Six months after the first international donor conference for Syria, humanitarian aid is failing. Security and living conditions have deteriorated dramatically. The population living in areas controlled by opposition groups have almost no access to official international aid. Across the country, there are enclaves surrounded by intense fighting, where virtually no aid is reaching the people trapped inside.

Dr. Mego Terzian was recently elected as the president of MSF-France. Born in Lebanon, he earned his medical degree in pediatrics from Yerevan State Medical University in Armenia in 1999. While still in medical school, he worked as a translator for MSF in Nagorno-Karabakh, and from 1999–2002, he worked as an MSF field doctor in Sierra Leone, Afghanistan, and Iran. In 2003, he became an emergency coordinator for MSF projects in Liberia, Ivory Coast, Niger, Pakistan, Central African Republic, Jordan, and other countries. From 2007 until being elected president, he served as the deputy and then the director of MSF’s Emergency Programming at MSF-France.

While international attention has focused on chemical weapons, our teams on the ground are seeing that it is above all the bombing, the consequent displacement of millions of people, and the targeting and collapse of the Syrian health system that are causing the largest number of deaths.

We can attest to the immense needs in the north of Syria, where MSF operates five health facilities in opposition-held areas. Already this year, in addition to carrying out thousands of surgical procedures, we have vaccinated nearly 70,000 children against measles and delivered almost a thousand babies, as women have lost access to maternal care. We are providing treatment for cutaneous leishmaniasis and typhoid, as well as other communicable diseases and chronic illnesses such as hypertension and diabetes.

Yet given the scale of need, what MSF is doing is extremely limited. Most aid in the country is coming through Syrian solidarity networks, but they are struggling in the face of massive medical needs. Their medical assistance is focusing primarily on providing treatment to the war wounded.

But what of the pregnant women? And the sick? The Syrian medical networks need more support.

The medical imperative is to meet critical health needs, wherever they may be.

We are doctors and nurses striving to fulfil that imperative impartially. But, under the current circumstances, we cannot work to our maximum capacity.

Medical assistance is being targeted; people in Syria today are risking their lives in seeking and providing healthcare.

We negotiate access with all parties, but we have yet to receive official authorisation to work in Syria.

Restrictions on the delivery of aid within the country are increasing. Humanitarian personnel who cross front lines risk being shot or kidnapped.

So if the aid arriving through neighbouring countries is stopped, a lifeline into Syria will be severed. Millions of Syrians will be left without medical services.

Neighbouring countries must continue to allow the flow of essential medicines, medical supplies, and medical personnel into Syria.

Borders must also remain open to allow refugees to escape. In Iraq, the last remaining open border crossing, at Rabi’a, is now closed. Thousands are stranded inside Syria, along a sealed border more than 800 kilometres long.

In countries bordering Syria, MSF teams are witnessing overcrowded hospitals and poor access to healthcare for refugees and a growing number of local residents. Official aid is dwindling in Lebanon, for example, yet tens of thousands of refugees have still not been registered by the United Nations. Without registration papers, these people are not eligible for most aid, including health services.

An immediate international financial effort is vital to support public health services in host countries and improve the living conditions of refugees.

All actors represented here today hold the key to increasing lifesaving assistance in Syria, wherever there is need, and to improving the living conditions of people fleeing to neighbouring countries. Yet the reality is that the official international aid system is not working.

We must—and we can—find other solutions.

Donors must increase funding through the aid channels that are able to provide effective humanitarian assistance, even if those channels are not part of the official aid system.

Neighbouring countries must lighten administrative procedures to facilitate the delivery of urgent aid.

Finally, we must reiterate that warring parties must refrain from attacking health structures and respect the safety of humanitarian convoys. Humanitarian aid must be allowed to access to all victims of the conflict, whether by crossing front lines or crossing borders.