In northern Syria, a decade of war has left water and sanitation infrastructure damaged and neglected. More than three million people — many of whom have already been displaced from their homes by conflict — now face a water crisis that has dire health consequences.
“Even when water is available and accessible to people in northern Syria, it is sometimes unsafe and contaminated,” said Ibrahim Mughlaj, a health promotion officer working for Doctors Without Borders/Médecins Sans Frontières (MSF) in northwest Syria. “We are regularly confronted with the health impact of poor water quality, which often brings waterborne diseases and other health issues into the camps, such as diarrhea, hepatitis, impetigo, scabies, and many others.” Limited access to safe water also hampers the hygiene measures necessary to control the spread of COVID-19.
In response to this crisis, MSF has developed a comprehensive water, sanitation, and hygiene (WASH) response, adopting a gap-filling approach to cover the needs. In the spring of 2021, we doubled the number of camps we covered in Idlib governorate. We are now running water and sanitation services in about 90 camps in northwest Syria, reaching around 30,000 displaced people.
Activities include hygiene kit distribution, water trucking and treatment, waste collection, water and sewage networks, latrine construction and rehabilitation, as well as community-based health promotion initiatives. In northeast Syria, we have also responded with additional safe water trucking in Hassakeh city and an increased malnutrition response in Raqqa.
The impact of decreased funding
Across northern Syria, humanitarian actors are trying to fill the gaps and respond to the many needs, but access to water and sanitation facilities remains an issue, mainly because of a decrease in funding for such activities. WASH operations currently represent just 4 percent of the entire humanitarian response budget for the whole of Syria, which is less than one-third of what was spent last year for the same activities.
In northwest Syria, the decrease in funding has forced many organizations to stop their water trucking activities in several camps. Areas like Deir Hassan, for instance, have been strongly impacted by this reduction of services. Since May 2021, the case numbers of waterborne diseases increased tremendously in the area.
“Just between the month of May and June 2021, which is the period when some of these activities were stopped, waterborne diseases increased by 47 percent,” said Teresa Graceffa, MSF medical coordinator for Syria.
In July 2021, our teams noticed rising numbers of diarrhea cases in more than 30 camps in Idlib governorate and also detected frequent scabies cases and other waterborne diseases throughout consultations in displacement camps.
Since the beginning of the year, 28 percent of the total consultations in an MSF-supported hospital in Idlib governorate were for cases of acute watery diarrhea. We launched a temporary emergency response and installed an oral rehydration point (ORP) in the hospital to help patients with mild to moderate dehydration and to inform, sensitize, and educate people on how to prevent the spread of diarrhea.
“But this is not a one-off problem,” said Dr. Mohammed El-Mutwakil, MSF field coordinator. “It is a recurring challenge that our teams face due to a structural issue that only worsens with time as funding for such activities decreases.”
Displaced women are carrying a pail of clean water provided by MSF in a camp in the northwest of the country. Syria 2021 © Abdurzaq Alshami
In northeast Syria, people have also been significantly affected by waterborne diseases and increased food insecurity and are at higher risk of malnutrition due to the poor quality of water and its limited availability. An MSF-supported primary health care center in Raqqa reported that the number of diarrhea cases in May 2021 was 50 percent higher than in May 2020.
In Hassakeh, one million people have faced reduced access to water for nearly two years due to repeated and sustained disruptions in the supply from the Alouk water station, which is under the control of Turkish authorities. People in northeast Syria are also impacted by a severe reduction in the volume of water in the Euphrates river, which is the most significant source of water for the area.
“[Our] initiatives are not permanent fixes,” said Benjamin Mutiso, MSF field coordinator. “There are still many people who suffer from the consequences of a lack of access to clean water and we find ourselves in a situation where we are unable to cover all the needs.”
The constraints force people in the region to take desperate measures that can put their health at risk. “When we can't [get water] we have to wait for support from humanitarian organizations,” said Hussain Muhammad, a man who currently lives in a displacement camp in Idlib governorate. And if it doesn’t come, during the winter we put pots under the rain to collect water. Since the roofs and tents are dirty, the water gets polluted and it becomes unsafe to drink or [use to] shower. When we used this water, my one-year-old son developed a kidney disease. I was told to buy him bottled water, but I couldn't afford it.”
“Funding gaps continue to widen, the distribution of water is sometimes politicized, while MSF and other organizations cannot fill all the gaps,” said Mutiso. “People’s health is at risk, and they cannot survive if they don’t even have access to the basics. Major donors should speed up the allocation of funds and ensure the continuity of water and sanitation activities essential to the survival of the people in northern Syria.”