Photo: Members of the White Helmets leading search and rescue efforts following the earthquake in NWS (GOV.UK, 2023).

Dr. Abdulhakim Ramadan

At dawn on February 6th 2023, a 7.8-magnitude earthquake struck southern Turkey and northern Syria making it the strongest recorded earthquake in Turkey since 1939. The initial earthquake was followed by another later that same day, with a magnitude of 7.5, with a different epicenter located 95 km southwest of the first quake. According to the UN Secretary-General, António Guterres, the earthquake was the worst disaster ever witnessed in the region with tens of thousands of fatalities and numerous injuries. What made the situation worse is the extreme winter conditions to which people were exposed after leaving the collapsed or damaged buildings. Although the calamity cannot be ignored for both countries.

NWS was severely damaged as a result of the earthquake and the situation worsened as the area is already struggling with the consequences of the 12-year conflict, where more than 4.2 million inhabitants are reliant on humanitarian aid (UN, 2023).

Within the first hours following the initial earthquake, media activists inside Syria shared photos and videos of difficult scenes urging the international community to act. Among the first-line responders, cries were circulated to humanitarian actors to support their dwindling efforts that could no longer withstand this unexpected ordeal.

This situation raised a concern about the international delay in responding. Human Rights Watch stated that the slow humanitarian response to the earthquakes that severely damaged opposition-held NWS reveals the inadequacy of the UN Security Council-mandated cross-border aid mechanism in Syria and the urgent need for alternatives. (ReliefWeb, a, 2023). Moreover, other entities went further blaming the UN for waiting for the approval of the regime president; Bashar Al-Assad, to start their operations from borders he does not control.

Meanwhile, inside NWS, Dr. Zuhair Kharrat, head of the Idlib Health Directorate, stated through the directorate’s YouTube channel that they had formed a crisis management team within the first hours of the earthquake (Youtube, 2023). He added that in the two days following the quake, health facilities had complained about power outages, shortages of orthopedic surgical supplies, anesthesia drugs, medical equipment, generators, and bedding items such as mattresses and blankets. Blood banks and dialysis centers were overloaded and lacked medicines and fuel.

However, efforts were coordinated and synergized between the Health Directorates, White Helmets, and the responses of local communities. This in turn encouraged international NGOs and relief experts to engage with the local actors and build on what has been achieved. This engagement, led by local actors, means that appropriate strategies can be formulated thoughtfully for the next phases.

Post-earthquake effects:

The earthquake caused devastating immediate damage, with 4540 deaths and 8786 injuries in NWS (ACU, 2023). Beyond the immediate impacts, this will result in disabilities and a long-lasting psychosocial impact on individuals and families. According to an OCHA report issued on 7 March 2023, 1500 buildings have been demolished or damaged in NWS leading to the displacement of 302,500 people and an increasing need for shelter. The weak health system which faced this devastating crisis was also terribly affected. 55 health facilities out of 245 were partially or completely destroyed, and medical and surgical equipment, as well as ICU beds, are in short supply (ReliefWeb, b, 2023).

Similarly, other sectors were also severely impacted such as education and WASH (Water, Sanitation, and Hygiene). According to the same OCHA report, 64% of individual’s affected have increased WASH needs and over 80% require hygiene kits. Therefore, there is a high risk of the outbreak of water-borne and other communicable diseases in the area. As for education, 40% of schools were damaged and many were used to shelter the displaced (ReliefWeb, b, 2023), resulting in the loss of access to education for more than 28,429 children. This will adversely impact the children and their wellbeing in both the short- and long-term.

Recommendations:

In general, the humanitarian burden in the region must be reduced, particularly in places where conflict has had devasting effects over the past 12 years. We are required to adopt a multi-system approach that can address the broad health determinants while considering how to orchestrate the efforts and make the most of limited resources. The milestones for such an intervention can be categorized by the following:

  • Addressing safety and security concerns: Advocacy is crucial to engage the international community and may support de-escalating the conflict and enable the accessibility of humanitarian aid. Maintaining the cross-border mechanisms to ensure they remain open is another way to guarantee the flow of necessary supplies and the transfer of expertise.
  • Maintaining the continuity of health service provision: the cornerstone for achieving this is ensuring the functionality of the health facilities, including supporting the health workforce and logistic requirements. In remote areas, such as camps, outreach mobile teams and clinics can play an invaluable role in providing essential health services and promoting health practices among their communities (Maghfiroh et al, 2022). Equally important is the psychosocial support that can improve the mental health of affected populations.
  • Ensuring the integration of health services with other sectors: in parallel with health interventions, other sectors need support including:
  • WASH sector: hygiene practices should be promoted among communities and sanitation infrastructure should be improved. According to the International Rescue Committee (IRC), the scarcity of clean and safe water creates a significant problem in NWS and needs to be addressed (IRC, 2023). These actions will in turn reduce the risk of communicable diseases, such as cholera which is currently spreading across the region.
  • Shelter: dignified housing is necessary to protect people from the uncountable factors harmful to their health. Linking this approach to livelihood pathways will remove their dependency on unsustainable aid.
  • Education: is critical in the early stage of life in helping children realize their potential and reducing the burden on families. In this regard, schools that ensure a supportive environment can improve students’ mental and psychological outcomes (Rossen et al, 2014). This action itself requires well-equipped educational facilities with adequate infrastructure and cadre.

Finally, we acknowledge that these few words cannot detail all solutions, but they can pace us while drawing attention to these critical issues and what needs to be done to solve them.

References:

ACU (2023). Syria Earthquake Situation Update – ACU. [online] Available at: https://acu-sy.org/periodic_imu_reports/syria-earthquake-situation-update/).  [Accessed 27 Apr. 2023].

GOV.UK. (2023). UK commits to additional funding to the White Helmets to support search and rescue efforts in Syria. [online] Available at: https://www.gov.uk/government/news/additional-funding-to-the-white-helmets-search-rescue-efforts. [Accessed 25 Apr. 2023].

International Committee of the Red Cross. (2023). After earthquake damage in northwest Syria, urgent action needed to prevent collapse of water systems and avoid devastating humanitarian consequences. [online] Available at: https://www.icrc.org/en/document/after-earthquake-damage-northwest-syria-urgent-action-needed  [Accessed 28 Apr. 2023].

Maghfiroh, M., & Hanaoka, S. (2022). Mobile clinics: Medical service strategy for disaster healthcare response operation. Journal of Industrial Engineering and Management, 15(3), 470-483.‏

Reliefweb, a (2023). Northwest Syria: Aid Delays Deadly for Quake Survivors [EN/AR] – Syrian Arab Republic | ReliefWeb. [online] Available at: https://reliefweb.int/report/syrian-arab-republic/northwest-syria-aid-delays-deadly-quake-survivors-enar  [Accessed 26 Apr. 2023].

Reliefweb, b (2023). Northwest Syria Earthquake February 2023, Bi-Weekly Highlights – 07/03/2023 – Syrian Arab Republic | ReliefWeb. [online] Available at: https://reliefweb.int/report/syrian-arab-republic/northwest-syria-earthquake-february-2023-bi-weekly-highlights-07032023  [Accessed 26 Apr. 2023].

Rossen, E. and Cowan, K.C., 2014. Improving mental health in schools. Phi Delta Kappan, 96(4), pp.8-13.

United Nations. (2023). Türkiye-Syria Earthquake Response. [online] United Nations. Available at: https://www.un.org/en/turkiye-syria-earthquake-response.  [Accessed 23 Apr. 2023].

Youtube.com. (2023). response of the Idlib Health Directorate and health facilities to the earthquake disaster. [online] Available at: https://www.youtube.com/watch?v=li7philQupg [Accessed 8 May 2023].