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Syria's refugees face a bleak winter
World Report
Syria’s refugees face a bleak winter Hundreds of thousands of war refugees from Syria are living in camps in neighbouring countries and face a difficult winter as temperatures drop across the region. Sharmila Devi reports.
www.thelancet.com Vol 380 October 20, 2012
Regional Response Plan to support up to 710 000 refugees in neighbouring countries by the end of this year. “Compounding the urgency is the upcoming onset of winter temperatures across the region in less than 10 weeks from now”, Adrian Edwards, the agency’s spokesman, told a press conference in Geneva on Oct 2.
“‘...it is a serious failure of the United Nations Security Council that we cannot resolve the crisis that has caused these families to flee.’” “We are in a race against time. In Jordan, for example, where thousands are living in tents, the average low temperature between mid-November and mid-March is 2°C. A winterisation plan is being developed but it too requires support and funding.” The refusal of Assad to let aid agencies operate within Syria itself combined with the highly bloody conflict that has killed several aid workers and journalists means that accurate assessment of the
humanitarian need, and death toll, are hard to come by. A team from WHO that visited Homs province with 2·2 million people in early September found a humanitarian situation that was “grave and continues to deteriorate” with one in four residents needing aid. The largest hospital in Homs with 350 beds had been completely destroyed. Workers from only two major organisations are able to cross Syria’s lines of conflict to operate officially with some effectiveness— the International Committee of the Red Cross (ICRC) and its partner, the Syrian Arab Red Crescent (SARC). Both groups’ position of neutrality is treated with mistrust by rebel and government forces and at least five SARC workers have been killed. Abdulrazak Jbeiro, SARC’s vicepresident, was shot dead in January. Unofficially, western doctors and aid workers from smaller nongovernmental organisations (NGOs) have dipped in and out of the country, often in the north from the Turkish border, but they are loathe to speak publicly about their experiences for
For The Lancet News podcast see http://www.thelancet.com/ lancet-news-audio-2012
For the Save the Children report see http://www.savethechildren. org.uk/sites/default/files/ images/untold_atrocities.pdf
Mohammad Hannon/AP/Press Association Images
Syrians are facing a second winter of war accompanied by shortages of medicine and rising food prices as global powers bicker about how to end a conflict causing a humanitarian crisis to worsen by the day, say aid agencies. Rebels control large areas of the north of the country and despite being poorly armed compared with forces controlled by President Bashar Assad, they show no sign of giving up their struggle that started during the wave of Arab Spring protests early last year. Syrian activists put the death toll at more than 30 000 while the Office of the UN High Commissioner for Refugees (UNHCR) expects a wave of Syrians fleeing to neighbouring countries to total more than 700 000 by the end of this year. As of early October, the number of Syrians registered or awaiting registration in Jordan, Lebanon, Turkey, and Iraq had passed 300 000, triple the level of just 3 months ago, said UNHCR. The actual number of refugees including those staying with family and friends was likely to be far higher while within Syria itself, an estimated 1·2 million people are internally displaced and another 2·5 million people are in need of humanitarian assistance. “From a humanitarian point of view, the weight of refugees is considerable but it’s hard to get real figures”, said Antoine Foucher, head of mission in Jordan for Médecins Sans Frontières (MSF), which runs a free hospital in Amman originally set up to treat Iraqis with injuries from bomb blasts and bullets but has seen an influx of Syrians needing medical care this year. “We may yet have another wave of Syrians as winter sets in, so we’re constantly on edge”, he said. The winter warning was echoed by UNHCR, which has appealed for US$487·9 million for its Syria
The Za’atri refugee camp in Jordan opened 2 months ago and is home to 30 000 Syrian refugees
1373
World Report
fear of jeopardising the safety of Syrian colleagues. Aid agencies have urged Assad to let them operate freely and effectively. MSF, which has donated tonnes of supplies including surgical and first aid kits to the SARC for use in field hospitals and clinics, was forced to suspend its work with migrants and refugees in the capital Damascus last year and it works mostly in neighbouring countries. Syrian doctors were treating many injured patients in clandestine facilities where hygiene and sterilisation were rudimentary and anaesthesia in short supply, said MSF. Syria’s Ministry of Defence, which controls the central blood bank, was withholding supplies from what they deem “terrorist” forces. MSF established a surgical trauma hospital in collaboration with the Union of Syrian Medical Relief Organisations that by the end of September had treated more than 1100 patients and done more than 260 surgical interventions. “However, the amount of medical assistance provided by MSF today is insufficient, given the level of needs throughout the country”, the organisation said. “MSF reiterates its call for authorisation to work in more locations inside Syria.” Additionally, there are reports of doctors who treated patients in the underground network of clinics being arrested and tortured. “We try to support doctors inside Syria with supplies of non-food items and we have issued a ‘Call to Syria’,” said Pierre Salignon, executive director of the Paris-based organisation Médecins du Monde. The call aims to remind the world that each person has the right to medical care without prejudice. “Today, in Syria, medical care is being manipulated, and sometimes even used as a weapon”, it says. “Health professionals are murdered and tortured, hospitals are inaccessible to the wounded who fear reprisals, and there are constant barriers to receiving medical care in hospitals and in bombed and besieged areas.” 1374
Meanwhile, the Syrian Government laid the blame for the refugee crisis on neighbouring countries who wanted to get foreign aid. Walid al-Moallem, Syrian Foreign Minister, told the UN General Assembly in early October that outside nations were also fuelling the conflict by supplying the armed opposition. Syrian refugees face differing challenges depending on which of the four main countries they flee to: Jordan, Lebanon, Turkey, and Iraq. Since the Jordanian authorities opened a camp for Syrian refugees, Za’atri, 2 months ago, it has received more than 30 000 people and aid agencies were struggling to cope. “It’s a logistical nightmare and we’re forced to scramble because often head office and people in the field don’t know what they’re doing”, said one aid worker who did not want to be identified. “Hopefully, we’ll be more organised in the coming weeks.” Residents in the camp only make up about 35% of the total refugees who have fled to Jordan, with the other 65% residing in urban areas, said UNHCR. MSF would be undertaking a needs assessment of the refugees staying in towns in the coming weeks, said Foucher. “The camp gets all the media attention but what is not spoken about are those people living in the towns staying with family or friends who are running out of money,” he said. The British charity Save the Children has used the testimony of Syrian refugee children to document what it called “appalling” torture, imprisonment and abduction of children in Syria. One teenager described being given electric shocks and sharing a cell with decomposing bodies while another saw a 6-year-old die after being tortured and starved. In Lebanon, the UNHCR said there were more than 80 000 refugees while tens of thousands of others had entered the country and not yet returned. In July, the Lebanese Government announced it would stop funding refugee-related operations,
including the cost of secondary health care. “For political reasons, the government has delegated responsibility to NGOs and UN agencies rather than receive money from external sources and jeopardise its neutrality in the Syrian conflict”, said Fabio Forgione, MSF’s head of mission in Lebanon. “Lebanon is the only neighbouring country that has not green-lighted camps, so Syrians are hosted by the Lebanese population. It’s a very small country so it’s more affected by the sharp increase in refugees.” On Oct 15, Turkey announced the number of Syrian refugees in its camps had risen above 100 000, a level it called its “psychological limit”. However, some 60 000 more people could be staying outside the 13 camps along the 550-mile border with Syria. Turkey is building more camps and said it could only admit more refugees when it has room. Some Syrian families wait with smugglers in fields and rush across when there are gaps between the Turkish border patrols. More than 33 000 refugees are in Iraq, many of them Syrian Kurds who have fled to the autonomous Iraqi Kurdish region in the north. The UNHCR estimated there could be 60 000 in total by the end of the year. The UK, which has announced support for Syrian refugees of some £30·5 million, has criticised the UN for failing to protect families in Syria. Recalling a visit to the Jordanian– Syrian border in July, William Hague, Foreign Secretary, said on Oct 7: “As of today, it is a serious failure of the United Nations Security Council that we cannot resolve the crisis that has caused these families to flee.” With no end in sight, aid agencies are left to pick up the pieces. “The Syrian conflict is likely to last for much longer, so there’s a clear need to have the gaps identified for the longerterm”, said MSF’s Forgione.
Sharmila Devi www.thelancet.com Vol 380 October 20, 2012
Syria’s refugees face a bleak winter Hundreds of thousands of war refugees from Syria are living in camps in neighbouring countries and face a difficult winter as temperatures drop across the region. Sharmila Devi reports.
www.thelancet.com Vol 380 October 20, 2012
Regional Response Plan to support up to 710 000 refugees in neighbouring countries by the end of this year. “Compounding the urgency is the upcoming onset of winter temperatures across the region in less than 10 weeks from now”, Adrian Edwards, the agency’s spokesman, told a press conference in Geneva on Oct 2.
“‘...it is a serious failure of the United Nations Security Council that we cannot resolve the crisis that has caused these families to flee.’” “We are in a race against time. In Jordan, for example, where thousands are living in tents, the average low temperature between mid-November and mid-March is 2°C. A winterisation plan is being developed but it too requires support and funding.” The refusal of Assad to let aid agencies operate within Syria itself combined with the highly bloody conflict that has killed several aid workers and journalists means that accurate assessment of the
humanitarian need, and death toll, are hard to come by. A team from WHO that visited Homs province with 2·2 million people in early September found a humanitarian situation that was “grave and continues to deteriorate” with one in four residents needing aid. The largest hospital in Homs with 350 beds had been completely destroyed. Workers from only two major organisations are able to cross Syria’s lines of conflict to operate officially with some effectiveness— the International Committee of the Red Cross (ICRC) and its partner, the Syrian Arab Red Crescent (SARC). Both groups’ position of neutrality is treated with mistrust by rebel and government forces and at least five SARC workers have been killed. Abdulrazak Jbeiro, SARC’s vicepresident, was shot dead in January. Unofficially, western doctors and aid workers from smaller nongovernmental organisations (NGOs) have dipped in and out of the country, often in the north from the Turkish border, but they are loathe to speak publicly about their experiences for
For The Lancet News podcast see http://www.thelancet.com/ lancet-news-audio-2012
For the Save the Children report see http://www.savethechildren. org.uk/sites/default/files/ images/untold_atrocities.pdf
Mohammad Hannon/AP/Press Association Images
Syrians are facing a second winter of war accompanied by shortages of medicine and rising food prices as global powers bicker about how to end a conflict causing a humanitarian crisis to worsen by the day, say aid agencies. Rebels control large areas of the north of the country and despite being poorly armed compared with forces controlled by President Bashar Assad, they show no sign of giving up their struggle that started during the wave of Arab Spring protests early last year. Syrian activists put the death toll at more than 30 000 while the Office of the UN High Commissioner for Refugees (UNHCR) expects a wave of Syrians fleeing to neighbouring countries to total more than 700 000 by the end of this year. As of early October, the number of Syrians registered or awaiting registration in Jordan, Lebanon, Turkey, and Iraq had passed 300 000, triple the level of just 3 months ago, said UNHCR. The actual number of refugees including those staying with family and friends was likely to be far higher while within Syria itself, an estimated 1·2 million people are internally displaced and another 2·5 million people are in need of humanitarian assistance. “From a humanitarian point of view, the weight of refugees is considerable but it’s hard to get real figures”, said Antoine Foucher, head of mission in Jordan for Médecins Sans Frontières (MSF), which runs a free hospital in Amman originally set up to treat Iraqis with injuries from bomb blasts and bullets but has seen an influx of Syrians needing medical care this year. “We may yet have another wave of Syrians as winter sets in, so we’re constantly on edge”, he said. The winter warning was echoed by UNHCR, which has appealed for US$487·9 million for its Syria
The Za’atri refugee camp in Jordan opened 2 months ago and is home to 30 000 Syrian refugees
1373
World Report
fear of jeopardising the safety of Syrian colleagues. Aid agencies have urged Assad to let them operate freely and effectively. MSF, which has donated tonnes of supplies including surgical and first aid kits to the SARC for use in field hospitals and clinics, was forced to suspend its work with migrants and refugees in the capital Damascus last year and it works mostly in neighbouring countries. Syrian doctors were treating many injured patients in clandestine facilities where hygiene and sterilisation were rudimentary and anaesthesia in short supply, said MSF. Syria’s Ministry of Defence, which controls the central blood bank, was withholding supplies from what they deem “terrorist” forces. MSF established a surgical trauma hospital in collaboration with the Union of Syrian Medical Relief Organisations that by the end of September had treated more than 1100 patients and done more than 260 surgical interventions. “However, the amount of medical assistance provided by MSF today is insufficient, given the level of needs throughout the country”, the organisation said. “MSF reiterates its call for authorisation to work in more locations inside Syria.” Additionally, there are reports of doctors who treated patients in the underground network of clinics being arrested and tortured. “We try to support doctors inside Syria with supplies of non-food items and we have issued a ‘Call to Syria’,” said Pierre Salignon, executive director of the Paris-based organisation Médecins du Monde. The call aims to remind the world that each person has the right to medical care without prejudice. “Today, in Syria, medical care is being manipulated, and sometimes even used as a weapon”, it says. “Health professionals are murdered and tortured, hospitals are inaccessible to the wounded who fear reprisals, and there are constant barriers to receiving medical care in hospitals and in bombed and besieged areas.” 1374
Meanwhile, the Syrian Government laid the blame for the refugee crisis on neighbouring countries who wanted to get foreign aid. Walid al-Moallem, Syrian Foreign Minister, told the UN General Assembly in early October that outside nations were also fuelling the conflict by supplying the armed opposition. Syrian refugees face differing challenges depending on which of the four main countries they flee to: Jordan, Lebanon, Turkey, and Iraq. Since the Jordanian authorities opened a camp for Syrian refugees, Za’atri, 2 months ago, it has received more than 30 000 people and aid agencies were struggling to cope. “It’s a logistical nightmare and we’re forced to scramble because often head office and people in the field don’t know what they’re doing”, said one aid worker who did not want to be identified. “Hopefully, we’ll be more organised in the coming weeks.” Residents in the camp only make up about 35% of the total refugees who have fled to Jordan, with the other 65% residing in urban areas, said UNHCR. MSF would be undertaking a needs assessment of the refugees staying in towns in the coming weeks, said Foucher. “The camp gets all the media attention but what is not spoken about are those people living in the towns staying with family or friends who are running out of money,” he said. The British charity Save the Children has used the testimony of Syrian refugee children to document what it called “appalling” torture, imprisonment and abduction of children in Syria. One teenager described being given electric shocks and sharing a cell with decomposing bodies while another saw a 6-year-old die after being tortured and starved. In Lebanon, the UNHCR said there were more than 80 000 refugees while tens of thousands of others had entered the country and not yet returned. In July, the Lebanese Government announced it would stop funding refugee-related operations,
including the cost of secondary health care. “For political reasons, the government has delegated responsibility to NGOs and UN agencies rather than receive money from external sources and jeopardise its neutrality in the Syrian conflict”, said Fabio Forgione, MSF’s head of mission in Lebanon. “Lebanon is the only neighbouring country that has not green-lighted camps, so Syrians are hosted by the Lebanese population. It’s a very small country so it’s more affected by the sharp increase in refugees.” On Oct 15, Turkey announced the number of Syrian refugees in its camps had risen above 100 000, a level it called its “psychological limit”. However, some 60 000 more people could be staying outside the 13 camps along the 550-mile border with Syria. Turkey is building more camps and said it could only admit more refugees when it has room. Some Syrian families wait with smugglers in fields and rush across when there are gaps between the Turkish border patrols. More than 33 000 refugees are in Iraq, many of them Syrian Kurds who have fled to the autonomous Iraqi Kurdish region in the north. The UNHCR estimated there could be 60 000 in total by the end of the year. The UK, which has announced support for Syrian refugees of some £30·5 million, has criticised the UN for failing to protect families in Syria. Recalling a visit to the Jordanian– Syrian border in July, William Hague, Foreign Secretary, said on Oct 7: “As of today, it is a serious failure of the United Nations Security Council that we cannot resolve the crisis that has caused these families to flee.” With no end in sight, aid agencies are left to pick up the pieces. “The Syrian conflict is likely to last for much longer, so there’s a clear need to have the gaps identified for the longerterm”, said MSF’s Forgione.
Sharmila Devi www.thelancet.com Vol 380 October 20, 2012