North-West Syria: Situation Report (18 October 2024) [EN/AR]

HIGHLIGHTS

• Hostilities have escalated across north-west Syria since 14 Oct. At least 12 civilians have been killed and over 40 others injured in 3 days and estimated 1,951 families displaced.
• Since the start of 2024, at least 46 civilians, including 12 children, have been killed due to hostilities and 180 others, including 67 children, injured, as of 18 October.
• As of 16 October, over 4,000 people have fled the conflict in Lebanon to north-west Syria, according to UNHCR. Over 80 per cent of them are women and children.
• The response is severely underfunded. With less than three months until the new year, the Humanitarian Response Plan for Syria is less than a third funded.
• The winter response plan, which seeks $111.6 million to help 1.4 million people cope with rain, snow, and freezing temperatures, is only a little over 10 percent funded.

KEY FIGURES

• 5.1M Population in north-west Syria
• 3.6M Food-insecure people
• 2M IDPs living in camps
• 4.2M People in need in north-west Syria
• 3.5M Internally displaced persons (IDPs)
• 1M Out-of-school children

Uptick in hostilities and clashes in north-west Syria

First series of airstrikes in three months

Hostilities and violence have escalated across north-west Syria since 14 October, with the first series of airstrikes reported in three months. At least 122 attacks have been reported in the first three days, 115 of which struck Idleb and western Aleppo including residential areas, local shops and farmland.

Since the start of the escalation on 14 October, at least 12 civilians, including three children aged one, three and eight, have been killed by hostilities across north-west Syria. At least 43 others have been injured, according to local health authorities as of 16 October.

On 17 October, the Deputy Regional Humanitarian Coordinator issued a statement calling for all parties of the conflict to “take all necessary measures to ensure that civilians and civilian infrastructure are protected” and ensure the “safety of humanitarian workers.”

Since the start of 2024, at least 46 civilians, including 12 children, have been killed due to hostilities and 180 others, including 67 children and 21 women, have been injured, as verified by local health authorities as of 18 October.

Camps, power station, schools among the affected

On 14 October, three airstrikes struck close to a tent settlement in Ma'arrat Misrin, a few kilometers away from where a UN delegation, led by Deputy Regional Humanitarian Coordinator David Carden, was overseeing a World Food Programme (WFP) distribution to displaced families.

On 15 October, two airstrikes hit a power station west of Idleb city, causing electrical outage in two water stations that serve as the main water source for 30,000 people in 17 surrounding villages. Water pumping has since halted due to a technical failure in one of the generators, and humanitarian partners are working to bring in alternative diesel generators. Two power station employees injured in the airstrikes have been treated at a hospital supported by the Syria Cross-border Humanitarian Fund (SCHF).

During the same period, artillery shelling continued to impact northern Aleppo in addition to clashes that erupted on 16 October, affecting schools – including the injury of four students and their teacher in Jarablus - and numerous displacement camps. Several families living in camps near the fighting zones have reportedly fled to schools, agricultural lands and olive presses.

The fighting led to the temporary suspension of schools in Azaz and humanitarian activities, including services in at least ten health facilities on 16 October. The IDP Task Force reported that an estimate of 1,951 families have been temporarily displaced from 14 to 17 October.

A temporary humanitarian ceasefire was agreed the afternoon of 17 October to allow for the evacuation of civilians, pathways for ambulances and the treatment of those injured. By 18 October, many of the displaced families have reportedly started to return.

Displacement and hostilities push repsonse to limits

The recent escalation of hostilities in north-west Syria emerged against a backdrop of strained resources and increasing displacement.

Over 4,000 people have fled the conflict in Lebanon since the escalation of hostilities started on 23 September, and arrived in north-west Syria, according to UNHCR as of 16 October. This is on top of the 3.5 million people who are already internally displaced in north-west Syria, 2 millions of whom live in camps and informal settlements.

With less than three months left until the new year, the humanitarian response remains severely underfunded. As of 18 October, the 2024 Humanitarian Response Plan for Syria has received only over a quarter of the funding needed. Consequently, humanitarian activities and facilities have continued to be suspended in north-west Syria on a weekly basis.

The Health Cluster reported that 60 health facilities had run out of funds as of the end of September. If this funding trajectory continues, 50 per cent of all functional health facilities in north-west Syria will fully or partially cease operations by December 2024.

Each month this year, the UN and its partners are reaching 1 million people in north-west Syria on average with assistance – but this is a significant drop from the 2.5 million people reached monthly in 2023.

In light of the recent hostilities that started on 14 October, the UN and its partners are continuing to closely monitor the situation and track displacement.

In case of mass displacement, there are aid pre-positioned aid inside north-west Syria ready to be released, including 10,000 ready-to-eat rations (RTEs), as well as stocks of tents and non-food items sufficient to meet the needs of around 5,000 households.

However, humanitarian partners flagged that the amount is insufficient in the case of prolonged displacement. The Food Security and Livelihoods (FSL) Cluster reported that an additional 50,000 RTEs are needed in Idleb, and an additional 30,000 in northern Aleppo at minimum, to respond to such an event. The Shelter and Non-Food Items (SNFI) Cluster noted that temporary shelter solutions will also be needed in that scenario.

1 in 5 suffers from mental conditions in north-west Syria

Suicide on the rise amid aid suspension

Years of conflict, repeated displacement and economic hardship have taken a toll on the mental well-being of the people in Syria. In north-west Syria, over 1 million people, or 20 per cent of the population, suffer from mental health conditions, including 230,000 who suffer from severe disorders. This is far higher than the global average (1 out of 8 people) estimated by the World Health Organization (WHO). Prolonged exposure to conflict has left individuals facing chronic stress, grief from the loss of loved ones, and the trauma of violence and displacement.

The groups most vulnerable to suicide risks in north-west Syria are unemployed individuals, displaced women, young adults between the ages of 18 to 38 - a significant portion being female, residents of crowded homes, and married women with children. This is according to recent research conducted by GIZ, the Mental Health and Psychosocial Support Technical Working Group (MHPSS TWG), and Suicide Task Force.

Nearly 300 suicide cases and attempts have been reported across Idleb and northern Aleppo in the first half of 2024, per the data provided by the MHPSS TWG, averaging at least one suicide attempt every day. Last year, the number of cases and attempts was over 260. According to data specifically collected by hospitals in Idleb and northern Aleppo, 38 suicide cases have been recorded from January to 4 September 2024 - 64 per cent were women and girls who ended their lives. Given the sensitivity and stigmatization of the issue, many cases are likely underreported.

In the face of these challenges, the mental health capacity in north-west Syria is severely overstretched, with only three psychiatric hospitals (Azaz, Sarmada and Al-Bab), 450 psychosocial workers, 78 trained doctors, 50 psychologists and two psychiatrists available to serve a population of over 5 million people. There are also no specialized child psychiatrists.

The situation has been further exacerbated by severe funding shortages in 2024, which led to a significant drop in humanitarian assistance including health services. By the end of September, 60 health facilities, including primary health centers, maternal and specialized hospitals, had run out of funds. Without increased funding, 230 health facilities – or half of all functional health facilities in north-west Syria – will have to suspend operations by the end of December, depriving over 1 million people of access to essential, life-saving, and emergency healthcare.

The case of the Azaz Mental Health Hospital

On 25 September, UN Deputy Regional Humanitarian Coordinator David Carden led an interagency mission with WHO and OCHA to the only mental health hospital in northern Aleppo, a governorate of 1.7 million people. The Azaz Mental Health Hospital, supported by Physicians Across Continents (PAC) and WHO, provides comprehensive mental health services for epilepsy, depression, psychotic disorders, and other conditions, including care for chronic and severe mental health patients.

Last year, the first Substance Use Disorders Unit in north-west Syria was established in the Azaz Mental Health Hospital. The unit, which also faces the risk of closure, has since helped over 150 patients complete six months of withdrawal and community re-engagement through case management services.

During the visit, the UN delegation met with health workers and staff operating inside the facility, including cooks who were preparing meals for patients, and the outpatient clinic. The outpatient clinic, which has over 5,000 registered patients, is currently operating partially with PAC’s resources, having lost all financial support by the end of August. Many staff are working for free, with no clarity about what the coming months will bring. Sustained health funding is needed to keep health services running without interruptions.

Integrating mental health at the forefront of response

Unlike in many other contexts around the world, healthcare services in north-west Syria are almost completely dependent on humanitarian funding.

The equivalence to a public health system does not exist and much of the operations of health facilities, including staff salaries, are backed by humanitarian organizations. After 13 years of conflict, the health workforce in north-west Syria is understaffed and fragmented due to insecurity, brain drain and unregulated labor conditions, among other reasons. There are less than 11 health workers per 10,000 population – far lower than the standard of 22 health workers per 10,000 people. Some areas are facing more critical shortages of doctors, nurses and midwives than others.

In times of funding shortages, mental health is one of the first services to be deprioritized. To address this issue, the MHPSS Technical Working Group, comprised of over 60 organizations and led by WHO, is working to integrate mental health and psychosocial support into the healthcare system and other sector programmes in north-west Syria. Doctors, nurses, and psychosocial workers are being trained in MHPSS interventions, with 82 primary health centers now integrating these services into their operations.

The MHPSS Technical Working Group is also leading the Suicide Task Force which adapts and translates international guidelines, develops training materials and key messages, coordinates suicide prevention activities, collects suicide data and oversees assessments. The Group emphasizes the importance of a comprehensive intervention approach, as suicide is not only a mental health issue but also a cross-cutting challenge that affects all Clusters, with significant implications for community resilience and recovery. The Group is also leading the substance use thematic group, as part of a global network, working to adapt materials and pilot the training for humanitarians on substance use detection and referral. At present, 100 aid workers from different fields are targeted for this training.

In 2024, WHO, in partnership with an NGO, is running a programme that addresses suicide prevention largely through education and awareness-raising efforts. This includes a four-day training for 500 medical staff at primary and secondary health facilities, as well as workshops on suicide prevention targeting media influencers, community leaders, school managers, and parents.

$38.1 million allocated by Syria Cross-border Humanitarian Fund (SCHF)

The Syria Cross-border Humanitarian Fund (SCHF) has allocated $38.1 million in its its first Standard Allocation of the year to help 1.7 million people in north-west Syria. 68 per cent of the fund went to national NGOs, either directly or through sub-granting. Since the start of 2024 and as of mid-October, the SCHF received over $55 million in paid contributions with the support of 13 donors.

View dashboard of SCHF's first Standard Allocation

Cross-border aid delivery and missions

• As of 16 October, the UN has completed 633 cross-border missions to north-west Syria since the first interagency visit to Idleb on February 14, 2023 – 314 of these missions were conducted in 2024.
• Since the beginning of 2024 and as of 17 October, a total of 483 trucks carrying humanitarian aid by seven UN agencies crossed the Bab Al-Hawa and Bab Al-Salam border-crossings.
• To mark World Mental Health Day on 10 October, UNICEF and child protection partners organized "Lego Day" for children in displacement camps in Azaz. This initiative is part of a “Play and Learn” project under the partnership of UNICEF and the Lego Foundation which aims to promote physical, emotional, social and cognitive development in children.
• In anticipation of the winter season, the humanitarian community launcheda 2024-2025 Winterization Plan on 17 September. The plan targets 1.4 million people in need of urgent winter assistance. Key interventions include providing fuel, stoves, winter clothing kits, and winterization kits, including thermal blankets and carpets, to keep families warm amid freezing temperatures. Where markets are functional, cash and voucher assistance are critical, allowing families the flexibility to purchase what they need while stimulating local businesses.