Intended for healthcare professionals

Editorials

Humanitarian catastrophe for civilians in northwest Syria

BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m451 (Published 06 February 2020) Cite this as: BMJ 2020;368:m451
  1. Aula Abbara1,
  2. Diana Rayes, researcher2,
  3. Munzer Khalil, director3,
  4. Mazen Kewara, country office director4,
  5. Ahmad Tarakji, board member5
  1. 1Department in Infection, Imperial College, London, UK
  2. 2Syria Public Health Network, London, UK
  3. 3Idlib Health Directorate. Gaziantep, Turkey
  4. 4Syrian American Medical Society, Gaziantep, Turkey
  5. 5Syrian American Medical Society, Washington, DC, USA
  1. Correspondence to: A Abbara a.abbara15{at}imperial.ac.uk

Nearly 2.7 million people urgently need food and water, shelter, sanitation, and healthcare

A humanitarian catastrophe is escalating in northwest Syria. Since mid-December 2019, a military operation led by the Syrian government and its allies has forcibly displaced more than 350 000 civilians from the southern district of Ma’arrat al-Nu’man in Idlib governorate towards the Syrian-Turkish border.1 The most recent forced displacement to the north of the governorate comes soon after the displacement of nearly 400 000 people between April and August 2019 into Idlib from across Syria, exacerbating overcrowding and shortages in humanitarian and healthcare provision (fig 1).12

Fig 1
Fig 1

Idlib governorate with arrows showing displacement away from south of the governorate to northwestern Idlib and northern parts of Aleppo governorate

In an area of nearly 6000 km2, Idlib governorate hosts more than three million people (70% of them women and children), more than half of whom have been forcibly displaced by conflict from other parts of Syria.3 Those newly displaced people have now fled further north to urban areas and to camps for internally displaced people along the closed Syrian-Turkish border. These areas already have large internally displaced populations, including an estimated 45 000 people who have fled to northern Aleppo governorate.4 Up to a million people now live in tented settlements near the Syria-Turkey border.

Nowhere in Idlib governorate is considered safe; even camps near the Turkish border are at risk of aerial bombardment, such as the fatal missile strike on Qah refugee camp in November 2019.5

The health and humanitarian response teams in Idlib governorate are already overburdened. Nearly 2.7 million civilians are in need of humanitarian assistance, including the provision of food, water and sanitation, health, and winter protection.4 Inadequate shelter from cold weather and flooding, as well as rising fuel prices, are exacerbating underlying health needs of the population, particularly from trauma, mental illness, and malnutrition.4

Half of all health facilities are closed, and more than 68 medical facilities have been attacked since April 2019.16 Worsening violence could further displace at least 400 000 more people and lead to the deaths of hundreds or possibly thousands of civilians, including children, trapped along the Syrian-Turkish border.6

Reduced access

The UN Security Council resolution for cross border aid was first adopted in 2014, allowing the use of four border crossings along Syria’s border with Turkey, Jordan, and Iraq. The crossings facilitated the delivery of essential aid to nearly 40% of the Syrian population, including in Idlib. Russia and China vetoed the existing resolution,7 and on 10 January 2020 an update to the resolution was adopted allowing just two crossings on the Syria-Turkey border, initially for six months only.8

Failure to keep all four border crossings open will be catastrophic as aid will have to go through Damascus, with the attendant risks of interference.910 Closure of all border crossings, which could happen if the UN resolution is not renewed, could deprive nearly four million civilians of essential humanitarian aid.

The international community must act now to protect civilians trapped in northwest Syria.6 Priorities include renewed diplomatic efforts to secure a permanent and immediate cessation of hostilities, which would allow the UN to protect civilians in the area; emergency funding for the safe and rapid evacuation of all civilians affected by shelling; additional emergency funding for healthcare (particularly for chronic diseases, mental health, and reproductive health) and cold weather supplies for those in camps and urban areas; revision of the new UN Resolution (2504) on cross border aid to its previous terms; and public condemnation of attacks on civilians, healthcare facilities, and infrastructure.6

So far, action has been limited by several factors, including UN Security Council processes that are impotent in the face of vetoes by permanent members; the politicisation of humanitarian aid; and disregard of humanitarian principles leading to deliberate attacks on civilians and healthcare facilities.256

These factors must be resolved urgently by international authorities for the sake of Syrians and all other populations affected by armed conflict. Otherwise, large scale population movements will continue, and the effects will be felt well beyond Syria, including a potential upsurge of refugees entering Europe.11 International solidarity to relieve suffering in Syria is now more urgent than ever.

Acknowledgments

We thank Miriam Orcutt for her reviews and comments.

Footnotes

  • Competing interests: We have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.

  • Provenance and peer review: Not commissioned; externally peer reviewed.

References