Afrin, Syria – Some four years ago, as a Russian-backed government offensive pounded Syria’s northwestern Idlib province, Youssef al-Jadou and his family of 10 had no option but to flee.
Today, as he sits inside his tent in the Ahl al-Tah camp for displaced people in northern Idlib on a cold winter afternoon, al-Jadou fears again for his family’s lives after the nearest charity hospital shut down due to a lack of funding.
“I can’t buy medicine for my children,” al-Jadou said, with tears in his eyes. “I’m barely able to get bread, how am I going to pay for healthcare?”
Like most of the population in rebel-held northwest Syria, al-Jadou relies on cash and food assistance to survive. But recently, more than a dozen charity hospitals in the region have either shut down or downsized because of funding cuts by international donors, according to medical organisations and local groups.
Al-Jadou says his children are malnourished and his two five-month-old babies have muscle convulsions. He also suffers from a heart condition. They have relied on hospitals providing them with regular treatment and free medication.
As the situation worsens, medical professionals are also feeling the pressure.
Dr Adib Abdulrahman is scrambling to keep the Haritan Charity Hospital for Women and Children in northern Idlib functioning.
In December, he received an email from the facility’s main donor, Relief International, which said it had to stop funding due to budget constraints. As a result, his staff work pro bono, in order to accommodate thousands of patients every month.
“But this isn’t sustainable,” Abdulrahman said. “We provide free services to about 7,000 patients monthly.”
The hospital currently operates at 50 percent capacity due to a shortage of medical equipment, disinfectants and fuel.
Abdulrahman says the situation is critical.
“We could stop work altogether at the end of the month if I can’t guarantee them [staff] a salary and secure supplies,” he said.
In the city of Afrin, the al-Mahaba Hospital once ran around the clock, providing emergency, paediatric and maternity services.
Now, its busy rooms and corridors are empty.
“We had doctors on call 24/7,” managing director Majid al-Aqraa said, with a sigh. “The hospital provided really good services.”
Medical staff and humanitarian agencies say funding gaps are not a new issue, but the recent cuts come at a time when hospitals are already strained following heavy snowstorms and rampant respiratory diseases among children.
“This disproportion between needs and funding has accelerated in recent years, with the financial crisis and COVID-19,” said Dr Fadi Hakim, advocacy manager at the Syrian American Medical Society (SAMS).
“Seasonal infections among children are increasing, the number of children with bronchitis has doubled.”
In Idlib, living conditions are already dire and continue to worsen, with 97 percent of the population living in extreme poverty and 80 percent relying on food assistance daily, according to the United Nations.
Residents are also struggling to cope with skyrocketing costs of fuel, food and medicine due to the plunge in value of the Turkish lira, the northwest’s adopted local currency, instead of the Syrian pound.
Almost two-thirds of 4.4 million people living in northwest Syria are internally displaced, but the UN has only been able to secure less than 40 percent of its funding needs by the end of 2021 for the province.
Despite an overall reduction in armed clashes across the war-torn country, humanitarian organisations fear donors assume that the conflict has ended and conditions have improved.
Claire San Filippo, who heads the Doctors Without Borders’ (Medecins Sans Frontieres, or MSF) Syria mission, said the downscaling of maternity services in Idlib has put women at risk, especially with the economic crisis making transportation more expensive.
She fears that pregnant women who need medical attention have to travel longer distances, and risk showing up late to hospital.
“This increases the risk of medical complications for both the mother and the baby,” San Filippo told Al Jazeera. “In one of our supported facilities, we had a woman who basically delivered near the entrance of the health facility.”
Overall, she said the needs are still “enormous” but fears that more hospitals will shut down in the impoverished province.
Dr Salem Abdan, director of the Idlib Health Directorate, said he has been working with humanitarian agencies to find new sources of funding for hospitals, but admits the situation is not sustainable.
“There is no way to self-fund the health sector in Idlib and northwest Syria, because of the war and the lack of internationally recognised authorities,” Abdan said, adding that Russian and Syrian army air raids on hospitals over the years have worsened the situation.
“All this could risk total collapse of the health sector.”
For his part, Abdulrahman said he does not expect any additional relief before August 2022 at the earliest.
Humanitarian agencies such as MSF have tried to respond to the medical crisis, including by working on improving water and sanitation services in the camps hosting internally displaced people and providing sexual and reproductive health services.
“If you downscale these services, that risks the lives of thousands of pregnant women and girls, and risks the spread of waterborne diseases,” San Filippo said.
Meanwhile, Hakim said SAMS had tried to respond to the situation by adding an extension to one of its children’s hospitals in Idlib – but what happened afterwards only confirmed the severity of the situation.
“We reached 90 percent capacity on the opening day,” he said.
Over at Lamsat’s al-Rahma camp for displaced people, near the Turkish border in northern Idlib, Sahar Darwish, a 35-year-old unemployed widow who lives with her three young children, is worried that if they get sick, she will not be able to get medicine or that hospitals won’t have the capacity to look after them
“It’s hard to go to other [charity] hospitals because they are extremely crowded now,” she said. “Private healthcare isn’t an option. We live in poverty.”
Ahmad al-Atrash reported from Idlib, Syria, and Kareem Chehayeb reported from Beirut, Lebanon