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Discrimination, inefficiency and politics plague medical care in al-Hol camp

Amid a dire humanitarian situation in al-Hol camp in Hasakah province in northeastern Syria, medical services are reportedly scarce and quality treatment hard to receive, in addition to complaints from residents of discrimination in access to services.

9 September 2019

AMMAN— Amid a dire humanitarian situation in al-Hol camp in Hasakah province in northeastern Syria, medical services are reportedly scarce and quality treatment hard to receive, in addition to complaints from residents of discrimination in access to services.

Mona Abdul Wahab, 25-years-old from Deir e-Zor, waited for weeks before receiving a ticket which put her nine-month-old child on a waiting list for medical treatment. However, she was only able to obtain the ticket due to the intervention of another camp resident as the child’s condition had deteriorated, “showing symptoms of malnutrition,” Wahab told Syria Direct

Still, compared to other residents, Mona’s child was lucky. Many children have died before they could receive urgent medical care. “Cases have arrived at the medical center and they had already died, or they would die during the necessary treatment,” the director of health and the joint administration of the Kurdish Red Crescent (KRC), Dr. Sherwan Barri, told Syria Direct

Between January and July 21, 409 children have died within al-Hol, according to the Syrian Observatory for Human Rights (SOHR). A combination of food scarcity and lack of clean water, temperatures as high as 50 degrees Celsius, and poor medical care has led to death and suffering. 

“Most of the cases are children suffering from malnutrition,” Dr. Barri said. “There is no children’s food in the camp, which forces residents to compensate with adult food.” 

Moreover, “there is only one room for treating those [suffering from malnutrition] in the Kurdish Red Crescent, [and] the same bed is used to examine more than one child at the same time.” 

According to a UN report published on Sept. 1, there are 68,823 people in the camp, 94% of them being women and children. 

In May, Medecins Sans Frontieres (Doctors Without Borders) issued a warning about the deteriorating health situation in the camp, and called for “humanitarian assistance to al-Hol continue to be scaled up, as well as for aid organizations to be given access to all parts of the camp and for people to be treated in a fair and humane way in line with international humanitarian law and principles.”

Barri noted that KRC has just signed an agreement with the International Rescue Committee (IRC) to build a center in the camp which will specialize in treating children suffering from malnutrition. He expects that its construction will be finished in the next few months. 

Only basic services provided

A family from Raqqa was sent to al-Hol after an Asayish (Kurdish internal security forces) patrol arrested the family for living in Hasakah city without a sponsor, according to the head of the family, who spoke to Syria Direct under a pseudonym.

One of the family’s children suffers from asthma but has been unable to receive suitable treatment within the camp, due to the “incompetence of the medical staff,” according to the father. “The work of the staff within the camp is limited to everyday illnesses, those that don’t need specialists.” 

“The interference of the Democratic Union Party (PYD) in the affairs of the IDPs visiting the health centers and their bad treatment of the IDPs affects the medical situation in the camp,” the father added. 

Sheikhmus al-Ahmad, an officer in the bureau of IDPs, Refugees Affairs affiliated with the Autonomous Administration of North and East Syria (AA), clarified that “al-Hol camp includes three primary hospitals; however, they do not provide any medical services besides primary care.” Those services are provided by the Kurdish Red Crescent, the International Red Cross and the Association of Syriac Churches. 

Al-Hol’s hospitals “do not perform any surgeries, but instead transfer surgical and complex cases to Hasakah province through the International Red Cross and Kurdish Red Crescent,” al-Ahmad told Syria Direct.

He admitted that “the lack of medical specialists in the camp led to incorrect treatment of those injured in the war.” 

A member of the Kurdish Red Crescent speaks with Syrian women at a makeshift medical center in al-Hol camp, 23/07/2019 (AFP)

Access to services according to nationality

Al-Hol was first established as a camp to house Iraqi and Palestinian refugees who fled Iraq during the 1991 Gulf War and was run by the Syrian government in cooperation with UNHCR.

Today, Iraqi refugees once again make up the largest number of the camp’s residents, after the Syrian Democratic Forces (SDF) began to house those who were living in IS-controlled areas along the banks of the Euphrates within the camp. 

According to the UN report, Iraqis make up 45% of the camp’s residents, while Syrians make up 41% and other nationalities make up 14% of the population. 

The camp is divided up into different sections, with the Syrians being separated from the other nationalities. The quality and types of services provided also vary from one section to another.

The Syrian section is the best serviced, having access to three medical centers. Then, non-Syrians who are accused of being IS members, are serviced by “mobile clinics provided by Doctors Without Borders and the IRC, for specific hours, daily,” according to Dr. Shaheen Muhammad, an AA health official in Hasakah province. 

“It’s basically a prison, and the tents are like cells,” Abdul Wahab said of al-Hol, which she recently left. “It’s surrounded by a military fence and is under severe guard by heavily-armed soldiers.” Still, her living conditions were much better than those non-Syrians living in the camp.  

Doctors Without Borders confirmed Abdul Wahab’s account, saying in a press release that “While some basic healthcare is available, it is not evenly distributed, nor is it equally accessible by everyone living in the camp. The so-called annex area, where ‘third-country nationals’ are held, is a separate fenced-off area, holding 11,000 non-Syrians, 7,000 of them children. Due to security concerns on the part of the authorities, this group has additional restrictions placed on them, which prevents free movement to other parts of the camp, where some basic health facilities do exist.”

Although SDF security precautions are taken to mitigate the risks posed by possible IS sleeper cells within the camp, legal activist and director of “Syrians for Truth and Justice,” Basem al-Ahmad, stressed that “security fears are not an excuse for taking any measures which restrict medical treatment. In parallel with the appropriate security precautions, humanitarian and medical assistance must be allowed in.” 

“The sleeper cells are using the restrictions [placed] on residents for their interests, and are supporting propaganda especially on this subject,” al-Ahmad told Syria Direct.

Medical blockade

Accounts that were provided to Syria Direct from those who have left al-Hol camp largely correspond with reports and press releases from humanitarian organizations. Statements from medical officials in northeast Syria do not deny the miserable situation in the camp either. However, there is disagreement over the causes of the lack of resources and quality medical care in the camps.

The director of humanitarian relief and regional relations for the Multifaith Alliance for Syrian Refugees (MFA), Shadi Martini, attributed the difficulty many humanitarian organizations have in reaching northeast Syria to “the existence of complex procedures and bureaucracy for getting aid into neighboring Iraqi Kurdistan,” explaining that “the concerned parties require a lot of paperwork.” 

“There are no crossings into the area with Turkey,” he added, saying that: “Some convoys wait for months in Iraqi Kurdistan to get clearance to enter Iraq. This entails paying about $8,000 to $10,000 in flooring fees per container.” 

Martini clarified that American aid convoys enter the Port of Mersin in Turkey, and after clearance procedures, the convoys are transported to Iraqi Kurdistan. There, the convoys wait on the border for a long time. This process is repeated when convoys attempt to cross from Iraqi Kurdistan to Syria. 

“There is no real way to make the process easier, nor are there any steps that can speed up humanitarian work.” 

There was supposed to be coordination between the MFA and the Global Coalition Against Daesh to create a program to facilitate aid entry into northeast Syria via cargo jets. However, the project was aborted after the U.S. President, Donald Trump, announced that the U.S. was going to withdraw from Syria, according to Martini. 

The AA, in a statement from a health official, Shaheen Mohammad, said that “the surrounding states and the [Syrian] regime are besieging the camp, [confusing] the camp administration, due to a lack of medical supplies and capacity.” 

Basem Al-Ahmad, however, demanded that the AA “reduce the restrictions on international organizations and make it easier for them to work in al-Hol and other camps and areas where victims are present in northeast Syria.” 

He also accused AA of “giving priority to local organizations at the expense of others,” while emphasizing that the AA must give space to international organizations to work freely. He also suggested opening a humanitarian corridor from the camp to hospitals in other areas such as Ras al-Ain and Qamishli.


This report is part of Syria Direct’s Connecting Communities through Professional Engagement Project in partnership with the Australian Embassy to Jordan’s Direct Aid Program.

The report was originally published in Arabic and translated into English by Will Christou

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