International Blue Crescent (IBC) Emergency Appeal: North-West Syria (October 2024)

This study developed by IBC in October 2024, addresses the increasing healthcare needs and preventions in northwest Syria through a multisectoral approach. Given the identified needs, the study is being presented to possible Donors as an emergency appeal for immediate support. Deteriorating Humanitarian Conditions in Syria North-west.

After more than 12 years of conflict, humanitarian conditions in north-west Syria continue to deteriorate due to ongoing hostilities, a worsening economic crisis, and the aftermath of the devastating earthquakes in February 2023. Approximately 4,1 million people require critical lifesaving assistance, with around 2,7 million internally displaced persons (IDPs). Emergency sites established as a last resort still host 1,9 million IDPs, about 80% of whom are women and children particularly vulnerable to various risks, including gender-based violence (GBV).

The major earthquakes that struck southeast Türkiye and north Syria on February 6, 2023, resulted in thousands of casualties and widespread destruction of civilian buildings and infrastructure in both countries. The earthquakes affected at least 96 communities across 35 sub-districts in northwest Syria (NWS), with more than 10600 buildings partially or destroyed.
These earthquakes have compounded the long-standing humanitarian crisis in northwest Syria, where 2,7 million people were already displaced, and 4,1 million people were reliant on humanitarian assistance. Some 1,9 million IDPs live in 1459 IDP sites, 80% of whom are women and children particularly vulnerable to protection risks, including GBV.

In September 2023, a significant number of Lebanese citizens, along with Syrians, fled to northwestern Syria due to a surge in airstrikes and escalating violence in Lebanon. The airstrikes, primarily targeting areas in the north of Lebanon, particularly near the border with Syria, caused widespread fear and devastation. As a result, thousands of Lebanese families sought refuge in neighboring areas of northwestern Syria, including Aleppo and Idlib regions.

This migration is seen as a reversal of earlier patterns, where Syrians had fled to Lebanon during the Syrian civil war. Now, the violence and instability in Lebanon—coupled with increasing tensions and airstrikes in northern regions—have prompted many Lebanese citizens, especially those living in vulnerable border towns, to seek safety across the border into Syria.
Many of these refugees have been forced to live in overcrowded and temporary shelters, increasing pressure on already strained resources in Syria’s northwestern regions.

This shift in migration patterns reflects the broader instability in the region, with ongoing conflicts exacerbating the humanitarian crisis for both Lebanese and Syrian civilians. The influx has led to growing concerns over the capacity of humanitarian organizations and local communities to support the new arrivals, who are often in dire need of shelter, food, and medical assistance.

Although the form of migration has shifted due to recent developments, the regional conflicts and instabilities that caused the displacement continue to play a significant role; poor living conditions further threaten life and health, especially for children, older persons, and people with pre-existing vulnerabilities.

With 2,1 million people in need of shelter assistance and over 1.000.000 people living in tents and makeshift shelters (90% of which are more than one year old), environmental conditions pose a significant humanitarian challenge in north-west Syria. The majority of people reside in old tents in IDP sites that lack proper sewage, drainage, electricity, and water supply.

Among the camp population, 80% are women and children who have experienced multiple displacements over several years, facing safety, security, and protection risks due to the temporary and undignified nature of shelter and settlement conditions.

The high rates of gender-based violence, the impact of poor living conditions on children, and the effects of climate change exacerbate the situation, rendering traditional approaches to shelter less effective.

There are 1468 IDP sites in northwest Syria, but only 188 are planned. The remaining 1245 sites are unplanned and spontaneously settled by IDPs themselves. These sites lack essential services, proper site planning, waste disposal, sewage systems, and a reliable water supply, making them difficult to access.

Food security remains of particularly serious concern, with an estimated 9,3 million people requiring food assistance to cover their daily needs, including 6 million people facing acute food insecurity. While 58% of the people in IDP sites are children, access to education remains limited.

In the region, only 40% of hospitals and 45% of Primary Healthcare Centers are functional. The main needs include comprehensive primary and secondary healthcare, trauma, postoperative care, physical rehabilitation, life-saving obstetric and reproductive health, and Mental Health and Psychosocial Services (MHPSS).

Children and adolescents have experienced significant and distinct impacts due to the crisis.
The under-five mortality rate, neonatal mortality rate, and maternal mortality rate have all increased significantly since the crisis began. Children face additional diverse and deep-rooted protection issues, including family separations and losses, trauma, and the depletion of family assets and coping capacities. Separated children, refugees, and internally displaced or returning children are particularly vulnerable to gender-based violence and sexual exploitation; fear, anxiety, and grief also severely impact their mental health.

Since 2011, the categories of vulnerable people have expanded to include new demographics such as internally displaced persons, persons with disabilities, vulnerable boys and girls, unaccompanied and separated children, orphans, and women heading their households.

The availability, accessibility, and quality of basic services in Syria, as well as housing and other public infrastructure, have deteriorated significantly due to the crisis and the 2023 earthquakes. Widespread damage and destruction, combined with large-scale urban displacement and a sharp decline in public resources, have further reduced the capacity and effectiveness of service providers to ensure equitable, inclusive, and safe access to sustainable, quality basic services.

The crisis has created substantial challenges for the education sector, and widespread poverty and unemployment have forced many children to abandon their education to work and support their families. Overall, the education system, including the quality of education, has been severely affected.

The health system has suffered from the destruction and degradation of health infrastructure, the attrition of staff, and a lack of essential medicines. Women and girls are especially impacted by the lack of access to sexual and reproductive healthcare. Ten years of crisis have also resulted in a high demand for mental health and disability services across various age groups.

Water and sanitation systems have also been severely affected by the crisis and earthquake.
The destruction and damage to water networks, combined with the displacement and loss of qualified technical water and sanitation staff, has decreased communities' access to safe water.

In the given context, the IBC strategically and urgently plans to support and focus on increasing improved, inclusive, safe, and equitable access and coverage of essential basic services and infrastructure, specifically for the most vulnerable people in Syria northwest.

Respectively, the key programming priorities are as follows:

• Ensuring reliable and safe water sources is essential for preventing waterborne diseases and safeguarding the health of IDP communities in northwest Syria, thereby supporting their overall well-being and resilience in challenging conditions.
• Supporting inclusive and equitable access to safe domestic and drinking water and clean sanitation, including improved hygiene practices.
• Addressing the urgent physiotherapy (PTR) and mental health and psychosocial support (MHPSS) needs of IDPs in northwest Syria by providing comprehensive and accessible medical care to enhance the well-being of affected individuals by delivering targeted health interventions that address both physical rehabilitation and psychological trauma, ensuring that all participants have access to essential health services and support systems amidst the ongoing humanitarian crisis.
• Supporting and strengthening essential health services, especially in Orthopedics,
  PTR, and MHPSS at in and outpatient clinics, and regional hospitals.
• Supporting livelihood opportunities through conditional short-term Cash for Work (CfW) employment opportunities to improve the structure of IDP settlements, improvement of regional structure and environments.
• Educational response that includes the restoration of schools damaged by conflict and earthquakes, the construction of new educational facilities in high-density areas, and the provision of essential resources and support for teachers and students to ensure a conducive learning environment for IDPs and local host communities.
• Strengthening and scaling up crucial nutrition services across primary healthcare services to prevent malnutrition in early childhood and pregnancy and to promote the growth and development of children.
• Contributing to the rehabilitation of critical civilian infrastructure linked to the delivery of basic and WASH services/facilities and the emergency restoration of damaged housing to improve living conditions for all populations, with a focus on those most in need in urban and rural areas in hard-to-reach areas, to pave the way for the dignified, safe, and voluntary return of displaced populations, and to strengthen resilience and socioeconomic revitalization of host communities.
• Enhancing the safety and well-being of IDPs in northwest Syria through a comprehensive protection response that addresses and mitigates protection risks, including violence and exploitation, while ensuring the safeguarding of vulnerable populations.
• Ensuring that displaced communities in northwest Syria have reliable access to sufficient, nutritious, and culturally appropriate food to meet their basic needs, thereby improving overall food security and enhancing the health and well-being of affected populations.
• Preparing displaced communities in northwest Syria for the winter months by implementing comprehensive winterization strategies that protect individuals from severe cold and related health issues, ensuring their safety and well-being through a range of solution-oriented approaches.
• To provide safe and secure living conditions for displaced individuals by implementing measures that protect them from harsh weather conditions and other environmental risks by including the provision and distribution of essential winterization items to enhance the safety and resilience of displaced populations to ensure their living environments are adequately prepared to withstand severe weather conditions and mitigate associated health and safety risks.
• To enhance access to education and vocational training for displaced populations by implementing measures that support the continuation of formal and informal education. This will be achieved through the construction of new school buildings, expansion of existing educational facilities, and the establishment of vocational schools. The aim is to increase schooling opportunities for both children and adults, ensuring that displaced individuals can access quality education and skills development, thereby improving their long-term resilience and integration into host communities.