,” she said.

A cease-fire was announced last Tuesday, but a senior Turkish commander said, via Twitter, that Turkey and its allies have continued to “launch attacks.” Rashid said her group is preparing for up to 45,000 refugees coming to Dahuk, Sulaymaniyah, and Erbil in Iraqi Kurdistan—a region that has dealt with its own hefty share of challenges, ranging from budgetary disputes with the Baghdad government as well as hosting hundreds of thousands of internally displaced refugees, according to the UN Migration Agency.

“It’s not like people go into Germany. They’re coming to the Kurdistan region of Iraq. You don’t have the infrastructure in place,” she said, while also referencing the lack of teachers and health care providers for incoming refugees.

Direct Relief sent shipments of requested medicines and medical supplies throughout the week to Kurdistan Save The Children, including Emergency Medical Backpacks, for use in Syria and Iraq.

Reflecting the highly fragmented nature of the conflict, a representative from the Syrian American Medical Society, mainly in northwest Syria, said their operations have not been impacted by the most recent Turkish offensive, but that the 2,000 health care providers they support are continuing to respond to the hundreds of thousands of people in the area who have been displaced this year, as well as those injured by the ongoing conflict are facing chronic conditions.

“We’ve seen more and more people living with disabilities with no access to the care they need,” said Lobna Hassairi, media and communications manager for the Syrian American Medical Society. “Women are afraid to go to hospitals,” she said, as a result of their systematic targeting.

Both Hassairi and Rashid said that their partners continue to treat injured civilians and decried the targeting of hospitals and civilians, which has taken place throughout the civil war. They both expressed grave concerns about the future.

“They (displaced people) have nowhere to go” said Hassairi.

“These people don’t have a place to run to,” said Rashid. “Running is in another context. If you leave your home, you are leaving it free for other people to take over. Honestly, I don’t know what’s gong to happen,” said Rashid, who said her group was in the midst of planning a three year cancer initiative before this month’s offensive began.

“Now it’s hard to plan for three days,” she said, even as she knows that the recovery from this conflict, will require a long view.

“No one thinking about this, but we’re going to have to deal with trauma. We’re still dealing with the traumatized children who had to leave their homes because of ISIS.”

The post In Northern Syria, Destruction and Displacement Confront Health Workers appeared first on Direct Relief.

The region is currently home to approximately 4 million people. It’s been a prominent fixture in the news in recent months, since the Syrian government launched an offensive in April to regain control of the Idlib province, an area near the Turkish border.

More than 300 have been killed in the ensuing conflict and 300,000 are displaced, according to the UN.

Hospitals lost, physicians fled

Even in less extreme circumstances, wars disrupt access to medical care, cutting off supply chains for vital medicines and making it dangerous to travel to a doctor or hospital.

But the situation is particularly bad in Syria. Hospitals were targeted for bombings, and the World Health Organization estimated that more than half the country’s health facilities have been destroyed or severely damaged since conflict first broke out in 2011. Likewise, Physicians for Human Rights reported that more than half the country’s physicians have fled.

Many of those remaining often have their hands full treating injured civilians. Triage is often performed in underground facilities, which are less vulnerable to bombing.

Yet chronic, non-communicable diseases like cancer are still an ever-present danger for many. The Syrian American Medical Society, or SAMS, estimated that, between 2011 and 2014, 200,000 Syrians died of chronic conditions – many of them unable to seek medical care.

And in northwestern Syria, where oncologist Bassel Atassi estimates that between 2,000 and 3,000 patients will develop cancer each year, there was nowhere to get reliable treatment.

“These patients are diagnosed with cancer, and either they die of the disease or they have to go to the areas in the south that have more conflict,” like Damascus, the capital, Dr. Atassi explained. High-quality cancer care is available in Damascus, but the journey is perilous. While some patients have the option of going to nearby Turkey to seek treatment, most can’t afford to do so.

Many of them would make a full recovery if care were available, but living in or near Idlib, they’re likely to die.

Oncology in a war zone

Dr. Atassi, who practices at Little Company of Mary Hospital Cancer Center in Illinois but is originally from Syria, is a member of the Board of Directors at SAMS. However, until last year, he hadn’t developed an oncology program in the region. “I always asked, ‘Why aren’t I doing anything for my own specialty?’” he said.

He saw an opportunity in the northwestern conflict zone: “I figured that there is much need, and it will be quite challenging and an adventure to do this.”

Most NGOs are hesitant about funding cancer programs. “They always talk about numbers, that we can treat 50 kids for one cancer patient,” Dr. Atassi said. “It’s [seen as] something expensive, something complicated, something where the patient will die” even with intervention.

But Atassi persisted. He found three oncologists willing to treat cancer in the region despite the dangers, along with a pharmacist and nurses, and purchased high-quality cancer meds. And on November 4, 2018, the SAMS Oncology Center opened in Idlib.

Dr. Jamil, an oncologist at the center, asked to be identified only by his first name because of the dangers of working in a conflict zone. “We have in Idlib [only] a few doctors with this specialization. We have to work to help patients with cancer,” he explained, when asked why he chose to continue practicing in this part of Syria. “In the last few years, we couldn’t help those people.”

Dr. Atassi recalls the story of a young mother with four children who had developed breast cancer and who – before the cancer center opened – had no treatment options except going to Turkey, which she couldn’t afford. The center gave her chemotherapy and surgery, and she made a full recovery.

A new model

The center, which treats 300 patients per month, is doing triage of a different sort. While other diagnostic and treatment options are offered, the staff primarily focus on breast cancer and lymphoma, which have relatively straightforward treatments. When they have more resources, they’ll add colon cancer to the roster.

“We have a philosophy in our center that we need to focus on curable cancer, not advanced cases or palliative treatment,” Atassi said. (They make an exception for lymphoma, which can be treated successfully even at an advanced stage.)

Direct Relief has supported SAMS’ work since 2012, providing medicine – including oncology drugs – to the society’s programs.

While the traditional aid model focuses on helping as many people as possible, the SAMS oncology center meets an essential need. “A cancer patient is a human being,” Dr. Atassi pointed out. “Cancer can be cured and managed for a long time for many people.”

Even at this moment, the center is a desperately needed chance to receive oncology treatment in a place where the healthcare system has been all but decimated. But, according to Dr. Atassi, people living in conflict zones are thought to have a higher risk of developing cancer as the years pass, which means that the center may become even more essential in the future.

Despite the dangers – and the inherent sadness of seeing so much serious illness – Dr. Jamil insisted it’s worth it. “We have a beautiful feeling when we treat those patients,” he said.

The post Bringing Cancer Care to a Conflict Zone appeared first on Direct Relief.

Midwives are the first line of assistance, providing high-quality care during routine deliveries and managing basic complications. They’re also trained to recognize when to refer a mother to emergency obstetric care.

Most obstetric complications could be prevented or managed if women had access to a doctor, nurse or midwife during childbirth, according to the World Health Organization.

But midwives can only do their work if they have the right tools.

Direct Relief’s Midwife Kit contains everything a midwife needs to deliver babies safely in almost any environment. Surgical instruments, sutures, IV sets, gloves, cord clamps, and more. Endorsed by the International Confederation of Midwives, the kit contains the 59 essential items a midwife needs to perform 50 facility-based safe births.

Indonesia

In addition to the bringing more than 600 newborns into the world each year, the midwives of Bumi Sehat are often first responders after disasters occur in Indonesia. After Indonesia’s succession of devastating earthquakes in 2018, the team care for mothers and babies outside of hospital walls in the devastated communities of Palu and Lombok.

Syria

In a country where facility-based births are becoming less common due to internal conflict, the Syrian American Medical Society operates midwifery schools that offer the resources to perform safe births virtually anywhere.

Haiti

Haiti has the highest rates of maternal mortality in the Western Hemisphere, but groups like Midwives for Haiti are working to ensure that the country has a trained workforce of skilled birth attendants to oversee deliveries in the healthcare facility setting.

Bangladesh

Medical care for Rohingya refugees in Bangladesh is extremely limited, with few places for women and children to receive medical treatment. That’s why Hope Foundation Hospital for Women and Children of Bangladesh is training local midwives to serve as the epicenter of maternal health in underserved communities.

Somaliland

With a mission to ensure mothers have access to a skilled birth attendant, Edna Adan University Hospital is working to train and dispatch 1,000 midwives throughout Somaliland.

The post Celebrating Moms and Midwives Around the World appeared first on Direct Relief.

Syria is no exception.

As the country’s 7-year conflict wages on and trauma-related injuries and deaths continue to mount, Syrians also are experiencing this epidemiological transition towards chronic disease.

One in 10 Syrians lives with diabetes, according to the World Health Organization, and diabetes now ranks among the top 10 causes of death and disability in the country.

Since the war began, many health centers specializing in diabetes treatment – and all insulin production centers – have been shut down, damaged or destroyed, creating acute shortages of this life-saving medication. Almost all insulin must now be imported, resulting in inflated prices and affordability issues for most diabetes patients, especially those who have been internally displaced.

To address insulin shortages in Syria, Direct Relief and the International Diabetes Federation’s Life for a Child program partnered with the Syrian American Medical Society to deliver approximately 15,500 vials insulin to more than 700 Syrians under the age of 26 with type 1 and 2 diabetes.

The delivery was made possible by a generous donation from Eli Lilly and comes as fighting throughout Syria has displaced thousands, many with co-morbid chronic diseases, into the northwestern directorates of Idleb and Hama.

For aid groups distributing insulin for free or at steeply reduced prices, logistical hurdles to importing and storing the medication must be overcome. These include keeping the medicine at a consistent temperature despite lengthy travel times and unreliable electricity.

Direct Relief ships temperature-sensitive medicines like insulin inside specialized packaging that maintains a constant temperature range between 35.6-46.4 degrees Fahrenheit for 120 hours. To ensure and verify that the cold-supply chain has been maintained throughout the transit process, temperature-data loggers are inserted into each package to record the internal temperature of the shipment every two minutes.

The latest shipment of insulin to Syria is part of a larger collaboration with the Life for a Child program, which aims to provide insulin, syringes, blood glucose monitoring equipment, test strips, HbA1c testing, and diabetes education to healthcare centers in 42 low and middle-income countries for the benefit of 18,000 children and young adults living with diabetes.

Since the start of the crisis in 2011, Direct Relief has delivered over 200 tons of medical aid valued at $100 million to approximately 30 healthcare organizations providing critical care to Syrians across eight countries – constituting one of the largest and longest-sustained emergency response efforts in Direct Relief’s 70-year history.

The post Insulin Reaches Syrian Children with Diabetes appeared first on Direct Relief.

The shipments, valued at $1.2 million, include more than 10,000 doses of antidote for sarin and other nerve agents of the type used in the April 4 chemical attack on the Syrian town of Khan Sheikhoun. The antidote has been in short supply in Syria and will be distributed to health workers by three Syrian medical aid groups, consistent with recently published WHO guidelines regarding preparation and response to chemical weapons attacks.

The shipments also include protective gear, respiratory supplies and surgical instruments to treat adults and children, and thousands of bottles of prenatal and children’s vitamins.

Relentless bombings of health clinics and hospitals in Syria have killed more than 800 health workers, according to the medical journal Lancet. Several were among the more than 80 killed in the April 4 sarin gas attack on Khan Sheikhoun.

Hours after the April attack, Direct Relief received an email from Dr. Ahmad Rami Moqdom, logistics manager for the Syrian American Medical Society. Dr. Moqdom told the story of Dr. Ali Darwish, a SAMS surgeon who died in another chemical weapons attack in Hama province on March 25. Dr. Darwish continued operating on a patient during the attack, collapsed in the operating room and died soon after.

“Our main concentration is to protect the medical staff who are in direct contact with the injured ones,” he wrote, emphasizing the need to protect doctors from chemical attacks in the future.

In addition to the Syrian American Medical Society, Direct Relief is providing specialized medicine and medical supplies to the Independent Doctors Association and Syria Relief & Development, which will depart Direct Relief’s warehouse in the coming weeks.

“While our number one priority to prevent aerial attacks on hospitals and health workers in Syria fails to be met by the international community, activating a preparedness plan for future chemical attacks will save countless patients and colleague lives,” said Dr. Salah Safad, Independent Doctors Association’s Health Programs Manager. “The Syrian regime has attacked us many times before and we are constantly adapting our operations to the weaponization of healthcare that has come to characterize our situation in Syria. As the medics treating patients under bombings and chemical attacks, being prepared with critically needed medication is of great benefit to our life-saving work.”

The deliveries to Independent Doctors Association and SAMS also include emergency health kits, each containing over 150 essential items such as antibiotics, surgical tools, and trauma and wound care supplies. The kits are designed to treat 1,000 patients for one month and have been honed and refined by Direct Relief over years of responding to disasters.

In addition to the nerve agent antidotes and protective gear, the delivery to Syria Relief & Development includes 4,000 bottles of prenatal vitamins and 8,000 bottles of children’s chewable multivitamins.

“Direct Relief is committed to doing all it can to prevent further human tragedy and loss of life among those trapped in a brutal situation, and for the medical staff who put themselves at risk simply trying to provide humanitarian care,” said Thomas Tighe, CEO of Direct Relief. “Medicine can’t end a war, but it might save a life.”

Since the Syrian conflict began, Direct Relief has made more than 160 emergency deliveries of medicine and medical supplies valued over $50 million to Syria and neighboring countries.

The post Direct Relief Equips Syrian Doctors with Chemical-Weapons Antidotes, Protective Gear appeared first on Direct Relief.

The message detailed the heartbreaking attack his group and others had just endured. Moqdom also recounted the loss of a SAMS physician who died when two barrel bombs containing chlorine and other chemical agents were dropped on a hospital on March 25, prior to the April gas attack.

“Thank you for your warm feelings. We appreciate your team standing with us during the last few years.  I’m sorry to say that one of our team surgeons, Dr. Ali Darwish, died last week when he was performing a surgery on his patient. His hospital in Hama was hit with aircraft bomb carrying chemical agents, most probably phosphoric agent like Sarin. The patient died as well. It was a big loss for all of us,” Moqdom wrote.

Darwish was one of the few medical staff in the facility at the time. He lost consciousness in the operating room after refusing to leave a patient’s side. He was evacuated to another hospital for treatment, but died from exposure to a chemical agent, according to SAMS.

In the email, Dr. Moqdom emphasized the need to protect doctors from chemical attacks in the future.

“Our main concentration is to protect the medical staff who are in direct contact with the injured ones,” he wrote.

Health clinics and hospitals have been the target of relentless bombings in Syria, including the very recent Sarin gas attack. At least 86 people were killed, 27 of which were children.  A number of those who perished were healthcare workers and first responders who lacked the protective gear needed to survive the attack and continue to treat patients.

One study estimates at least 814 healthcare workers were killed in Syria since the conflict began in 2011.

“With direct and repeated targeting of medical workers, healthcare facilities, and ambulances, Syria has become the most dangerous place on earth for healthcare providers,” the study’s authors state.

Direct Relief has been sending medical aid and supplies to the region, but the supplies requested after last week’s attack were different than requests past.

SAMS and other organizations have called for specific items that fall into similar categories:

• Medicines that stop damage from nerve gas and other poisons: Banned nerve agents like Sarin gas are highly toxic to people and can cause death quickly, even in small doses. Medicines like atropine are used to halt the effects of the poisoning, if they can be administered in time.
•  Personal protective equipment: Disposable coveralls, masks, gloves, and other gear allows healthcare workers to stay safe while treating patients who may have been exposed to toxins.
• Respiratory aids: Oxygen masks for adults and children were requested, along with nebulizers, which allow medicine to be administered as a mist that can be easily inhaled.
• Surgical gear: Basic surgical items have also been requested by doctors, including tubing and catheters. Direct Relief will be coordinating a shipment of these critical, lifesaving items and is actively reaching out for cash support and company donations of medical products.

Many of these critical items are low cost. For example, a child’s oxygen mask costs around 75 cents and an adult’s costs 90 cents. SAMS has requested about 1,000 of these masks, about $840 worth of supplies. Other items are similarly low-cost, yet crucial, for doctors and patients on the front lines: disposable gloves (5 cents per pair), disposable protective suits that cover the entire body ($6.25 each) and protective masks (about $1 each).

Direct Relief will also be sending the two prescription drugs that work to stop damage from nerve gas attacks, atropine (about $37 per vial) and pralidoxine (about $97 per dose).

Direct Relief is coordinating a shipment of these lifesaving items and is seeking donations of financial and material support from individuals and manufacturers. To donate directly to the SAMS effort, visit their Facebook donation page here.

The post Direct Relief Working to Protect Frontline Healthworkers from Deadly Gas Attacks in Syria appeared first on Direct Relief.