In 25 years working at Médecins Sans Frontières (MSF), I have often been asked about the things I’ve seen through my work that have really stuck with me. Sometimes there is a stand-out experience or person. But what’s harder to explain is that sometimes what stands out is a feeling, something in the air that you can’t quite explain. This was definitely the case during my recent visit to our programs in Northeast Syria (NES).
NES is entangled in a web of complex geopolitical forces. Wedged between neighbouring Turkey and Iraq and governed autonomously from the rest of Syria, these lines of control buzz with frictions whirling above the heads of the approximately more than three million people who reside there. One of the first stops during my visit was Al-Hol Camp, a massive detention camp on the southern outskirts of Al Hol town, close to the Syria-Iraq border. Here, over 43,000 people are detained in what is effectively an outdoor prison, consisting of tents surrounded by a large fence and a scattering of armed guards around the perimeter.
As the temperature surged above 40 degrees Celsius, I couldn’t fathom how anyone could endure the heat and the dust while living in a tent, for years. I had read and heard a lot about Al-Hol camp before visiting, but seeing it firsthand made me realise how incredibly unforgiving it is, a restricted context within another restricted context.
The camp originally provided temporary accommodation and humanitarian services to people displaced by the conflict in Syria and Iraq. However, it has increasingly descended into an unsafe and unsanitary open-air prison after people were moved there from Islamic State-controlled territories in December 2018.
Since that time, the people in the camp have effectively been trapped in limbo, with only a trickle of the detainees having been returned to their countries of origin including France, Canada, Australia, Syria, and Iraq. Walking through the camp, what struck me most was the sheer number of children. A staggering 65% of people at the camp are under the age of 18, and 51% are under the age of 12. As you enter the camp, you see children playing in the dirt with makeshift toys crafted from garbage. They don’t have regular access to education or social activities. As you watch them try to pass the time, it becomes clear that that no-one, especially children, should be forced to live this way.
I couldn’t help but wonder what kind of future there is for these kids, trapped in the middle of violence and desperation. For years we have documented the unsafe conditions in Al-Hol and yet, over five years later, things remain eerily the same. In the weeks after I left NES, there was another violent raid by security forces. In the early hours of the morning on 10 June, tents were slashed, people were physically assaulted including a woman and a child who were treated for injuries in our camp clinic, personal belongings were destroyed, and nine children were separated and removed from their distraught mothers. These women have still not been provided information about the whereabouts of their children. Boys aged 12 and above are routinely removed and placed in detention centres outside the camp with little to no contact with the outside world. The recent so-called “security operations” followed a similarly violent raid on 29 January, during which tents were ransacked, people were beaten, and at least one child and one woman died, while several others were injured.
When I visited our programs in the cities of Raqqa and Hassakeh, I began to understand that the desperation in NES is not limited to Al-Hol. Across NES, the gaps in services are clear. In the Hassakeh non-communicable diseases (NCD) program, there are nearly 3,000 patients, while the Raqqa NCD program supports over 2,800 patients. Seeing these initiatives, and speaking with patients, it was clear how the economic crisis in Syria, on top of everything people have experienced during over a decade of conflict, has now really hit hard.
I heard stories of people facing seemingly impossible choices and spoke with those who rely on MSF’s free services because they simply cannot afford healthcare. For some, this means deciding between putting food on the table for their families or buying medicine for their chronic conditions.
I spoke to people in mourning for everything that has disappeared in what seemed like the blink of an eye. Prior to 2011, Syria had a well developed healthcare system, but speaking with people in NES, I got the sense that they feel trapped in this small corner of the country, unable to cross borders or to see any future beyond the day-to-day.
This feeling of abandonment was a sentiment that echoed in many of the stories I heard. The data unfortunately proves it. Whilst I was in NES, the 2024 donor conference for Syria took place, resulting in a 20% reduction of donor funding for humanitarian programs across the country. This marks the second consecutive year of funding cuts. When you consider that in 2024 US$4.07 billion is required to respond to humanitarian needs in Syria but just 6%, or US$326 million, has been funded through the Humanitarian Response Plan, it’s easy to see how paralysing the situation is, with interest and support waning.
In Al-Hol camp, for example, the needs couldn’t be any more pressing: in March of this year, the World Health Organization-funded medical referral system from 11 camps, including Al-Hol, ceased due to lack of funding. This funding cut essentially eliminates the possibility for people in Al-Hol camp and other camps in NES to access specialist healthcare. This includes treatable and preventable diseases, as well as urgent specialist care like surgery.
I left NES with a feeling that while there is some hope, this forgotten corner of the world is shouldering many issues alone. It’s a place where the international community still has a huge part to play in providing humanitarian assistance. This is particularly true in Al-Hol Camp, where the Autonomous Administration of North and East Syria, the US-led Global Coalition to Defeat ISIS, international donors, and countries with citizens detained in Al-Hol must urgently provide a long-term solution for people detained in the camp. Whilst the Syrian conflict has abated, there is a perpetual sense of the potential for escalation. This is the feeling, the thing that is hanging in the air. And it compounds the significant trauma that has already been experienced by the people in NES, as they remain trapped and vulnerable, awaiting whatever comes next.
This is an edited version of a blog published on the MSF website.
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