Syria: Flash Update -#2 - Madaya/Bqine - 17 January 2016

Situation Report
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  • On 11 and 14 January, two UN/ICRC/SARC convoys simultaneously delivered humanitarian assistance to Madaya/Bqine and Foah/Kafraya for 40,000 and 20,000 people under siege respectively.

  • During these missions, UN/SARC/ICRC teams confirmed cases of severe malnutrition in Madaya and related deaths.

  • 5 people reportedly died of starvation since the 11 January convoy entered Madaya/Bqine.

  • Several cases require urgent specialised care outside of Madaya. While 10 people were evacuated in the last days, approvals for the evacuation of others remains pending.

  • More than 400 cases have been assessed. Mobile clinics and medical teams have been allowed in to treat those who can be treated inside.

Situation Overview
The Government of Syria and allied forces have surrounded the area of Madaya and Bqine since July 2015. Since September 2015, these forces have imposed increasingly strict restrictions on humanitarian access, commercial traffic on freedom of movement for the civilians inside the enclave, under the control of several non-state armed groups since late 2012. Despite the existence of a local agreement since January 2015, the access restrictions imposed on Madaya have translated into a severe deterioration of the living conditions for the estimated 42,000 people trapped in Madaya and Bqine, of which approximately 17,600 are IDPs from the neighbouring towns of Az-Zabdani, Bloudan and surrounding villages.

On 18 October, the UN/ICRC/SARC team delivered a shipment of food, nutrition and health items to Madaya. On this occasion, the team did not observe any evidence of malnutrition or starvation. During the first convoy in January, the UN/SARC/ICRC teams observed a significant deterioration in the humanitarian situation in Madaya since access was last permitted on 18 October 2015 linked to an acute scarcity of basic foodstuff in the town.

Humanitarian Situation
Community members reported that, in weeks preceding the initial humanitarian convoy, many essential food items were either unavailable or unaffordable because of inflated prices, including reportedly:

Wheat flour: Unavailable
1 kg of sugar: 80,000 SP (205USD)
1 kg of wheat: 80,000 SP (205 USD)
1 kg of bulgur: 75,000 SP (192USD)
1 kg of bean: 100,000 SP (256 USD)
1 kg of humus: 75,000 SP (192USD)
1 kg of rice: 80,000 SP (205USD)
900 grams of baby milk: 110,000 SP (282USD)
Biscuits (per piece): 6,000 SP (15USD)

On 11 January, critical cases of malnutrition were observed and cases of people suffering from moderate or severe acute malnutrition were confirmed. Despite the entry of medical materials and mobile clinics, following the identification of severe needs in the last days that are allowing the treatment of many people inside Madaya, assessments made to date indicate that dozens of individuals need immediate specialised care outside of Madaya if they are to survive. Further assessments may identify more of such cases. Since 11 January, despite the assistance provided, five people reportedly died of severe and acute malnutrition in Madaya.

The joint UN, ICRC and SARC teams visited clinics and met with the few remaining medical teams in Madaya/Bqine. Many doctors reported a general lack of medical supplies. Many of the materials on hand were expired, inappropriate and/or insufficient for the basic needs in the community. Several community leaders confirmed that children in the area had not been vaccinated in several months despite the existence of vaccines. UNICEF, WHO and SARC are planning a vaccination campaign in the coming days, as well as upgrading the capacity and readiness of hospitals in in Az-Zabdani (Al Jourjanieh Hospital – 5 km from Madaya) in addition to referral hospitals in Damascus to receive any critical cases.

Schools are currently inactive in Madaya/Bqine. Government teachers are reportedly unable to exit the town to receive their salaries whilst many children mentioned not having enough energy to study or play, and that chairs and desks have been used as firewood to heat up houses.

Many children in Madaya have reportedly been separated from their primary caregivers. Although many families are located in the surrounding areas, fighting and strict restrictions on the movement of children often prevent families from reuniting. Several children presented symptoms of trauma. Some community members note the growing prevalence of behavioural and sleep disorders among children. Youngsters, well under 18 years of age, were seen carrying weapons in Madaya, adding to concerns on child recruitment. The local community report that women are routinely harassed when approaching military checkpoints outside Madaya/Bqine, and the joint team that entered Madaya received several unconfirmed reports of gender based violence.

Individuals in Madaya were also concerned about their inability to register births, deaths and marriages as there is no working Civil Registry Office in the town. This may lead, inter alia, to statelessness. Persons who need issuance or renewal of civil and identity documents or have lost them will face additional problems to access safe areas.

The team heard reports of landmines preventing attempts to exit from Madaya/Bqine through informal routes. Community members reported that landmines, many of which were reportedly laid since late September 2015, surround the two towns. Many civilians, however, continue to risk their lives in attempting to leave, often to search for food on the outskirts. A number of community members have had limps amputated due to landmine explosions.

In addition, forced displacement reportedly continues in Madaya/Bqine and the surrounding areas. Approximately 145 families from Az-Zabdani were forced to move to Madaya/Bqine during October 2015 - January 2016 by Government forces. As recently as 9 January, 20 families were forced from nearby Bloudan to Madaya/Bqine.

Around 100 individuals were reportedly allowed to exit Madaya/Bqine since October 2015 by Government and allied forces. Approximately 50 individuals left on 11 January 2016, when hundreds of civilians were gathered at the entrance of Madaya.

UN Office for the Coordination of Humanitarian Affairs
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