“It’s only recently I discovered I had only one kidney. My immediate thought was how I’d be able to provide for my family now that I’d need transport for regular hospital visits for treatment.”

Mohamad*, 34, is father to two girls and a boy. He’s also the breadwinner of a family that’s been displaced several times in the last six years, due to fighting in northwest Syria. As of today, there is a ceasefire in place and Mohamad, his wife and children live in the village of Sheikh Yousef in Idleb governorate, some 30 kilometres from the hospital, close to the border with Turkey.

A couple of months ago, Mohamad was at work when he suddenly felt excruciating pain under his left ribcage. He was taken to hospital where examination revealed he’d been born with only one kidney. One in 750–1,000 people have the condition. Most lead normal lives, despite a slight risk of decreased kidney function or high blood pressure later in life, which is why regular medical check-ups are advised.

“I never had any health problems. Now, however, I’ve been told I can’t do physically hard labour and I need to go to the hospital every now and then”, Mohamad says. Indeed, it was at Kafr Takharim hospital where he learnt about WHO’s referral system and the transport it provides through the nongovernmental orgnization SRD (Syria Relief and Development), free of charge.

With only half of health facilities in northwest Syria functioning, what makes it possible for a fragmented health infrastructure to cope with the health needs of four million people, of which the majority are internally displaced like Mohamad, is a referral system put in place by WHO.

Attacks on health care, a hallmark of the conflict in Syria, have brought the number of functioning health facilities further down and deprived civilians of basic access to medical care. Mass displacement has also forced some health responders to suspend their services, while some have been able to relocate and cater to the displaced in camps or settlements.

The total number of facilities that are still running in Idleb and Aleppo is close to 300, while the pre-war figure was close to 600. This figure includes primary and secondary health facilities, specialized health centres, labortories and ambulances. And between them, there is a tight network, operated by dozens of health partners like the SRD, that make sure patients get the medical treatment they need despite the many challenges.

“My life has changed. The condition does restrict me and I’ve got financial concerns. But I’m also relieved because the referrals save me money and effort. And I have full confidence that I’ll manage to find a job that doesn’t require hard physical work, and at the same time, take care of my family.”

*Not his real name.