The battle to treat the survivors of the earthquake in Syria

A 7.8-magnitude earthquake struck Turkey and Syria on February 6, killing more than 47,000 people. Photo: Sloan George/Washington Post via Getty

The 7.8-magnitude earthquake that struck Turkey and Syria on February 6 killed more than 50,000 people and flattened multiple cities. More than 4,500 dead and 8,500 wounded in northwestern Syria, a region where there is no unified government that has been isolated from the world for more than 12 years amid a devastating war. An already depleted healthcare system — 4.7 million people sharing just one MRI machine — is on its knees. More than 10,000 buildings have been totally or partially destroyed, displacing 11,000 people, according to the UN agency for the coordination of humanitarian affairs (OCHA). The earthquake also destroyed warehouses storing medicines. Nature spoke to doctors, engineers and other experts on the ground, as well as those helping remotely from Europe and elsewhere in the Middle East. That’s what they said.

Credits: Seismic intensity data: USGS. Waterways: OpenStreetMap Humanitarian Team. Build: AtlasAI. Administrative boundaries: United Nations Office for the Coordination of Humanitarian Affairs.

After the Arab Spring in 2011, the Syrian government used military force against all opposition. About 60% of northwest Syria’s 4.7 million people are internally displaced, having fled bombing attacks by the government of Bashar al-Assad with military support from Russia.

The United Nations and aid agencies are struggling to get supplies and expertise to the quake-affected areas, because there are only three temporary crossing points along the 911-kilometre border with Turkey.

Medical emergency

Hospitals in this region have been overwhelmed trying to accommodate thousands of injured people in settings with very limited beds, medical supplies, surgical equipment, and intensive care facilities.

According to the World Health Organization, more than 8,500 wounded people must be accommodated in only 66 functioning hospitals, which provide 1,245 beds for short hospital stays. Moreover, in northwestern Syria, there are 86 orthopedic surgeons, 64 X-ray machines, 7 CT scanners, and 1 MRI machine across the region, according to data collected by the World Health Organization and published at the end of 2022. A female pathologist says Women Ikram Habboush, director of the only general maternity hospital in the city of Idlib, “The medical situation in northwestern Syria is catastrophic.”

“The supply of antibiotics has run out since the third day” after the earthquake, says Abdulkarim Ikziez, an epidemiologist at King’s College London, who now fears the spread of infection. “We used medicines and serums that would have lasted for four to six months in two to three days,” Habboush adds. The World Health Organization has begun airlifting in medicines and medical supplies, but says northwest Syria also needs basic diagnostic equipment such as x-ray machines.

The acute shortage of healthcare in the region is partly caused by the targeting of hospitals and medical personnel during the war, explains Xize, a research associate on a UK-funded project called Research to Strengthen the Health System in Syria. In a separate study, Exize estimated that as of June 2021, 350 medical facilities had been attacked and 930 healthcare workers had been killed.

“People everywhere are working to take advantage of whatever resources are out there, including basic ambulances,” Exize says. “The medical staff has been working non-stop,” adds Haboush, who was working in the maternity hospital in Idlib when the first earthquake struck at 01:17 UTC. The hospital occupies the fifth and sixth floors of the building. “We had to evacuate the nurseries and move all the children to the ground floor,” Habboush recalls.

According to three doctors Nature spoke to in northwest Syria, the most common injuries are broken limbs, traumatic injuries, crush injuries including ‘crush syndrome’ (damage leading to organ malfunction including kidney failure), and bleeding.

Cardiologist Jawad Abu Hatab, dean of the Faculty of Medicine at Aleppo Free University in northwestern Syria, says that people who suffer from itchy syndrome need intensive care and dialysis. However, the region has only 73 dialysis machines, according to data collected by the World Health Organization.

“There were also cases of cardiac arrest due to the shock and horror of the disaster,” Abu Hatab adds. The medical community is also preparing to deal with more post-earthquake trauma cases, especially among children and women.

Doctors say they urgently need more dialysis machines and orthopedic surgery equipment, along with painkillers and antibiotics. “These supplies weren’t plentiful before the earthquake,” Habboush says, and they will now run out.

Rescuers searched for survivors amid the rubble of collapsed buildings in Harem, one of the towns with the highest number of deaths and injuries. Image credit: Omar Haj Kaddour/AFP via Getty

Visual damage assessments

Volunteer engineers go door-to-door to check which of the roughly 8,500 quake-damaged buildings are safe enough for people to return to. But lacking the necessary tools and safety equipment, they resort to tapping walls with household items such as simple hammers and making decisions with the naked eye.

It’s hard work. As of February 25, some 2,644 of the damaged buildings had been assessed, according to the Free Syrian Engineers Association, a volunteer group based in Azaz near Aleppo, which is coordinating the effort.

At the same time, experts from the Syrian diaspora are helping to conduct virtual assessments in places local engineers can’t reach. Residents of damaged buildings take photos and videos of the interiors and send them to members of the Doha-based Syrian Engineers Association in Qatar.

“Assessing the structural status of buildings is as urgent as the medical situation and should not be underestimated because aftershocks are still going on,” says Muhammad Azmi Tawakul, a civil engineer and president of the association. He adds that in northwest Syria, people have to use whatever methods are available.

Engineers try to estimate whether buildings are habitable (safe with minor cracks), temporarily unusable (needing reinforcement) or unsafe – in which case the occupants must evacuate immediately.

Buildings subject to collapse shall be reinforced with any available materials, regardless of whether they are suitable or not. Carbon fiber-reinforced polymers would work better for seismic reinforcement, Mohamed Khair Hayek, an engineer at the volunteer association, told Nature. Instead, they have to use a brittle industrial iron. “We are in an emergency situation, so we must respond quickly using the resources we have,” says Hayek.

The Society of Engineers, which is based in northwestern Syria, collects data daily, “and the next step is to analyze reports and prepare statistical studies, which will be important in the reconstruction phase,” says Society member Ali Hallaq, a computer engineer.

Many buildings will have to be rebuilt, but there is a shortage of engineers in northwest Syria, Hayek said. Before the earthquake, Hayek says, “we talked about the need to train engineers to rebuild in accordance with appropriate safety standards,” and adds: “Now it has become a necessity.”

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