 I'm going to present a baseline health survey we carried out in November 2017 in northern Syria. Half of the Syrian population has been displaced since the conflict started in 2011. Over 5 million South refugees in the neighboring countries and over 6 million are currently displaced throughout Syria. Most internally displaced persons, IDPs, live in unofficial settlements or temporary camps with limited security, protection or access to essential aid or medical services, causing an access in morbidity, mortality and psychological distress. Since November 2016, an intensification of the military operation has been observed in northern Syria. The resulting heavy fighting and airstrike contributed to the deterioration of the IDPs health status and living situation, triggering considerable population displacement. In October 2017, in the last weeks of year-long sieges around Raqqa and their resort governates, a large influx of IDPs has been observed arriving to Anissa Camp in Raqqa Gobernate. At that time, MSF OCP was supporting a primary health care clinic, running community health worker network, providing mental health care and running a nutritional center, and MSF OCA was responsible for vaccination activities in the camp. Given the violence and insecurity generated by the conflict, international organizations have faced difficulties to be present, to respond and bear witness to the humanitarian and medical needs of the IDPs in northern Syria. To fill the gap in information, a retrospective morbidity and mortality survey was conducted during summer 2017 in Anissa and Membech camps. The aim was to get health indicators and descriptive measurements to inform the health response and to provide means to quantify the impact of the conflict. In October 2017, when we observed the large influx of IDPs coming to Anissa Camp from previously besieged areas, we decided to recondect the survey in order to ensure the relevance of our medical activities and increase our understanding of the humanitarian impact of the conflict. Between November 8th and 18th, 2017, we conducted a cross-sectional survey among IDPs arriving in Anissa Camp after the 1st of October. The MSF community health worker network visited all the tents on a weekly basis and were able to provide us a camp population census with information about demographic, date of arrival, origin and location in the camp. At the time of the survey, the camp population consisted of 13,840 individuals distributed in 2,127 tents. Our sampling frame of recently arrived IDPs consisted of 587 tents. From these, we randomly selected 275 households. Once verbal informed consent was obtained, a structured questionnaire was administered to the head of the household in local Arabic. We collected information about demographic history of displacement, one-year retrospective mortality, two-week morbidities, chronic disease, vaccination among children under 5, violence exposures in the last year and two-week mental health symptoms. The mental health part of the questionnaire was the WHO-UNHTR standardized assessment tool. Beside the questionnaire, all children between 6 months and 5 years, an old pregnant and breastfeeding woman, under one malnutrition assessment through mid-upper arms circumference measurement. For this presentation, we decided to focus on the one-year retrospective mortality, the violence exposures in the last year and the two-week mental health symptoms. Mortality rates were calculated using the individual person-day contribution of all household members present at some point in the household in the last year. The individual recall period started one year before the interview or on the day of birth and ended the day before the interview on the day of death or on the day of last contact in case the household member was not in the family anymore. Overall, an age and sex stratified mortality rates and prevalence estimates were calculated along with their 95% confidence interval. The study was approved by the MSF Ethical Review Board and the local health authorities. Out of the 275 households fulfilling our inclusion criteria, 257, 93% were included in the survey. Eight households were absent, and 10 refused to participate. 95% of our sample used to live in Raqqa or their resort governates before arriving to Anissa Camp, and 73% moved more than once since the beginning of the conflict. A total of 1,482 individuals used to live in the selected household at the time of the survey. The average family size was 5.8 individuals. Our sample, 53% of our samples were females and the median age was 12 years. Between November 2016 and November 2017, the crude mortality rate among the survey population was 0.56 death per 10,000 people per day, which is five times higher than the pre-war estimates. 65% of the death in our study were caused by war clashes and 84% were reported between June and November 2017, period during which Raqqa and their resort governates faced heavy airstrikes and fighting. The period specific CMR was 1.04 per 10,000 per day, which is nine times higher than the pre-war estimate. We attempted to understand the potential survival bias that is known to be present in such conflict setting where heavy artillery can kill entire family, leaving no one to report for this death. Out of the survey family, 35 person could recall at least one family unit among their neighbors or extended family that was entirely killed in the last year. In the last year, almost one-third of our survey population had experienced at least one violent event. The type of violence that was mostly reported was witnessing atrocities such as execution, flogging, or public body displays. 19% of our sample witnessed these atrocities in their home area. Children were also highly exposed to violence. 20% of children under the age of 15 years had experienced one violent event in the last year and 10 person witnessed atrocities. A specific psychological trauma might be found in men aged 15 years and older, as they also experienced direct violence. 16% were detained or tortured and 11% were tortured, beaten or attacked in the last year. Among participants older than two years, 38% reported to be so distressed, disturbed, or upset that they were completely or almost completely inactive in the last two weeks. Considerable prevalence of depressive symptoms leading to functional impairment were found in our sample. 29% of the respondents declared to be uninterested in things they used to like and 14% so hopeless that they didn't want to carry on living for most of the time in the last two weeks. Finally, a group known to be particularly vulnerable with psychosocial needs not sufficiently addressed are the children. As mentioned earlier, children witnessed or experienced war-related violence. 20% of the children between 5 and 12 years reported bedwetting at least twice in the last two weeks, a common sign of trauma and distress in this age group. Our study presents several limitations. First, the recall period was quite long for some indicators, likely resulting in recall bias, especially for violence exposure. Community pressure might have highly influenced the reporting of sensitive information such as death among fighters, torture, detention, or sexual violence. Fearing that their reputation or even their safety might be endangered if they disclose this information, respondents probably underreported these events. Retrospective mortality surveys are prone to survival bias and lead to an underestimation of the mortality. Death in household where everyone was killed or where the few survivors joined other family were not accounted by the current methodology. Our results show that 35% of the family knew at least a family that was entirely killed. Even though we couldn't really quantify precisely the survival bias and we couldn't exclude multiple reporting, this estimate indicates that the underestimation might be important. Finally, the mental health assessment tool led to some difficulties. The wording of the question was complex and we probably lost some meaning during the interviews. Therefore, our estimation of psychological distress might be a distortion of the reality. To conclude, war in Syria has lasted for seven years causing considerable population displacement, extensive violence, and countless death. In our study we found CMR between five and nine times higher than the pre-war estimate, indicating the magnitude of the crisis in northern Syria in the last year. We also demonstrated that the survivor were highly exposed to violence. The prevalence of mental health distress across all age groups indicates that conflict had an immense psychological impact on this population, whether it's violent nature, the relentless force displacement, the insecurity about the future, their living condition in the camps, or their multiple losses they have experienced. So as a recommendation, we recommend to urgently reinforce mental health and psychosocial support activities in this region. So I would like to thank everyone who facilitated the study, but mainly the participant who welcomed us in their tans and shared their tea and their painful experience. Thank you for your attention.