22 November 2017, Damascus, Syrian Arab Republic – Seven people have been killed and 42 people injured in Damascus city and surrounding areas in recent days. In eastern Ghouta, Rural Damascus, local health authorities report that during a four-day period alone from 14 to 17 November, 84 people were killed, including 17 children and six women; and 659 people were injured, including 127 children and 87 women. During the same period, more than 200 surgical operations were conducted in eastern Ghouta’s overwhelmed and under-resourced hospitals. Despite escalating violence and increasing humanitarian needs, life-saving medicines, medical equipment, and surgical supplies are prevented from entering the area. The medical evacuation plan, developed by the Syrian Arab Red Crescent and the World Health Organization to transfer critically ill patients to key referral hospitals in Damascus, Rural Damascus and Idleb governorates, has remained unapproved Lack of essential health services, as well as limited electricity, fuel, safe drinking water and basic sanitation services are increasing the risk of disease outbreaks such as diarrheal diseases, typhoid and hepatitis. Inter-agency convoys to the area have been irregular, and the aid provided has been insufficient to meet the increasing needs of up to 400,000 people besieged for more than four years. Hospitals and healthcare centres have been damaged, severely limiting medical care for people at a time when they need it most. On 18 November, al-Mujtahed Hospital in Damascus city was targeted, and two resident doctors and three patients were injured. The 412-bed facility is one of the main public hospitals in Damascus that can serve patients from eastern Ghouta and other parts of the country. “Continuous and unimpeded humanitarian aid to eastern Ghouta is urgently needed, and medical evacuations of critically ill patients are long overdue. Life-saving health supplies are available, and WHO, along with partners, stands ready to respond to health needs once access is granted,” said Elizabeth Hoff, WHO Representative in Syria.