Category: News & Stories

Amidst the hustle and bustle of hospitals and clinics, a cadre of diligent workers labour tirelessly to ensure the safe passage of new life into the world. As the world observes International Midwives Day, Médecins Sans Frontières/ Doctors Without Borders (MSF) takes a moment to honor the unsung heroes behind countless safe births and healthy mothers—midwives. Join us as we shine a spotlight on the incredible journey of Nour Al Sayyed, a passionate midwife making a difference in the Baalback-Hermel project.

It was a bright sunny morning when Nour arrived at the MSF-run primary healthcare clinic in Arsal, a border town on the outskirts of the Baalback-Hermel Governorate. As she stepped through the doors, a sense of purpose enveloped her, energizing her for the day ahead. Inside, the clinic hummed with activity. Doctors and nurses attended to the patients while expectant mothers sat patiently in the waiting area, their faces alight with a mixture of excitement and trepidation. For Nour, each day brought with it a new opportunity to make a difference, to be a source of reassurance in the lives of these women. With a smile on her lips and a gleam in her eyes, she embarked on her rounds.

Globally, maternal mortality remains a significant concern, with a death occurring almost every two minutes in 2020 according to the WHO. In Lebanon, the fight against maternal mortality remains a crucial one and midwives like Nour stand at the forefront, offering vital support to women and families during the vulnerable journey of pregnancy and childbirth. In 2023 alone, MSF assisted more than 2,900 expecting mothers to deliver their babies safely under medical supervision.

Nour’s journey into midwifery was driven by a deep-seated desire to make a difference in the lives of others. “What attracted me initially to the field of midwifery was the opportunity to provide support and assistance to women and families during pregnancy and childbirth,” the 28-year-old shares. Her commitment is fueled by the satisfaction of witnessing the surge of happiness on a mother’s face when hearing her baby’s first cry after birth. After starting as a midwife in MSF’s Mother and Child Center in Arsal, Nour became a full-time midwife in the MSF clinics of Arsal and Hermel, where MSF provides primary healthcare services to patients with non-communicable diseases (such as hypertension, diabetes, asthma, epilepsy), sexual and reproductive health services for women, paediatric medical consultations, and mental health services to vulnerable communities in surrounding areas. Throughout the day, Nour’s schedule is packed with everything from counseling women and providing family planning services to conducting clinical examinations, assisting during childbirth, and offering support throughout the pregnancy, childbirth, and postpartum periods. In MSF’s primary healthcare clinics of Arsal and Hermel, Nour provides comprehensive care and health advice for pregnant women. Beyond clinic walls, Nour and her colleagues extend their services, venturing into the many camps of Arsal, where pregnant women cannot easily access health care services. Currently, MSF extends outreach activities to tens of camps and informal tent settlements in and around the Arsal vicinity. A traditional town in the mountainous region on the border with Syria, Arsal is home to 50,000 residents and over 20,000 refugees, according to UNHCR. Our midwives conduct daily educational sessions and offer family planning services to approximately 40-50 women a day within these camps.

Under the threat of aerial bombardment, an estimated 1.7 million men, women and children have been forcibly displaced to Rafah, a tiny sliver of land in the south of the Gaza Strip, in Palestine. However, even in Rafah people have not found safety.

Military operations are ongoing in Rafah and the confirmed threat of a full-scale imminent military incursion by Israeli forces looms over people there, who now face the risk of death by disease or starvation in a place where the healthcare system has been decimated.

On 13 October 2023, our medical teams, alongside civilians, were forced to evacuate from north to south Gaza, where they rapidly established emergency medical responses in Rafah and Deir Al-Balah.

This Médecins Sans Frontières report, Gaza’s Silent Killings: The destruction of the healthcare system and the struggle for survival in Rafah, draws upon medical data and the testimony of patients to demonstrate that even in Rafah, conditions for survival are not in place.

Gaza’s entire healthcare system has been decimated and people are under siege. Without access to medical care, thousands more lives will be lost, beyond those killed in the Israeli bombardments seen in the news – these are Gaza’s“silent killings”.

Port Sudan/Darfur, 12 April 2024 – In one of the world’s worst crises for decades, Sudan is facing a colossal, man-made catastrophe one year after the start of the war between the Government-led Sudanese Armed Forces (SAF) and the paramilitary Rapid Support Forces (RSF). It is a matter of life or death for millions of people to urgently enable safe humanitarian access. As governments and officials, aid organisations and donors meet on 15 April in Paris[1] to discuss ways to improve the delivery of humanitarian aid, Médecins Sans Frontières (MSF) is making an urgent call for them to immediately scale up the humanitarian response.

Millions of people are at risk, yet the world is turning a blind eye as the warring parties intentionally block humanitarian access and the delivery of aid. The United Nations (UN) and member states must redouble their efforts towards negotiating safe and unhindered access and to scale up the humanitarian response to prevent this already desperate situation from deteriorating any further.

Exchanges of fire across the border between Israeli forces and Hezbollah and other groups began on 8 October 2023 and show no signs of abating, while the conflict has recently spread to northeastern Lebanon with Israeli forces bombing Baalbek-Hermel governorate.

Many of the displaced people left their homes with no possessions and struggle to get hold of basic necessities such as food and blankets. More than 60 families are living in an abandoned hotel repurposed into a shelter in Al-Merouaniye, some 60 km from the border. One of its residents is Ali Hammoud, a barber and a father of three from Rab Al-Thalathine, who fights back tears as he recounts his family’s ordeal.

“My older son has had three mental crises,” he says. “We go to sleep, wake up, and repeat this every day. We are worried that our kids will develop mental problems from this situation. The same routine, day in and day out, is more burdensome to a child than an adult.”

Teams from Médecins Sans Frontières/Doctors Without Borders (MSF) are providing displaced people who fled the border region with psychological first aid. Felicitas Steinhoff, MSF’s mental health activity manager, warns of the psychological toll of prolonged displacement: “We’re seeing an increase in depression and anxiety disorders,” she says. “In terms of mental health, I think people are really good at coping with short-term stress, but what we see here is families who have been displaced from their homes for over five months now and who are living with a lot of uncertainty around when and even if they might be able to go back.”

An MSF mobile medical team also provides people with care for chronic diseases and makes regular visits to a clinic in Nabatiyeh governorate, alongside the border. The team provided 373 consultations since the start of 2024 in both locations.

Twenty-five year old Rima is also a patient at the health centre. She described the barriers she faces to access quality healthcare. “If you don’t have enough money or can’t pay immediately, you won’t have access to health services. Plus, the national social security fund now covers very little, with the currency decline. One has to pay a lot of money for hospitalization.”

Ataa and Rima are like many others who struggle to access healthcare in Tripoli, Lebanon. Living conditions have deteriorated over recent years due to limited housing, depleted infrastructure, lack of clean water and sanitation, and inadequate access to social services. The unemployment rate exceeds 35 percent and half of the city’s residents live below the poverty line[1]. The escalating financial challenges have made it increasingly difficult for individuals to access essentials such as food, water, and medical supplies.

These factors take a severe toll on people’s mental well-being and cause significant stress, trauma, and depression. Many of Tripoli’s healthcare centres are struggling to provide residents with the medical care and medications they need due to a lack of staff and supplies. The high cost of care also puts healthcare centres out of reach for many. On top of that, the economic crisis has increased the cost of services in private clinics and a shortage of many essential medicines.

Recognizing the urgent need for accessible and equitable healthcare in Tripoli, in June 2022, MSF launched a project to support the city’s primary healthcare system. The project supports four primary healthcare centres in different areas in Tripoli, focusing on non-communicable diseases, such as diabetes and heart disease, and mental health services. This support includes providing technical guidance to local health workers, subsidizing the cost of non-communicable diseases consultations for patients at the supported facilities, capacity-building, social work, and donating medicines.

“The earthquakes created more poverty, homelessness and displacement, and caused a decline in people’s living conditions, worsening the economic situation and the functioning of the education system and causing damage to infrastructure,” says MSF head of mission Thomas Balivet. “In addition, thousands of children lost caregivers or suffered physical injuries and amputations. All of these factors have exacerbated the mental health situation for thousands of people across the region.”

Before last February, many people in northwest Syria had already been displaced from their homes by the war. In the aftermath of the quakes, they found themselves destitute – without shelter, food, clean water or other basic essentials.

“We left our hometown in Saraqib, east of Idlib, because of the war and constant shelling, and after years of being displaced and looking for safety, we settled in Afrin, further north,” says Hind. “The house we stayed in had no walls – we hung up blankets for shade and privacy. My husband used to work but we barely had enough to eat. Then the earthquake happened and we lost everything again.”  

The first quake, of magnitude 7.8, left a swathe of destruction reminiscent of the war damage that already scarred northwest Syria.

Omar Al-Omar, MSF mental health supervisor in Idlib, remembers the first hours after the earthquake. “At the break of dawn, I went down to Salqin, a town in Idlib province. I saw entire buildings collapsed and turned into rubble. What hurt me the most was hearing the voices of people under the rubble asking for help, while I was unable to provide assistance. Then I went to Salqin hospital, which is co-managed by MSF. When I entered, I was shocked by the sight of the wounded and corpses in the rooms and corridors of the hospital. I was no longer able to stand – I sat on the ground and burst into tears. In the hospital, we could feel the aftershocks, and every moment large numbers of wounded and injured people entered the hospital. It was a night that will remain engraved in my memory until the last day of my life.”

Even before last February, the healthcare system in northwest Syria was struggling, with underfunded medical facilities and limited services. The earthquakes damaged 55 health facilities, leaving them unable to function fully. As well as medical assistance, people across the region needed toilets, showers, heating systems, winter clothing, generators, blankets, hygiene kits and cleaning products. 

In the hours following the first quake, MSF teams provided emergency medical care and immediately started distributing MSF’s existing stocks of essential relief items. In the following days, MSF sent 40 trucks loaded with medical and non-medical items to the area, including food and shelter materials. Meanwhile MSF water and sanitation experts constructed toilets and showers for earthquake survivors and provided them with clean drinking water.

“Following the acute phase of the emergency response, our focus shifted towards providing shelter, food and relief items, ensuring access to healthcare as well as water and sanitation services,” says Balivet. “The lack of these basic necessities has had a profound impact on people’s mental health.”

One year on, the physical destruction caused by the quakes is less visible than before, but the impact on people’s mental health is stark.

“Since the earthquake, cases of post-traumatic stress disorder and behavioural problems have surged, especially among children,” says Omar, “in addition to panic attacks, various types of phobias and psychosomatic symptoms.”

Addressing people’s mental health needs

MSF has provided mental health services to people in northwest Syria since 2013. After the earthquakes, MSF launched a comprehensive mental health initiative as part of its emergency response. Mobile teams of mental health counsellors were deployed to provide psychological first aid, as well as specialist counselling for moderate and high-risk patients, in 80 locations across the region. They also ran sessions to help people deal with both their immediate psychological reactions and the emotions that come later. MSF teams provided a total of 8,026 individual mental health consultations in the aftermath of the earthquakes.

‘Safe spaces’ for women and children

MSF also set up a ‘safe spaces’ programme in four locations in northern Aleppo and Idlib provinces, in collaboration with partner organisations, to provide places where women and children could take a moment of respite from the harsh reality outside. These activities are still running, with three additional sites added in Idlib province. Within these dedicated tents, women and children engage in games and activities, such as drawing, take part in group sessions, or simply sit and rest. Whether engaged in quiet contemplation or lively conversation, the women and children in these spaces find a refuge where they can momentarily disconnect from the weight of their troubles and simply breathe.

Some 25,000 women and children have used the safe spaces; MSF teams also referred 1,900 of the women and children to other organisations to receive follow-up treatment for physical or mental health issues.

Hind, who frequently visits one of MSF’s safe spaces, says: “When I come inside the safe space, I forget everything, I forget the agony and fear. My children come with me and play. We all forget the fear, we all forget what happened after the earthquake.”

Living amidst the rubble of the conflict and the earthquakes, people in northwest Syria still need clean water, food, shelter and access to essential healthcare. “Investment in improving the living conditions of the people of northwest Syria is essential,” says Balivet. “Only by addressing the root causes of suffering can we hope to pave the way towards recovery.”