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A Syrian man wheels a severely injured woman to a hospital for treatment after an artillery shell landed near a bakery in Aleppo, Syria, on Oct. 23, 2012.NARCISO CONTRERAS/The Associated Press

One of the world's most dogged medical charities says the health-care system in Syria has collapsed, unable to keep pace with not only military and civilian casualties of the civil war but also everyday conditions like pregnancies and chronic illnesses.

In an open letter last week to the global community, the group Médecins sans frontières (Doctors Without Borders) implored the U.S. and Russian governments to apply the same level of diplomatic energy to addressing an increasingly unstable humanitarian situation in Syria that they did to secure a deal on the control of chemical weapons.

"Given the multiplicity of states and non-state actors involved in the Syrian conflict, it is imperative that the Russian and U.S. governments work with their respective political allies to develop a strategy for facilitating a massive infusion of humanitarian assistance wherever it is needed in Syria," wrote the group's international president, Unni Karunakara.

The letter was dated Sept. 27 and widely distributed to diplomatic missions at the United Nations, including the Canadian mission, and governments and non-state actors, such as Hezbollah, that have weighed in on the Syrian conflict.

The executive director of MSF Canada, Stephen Cornish, echoed the letter's sentiments in an interview with The Globe and Mail's editorial board on Monday. Mr. Cornish, who recently returned from three weeks in Syria and neighbouring countries, described scenes of devastation and desperation.

Once-stable families relegated to vagrancy have been toting what belongings they have in rented blanket tents that double as overnight shelters. Pregnant women routinely return to urban-area war zones for medical care because of a scarcity of other options. Children prepare to live in open barns with mud floors for a second winter.

"Just to carry out medical activities is a challenge in and of itself," Mr. Cornish said. "The reality is the health-care system has all but collapsed."

Mr. Cornish called on governments to better target their aid. For instance, he said, counties like Canada could assist in winterizing accommodations for displaced Syrians.

Founded in in 1971 in Paris, MSF considers itself a neutral player in the conflict zones it serves. Staff deliver medical services to people affected by wars and natural disasters that otherwise would not have access to treatment.

Of the 91 public hospitals across Syria, MSF says 55 have been damaged or destroyed. Doctors have fled the country in huge numbers, according to the group.

MSF says it runs six hospitals and two clinics in Syria and sees about 10,000 patients and conducts 430 operations per month. In early September, one of its surgeons, Muhammad Abyad, a Syrian, was killed in the northern province of Aleppo. Mr. Cornish described the death as an "assassination."

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