Caption 1: Dr. Ghazwan Bweedani at Azaz Mental Health Hospital with a patient.

10 October 2024 – More than thirteen years of crises have taken a heavy toll on the health and well-being of Syria’s population, particularly its healthcare workers. On this World Mental Health Day, themed “Mental Health at Work,” WHO is highlighting the immense challenges faced by healthcare providers and patients across the country. Their stories reflect resilience in the face of hardship, set against a backdrop of dwindling resources and a health system stretched to its limits.

In Aleppo, Dr. Hiba Aubrey, an Ear Nose and Throat (ENT) doctor and head and neck surgeon, remembers the morning of 6 February 2023 as if it were yesterday. “At 4:17, we were jolted awake by strange noises and the ground was shaking beneath us,” she recalls. Leaving her family in what she hoped was a safe corner of their damaged home, she rushed to the hospital, where crowds of injured patients awaited care.

“Our duty was greater than our fear,” says Dr. Aubrey, reflecting on how she and her colleagues prioritized attending to patients despite constant concerns for their families' safety.

The earthquake shattered not only buildings but also lives, leaving deep emotional scars. The country has seen an 80% increase in depression and a 570% rise in stress-related disorders, along with higher mortality and morbidity rates linked to these conditions.

Caption 2: Dr. Hiba Aubrey, an ENT specialist, in an operating room in Aleppo.

In northwest Syria, nearly 20% of the population — about 1 million people — live with mental health disorders. But in a region of 5.1 million people, only two psychiatrists and 78 trained doctors remain.

At Azaz Mental Health Hospital, psychiatrist Dr. Ghazwan Bweedani not only treats patients dealing with the mental toll of conflict but also feels its effects himself. The hospital, a critical resource for those suffering from chronic conditions like schizophrenia and bipolar disorder, is grappling with severe funding shortages. “So many of our services are in jeopardy,” explains Dr. Bweedani. “We can’t even pay rent for additional space, let alone ensure regular salaries for our staff. Patients are crowded into just one area.”

Despite these challenges, the hospital’s 35 staff members, many working without pay, continue to provide essential care to 25 to 30 outpatients daily. But due to the lack of funds, the hospital has been forced to cut back on critical services that help communities.

The theme of this year’s World Mental Health Day—Mental Health at Work—is particularly relevant in Syria, where healthcare workers like Dr. Aubrey and Dr. Bweedani must confront their own trauma while continuing to care for others. The constant strain has led to increasing burnout and stress among medical professionals, who often work beyond their shifts without adequate support.

“This is not just a health issue; it’s a protection issue,” Dr. Bweedani emphasizes, pointing to the broader risks that arise if healthcare facilities are forced to close due to lack of funding. The Azaz facility is on the brink of closure, potentially leaving thousands without access to care, further endangering those with severe mental health conditions and escalating the crisis.

While health workers across Syria continue to provide life-saving services, they do so in an environment where their own well-being is often overlooked, compounding the challenges of delivering care in a country that has suffered multiple crises.

WHO, in collaboration with the Ministry of Health and partners, is fully committed to improving access to mental health services for all those in need. Over the past two years, more than 1 million mental health consultations have been provided, demonstrating a strong effort to support the mental well-being of the Syrian people but more is needed to ensure healthcare workers themselves have the necessary space, supplies and salaries to continue providing their life-saving services.

6 October 2024 – The World Health Organization (WHO) welcomes the US$ 5.5 million funding received from the United Nations Central Emergency Response Fund (CERF) to enhance its integrated multisectoral emergency response in Syria. The funding will enable WHO to continue delivering life-saving healthcare services to the most vulnerable populations in conflict-affected regions of the country.

The support aims to reduce morbidity and mortality by ensuring access to essential health care, including advanced nutrition services, and by delivering health services to people in need in north-west Syria and north-east Syria, including sub-districts in Aleppo, Al-Hasakeh, Dar’a, Deir-ez-Zor, Idleb and Lattakia.

“We are grateful for CERF’s continued support in addressing urgent health needs in Syria, particularly in this critical time where needs are increasing day-by-day” said Dr Iman Shankiti, acting WHO Representative to Syria. “The funding will enable WHO to restore and strengthen critical health care services and respond to severe malnutrition cases in the most hard-to-reach and underserved areas of the country.”

The funding will support an estimated 1.8 million people in prioritized areas, aiming to improve access to primary and secondary health care, bolster emergency referral systems – with a focus on children with malnutrition, provide essential supplies to nutrition stabilization centres and hospitals, and strengthen the capacity of local health care workers on mental health, gender-based violence, and communicable diseases.

“The greatest strength at WHO is our ability to reach people in need, no matter how remote or challenging the circumstances. We are thankful to CERF for enabling us to cover critical gaps in the healthcare system in north-west Syria, where we often must make painful decisions to prioritize the most vulnerable,” said Ms Rosa Crestani, Head of Office, WHO Gaziantep in Türkiye.

Through this generous contribution, WHO, in collaboration with local health authorities and NGOs, will address the immediate health needs of communities across Syria - including internally displaced persons, returnees, and other vulnerable group. This comprehensive response will save lives and help stabilize healthcare systems in the areas most affected by the ongoing conflict and the worsening situation in Syria.

Throughout WHO’s response, the funding will also be utilized to build local capacities through risk communication and community engagement (RCCE) activities and tackle sexual exploitation and abuse, helping to ensure that protection and accountability remain central to the humanitarian response.

Jehan receiving free maintenance for her artificial limbs at the Rehabilitation and Artificial Limbs Centre. Photo credit: WHO Syria.17 September 2024, Damascus, Syria – Improving Diagnosis for Patient Safety, the theme of this year’s World Patient Safety Day – observed annually on 17 September – calls global attention to the critical need for timely and accurate medical care. It is a message that resonates deeply in conflict-affected Syria.

The experience of Jehan, a 38-year-old woman from Al-Dhiyabiya in Rural Damascus, provides a reminder of the devastating consequences of delayed care. Jehan’s life changed in 2012 when conflict reached her neighbourhood. Returning home to retrieve essential items for her children, Jehan was severely injured by a shell. When she finally reached Al-Mouwasat Hospital in Damascus the doctors who examined her had no choice but to amputate both her legs.

"I spent two months in the hospital, grappling with the physical and emotional trauma of losing my legs. To make matters worse, my husband went missing and I haven’t heard from him since. The transition from being an active mother and wife to someone who needed constant help was incredibly difficult," said Jehan.

During her treatment at Al-Mouwasat Hospital, the possibility of prosthetic limbs was mentioned and Jehan received a referral to the WHO-supported Rehabilitation and Artificial Limbs Centre in Damascus. Overwhelmed by despair at her situation, Jehan didn’t visit the Centre until 4 years later when, with her family's support and accompanied by her mother, she finally went.

"The doctors were extremely supportive. They immediately took measurements for my prosthetics, which were provided free of charge and fitted within a week. I received a month of training at the Centre on how to walk with my new limbs," said Jehan.

Dr Iman Shankiti, acting WHO Representative to Syria, highlighted the importance of WHO support for the Centre since 2015, stating: "WHO’s continued assistance to the Rehabilitation and Artificial Limbs Centre is essential, especially as the crisis increases demand. Psychosocial support is also crucial to provide comprehensive care for these patients”.

Today, Jehan leads a more independent life. She works at a bag-printing shop to support her children and says she feels "an empowered woman again”.

Head of the Rehabilitation and Artificial Limbs Centre Dr Rafif Dahia said: “Our centre has become a lifeline for Syrians with disabilities. We've grown from treating 15 patients a month in 2001 to managing 50 to 60 cases today. All services are provided free of charge”.

In 2023, WHO’s support helped over 1350 people receive prostheses and 640 staff members were trained or retrained to ensure continuation of this essential work.

Jehan's story is a testament to the resilience of the human spirit and the power of timely medical care. As we observe World Patient Safety Day 2024, Jehan’s journey from injury to recovery serves to underline the critical role that access to health care and accurate diagnosis play in preventing lifelong disability.