In 2021, the conflict in Syria now stretches back ten years and is quite possibly one of the most complex conflicts of our times, with a current tally of 6.6 million people registered as refugees in neighbouring countries -Turkey, Lebanon and Jordan-, 6.7 million people displaced inside the country, and barely 200,000 relocated in so-called “third countries”, including Canada, the USA and the UK. According to OCHA, in 2020 an average of 76 explosions occurred daily in the country and there were 813 cases of recruiting and using children in armed actions.
Despite the serious human rights violations and internal warfare, the focus on the needs of refugees and displaced people from Syria has not gained adequate and sustained support from the international community. By contrast, their access to dignified humanitarian conditions, such as their right to asylum, has been impeded as much by the lack of resources as by counterproductive policies and measures from countries that committed to supporting them. In September 2021, the UN’s Assistant Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator highlighted how the needs at this time in Syria are greater than ever, despite waning media coverage. Across the whole country in September 2021, an estimated 13.4 million people have required humanitarian assistance, a 21% increase with respect to 2020 and the highest since 2017.
Over the past year, in addition to the intensification of the conflict, there have been serious issues regarding the availability of access to water, particularly in the north of the country, along with an economic crisis. In August 2020 alone, that access to water severely affected 460,000 people, and in 2021 the situation has been exacerbated by the effect of climate and human factors, especially in the north of the country, leading to the threat of drought and severe damage to agricultural production, sanitation conditions and health.
In the case of north-east Syria, where Médicos del Mundo works, an estimated 1.4 million people -over half the population in the region- need humanitarian aid and 1 in 4 people are considered internally displaced. Inside a context of mounting and constant hostilities that are taking lives, destroying homes and affecting the most basic infrastructures, over 40% of families have been displaced more than three times, and with huge difficulties in their chances of moving forward.
Some data summarises the country’s critical economic situation: the 78% fall in currency value since October 2019, the 236% rise of average food costs between December 2019 and December 2020, the loss of 300,000 jobs since the start of the COVID-19 pandemic and approximately 50% unemployment. Thus, estimations show that nearly 90% of the population lives under the poverty threshold and between 60% and 65% in extreme poverty, as opposed to 50%-60% in 2019.
In terms of the health situation, in 2020 alone there were 28 attacks on health establishments. Barely 58% of hospitals and 53% of primary health centres remained in operation and it is estimated that half of healthcare staff have left the country. Over 12.4 million people face food insecurity, and in 1.3 million cases it is at an alarming level. Child malnutrition has afflicted 600,000 children chronically and 90,000 acutely, while one in three homes report signs of distress among their young. Anaemia also affects one in three pregnant women (OCHA, 2021).
The first case of COVID-19 in Syria was detected in March 2020 and one year later 47,812 cases had been confirmed. The pandemic has negatively impacted healthcare, specifically in the provision of services through health centres, primary health centres and services aimed at the most vulnerable groups. The fear of being infected has also caused more people to stop visiting services, which has meant fewer recorded visits and check-ups. Staff training has also remained in limbo. COVID-19 stigma also increased and most people didn’t want to be associated with health staff or primary health centres. Although other ways of reaching the community have been set up, there is still a need to carry out more activities for longer to reach the majority of the population.
In this context, access to humanitarian aid is key. Despite that, between 2020 and 2021 two of the three available border crossings north of Syria were closed for such purposes. Only the Bab Al-Hawa crossing remains open, while the Yaroubiah and Bab Al-Salam crossings were closed to humanitarian aid in January and July 2021, respectively. In January 2022, the UN Security Council will make another decision regarding border crossings.
Furthermore, although the situation in Syria has received attention from donor countries, the support granted does not cover a third of the needs expected, a situation which has worsened in recent years. International organisations have made numerous pleas to keep the focus set on the serious situation in the country by the international community, particularly at critical moments such as the intensification of the conflict and threats of closing border crossings, as well as essential issues such as the access to humanitarian protection.
Médicos del Mundo’s work involves supporting 14 primary health centres and four specialist teams, providing services for more than 800,000 inhabitants, especially primary health care, reproductive health, mental health and psychosocial support consultations (Médicos del Mundo, 2021).
Syrian civil society, in addition to responding directly to needs in core sectors, and despite the major difficulties caused by a conflict, continues to work to find alternatives and to call attention to lessons learned through the country’s experience and what it can contribute to conflicts in the Middle East, particularly in relation to the situation in Afghanistan.
To respond adequately to the humanitarian crisis experienced in Syria, there is a need for donor countries to keep up their commitment to the Syrian population, increasing their funding for humanitarian actors. By the same token, the international community must guarantee ongoing cross-border access for NGOs in order for them to provide essential services with no barriers or interruptions. Equally, it must assume its responsibility to uphold International Humanitarian Law and human rights, including the right to health.