 Good morning and good afternoon. My name is Mona Yucubian. I'm the Vice President of the Middle East and North Africa Center at the US Institute of Peace. It's my pleasure to welcome all of you to this very important webinar marking the one year anniversary of the catastrophic earthquakes that hit Turkey and Northwest Syria. One year ago today, an earthquake measuring 7.8 on the Richter scale hit Southeastern Turkey, Northwestern Syria. Some 59,000 people were killed. At least 6,000 people were killed in Syria. It affected one of the most vulnerable parts of Syria, Idlib, government, where some 4.5 million people, many of them displaced multiple times were living. The earthquake had the effect of exacerbating an already extremely dire situation on the ground in Syria. Today, we are joined by an esteemed panel who will help us understand both the immediate impacts of the earthquake, where Syria is one year from since the earthquake and what we can expect going forward as the country continues to contend with many, many challenges. I'm happy to welcome Dr. Mufad Dabhamadeh, who is the president of the Syrian American Medical Society, or SAMS, based in Chicago. Dr. Hamadeh is a practicing physician. He's board certified in medical oncology and hematology. Dr. Mufad Dabhamadeh arrived in Turkey less than one week after the earthquake to assist with relief efforts. Dr. Bashir Tejaldin joins us from Idlib in Northwest Syria. He is SAMS country director for Turkey and Syria. He's a medical doctor with a master's degree in internal medicine, and he's been working on the humanitarian response in Syria since 2012. Alex Mahoney is the division chief for the Middle East and Levant with U.S. AIDS Bureau for Humanitarian Assistance. He helped lead BHA's response to the Turkey-Syria earthquake from Washington, D.C. as BHA's associate response director. Alex has been involved deeply with USAID humanitarian response in Syria since 2011. What we'll do, I'm gonna engage our guests in discussion for about a half an hour or so, and then I'd like to bring in questions from all of you tuning in online. Please note you can ask your questions in the chat box that appears on the event page. So with that, Dr. Mufaddal, I'd like to start with you. Maybe first say a word or two about SAMS for those who may not be familiar with SAMS, and then maybe talk about your own direct personal experience having traveled to Turkey just after the earthquakes. Thank you very much. I appreciate this opportunity. SAMS has been working in Syria since the war started in Syria over 12 years ago. Initially, SAMS was established in 1998 as basically a medical society organization that has roots in Syria and tried to help the Syrian people in education, mainly. It was more like a social club, but then after the war started, SAMS transformed itself into building a network of healthcare providers inside Syria during the most difficult days and times of war. So we helped build field hospitals or supported the staff that are helping the victims of war. We helped establish essential needs clinics and field hospitals. We even built underground hospitals to protect them during the days of war. We built cave hospitals. So we have a vast experience in going through all those stages of the war, supporting our staff, supporting the doctors, supporting hospitals, building clinics. So our staff are very well used to war, destruction, collapse of buildings, used to receiving very sick and critical conditions of war. So the earthquake came and it was basically an exaggerated experience for them and they've never seen anything on that scale that big before. In addition, the earthquake itself was the scariest thing they ever experienced as many, many people told me. It was much worse than the barrel bombs they faced, more worse than the chemical weapons attack that they were subjected to. The fear that an earthquake can still in your heart and body and mind is nothing like you can ever experience in your life. So a lot of destruction happened in a very vulnerable area, as you have said before. Basically, these are an area that is underserved in terms of healthcare infrastructure. But our experienced staff and dedicated staff worked day and night over the soon, 24 hours after the earthquake and the days after and they've done a remarkable job of saving as many lives as they could. Obviously for us here living in the US, the leadership of SENS was extremely concerned knowing how much of a dire need they need, how much health they need. So we established a warehouse immediately and received tons of donations from a lot of people. And then our team, our president then traveled to Syria the next day and he met with the local leaders there, mainly the White Helmets and the Syrian forum and they formed a kind of a union to work together and to try to help solve the problems. That was very effective immediately after the earthquake. So we had to, you know, we were able to provide some help and needed equipments, but that was a trickle of the need that they needed at the point, at that point. The one thing that's notable is the first international aid arriving to Syria was over seven or eight days after the earthquake. Very sad because the Syrian people were practically left alone. They were left to their own devices. Luckily with the help of the White Helmets who had a great experience in recovering after collapsed buildings and their, the help of the community providing all they needed in terms of heavy lift equipments and that separate helped save many lives. One thing that I happened that after I talked to the White Helmets said, we were done removing people from underneath the rebels much sooner than the Turks. For one reason is we don't follow safety standards. We go in, we expose our lives to danger, we are ready to sacrifice our lives to get the people out. So they were, you know, and that's how they used to do it for over the last few years anyway. So we had a great, you know, the infrastructure we built even though the whole experience exposed many, many gaps in it, but it was strong enough to be able to withhold a few days and help save many lives as they can. We arrived there, obviously we got to the hospital. We met some of the victims that were there and I can't forget the few moments that was extremely emotional for us. You know, the one thing that surprised me more than anything else is how numb people were. You know, I'm looking at the victims and seeing the people, the children who lost everything, lost their parents and my tears in my eyes and everybody else is very numb. And I experienced that before when I went to Syria after major events, after bombardments and it was sad to realize that those people in Syria got used to tragedies. It's not new to them, it's a normal life for them as if death, destruction and loss is their normal life and it's been that way unfortunately for the last 12 years. Moving forward, I think the earthquake had a lot of good and good, you know, good effects and you know, silver lining we can say that is on one hand, we've seen a lot of help from the international community from especially the American community here, the donations for them and we were able now to establish medical missions going to Syria every month since the earthquake and I just was on the 12th mission, medical missions and they had opened up the borders and we've seen some of the gaps in there that we were able to fill now and we can talk about it a lot. So we have enough money, we have enough support now to build a brand new hospital and brand new cancer center, a brand new radiation oncology center and we have a drain now to build a Sam city that after we bought like a over 12 acre land and we're starting the construction process now. So there are new things that are coming up, new teaching opportunities and new training opportunities that are opening up for now and we're working on it. Unfortunately, I visited Jim Daerys, the one, the area that was hit the most since the earthquake. The rebels gone and but no constructions started the tents that were erected there. The refugees are still there and their condition hasn't changed much. Thank you. Thank you so much, Dr. Mufandar. You've unpacked quite a lot that I want us to dive into more deeply. We're gonna turn back to certainly where things are today and also how organizations like Sam's are thinking about engaging on these many challenges going forward. I would though like to talk, to turn to Dr. Bashir at this point and Dr. Bashir, you are joining us from Idlib. Where were you when the earthquake hit? I think from someone that experienced it directly, I think it would be helpful for our audience to understand the enormity of that earthquake and then understand from your perspective there on the ground, how you were able to mobilize. I think Dr. Mufandar raised a very important point that it took seven, eight days before any sort of international assistance made its way into Syria. And so I think it would be useful for us to understand from your perspective there on the ground what that situation looked like and how you were able to mobilize and also work with the White Helmets. Dr. Mufandar has mentioned the White Helmets, Syria's first responders who operate in opposition-held parts of Syria and do enormous work saving people from barrel bombs and other things. They of course as first responders then turned to earthquake rescue, search and rescue. So please fill us in on how it was from your perspective. Hi, good morning everyone. I usually am based in Gaza and I was in Gaza when the earthquake happened. Usually as any normal day was preparing, was sleeping, preparing to wake up and say goodbye to my children and kids going to their schools and I start my work going to the office. But unfortunately that early morning it was cold weather and it was alarming to a snowstorm in the city and southern of Turkey as well. Unnormal, we woke up about one and a half hours earlier than we were supposed to wake but everything around us was shaking. Unconsciously, me and my wife moved directly to the kids' rooms and making sure that they are okay, taking them and taking them out of the house. At the street we found hundreds of people, our neighbors just in the cold weather in different uniforms and just staring at them and trying to recognize what's happening. A lot of children were in the cold weather. So directly as well as we were in the cold weather as well as soon as we are in the street start to communicate with my colleagues I'm working with a team of about 200 staff responsible to also supervise and support more than 2,000 staff in the health facilities in Syria where we are implementing our program. So also making sure we have communication with everyone but really at that first 30 minutes or one hour we start to receive a lot of tragedies. I'll summarize it with one story where one of the hospitals manager one of the biggest hospitals manager in Idlib in northern Syria was trying to, I communicated him asking what the needs they are, what the cases they are receiving. He was at that time in Idlib at the hospital while his family, his wife and three children including one newborn kids around one month age were based in Al-Takya. And he just told me that I get some news that our neighbourhood have been destroyed totally. So please make sure you are communicating with my family we have a lot of cases, hundreds of cases at the ER department we need to respond. So please it's your responsibility just make sure that my family are okay. So at that time you can manage that balance between the doctor who is trying to help people who have been affected by the earthquake in Syria while his family are living in Turkey and they are also one of the most affected cities and communities. Unfortunately at the next day the rescue teams could find his two daughters while he lost his wife and his newborn kid. And then he continued his work. And this is the situation of all the health care providers including physicians, nurses, medwives in northwest Syria. On the other hand, on the other part of the borders at the first two nights we spent the nights in the open settings in temporary shelters and cars. So we have almost about 85 staff members here in Gazanthab office and they need to respond to the crisis. So they were trying to communicate with the partners, donors with the field around the time to make sure that they are providing the support while their families are in need for them. Today after one year actually also I woke up early to come from Gazanthab to Syria. Also I woke up at 4am and after a few minutes I just checked my laptop and started to receive hundreds of notifications of friends and colleagues who are recalling and remembering their beloved persons and their colleagues who have been lost last year. Still a big trauma to the people, especially in Syria. I went to Genderis this morning to participate in an event that has been organized by the White Helmets and they also presented a video about their response in the first hours. Beside me there was one of my friends who started to cry as soon as he watched the video because himself, he was helping in the risk-free teams and he lost 17 members of his family. Unfortunately like Dr. Mufattal mentioned, Dr. Mufattal was in Syria last month and today still a lot of construction work needs to be done. Genderis as one of the most affected communities in northwest Syria still have a lot of distracted buildings and on my way from Genderis to Idlib which is about two hours driving. There are a lot and tens of thousands of informal shelters and tents on both sides of the roads. Although the consortium and union we worked on along with White Helmets and Syrian forum directly after the earthquake, we provided some infrastructure, construction rights, the main roads to facilitate access. We with our partners started to rehabilitate the affected schools or some of them trying to improve the health infrastructure but really still maybe hundreds of thousands or millions of people and children don't have access to education, don't have access to healthcare services and during the last year although there are a lot of support done but it's really very minimal compared to the needs especially when we know that before the earthquake there was the cholera outbreak, before that there was the COVID outbreak and after the earthquake itself the escalation took place in the area on October last year resulted in additional hundred and twenty thousand displaced people. Also the acute shortage and decreasing of the humanitarian funding to northwest Syria including the big cut of the WFP program and that will start to treat the food security. So unfortunately after one year still a lot of work is needed and really the needs are increasing day after day now we are reaching the highest number of people in Syria mainly in northwest Syria. So it's again an open call for all of us to increase our participation to those people. Thank you Dr. Bashir I wonder if you could just in the immediate aftermath of the earthquake could you speak a little bit more about the role of the White Helmets because I think folks should understand that these first responders really played a heroic role in the absence of any sort of international assistance at least again in that first week or so. What was your sense of what role the White Helmets played in terms of search and rescue efforts? Actually the White Helmets teams I can as I told many of them today when I met with them you are doing exactly what the midwives and obstetricians is doing you are taking the new lives but not from the womb of a woman but you are taking those slides from under the the ribbons. They have very limited resources they didn't receive the support of those heavy equipment usually used in such disasters but they really used their willingness to help the people using their hands their simple tools just to save whatever they can save and they at least in the first five days they worked around the clock they didn't stop any minute they are just like the the doctor I spoke about him who lost his wife and his to his new new born kid they are the same they lost their family members but they also continue to risk doing lives and provide the support taking the injured people from under the ribbons and referring them to the his facilities to be treated so without without their contribution the healthcare worker could not also provide or continue the life saving services so this is in brief their initial work at the very critical phase and then in the second phase they start to open the main roads so the other sector could go and provide the services and assist them to the population in the collective centers or in the settlements camps or informal settlements and their first phase was to removing the variables so they played and still are providing a lot of important work thank you Dr. Beshear um Alex if I could turn to you maybe you could provide some insight from your perspective at USAID sitting in the Bureau of Humanitarian Assistance in terms of what were the challenges that USAID was faced with in the immediate aftermath of the of the earthquake particularly again trying to get assistance into into northwest Syria what what were the unique challenges that you all found yourselves confronted with in that situation sure good morning first let me just say thanks Mona to you to USIP and Sam's for hosting this this event I think it's really important that people continue to to recognize that that Syria remains a major humanitarian crisis and it it needs our continued attention um I'll talk about the challenges but I first want to I want to talk about how we responded to this immediately after the earthquakes hit Turkey and Syria we mobilize a dart that's a disaster assistance response team which is a team of specialists that are that are trained to respond to disasters around the world and that included a large urban search and rescue component so our response focused from day one on both Turkey and Syria the dart comprised more than 200 staff at the peak and that included incorporating an existing team that we have for Syria that that operates out of Turkey and Jordan to to help respond to the ongoing crisis in Syria the assistance we provided for both countries totaled more than 242 million dollars and that was for food health shelter water sanitation and other life-saving support with that support for example the UN World Food Program has reached 2.7 million people with hot meals and food rations as well as with multi-purpose cash assistance we brought in in the days after the earthquake 10 flights with nearly 1.8 million pounds of relief supplies for both Turkey and Syria for onward distribution through the international organization for migration and we also partnered with our Department of Defense to transport nearly 600 thousand pounds for newly displaced people again both in Turkey and Syria in Syria we our partners distributed critical medical supplies and provided mental health and psychosocial support speaking specifically for Syria we provided more than 170 million dollars to both UN organizations and non-governmental organizations working in the in the northwest part of Syria which was hardest hit by the quake so the world food program for example reached 2.2 million people with emergency food assistance and I should also mention that that our support immediately following the earthquake included funding to the white helmets to help them with their heroic work they they are an ongoing partner of USAID and and right in the aftermath of the earthquake we gave them an additional awards to help to help their rapid response in terms of challenges I would say the the top shot well there were two one is common in in any earthquake which is that the people who are who are there to respond are are often also directly affected by the quake so you heard already from from our SAMS colleagues about about staff whose families suffered suffered losses and many of our partners experienced the same I had to I had to sign many condolence letters for for for partner staff who died as a result of the earthquake this also affected the Turkey aside and importantly it affected staff and infrastructure at the border crossings so so that was one factor in in aid access but I would say the biggest factor and this remains an ongoing issue it's just the the tenuous nature of of access into into northwestern Syria so so about a week after the earthquake the the regime granted access to two additional crossings in addition to Bab al-Hawa which was already which was already open to UN agencies they added Bab al-Salam and Bab al-Rai which was welcomed but but a week after and and recently they they reauthorized Bab al-Hawa for for another six months but what we really need to see is is ongoing access and and that didn't exist the White Helmets did amazing work in the days and hours after the earthquake one of the characteristics of search and rescue operations is you must begin to work within immediately because because people cannot survive long buried under rubble so they were able to do that but really there there should have been more organizations and and it was just very very difficult for for you know search and rescue requires hundreds of teams of hundreds of people and heavy equipment and and getting that in was was extremely difficult yeah I think thank you Alex thank you for both the descriptions of what you all were able to do but also these challenges and I'd like to sort of come back to you a little bit on that because it was notable the disparity between the ability for international teams to quickly get into Turkey versus the difficulties of of accessing Syria and it sort of for me raised the question of is there not do we need a doctrine of you know the responsibility to rescue where when there's a catastrophic event like a 7.8 magnitude earthquake there needs to be a way to address whatever the risk issues are of engaging in a cross-border sort of assistance mechanism so that people in need in those precious early hours after something like an earthquake which really means the difference between life and death are able to access you know the search and rescue teams are able to access people much more quickly I don't know if there's any thinking going on within USAID on should there be another such disaster in another conflict zone how to address these kinds of almost legal restrictions that impede the access of aid immediately following a natural disaster is there any thinking going on at aid about that so this is something that we think about and work on all the time I think what makes Syria unique is the issues around access to areas that the regime does not control and until until last until July of 2023 there have been a UN Security Council resolution for at least one of those crossings one of the things that we have advocated for is that we we need to see those crossings formalized again through through a security council resolution right now access remains tenuous because it's dependent on the the Syrian government continuing to to agree to to permit aid to come through so I think that's the most critical aspect of it in in most countries there there is an understanding with with governments that that when when something catastrophic like an earthquake happens you need to get bureaucratic obstacles out of the way and and you know allow allow teams to come in and and allow them to do their work so it's rare that we see challenges like we like we did in Syria with with just days and days needed for for for substantial aid to get in so I would advocate revisiting those those resolutions most importantly but ultimately there also needs to be a enduring political solution to the conflict in in Syria the you know this comes in the context of a humanitarian crisis that has lasted over over 10 years and has left people incredibly vulnerable which also contributed to the difficulties in responding to the earthquake thank you Alex Dr Mufaddel I'd like to turn back to you you've been making several trips back and forth to Syria and I want to understand you know how Sam's is prioritizing what are the where where does the greatest need lie and in particular I think I would highlight I think as Alex has also alluded we're seeing actually humanitarian need increase in Syria the numbers of people who require humanitarian aid has actually increased in 2023 we have issues as Dr Bashir mentioned of schools being destroyed by the earthquake and adding to the number of Syrian children who are out of school because they're on schools to go to there's just enormous need and not to mention as I think you noted the the reconstruction from the earthquake sounds like has has moved at best quite slowly so when Sam's is looking at this kind of wide range of challenges how do you think about how to prioritize where and how to engage understanding that you are primarily a health providing organization but how do you think about it in the context of the much broader need that is evident in Syria yeah thank you it's a million dollar question but before I start answering this I want to take this opportunity to thank USAID for all the support they have given us over the years and the extra 2.2 million dollars I guess out of the earthquake their support has been essential in maintaining our function on work in Syria and North West Syria over the years going back to the question that when I was asked once what do the people in Syria need the most at this point and my answer was hope I think the problem is with Syria is the problem the uncertainty right now the uncertainty that has been going on for years we enjoyed a relatively a relative count for last two years and many changes happened over the with that relative calm in last two years so if we can be assured of the future then people can start thinking about building their future the most heartening thing is when you ask a child in Syria what you want to be when you grow up and he says nothing because they have no future is so this is the the most important thing for the people now is to believe in a future and and you know from the health wise health care wise and health infrastructure is you know I think one thing that is missing and I think the need of the most right now is psychosocial support psychological support to many people I mean the Syrian people are probably the most resilient people that have ever seen and I want this in my life I have never seen more resilient people than Syrian people but you keep on relying on their resiliency you know if it doesn't work anymore it has to there has to be some more psychological support children children is the biggest disaster for Syria over the last 10 years I call the this generation of children is the last generation the last school the last their friends the last their families the last communities the last their their their support they lost everything we see many children working now and they lost that they left school because they can't find enough to eat for schools health children mental health for children children with disability is a big thing that we're going to try to work on many children with disability whether mental physical and psychological and you know a lot of those that we're starting working on for healthcare wise we need the healthcare infrastructure the hospitals we have now we're supporting they're doing a tremendous job we're building new hospitals renovating new hospitals that's not enough it's time for us to build quality healthcare services quality constructions and that's why we're working on training doctors on we have fellowship programs we have residency programs we you know and whole entire idlib there's on the north west there's only one psychiatrist there are no pediatric oncologists treating cancer patients so we are training pediatric oncologists we're sending them to Jordan to train at King Hussein cancer center we graduated two new hematologists on colleges so they can treat cancer center there are certain diseases are not covered by aid but they're not covered by grants we have to dig into private funds in order to cover the cancer is a big thing and that was a very vulnerable thing when the borders were turkey with clothes people lives were endangered and cancer patients found no way to get cancer now because of expanding our cancer program our oncology program we're getting some grants for medical oncology for kid care for drugs we'll be able to provide more people with within care they need at home they don't have to travel to Turkey to that so that exposed many things and immediately after the after the aftermath dialysis kids were missing we didn't have enough dialysis because we didn't have enough dialysis machines with crushed ones injuries many patients on terino failures and that was biggest problem initially after the so now with the with the support we had after the earthquake Sands decided that we're going to build now a new infrastructure so we're embarking on a new hospital now actually about the land we're building a 450 bed hospital it's going to be the state of art and it's going to have to be american standards it's not going to be field hospital centers anymore we that's the people of syria and the doctors in syria deserve better so we're going to build a cancer center also and we are building teaching institution that trains doctor to lift us level of health care services to the level that is standard worldwide and we're getting a lot of support the doctors in syria are excited excited about it we're getting help from the community moving forward i think you know we need to invest in our own communities there two examples that i learned recently about how we can do that especially in light of declining aid to syria as one is we just opened up a new clinic at new small high schools and then a cat scan saved of the cat scan in a small village in syria called serene the whole community was so excited about it the land grew king to us and said i don't want any more money i will give you the land for free i will do everything and the whole community celebrated the this new machine and they expressed their wills to do everything they can to help us expand and bring in more health care services to syria so we're really need to change the mentality from the receiving to the giving to to partnering with the community just like happened after the earthquake when all the contractors all they have the private heavy equipment system came to us came to the white house and here's our machines they're under your your your control you can under your service do anything you want to help people i think that's you know providing hopes stability training people to be able to be dependent and and to win them off of aid it's an extraordinary effort and i i want to explore that a little bit more deeply but you mentioned something that actually connects a bit to one of the questions that's being asked which is you talk about building that you know syria northwest syria is in dire need of health care infrastructure and building hospitals and you said building them to american standards and the question that's in the chat that i want to sort of pose to you but also maybe to alex is apparently in in parts of turkey those buildings that were earthquake compliant fared much better those those buildings that were built to code in other words actually did much better in the earthquake than when there were uh you know shortcuts taken i assume dr muffaddell given particularly now this history and this is a this is a tectonic an area of of significant tectonic activity that buildings that you all would would would build in syria would would also comply with um earthquake standards is that something that you consider now as you move absolutely absolutely our new design is earthquake resistant it's environmentally friendly solar energy it's all going to be incorporated together in that new building okay and alex do you have any thoughts on that from from though your perspective at aid did you all see a difference in how different structures fared in various parts of turkey depending on whether or not they were compliant with building codes yes and and we see that in earthquakes around the world earthquakes are sometimes described as a man-made disaster because it's the it's the structures that that fall and and kill people and and building codes are absolutely critical to to reducing to reducing deaths and injuries so so so yes that that is incredibly important i think if you if you look at syria and look at the history of the you know the last decade plus uh since the since the crisis began uh including you know barrel bombs and and and all kinds of just just widespread destruction even buildings that were relatively sound have been made more vulnerable so so um you know i think syria again is a in a very difficult place uh in in terms of in terms of the soundness and safety of buildings it is a critical issue for survivability in earthquakes yeah no you point to a very important issue which is of course before the earthquake hit many of these buildings in northwest syria were already compromised by virtue of having uh been subject to bombardment and fighting and so forth um uh dr basher i'm going to turn to you again and see if i can have you talk a little bit more about the psychosocial needs on the ground um what you are seeing inside syria uh and even frankly among your own staff as you noted who have suffered enormous loss as a result of the earthquake how are you contending with the challenge of uh addressing trauma particularly with children and are there innovative ways that you're looking to integrate psychosocial services into the care that you provide it's actually the mental health and psychosocial support is uh is of high need since more than a decade during the syrian crisis but after the earthquake the population mainly in northwest syria experienced uh new modality of uh of the psychosocial uh shocks and uh people experienced many and many shocks but after the earthquake it was really very uh unique because also the the staff themselves have been affected directly so the service providers has to be uh uh uh who has to respond to the crisis have been heavily affected by losing a lot of uh relatives uh and that was obvious uh from uh for us because after the few months of the earthquake we did some uh surveys there is a high burnout uh rates among the uh service providers uh and even within the beneficiaries we are facing new uh or higher level of btsd post-traumatic uh uh stress disorder uh more uh uh uh mental health disorders uh we need more needs and uh more disorders mainly with the children at the at the same time we have uh huge lack and huge shortage of the service provider mainly for the mental health and psychosocial support like Dr. Fadal mentioned in ad-lib only there is one psychiatrist is uh uh for more than five million population which is uh usually under a standard but also for the psychologists and psychosocial workers usually this sector in in the health system in syria is ignored and was not very grown even before the crisis so the needs was uh and still very uh big and uh huge what we did as a first uh respond for example insams we have different uh offices in the region so different the teams from different offices stepped in and provide the support and those peer support to the uh service provider that also helped a lot in uh relieving the stress to the uh provider and providing support in addition to other initiatives uh personally for me i found the most uh uh intervention that helped me to relieve some stress is that flexibility provided from uh the leadership of the organization so go and use all the resources you can don't even even look after so i have this flexibility that gives me more hope but at the community level uh because we have a shortage of staff we already started around the earthquake some community programs that one of them is the uh sita program partnership with uh uh some universities the johns hopkins university it's uh this approach is just to train uh the local woman at the community to provide the psychosocial support to their peers women's and children which is very uh a unique program very useful program and we expanded after the earthquake uh again also on the other hand because we have a lack of uh of the staff although we expand and integrated the uh the psychosocial support in all our activities including uh outpatient inpatient primary health care and secondary health care uh specific uh uh for them uh patients with non-communicable diseases and chronic cases like the cancer and the cardiac diseases we are integrating the social support services but on the long uh uh run also we uh we initiated uh long term uh educational program targeting uh many uh branches of the mhpss including uh uh psychiatric nursing clinical psychologists and psychosocial worker so we are also working on the long term in uh uh education and training program so we can also uh provide the community at large with the uh uh the human capacity to to to expand those programs and meet some of the needs but uh necessary uh one of the very big problems in northeastern Syria is the mental health psychosocial supports uh strengths uh uh and also we have uh high rates of uh drugs addiction we have uh high rate of uh uh suicide uh as well which is also uh uh increased after the earthquake relatively but the the uh root cause uh also is uh my opinion and many others opinion is uh what Dr. Mufaddal mentioned the lack of hope yeah well I want to before turning to Dr. Mufaddal because I'd like to give you Dr. Mufaddal the last word I I do want to turn briefly to you Alex you've been covering Syria since the start of the conflict the conflict will enter its 14th year next month and we're seeing significant issues with diminishing humanitarian aid budgets donor fatigue competing needs both in the region and around the globe the WFP for example is slated to phase out I think I understand a significant amount of its funding for Syria in 2024 from your vantage point at USA how do you view how to address these significant challenges in Syria going forward in an age of of diminishing assistance budgets thanks Mona that is a that is a good question and a and a tough one uh one of the things that we are facing I think the world is facing is just a an era of growing humanitarian need we we've seen multiple new crises spring up in the last few years um growing numbers of people in need and and declining budget so so that is the overall context um that that is driving some of the reductions that you you referred to in Syria um for us what we are continuing to do first of all we we remain committed I want to emphasize that to to responding to the crisis in Syria but I think we all need to think about how to how to change how we respond and we need to think about about bringing new donors to the table um to to address the the growing needs in Syria and worldwide so so advocacy around the world with other governments other donors is something that that my bureau is very intensely engaged in and trying to try to message the the critical needs that continue to exist in in Syria that's one of the reasons I'm I'm here today and and why this this um this is so important that we have this discussion so so that is one part of it and then the other part of it is there are there are different ways to to provide humanitarian assistance um there are ways that that we can be more effective and more efficient uh in terms of costs um so so we just need to all think about that and and work together more closely than ever to to to be as efficient as possible I think increasing the the size of the donor pool is is the most important um thing that we can strive for so I think with that with our remaining few minutes Dr. Mufaddal I'd like to turn to you because you lead a Syrian-American diaspora organization that is playing a critical role on the ground in northwest Syria and I think in many ways you are addressing precisely the kinds of gaps although they're enormous uh that that Alex has pointed to in your just few minutes of concluding uh comments could you let us sort of understand you've given us already some different very creative ideas that Sam's is is thinking of how do you see the future in Syria and the role how do we move forward it is a very tough question but listen I don't want to diminish the need of aid to Syria although and and a meeting that is focused on aid to Syria but the Syrian people are very creative hardworking and very smart given the opportunities they don't need aid they can they can thrive they can do a lot of good things a biggest example of the Syrian population Syrian the people is the Syrian-American community here uh this is a great community what Sam's have provided to the Syrian people and what was able to do over the last 12 years I don't know of any other organization in the world or in the Syrian history that was able to do what Sam's have done to the Syrian people we treated 22 million people over the last 15 years we saved thousands and thousands of lives and that we're just an example of what Syrian people can do if they were given the opportunity to thrive I think of all we need to do is try and find a solution give them a chance to live and of course we keep on keeping pouring aid and all that stuff and things but if we were able to provide the people of Syria with hope and a chance to work get rid of corruption and the things that ties them down I think Syria will not only thrive but it will be a beacon in the area that will provide aid to everybody else and I truly believe in that but until we get there we still need to support the essential needs of men and Syrian people and help them build their own institutions help them develop their own their own ways to help each other to help them to help you know the Syrian population be independent and be able to develop their own institutions and or and their own their own ways of doing things so they can be able to be eventually independent and I think this can happen but it will require hope stability and believe in the future Dr. Mufandal I want to thank you for helping us end this on a hopeful note because I think I would certainly agree with you that is really critical for the Syrian people going forward I want to thank you Dr. Mufandal Dr. Bashir I want to thank you and Alex Mahoney as well for this excellent discussion Syria does not really get the attention it needs I think in this day given all of the other issues in the region and around the globe so I thank all of you for your time and your tremendous insights and helping to eliminate where Syria is one day one year after the February 6 earthquake thank you very much and thank you to our audience for participating in this very important discussion I wish everyone a pleasant rest of your day thank you thank you