our doctors are COOL! #JustSaying 


fresh floride cleanse = awkward smile.... 






## Message From **SAMS** President 

Many years ago, our very capable members came together to establish a foundation of medical expertise with the capacity to aid hundreds of thousands of daughters, sons, fathers, and mothers who did not know the next time they would be able to receive the medical support they needed. To see what has been accomplished by this commitment is nothing short of a miracle. Thankfully, we have successfully built a network of diverse providers, life-changing programs, and millions of beneficiaries. Previously we discussed our new shifts toward medical education, mental health, and psycho-social services that chart a new path toward sustainability for our beneficiaries. The shift has paid dividends, the fruits of which include the new opportunities made possible by providing occupational therapy to many who want to head into the workforce as well as many new projects being maintained by dedicated staff. 

With your help, a new avenue of aid and services has been introduced. Now for the first time in years, the future looks bright and full of hope.Your help in alleviating their concerns allows them the opportunity to see past their current conditions and focus on things like caring for loved ones, pursuing careers, and getting an education. 

As advocates for the vulnerable and voiceless, your efforts have solidified border-openings and access for aid to reach those in dire need. SAMS is now recognized beyond just aid providers but champions of change. 

Our tomorrow is brighter than ever because of your support and for that we extend our warmest appreciation and congratulations for being at the forefront of life-changing service. 



**----- Start of picture text -----**<br>
Message<br>From<br>SAMS<br>Foundation Chair<br>**----- End of picture text -----**<br>


In 2022, the most profound impacts of the COVID pandemic subsided, and SAMS emerged from the global crisis stronger and wiser. We resumed our role as a major health care provider to a population of 4.5 million in NW Syria providing nearly 3 million medical services, including more than 100,000 surgeries. 

With each crisis comes new opportunities. SAMS experience treating critically ill patients in the newly established COVID ICUs enabled us to start a new badly needed ICU fellowship program in NW Syria with the help of SAMS ICU committee in the US. We also expanded our existing and unique as cancer center in NW Syria and started few one of a kind “signature” programs such as cochlear implant at Bab AlHawa hospital, cardiac catherization in Afrin and AlBabhospitals and the stroke unit in Idlib Central hospital. 

I had the opportunity to witness first hand the resilience and hard work of our staff and providers during my visit to NW Syria in the fall of 2022. I saw complex life saving pediatric surgeries at Bab AlHawa hospital, the critical stroke patients cared for at Idlib central hospital ICU, the very busy neonatal ICU at Avicenna hospital in Idlib, and the high risk pregnancies managed at AlUmuma hospital in Idlib. I also visited the recently rehabilitated and expanded Alaterab cave hospital and Afrin hospital which were both attacked viciouslyb in 2021 with casualties among staff and patients. I also visited SAMS’ oncology centers in Idlib and Al Bab, the only such centers in NW Syria, that were as busy as ever. The highlight of my trip was visiting the new, one of a kind SAMS cath lab in Afrin hospital and soon to be installed cath lab in Al Bab hospital. 

We all should be proud of SAMS impact on the ground. 

**Dr. Amjad Rass SAMS President** 

**Dr. Basel Termanini SAMS Foundation Chair** 



2022 IMPACT AT A GLANCE
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MEDICAL SERVICES
MEDICAL WORKERS
SURGERIES IN SYRIA
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BENEFICIARIES
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In 2022, SAMS provlded +2.9 Mll. medlcal servlces to those In acute
need. wlth an average cost of $15 per service.

OUR PROGRAMS

## **Our Programs: Primary Care & Outreach** 


It’s expected that displacement will disrupt day-to-day life for refugees. At SAMS one of our primary goals is to help them restore their health and well-being. At times it can mean the difference between life and death. Our mobile clinics put medical services like primary care within easy reach for our beneficiaries. Mobile clinics complement the traditional fixed clinics or medical centers and act as a bridge to the standard care. Primary care accessibility also means preventative care accessibility. Diseases, injuries, and common ailments can be remedied with ease because mobile medical services act as a first line of defense. 

## **Pushing Past the Pain** 

At 12, Hakeem was diagnosed with kyphosis, causing his spine to curve and chest to jut out. He felt shame and pain, making him unable to play with peers. Despite hospital visits, there was no improvement. In September 2022, an orthopedic referral led him to a SAMS Hellas pediatrician in Ritsona refugee camp. After a few fittings, he received a custom orthopedic corset. Initially, it was painful, but with guidance, he grew accustomed to it. Days into the treatment, his mother thanked the SAMS team, sharing Hakeem’s progress. Now, with a more normal spine, Hakeem is reclaiming his childhood. 

**4** 



## **Our Programs: Secondary & Tertiary Care** 

Care for chronic illnesses is all too often a casualty of the crises Syrian refugees face year-to-year. In the face of acute health issues, health facilities struggle to provide services for cancer treatment, for example. Therefore, not only is SAMS the only NGO serving the population with comprehensive services, including for chronic illness, but the treatment is free-of-charge for all. Our Al Bab Multispecialty Health Center in Idlib and the oncology unit at Jarablus Primary Health Center work in unison to ensure countless patients are not overlooked. Surgeries, dialysis, and internal procedures are a part of but not limited to the secondary and tertiary services provided by SAMS staff. 


## **Mustafa’s New World** 

Mustafa al-Kabi believed in what he saw, yet his vision was fading. Despite being uprooted from East Ghouta, he remained playful like other children. But in a family camp in Afrin, his sight worsened, concerning his family. At Bab al-Hawa Hospital, neurosurgeon Dr. Mohamed Al-Jisri diagnosed him: complete vision loss in the left eye and severe deterioration in the right. An MRI revealed fluid pressure on half his brain. Dr. Al-Jisri noted, “After quickly conducting surgery, his condition stabilized. Had the fluid burst, it could’ve harmed his brain.” Post-surgery, Mustafa began regaining vision, bringing immense joy to his father. 

**5** 



## **Our Programs: Maternal & Newborn Care** 


Maternal mortality and morbidity is an unfortunate consequence many displaced and refugee women face. Access to prenatal and post-natal care can mean the difference between life and death. As mothers carry precious life within their wombs, SAMS medical staff work daily to bridge the medical gap that have been created by prolonged conflict and regional instability. Hospitals and localized clinics support these mothers and their infants from the first sonogram to the baby’s first doctor’s visits and thereafter. 

## **New Life for Muhammad’s Family** 


Muhammad Rustom Maafa was born prematurely at Qah Maternity Hospital. And like any family that has a newborn, his parents hoped to be able to leave quickly with their new pride and joy. But his feeble state prevented him from going home with his mom. For the next 45 days Muhammad would stay in the neonatal ICU to receive treatment. After nearly two months of regular visits with their son, his proud parents were finally able to take their baby boy home. Because of the help of SAMS supporters, Muhammad has overcome the challenge of a highrisk premature birth. Their new life continues on. With our staff providing the follow-up care children like Muhammad might need, they ensure have access to dignified life-saving care. 

**6** 



## **Our Programs: Rehab Medicine & Services** 

Many overlooked areas of treatment for people occur because of the lack of funding and qualified providers of affordable care. Due to this, medical problems that can be addressed by strategic care over time are ignored. Bringing this concern to the forefront has allowed SAMS to support services like Physical and Occupational Therapy, Hearing Loss Interventions, and Speech Therapy. Removing the barriers to these services gets children back to school, parents back to breadwinning, and those in critical areas in public service back to their stations. 


## **Getting Khadijah Back on Track** 

When Khadijah was diagnosed with Quadriparesis at 44, her whole life threatened to change. The unknown condition’s severe weakness bouts had alarmed her. At the SAMS Physiotherapy Center in NW Syria, she struggled with walking, transfers, balance, and muscle fatigue. Tests showed she could only stand for 12 seconds with open eyes, explaining her difficulty in daily tasks. 

At the center, her treatment plan involved electrical devices for pain relief and muscle strengthening, alongside therapeutic exercises for flexibility. After just seven sessions, Khadijah’s condition significantly improved. What began as a health crisis transformed into a challenge she was helped to conquer. 

**7** 



## **Mental Health** 


Mental health support within the displaced and conflict-affected communities has emerged as a vital lifeline for those grappling with the profound and sometimes debilitating psychological effects of conflict and displacement. These initiatives have made important strides in recognizing that mental well-being is deeply interconnected with physical health, and treating it is just as crucial. SAMS implements a range of mental health and psychosocial support (MHPSS) programming for affected populations across Jordan, Lebanon, Syria, and Türkiye. Highlights from 2022 include the programs below: 

## **Mental Health: Psycho-Social Centers** 


SAMS continued to offer comprehensive mental health support through six specialized centers in Amman and Irbid (Jordan), Idlib (Syria), and Gaziantep, Kilis, and Istanbul (Türkiye). SAMS teams - which include community outreach workers, social workers, clinical psychologists, and psychiatrists - offer in-home assessments and referrals, individual and group psychotherapy, psychiatric care and medication, case management for survivors of gender-based violence, support groups, educational workshops, technical trainings for government workers and community-based organizations, and internship supervision for university students. SAMS also operates multiple safe spaces in Syria and has integrated mental health services in its facilities through physicians trained in WHO mhGAP interventions. 

**8** 



## **Mental Health: Psycho-Social Training** 

Throughout 2022, SAMS partnered with Johns Hopkins University to train and certify 13 women in Syria as mental health counselors for children and youth within their communities. The women were trained and supervised using an evidence-based intervention called CETA, which was designed to help non-specialists provide safe, high-quality mental health care in low-resource settings where specialists are scarce. During the training program, 95 children and adolescents completed a full round of supervised CETA sessions, and 79 caregivers received additional support from the counselors. 100% of the participants showed a clinically significant reduction in mental health symptoms after participating. The trained counselors are currently part of SAMS psychosocial team and continue to provide mental health services for families in Syria. 


## **Mental Health: Psycho-Social Assessment** 


SAMS commissioned an in-depth study of the mental health landscape in northern Syria. This study delved into aspects such as salaries, job satisfaction, educational backgrounds, facilities, and available training. Notably, it featured specific reports on Clinical Psychology and Psychiatric Nursing, offering strategic guidelines for their development. Through SAMS’s mental health initiatives, professionals create safe environments for trauma victims to heal. By addressing the hidden scars of war, these programs not only assist in trauma recovery but also enhance emotional, mental, and physical well-being. Such support instills a sense of agency, community, and hope, ultimately uplifting the overall quality of life for individuals. 

**9** 



## **Outbreak Response** 


Despite its decline in the headlines, the effects of COVID-19 on the everyday lives of program participants are constant. ICU beds are open to any new cases resulting from the Delta and Omicron variants. SAMS is at the forefront of community-wide vaccination campaigns, case management, and is an important fixture in the NW Syria COVID-19 taskforce. Cholera also remains a threat to vulnerable populations and remains a focal point by SAMS staff. The treatment facilities are a valuable resource for community members seeking preventative and emergency care. 


**10** 



## **Non-Medical Crisis Response** 

Incredible non-medical humanitarian aid has been extended to Syrian refugees, showcasing the strength of compassion and solidarity. Various organizations and individuals have stepped up to provide essential support, ranging from shelter and food to education and psychological assistance. Additionally, provisions such as clothing, hygiene supplies, and clean water contribute to restoring dignity and well-being. The outpouring of non-medical aid reflects the global community’s commitment to standing together and making a positive impact on the lives of Syrian refugees, reminding us of our shared responsibility to uphold the principles of empathy and humanity. 


Across rural areas of Idlib, in January and February 2022, SAMS supported the distribution of winterization kits for 1,303 families, together with implementing partner, Mercy Without Limits. The kits included warm blankets, stove heaters, and fuel, and brought much needed warmth during winter snowstorms for those residing in camps and informal settlements for the displaced. In December 2022, SAMS supported the first of three rounds of fuel distribution for 574 displaced families residing in Azaz and Salama districts of Aleppo, together with implementing partner, Ghiras Al Nahda. In all of these distributions SAMS and partners prioritized households that were particularly in need of assistance during the cold winter months – families with young children; older persons; persons with disabilities; households with chronically ill family members; and women and child headed households. 


In Lebanon, SAMS volunteers distributed 1,000 winterization and hygiene kits to Syrians residing across informal tented settlements in the Beka’a and Arsal, where SAMS already conducts community health and psychosocial support interventions. Based on feedback from camp residents on most needed items, kits contained winter blankets, socks, gloves, diapers, feminine hygiene pads, toothbrushes, tooth paste, and rechargeable LED lights. 

In Greece, in late November 2022, SAMS Hellas staff distributed 147 pairs of shoes for adults and children arrivals by sea, hosted in long-term accommodation centers that are served by the mobile medical team. 

**11** 



.•J5
SPECIALIZED CARE

## **Specialized Care: Cardiology** 

Based on the continuing needs to fill the gap in advanced cardiology services, SAMS established and supported the catheterization unit in Al Shifa Hospital in Afrin. The need for these services were confirmed based on SAMS communication with the Turkish Health Directorates, which showed that a huge number of referrals were being conducted to hospitals in Türkiye to receive the cardiac catheterization services due to the scarcity of this service within NW Syria. The activation of this Cath lab was critical to ensure the availability of this life saving intervention and contribute to the reduction of morbidity and mortality in NW Syria. Providing catheterization services inside NW Syria relieved patients of the burden of travel and the high cost of the procedure when they seek medical care from the private sector, or in government control areas, and avoid the potential deterioration in medical status when enrolling in long waiting lists to receive it in Türkiye. 

Activated in June 2022, cardiac catheterization was provided by a well-trained Cath team which consisted of 4 cardiologists, 3 Cath technicians and a nurse, with the support and consultation of SAMS cardiology committee in the US. The average number of recipients of care under this project is 35 patients per month. These patients also received follow up care, medications and information on prevention and lifestyle modification, including instructions on smoking cessation and committing to a healthy diet. 

In addition to their role in providing the cardiac Cath services, the cardiologists provided cardiology consultations for patients in the other departments when needed and performed other procedures such as electrocardiogram and echocardiography. SAMS procured an additional cardiac Cath equipment to establish and operate a second Cath lab in another facility in NW Syria in 2023. 

**13** 



## **Specialized Care: Stroke** 

Stroke is one of the leading causes of death and disability worldwide. About one third of patients die from stroke and one third live with severe impairments. The best chances for recovery from stroke are given when patients are treated in specialized wards known as stroke units. In 2022, SAMS established a stroke unit in one of its hospitals in Idlib city to provide a multidisciplinary team approach including specialist nursing staff and welltrained neurologists with the support of telemedicine from experts in the field. The unit offers continuous monitoring of patients for early identification and treatment of potential complications, provision of thrombolytic treatment when indicated, and facilitation of early mobilization and rehabilitation. A stroke clinic in the facility ensures secondary prevention measures are integrated in patients follow up management, like treatment of comorbidities and patients’ education. 

**14** 



## **Specialized Care: Oncology** 

Cancer patients in Syria struggle to access care and are more likely to be diagnosed when their disease has already reached an advanced stage, making treatment more difficult and reducing their chances of survival. 

SAMS life-changing oncology program in Syria has been a beacon of hope for those battling cancer since 2018. In 2022, 2779 patients were assisted through specialized medical teams in 3 clinics in Idlib, Al Bab and Jarablus cities, with the remote support of a dedicated SAMS committee of over 20 specialists in adult, and pediatric oncology and pathology always available for consultation and advice on the management of challenging and advanced cases and sharing up to date medical information. 

The oncology program covers a full range of services, such as laboratory and pathology tests, diagnostic imaging including CT scans and mammograms, surgeries, chemotherapy infusion and management of side effects, blood transfusions, psychosocial support and nutrition counseling, all free of charge. Chemotherapy medications of breast cancer, lymphomas, colon cancer, gonads cancer, and pediatric leukemias are always fully covered, in addition to infusion services for other types of cancers where the medications are secured from outside sources. SAMS oncology team is also active in the assessment and referral of selected cases to Turkish based oncology centers for advanced treatments and radiation therapy that are not available in northern Syria. 

To improve the capacity of the local physicians, SAMS completed the training of 7 internists in adult oncology and hematology, started the training of 2 pediatricians in childhood cancer and blood diseases and is planning to launch a training program in pathology in 2023. SAMS also facilitates in person training and assessment visits whenever possible by its committee specialists. 

**15** 



## **Specialized Care: Oncology** 

SAMS also continues to work on building a strong framework of a multidisciplinary approach that coordinates between primary care physicians, the surgeons, interventional procedures providers, social workers, and the referral network and further developing the patients’ electronic medical record system that improved data exchange among all participants in oncology patients care. 

By providing advanced medical treatments, expert care, and emotional sup-port, SAMS transformed the lives of cancer patients and their families. This program not only addresses the medical needs of individuals but also offers comprehensive assistance, including counseling and rehabilitation services. Its impact reaches far beyond medical outcomes, empowering patients to face their diagnosis with courage and determination. Through this program, the community has witnessed the power of innovation and compassion in improv-ing the quality of life for oncology patients, demonstrating the potential to bring positive change even in challenging circumstances. 

## **Ali’s Resilience & Healing** 


At 21, Ali turned to the SAMS Oncology Center in Idlib, where hope began. Despite his lymphoma diagnosis, he embraced chemotherapy, stating, “Even with challenges like hair loss, the diminishing pain and masses showed me the power of perseverance.” When faced with another abdominal cancer diagnosis, Ali remained resilient until the cancer was treated. We’re inspired by his journey and privileged to empower and heal him. 

**16** 



ps
SPECIAL FOCUS:
CARE FOR CHILDREN

## **Care for Children: Cochlear Implants** 

Cochlear implants wield transformative power for people with severe -to-profound sensorineural hearing loss where cells in the inner ear are damaged and cannot detect sound properly. 

A cochlear implant system has two main components. The externally worn audio processor detects sounds and sends them to the internal implant, which is placed just under the skin behind the ear. By bypassing damaged parts of the ear, the cochlear implant directly stimulates the auditory nerve, and restores the hearing experience, thus fostering speech and communication skills development. This breakthrough technology has opened up new avenues of interaction, education, and employment, empowering those with hearing loss to lead fuller lives and contribute meaningfully to their communities. 

In 2022, SAMS invested in these ingenious devices and the surgical tools needed for the implant surgeries, to restore the gift of sound and enable 35 hearing impaired children in Türkiye and Syria to have a chance at an enhanced life experience and reconnect with the world around them. Through collaboration with visiting surgeons and audiology experts, the program in Syria included several virtual and in person hands-on training to ENT surgeons and other specialists with the goal to build local capacity and establish the Cochlear Implant Surgery as a service that can be provided in North Syria by local medical teams. The training included hearing evaluation techniques, post-surgery calibration of the hearing aid, speech therapy approaches, and developing post-surgery individualized rehabilitation plans. 

**18** 



## **Care for Children: Cochlear Implants** 

In this touching photo, Abdulkareem is experiencing the sensation of hearing for the very first time. The hope and promise of a brighter, more fulfilled future can be seen clearly in his eyes. He is among five fortunate children to receive cochlear transplants, generously funded by SAMS, at Bab Elhawa Hospital. Now with his sound transmitter in place, Abdulkareem is ready for his next journey to Termanin’s Center, where he’ll undergo speech therapy. Dr. Hamza, our leading ENT specialist in Syria, assures that from evaluation to training, every step is fully covered by SAMS. 

“While waiting outside the operating room, the stress and fear I felt for my daughter were unparalleled. I just wanted her to be okay,” Ghazal’s father shared. At 3, tests in Syria confirmed her hearing impairment. A doctor suggested a hearing aid and speech therapy. At the SAMS center in Termanin, she was diagnosed with severe sensorineural hearing loss, leading to a recommendation for cochlear implant surgery. Recently, she was approved for the SAMS cochlear program at Bab Al Hawa hospital. After thorough preparations, she underwent the surgery. “When doctors confirmed its success, I was overjoyed,” her father exclaimed. 

The SAMS Cochlear Implant program at the University Hospital in Gaziantep, Türkiye, assists In 2022, SAMS invested in these ingenious devices and the surgical tools needed for the children with hearing impairments. Recently, we implant surgeries, to restore the gift of sound and enable 35 hearing impaired children in met Zakaria and his father pre-surgery. The faTürkiye and Syria to have a chance at an enhanced life experience and reconnect with the ther shared, “My son was born deaf. We discovworld around them. Through collaboration with visiting surgeons and audiology experts, ered it at 18 months. Seeking a cochlear implant the program in Syria included several virtual and in person hands-on training to ENT surtook over a year, but SAMS provided hope.” He geons and other specialists with the goal to build local capacity and establish the Cochlear expressed a wish for all in need to receive help. Implant Surgery as a service that can be provided in North Syria by local medical teams. After a successful surgery, Zakaria is recovering The training included hearing evaluation techniques, post-surgery calibration of the hearing well. Soon, he’ll get his external hearing aid and aid, speech therapy approaches, and developing post-surgery individualized rehabilitation start speech therapy at the SAMS Physical Therplans. apy Center in Gaziantep. 

**19** 



## **Care for Children: Autism Center** 

In collaboration with Take My Hand Social Assistance Association, SAMS has supported over 100 refugee children with autism in Türkiye, expanding to offer mental health, psychosocial support, and protection. Mainly serving Syrians, the program also helps Palestinians, Egyptians, Iraqis, and others. Our Arabic-speaking specialists provide ABA therapy-based special education. This includes individual, group, and sensory-integration sessions vital for public school enrollment. Parents and caregivers also receive consultations. 

Take My Hand, the sole provider of this special education in the area, has over 200 children waiting. To aid more children, especially outside Istanbul, SAMS and Take My Hand launched online sessions in 2022. 

## **Autism & Alphabets: Hisham’s Breakthrough** 

At 4, Hisham was diagnosed with autism spectrum disorder, evident in his pronounced emotional reactions, distinct speech delay, limited interaction with peers, and specific food aversions. Soon after the diagnosis, his family sought assistance from the SAMS-supported Take My Hand Center in Istanbul. A devoted team of specialists delved deep into understanding Hisham’s unique needs. Their primary focus was enhancing his Turkish language skills, particularly since Hisham had a multilingual background, and they aimed to prepare him for integration into a Turkish school setting. Through curated sessions, combined with the unwavering support from his family and teachers, Hisham showed significant improvement. He transitioned from merely recognizing words to confidently constructing complete sentences. He successfully cleared his entrance exams for a Turkish public school. We are proud of Hisham’s accomplishments and look forward with optimism to his future journey. 

**20** 



## **Care for Children: The Helping Hand** 

SAMS implements a psychosocial support program for adolescents in Jordan and Lebanon called The Helping Hand, which features a digital mental health game designed to help youth navigate life’s challenges. The game was developed specifically for Syrian refugees and vulnerable youth in the region, and facilitators use the game as a tool for teaching youth how to respond to common experiences such as bullying, traumatic memories, heartbreak, and social anxiety. In 2022, 698 adolescents in Lebanon and 321 adolescents in Jordan participated in the program. Some have also received training to become youth leaders who will share the game with their peers and develop psychosocial activities for their communities. 

## **Joud’s Fresh Start** 


15-year-old Joud has been a victim of bullying by her classmates due to the shape of her teeth, which impacted her confidence and self-esteem. One day, she mastered the courage to start fresh and joined the SAMS-supported Helping Hand program in Jordan. Through various interactive games and activities, she could tackle the triggers of her trauma and cognitively address them. She realized she was not alone and managed to stand up for herself. Joud wants to be a doctor to help others heal. 

**21** 



## **Care for Children: SAMS Medical Missions** 

In 2022, SAMS incorporated Children surgical dental services as a standard component in its missions with teams consisting of pediatric dentists, periodontists, and dental surgeons, continued its dedication to pediatric strabismus care (squint surgeries) in every mission, sponsored pediatric orthopedic surgical mission for congenital cases like dislocated hip and club foot, and conducted the first pediatric cardiovascular surgery mission where Syrian and Lebanese children with congenital heart disease underwent lifesaving operations in Beirut performed by a visiting expert team. 

## **Duha’s New Future** 


Duha’s mass on the spinal cord affected her ability to move and made walking difficult. It also affected her external appearance, causing her many social challenges. SAMS performed the necessary examinations and referred her to Dr. Hugh J. Garton, who was part of SAMS’s neurology mission to Jordan. Duha’s surgery lasted 9 hours and was a success, painting a new future for Duha and bringing happiness and hope back to her parents. 

**21** 



OUR COUNTRY PROGRAMS



## **Syria** 


With the help of our donors, advocates and field staff SAMS was able to serve over 1.3 million beneficiaries with over 2.7 million total services rendered. SAMS staff in Syria combined with our facilities and partners placed approximately 2.900 service providers in the fields of health care, administration, and management. Through them, SAMS operated 36 facilities in NW Syria providing a variety of medical care including delivering babies, general and specialized surgeries, interventional procedures, physical therapy, dialysis sessions, blood transfusions, vaccinations, diagnostic tests and imaging, dental services, psychosocial support, inpatient and 

critical care, and chemotherapy. Covid-19 is still a lingered force which caused over 1,800 patients needing care. Other ongoing services were but not limited to: cholera treatment, ophthalmology surgeries, PPE distribution, winterization assistance, cardiac care, and speech therapy. Mobile clinics have been a prized resource providing over 56,000 services. 




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## **Outbreak ResponseTürkiye** 


SAMS’ commitments in Türkiye have continued as many refugees work daily to regain footing in their lives. Over 92,000 services in total were delivered to refugees in Türkiye to more than 15,000 beneficiaries. Our services providers totaled over 100 field staff in 5 facilities. Türkiye’s hallmark programs are physical therapy and psychosocial services. Physical therapy specialists in Türkiye provided 19,000 services for people with disabilities, while mental health and psychosocial support programs supported 72,000 adults and children with individual and group treatment options, as well as free medications prescribed by psychiatrists. SAMS also continued to support a special education center for children with autism spectrum disorders, providing support to both young people and their caregivers. Finally, speech therapy was provided for more than 1,100 people. 


## **Jordan** 

In Jordan, over 37,000 services were rendered to more than 21,000 beneficiaries by a support staff that just surpassed the 50- member mark. Psychosocial services had the most activities with more than 17,000 beneficiaries in across Jordan. SAMS conditioned to operate its rehabilitation center in Wadi Seer, a suburb of Amman, and a medical center in Zaatari camp with an emphasis on dental care for adults and children. SAMS also organized and hosted international multi specialty medical missions that regularly provided pediatric dental surgeries, opthalmology screening and interventions and life saving cardiac catheterization, in addition to other types of surgical interventions based on the needs assessed among the refugee and host communities. 


**24** 



## **Lebanon** 

SAMS interventions in Lebanon totaled over 45,000 in service and reaching around 25,000 beneficiaries.  More than 40 SAMS field staff operated in at least 3 locations in Lebanon and through many partners, providing psychosocial support, sponsorship of diagnostic tests and oncology treatments. SAMS also contributed to the cost of secondary and specialized care for those in need in multiple hospitals in all 5 regions of the country. Our community based dental project “Miles for Smiles” provided over 15,000 services, and the PPE distribution project secured 523,000 masks. In 2022, SAMS Lebanon continued implementing its winterization activities through the distribution of blankets, personal needs kits, winter clothes items, and rechargeable portable lights. International medical missions included specialists in pediatric orthopedics, pediatric cardiovascular surgery and maxillofacial reconstruction. 




## **Iraq** 


Iraq and KRI remain a part of SAMS priorities. In 2022, our 12 staff suported activities that provided over 7,500 services to people in need in  health and dental care. SAMS well equipped dental clinic with its 2 dentists and assistants performed over 3,065 interventions in dental care to refugee camp residents and the surrounding host community. Together with Life for a Child and the Layla Qassim Center for Diabetes in Erbil, SAMS also provided health education and glucose monitoring supplies for 430 young people with diabetes. In partnership with Human Appeal, SAMS also distributed hundreds of thousands of dollars of essential medical supplies and equipment to public health facilities in Dohuk and Erbil, where tens of thousands of Syrian refugees and displaced Iraqis continued to reside. Many of these supplies came at a critical time to meet the demands of COVID-19 suspected cases. 

**25** 




## **Outbreak ResponsePakistan** 


SAMS services to Pakistan reached over 6,000 beneficiaries. Beneficiaries were mainly supported through clean water interventions. The 2022 devastating floods in Pakistan lasted throughout the monsoon season and submerged one third of the country, affecting 33 million people, half of whom were children. The disaster left 20.6 million in need of humanitarian assistance, 5,5 million with no access to clean water, and over 2 million homeless. Through a partnership with the Human development Foundation, SAMS sponsored relief efforts in Jacobabad in the Sindh region. Our contribution secured medications and supplies for the mobile medical camps, hygiene kits for the survivors and clean drinking water distribution for the flood affected households. 


## **Egypt** 

Over 100 services were provided to more than 60 beneficiaries in Egypt. These services revolved around cardiac care. More than 60 cardiac cauterizations were completed. SAMS cardiology members organize successful cardiac missions to Egypt in collaboration with the cardiology department at Ain Shams University Hospital. These missions provide highly specialized consultation and life-saving treatments to patients in need with coronary heart disease and irregular heartbeats refractory to medications. The patients are usually selected in collaboration with local facilities’ staff and specialists and the patients’ tests are reviewed by our volunteer cardiologists prior to any intervention. 


**26** 



## **Greece** 


A staple program for SAMS has been support of refugees in Greece. As they work to regain stability each intervention is provided to ensure short and long time thriving. Over 12,000 services were provided to more than 7,700 beneficiaries. Projects supported interventions in vaccinations, mobile clinic services, PPE distribution, and winterization assistance. Mobile clinic services remained a dominant program having over 9,000 services delivered in 8 camps in the Atica regions and 2 clinics in Athens serving refugees and migrants from over 30 nationalities. Since November 2020, SAMS Hellas Mobile Medical Team (MMT) has provided outpatient medical consultations (pediatrics, OB/GYN and general medicine), health education activities, and COVID-19 vaccination strategies via delivery of vaccine awareness activities. 

## **Ukraine** 

SAMS’ response to the war in Ukraine started in March 2022 by procuring and delivering medical equipment and supplies to Bovary Hospital in Kyiv suburb, followed by facilitating missions by selected surgeons in the field of orthopedic, hand, and craniofacial reconstruction to assist in trauma related cases among survivals of war injuries. To better address the need for dependable and timely supplies delivery, SAMS partnered with United Health Ukraine, a US based diaspora medical organization,  and the Revival Institute in Ukraine and designed a project to procure and deliver pharmaceuticals and medical commodities as standardized kits for surgical interventions to up to 22 frontline hospitals, based on real-time needs, and build the capacity of frontline health services providers, through the delivery of a tailored training program and development of Mass Casualties Incidents (MCI) preparedness and response plans. 


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MEDICAL MISSIONS
IK

## **Medical Missions: Syria & Beyond** 

SAMS organizes medical missions to serve refugees and host communities in need. licensed volunteer health care providers from the US and abroad participate in these missions, provide primary and specialized medical care, offer peer to peer hands-on training, and distribute needed medication and supplies, all in collaboration with local facilities and health care authorities. In 2022 over 20 medical missions were serviced. 

SAMS’v medical mission program developed into one of the most engaging for members and volunteers, regularly serving in Jordan, Lebanon, Egypt, Syria, and Greece, and including specialized medical consultations, surgical interventions, dental services, and primary care days, all free of charge for the beneficiaries. SAMS also 


Did we just spot a ROCK fan!? 

built relationships with local volunteer physicians in these countries who would screen and refer cases for upcoming missions, provide follow up care when needed and conduct interventions in between the international missions. 

With the eruption of the war in Ukraine, SAMS contributed to the planning and the logistics arrangement of medical missions to help respond to the increase in needs for selected surgical skills in orthopedics, oncology surgery and craniofacial interventions. 


**29** 



. 3TALIOA51
MEDICAL EDUCATION
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## **Med. Ed. : Supporting Future Learners** 


The SAMS Scholarship program for students pursuing degrees in healthcare fields is a hallmark of development work for Syrian refugees in neighboring countries All selected students passed an evaluation and screening process which considers academic excellence, financial need, and history of support in medical and humanitarian relief work inside Syria. 

Since 2015, SAMS has provided financial support and educational assistance for over 50 students enrolled in universities in Türkiye. SAMS has also provided full financial support for 6 Syrian refugee students enrolled in medical school in Bosnia. In Jordan and Lebanon, SAMS has provided financial support for over 10 students. Lastly, in the United States, SAMS provided interest free loans to Syrian medical graduates seeking medical training in the United States. More than 150 graduates reaped the benefits of this initiative, with loans totaling over $350,000 disbursed. Through these targeted programs, SAMS aims to expand educational opportunities for Syrian students and help them advance their education and careers despite the ongoing conflict. 

**31** 



## **Med. Ed. : Allied Health Scholarship** 


In 2018, SAMS established two midwifery training programs in NW Syria that align with global standards for reproductive health and midwifery education. These programs have been adapted to reflect the context in NW Syria by SAMS specialists, and graduates of these programs have credentials that are recognized by WHO, UNFPA, and the local health sector. The first program is an 18-month intensive course, during which students who already hold nursing degrees receive theoretical and practical training to become midwives. As of late 2022, a total of 75 new midwives, all of them women, had graduated from this program. 

The second program is a three-year midwifery course that students with a high school diploma are eligible to attend. These students receive theoretical and practical training that includes topics such as basics of nursing, anatomy and physiology, microbiology, and clinical assessment, as well as specialized courses in midwifery, including antenatal care, natural delivery, newborn care, and postpartum care. 

**32** 



## **Med. Ed. : Nursing Program** 


Since its inception in 2015, SAMS has graduated over 200 nurses and nursing assistants in uniquely tailored nursing programs designed to fit the needs of the community. In 2018, after observing nursing shortages across health facilities, SAMS began offering a two-year nursing program that has graduated 106 nurses (50% male, 50% female) between 2018 and 2021. 

In 2022, Responding to the needs of critical care, SAMS developed a curriculum for a specialized nursing diploma in Adult ICU Care, which is currently lacking in Syria. Once implemented, the Adult ICU Diploma nursing curriculum will be made available across the region, as a reference and building block to promote standardization within this field of nursing. 

**33** 



## **Med. Ed. : Postgrad Medical Education** 

To build capacity of the local health workforce and sustainability of the fragmented health system, SAMS directly manages and implements many fellowship and residency programs in northern Syria, which have become a growing priority in recent years. These programs include Pediatric Oncology, Adult Oncology, Neurology, Pathology, Adult ICU, and currently in development: Gastroenterology, Adult Cardiology, and Pediatric Cardiology. 

Since September 2018, SAMS started supporting the resident doctors project in partnership with the Syrian Board of Medical Specialties (SBOMS), targeting 20 physicians within the project who are now receiving their training in a variety of specialties under the supervision of specialized doctors distributed over 9 facilities. SBOMS has an independent legal and financial identity and is recognized by the Syrian Interim Government Ministry of Health (MoH). 

SAMS will be supporting 15 residential doctors to start or resume their specialties studies in a variety of fields such as cardiology, endocrinology, gastroenterology, nephrology, obstetrics and gynecology, ophthalmology, orthopedic surgery, pediatric, urology and vascular. 

In addition, and in collaboration with SBOMS committees, SAMS Technical Committees with the SBOMS scientific committees were able to develop a robust standardized curriculum for the training centers that has been utilized starting from the last phase. 

SAMS and SBOMS collaborate in providing medical education services to resident physicians in Syria based on the principle of providing technical and general administrative and financial support by SAMS, and scientific follow-up by SBOMS. A new memorandum of understanding was in place between SAMS and SBOMS in 2022. 

**34** 



## **Med. Ed. : Success Story** 

## **Safaa Succeeds** 


After our displacement from Homs, starting anew was daunting. My husband and I were desperate for work, but opportunities seemed scant. As we grappled with the emotional weight of our struggles, I came across a lifeline: a program for nursing graduates at a SAMS-supported Midwifery Institute in Termanin. 

This 18-month course not only aligned with my long-held dream but also provided a monthly stipend. Recognizing the chance to support our family and further my education, I took the leap and was elated to be accepted. 

Our cohort began with 20 students, each with our own challenges. 

For many of us, the major hurdle was navigating through the English references. Fortunately, I was provided a tablet, a tool that became invaluable for translation, research, and understanding. As the months went by, my confidence grew, and I honed numerous skills, most notably, the art of communication. 

Upon completion, my journey came full circle as I found a position as a midwife in the very hospital where I trained. My heart swells with hope that all women in the health sector can tread a path towards their dreams. 

**35** 



11
ADVOCACY
11

## **Advocacy: US Government & Congress** 

SAMS maintains strong relationships with the US Government, including Members of Congress, USAID, the White House, and the State Department. SAMS leadership and staff hold regular meetings with these stakeholders to discuss the humanitarian situation in Syria. During 2022, Advocacy increased its presence on the hill with three major hill weeks engaging both members and staff on Syria related issues. HQ Advocacy regularly provides Congressional offices with reports from the field and submitted SAMS reports into the record for Congressional hearings on multiple occasions. 

In addition to this Congressional work, SAMS Advocacy also conducted regular coordination with USG officials inside State, USAID, and the National Security Council, including arranging regular calls with Deputy Secretaries and SAMS’ leadership. 


## **Advocacy: European Union** 


In 2022, Advocacy arranged four tours of European capitals to strengthen our partnership with European governments and increase funding levels from these partners. Capitals visited included Paris, London, Berlin, Brussels, Geneva, the Hague, Rome, Athens and Luxembourg. The major outcomes of these trips included increased funding from European partners, the process of registration as an organization eligible for direct funding in several European states and a presentation in the German parliament. European governments have been particularly generous in the wake of the earthquake in 2023 and we look forward to working with these partners even more in the coming year. 

**37** 



## **Advocacy: United Nations** 

SAMS’ Advocacy also maintains active partnerships with several UN missions, providing regular consultation on the status of cross-border aid and developments related to the management of the cross-border mechanism. In 2022, SAMS also convened several roundtables with UN missions in partnership with ARCS and Guernica 37 to present the Syrian NGO perspective on how the cross-border mechanism could be made more sustainable and effective. 


## **Advocacy: Reporting** 

During 2022, Advocacy took park in three major reports. The first and most important of these was the A Heavy Price to Pay Report on attacks against healthcare in Syria. This report was briefed both at the UN and in European capitals and has been distributed to partners at policy institutions and inside USG. The report tracks attacks against health facilities and health workers between 2015 and 2021 and is in the possession of the IIIM and other bodies that are pursuing accountability for Syrians who are the victims of war crimes. The reports’ findings were also presented directly at the UN by advocacy staff and hosted by the Canadian Mission. 

SAMS Advocacy also completed a major research report on disability and accessibility at our facilities across Syria. The report is the first of its kind, and includes interviews with doctors, nurses and persons with disabilities. We are currently in the process of briefing the report to partners in the disability space and will likely have a launch event in Europe and DC this summer. 

SAMS HQ Advocacy also participated in the rollout of the Legal Report commissioned by ARCS and drafted by Guernica 37, which examines alternative aid mechanism to the UN Security Council resolution that currently enables cross border aid. Advocacy arranged a launch event for this report at CSIS and has also briefed the report to over a dozen government partners both at the UN and in capitals. 

**38** 



Reports
Report5
Report$
October l. 2022
SeDtember 13. 2022
August 4. 2022
THE USE OF INDISCRIMINATE
WEAPONS IN SYRIA
A HEAVY PRICE TO PAY
(TURKISH VERSION: ODENEN
A6IR BEOEL)
LESSONS FROM
INTERNATIONAL COURTS FOR
DOCUMENTERS OF ATTACKS
ON MEDICAL FACILITIES IN
SYRIA
regularly condemned warring oarties
for carrying out Incliscriminate
warfare In Syria. Including by using
allegedly Indiscriminate weapons....
The Turkish version of our Rewt.. A
Heavy Price to Pay." Attacks on
Healthca￿ Systems In Syro 201S.
2021.
The law Of arme(* ¢c>nflict. or
International humanitarian law {"IHL").
has long Pfotectecl medical personnel
and tacilitiÈs 2 ThÈ firsi arlicle
READ MORE
AEAD MofiE
READ MORE
HEALTH RESEARCH
A4
May 16, 2022
A HEAVY PRICE TO PAY:
ATTACKS ON HEALTHCARE
SYSTEMS IN SYRIA 2015-2021

## **Health Research in a Complicated ConflictOutbreak Response** 

As the Syrian crisis unfolds, the role of health research grows clearer. SAMS is at the forefront, enhancing our research capacity with a team of skilled doctors. In partnership with academic entities, we established a research department in 2022. Our research aims to inform decisions, aid advocacy, and optimize response by disseminating knowledge and best practices, while also narrating Syria’s health situation for future interventions. 

SAMS proudly advances its Avicenna Journal of Medicine, emphasizing our dedication to research and better healthcare in Syria and the broader region. 

## **SAMS Research in 2022 at a Glance** 

- **6 Peer-reviewed papers in 2022** 

**- 3 Evidence based grey litterature reports** 

- **12  Events and Conference participations** 

## **Peer-reviewed publications featuring SAMS** 

- (2022) Protracted armed conflict and maternal health: A scoping review of literature and a retrospective analysis of primary data from NW Syria. https://doi.org/10.1136/bmjgh-2021-008001 

- (2022). The impacts of the Syrian conflict on child and adolescent health: A scoping review. Journal of Public Health (Oxford, England). https://doi.org/10.1093/pubmed/fdac132 

- (2022). Cancer Diagnoses during Active Conflict: Experience from a Cancer Program in NW Syria. Avicenna Journal of Medicine. https://doi.org/10.1055/s-0042-1755331 

- (2023)Investment in Cancer Prevention and Care for Forcibly Displaced Syrians Is an Urgent Priority | JCO Global Oncology. https://ascopubs.org/doi/10.1200/GO.22.00382 

- (2022). Just responses of the kidney community in manmade crises. https://doi.org/10.1016/j.kint.2022.08.033 

- (2022). Telemedicine interventions in six conflict-affected countries in the WHO Eastern Mediterranean region: A systematic review. Conflict and Health. 

## **Thematic priorities for SAMS health research in Syria** 

## **- Health research in conflict** 

Covers medical specialties like pediatrics, maternal health, dental care, diseases, mental health, nephrology, and oncology. 

## **- Health systems and the triple Nexus** 

Focuses on cost-effectiveness, care models, sustainability, and innovative intervention themes. 

## **- Attacks on health and IHL violation** 

SAMS collaborates with John Hopkins, Harvard, and Berkley on documenting health system attacks, deconfliction, advocacy, IHL violations, health access impacts, and relief operations. 

## **- Health workforce, Medical Education** 

Examines Syria’s health force in asylum and internal control areas, assesses workforce gaps, and explores medical education enhancement. 

**40** 



SAMS SOCIETY & MEMBERS
f I

## **Outbreak Response SAMS Society: Networking & Peer Support** 


SAMS brought together its members from around the world in 2022 for its conferences where hundreds of members got to meet, learned about cutting-edge topics, planned for the future of SAMS, and more. SAMS organized two conferences: the 20th International conference that took place in Istanbul, Türkiye which focused on “Closing the Equity Gap in the Pandemic Era and Beyond Through Innovation’’. And the 11th National conference in Chicago theme “Promoting Healthy Communities Through Medical Sciences, Policy and Interventions”. 

In 2022, SAMS members also contributed to the quality of care at SAMS’ medical facilities in Syria through specialized committees that provided peerto-peer consultation, clinical guidelines and best practices, online lectures, interactive webinars, and educational courses. They also had a major role in expanding medical training for healthcare professionals in Syria to continue well-established fellowship programs in neurology, pediatric oncology, advanced neonatal intensive care, and pathology programs. 


**42** 



## **Outbreak Response SAMS Society: Member Contributions** 


Serving as medical mission volunteers in 2022, SAMS Members supported refugees and vulnerable host-community members in multi-specialty missions in Jordan, Lebanon, Egypt, Ukraine, and a multi-purpose mission to NW Syria in November. The members not only worked with staff to identify the medical needs of the refugees, recruited skilled local volunteers, and helped raise funds, but they also took time off to provide high-quality medical services to those who might not otherwise have been assisted. Often, the members remained involved long after the mission to ensure that patients received adequate follow-up care. 


Supporting new healthcare professionals is also a priority for SAMS members. Through its networks across the United States and beyond, SAMS’ Education Committee spearheaded collaborative educational programs to support medical professionals inside Syria and elsewhere by providing opportunities to expand their knowledge and experiences. The committee also provided medical students of Syrian descent with scholarship opportunities to pursue their education and residency programs in the United States, a career journey interrupted due to the conflict.  Further, members worked on reviewing young physicians’ medical residency applications and improving their interview skills by conducting mock interviews workshops. Research is another avenue in which many of SAMS’ members contribute in 2022. Since the start of the Syrian conflict, SAMS has been engaging with impactful research projects and researchers that are in line with its aims of improving the health and h- 

umanitarian situation for Syrians and other vulnerable populations. In 2022, SAMS’ members had an active research committee that oversaw SAMS’ research activities with the main aim of supporting high quality, operational research to benefit Syrians and others affected by humanitarian crises. 

**43** 



FINANCIAL STATEMENT

2022 Financial Statement
SUPPORT AND OTHER CONTRIBLrrioNS
2021
2022
Contributions
7,589,368
7,286,778
Grants
30.458,483
29.503,604
Gift in Kind
4.615,207
4.662,349
Total Revenues
42.663.058
41,452,731
EXPENSES
2021
2022
Program Servlce
Medical Relief Programs
38.114.088
38.892.431
Supportlng Servlces
Management and General
929.999
1.217.957
Fundraising
942.760
1.295.606
Total Expenses
39,986,847
41,405,994
Net Asset
15.307342
15.353.979
2022 DISTRIBUTION OF EXPENSES
Manag•m•nt a
Admln 3%
Fundralslng 3%
Programs 94%
45

2022 Financial Statement
Financials Over 7 Years
Expenses • Support
$60
$20
$0
2016
2017
2018
2019
2020
2021
2022
Source of Financial Support
Grant
Indlvldual
GIK
$60
$40
55.03
$4.62
$4.06
$19.11
14.10
$11.53
13.58
$20
$16.08
$17.87
$21.76
$30.Sg
$30.49
$29.50
$0
2016
2017
2018
2019
2020
2021
2022
46

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## **Outbreak ResponseSAMS in the Media** 





## **In 2022, SAMS:** 

- was mentioned in **87** news pieces. 

- gained a total of **23.1k** new social media followers. 

- posts reached **59.2k** views and **25.9** hours of video content. 



**48** 



## **SAMS LEADERSHIP 2022** 

## **Foundation Board of Directors** 

Dr. Basel Termanini (Chair) Dr. Ammar Ghanem (Vice Chair) Dr. Samer Al-Khudari (Treasurer) Dr. Abdulfatah Elshaar (Secretary) Dr. Maher Azzouz (Former Chair) Dr. Jihad Alharash 

Dr. Amjad Rass Dr. Wareef Kabbani Mr. Ismail Aajoukah 

## **Society Board of Directors** 

Dr. Amjad Rass (President) Dr. Ihsan Mamoun (Vice President) Dr. Samer Al-Khudari (Treasurer) Dr. Hala Nas (Secretary) Dr. Mufaddal Hamadeh (Former President) Dr. Hend Azhary Dr. Wareef Kabbani 

## **Senior Staff** 

David Lillie, Executive Director Dr. Randa Loutfi, Director of Programs Safaa Aladham, Director of Finance 

**49** 





**ANNUAL REPORT 2022** 


Contact: Mailing Address: info@SAMS.net 1012 14th ST. NW, Suite 910 P.O. Box 34115 (202) 930-7802 Washington, DC 20005 Washington, DC 20043 (866) 809-9039 sams_usa **f** Syrian American Medical Society Syrian American Medical Society-SAMS 

www.SAMS.net