You can’t turn on the TV, radio or open a newspaper at the moment without hearing about Syrian refugees and the ‘European Migrant Crisis’. But did you know that the Syrian conflict has been raging for more than 4 years? Or that less than 10% of Syrians who have fled the conflict have sought safety in Europe – while over 4 million Syrian refugees are registered in Egypt, Iraq, Jordan, Lebanon, Turkey and North Africa (UNHCR – 13th Sept ’15). Or that UNOCHA estimates there are 7.6m internally displaced people in Syria, and that 12.2m people are in need of humanitarian assistance? Or that the majority of the humanitarian response is being implemented by Syrians themselves?
We asked Eba Pasha, humanitarian health worker, to recall her experiences working on the World Health Organisation’s response to the Syrian crisis.
The crisis in Syria is incredibly complex, and probably one of the most difficult environments I have ever worked in. The crisis is highly politically fuelled – both overtly and covertly – with a highly political humanitarian response – also overt and covert. After more than four years of war, the entire country is a battleground. Over 1,200 militia and rebel groups have formed to fight against the current government, and often against each other. Each street, each police station, each house is owned or under the control of whichever group fought for and gained power in the area. In some areas the group that’s in power changes – or changes their affiliation to whichever larger consortium they perceive will give greater stability or benefits, for themselves or for the area – on a daily, weekly or (if the area is lucky) monthly basis. Al Khorason, Al Nusra, Free Syria Army and Islamic State (IS) are the most famous of these groups and are seen by some as committing heinous violations of human rights. But these are just some of the umbrella groups fighting against the government – there are also groups that fight for the government. So for the Syrian population, whether you are in an area held by the government or the opposition, instability is constant and the humanitarian needs are great.
Pre-conflict Syria had a population of just over 21 million. It is estimated that over 4 million people have fled as refugees into neighbouring countries, but of the 17 million remaining, over 12 million – nearly half of which are children – need some form of humanitarian assistance. 7.6 million are internally displaced, many of whom repeatedly displace as conflict lines shift and they flee violence. 4.8 million people live in hard to reach areas i.e. either besieged areas surrounded by government forces, or areas held by rebel groups which do not allow humanitarian access. Public services are used as a weapon of war – armed groups have gained control over dams and reservoirs, or destroyed water treatment plants – worse, they have halted water supplies to gain control over the population as a means to gain power. Medical clinics have been encouraged to operate so that a group locally in power can gain the loyalty of the population, only for them to attack and destroy it should the population not accept them. Both government and opposition groups have attacked health facilities – according to Physicians for Human Rights, 295 such attacks have occurred, with 654 medical personnel killed (as of July 2015). Over half of the Ministry of Health hospitals have been either damaged or destroyed and only 43% are fully functional. Prior to the crisis, Syria had a very strong pharmaceutical industry and produced all of its own medication for the population. After four years of conflict, the infrastructure is completely damaged and production is minimal, with an estimated 10 to 20% of the population’s medication needs being produced in-country. As such, the entire population is at risk and in need of access to adequate treatment and drugs.
During my time in Jordan, I worked in the health sector with the World Health Organization. Part of my work entailed getting medical supplies to health facilities in hard to reach areas, under UN resolution 2165 (July 2014), which allows the United Nations to provide humanitarian assistance in such zones, either by cross-border or cross-line means. The other part of my job was to try and build a coordination mechanism whereby all health actors operating from Turkey and Jordan (cross-border into Syria) and within Syria could collaborate, to determine gaps and respond as needed.
Given the volatile security situation – and since the rise of the Islamic State and the increased frequency of kidnappings and abductions – from early 2014 most international NGOs did not have a presence within Syria for cross-border operations. That is to say there were no international staff, nor were there headquarters or bases for operations in those areas. INGOs were therefore operating remotely. A few INGOs were able to gain permission to work in Damascus, but were not able to serve populations in opposition-held or hard to reach areas. The same was true for UN organisations, even after UN Resolution 2165 came into effect. As such, the humanitarian response has been conducted by the Syrian population themselves. Physicians, surgeons, nurses, radiographers, paramedics and hospital managers are all Syrian, committed to the population and willing to take the risk. They are organised and have health committees, health NGOs, community organisations and district Ministries of Health, and have incredible reach. It is through them that international humanitarian agencies (both INGO and UN) are able to work. International agencies bring their technical expertise, alongside funding for capacity building and supplies – the Syrian NGOs, clinics and staff implement the activities. This partnership is critical and the only means to ensure a humanitarian response in these difficult areas.
For suggestions on how you can productively assist Syrian (and other) refugees, read our latest edition of Aid in Action.
International and local/diaspora actors in the Syria response (HPG Working Paper)