Syria is a highly urbanised country, and the conflict there has had a particularly devastating impact on its cities and towns. Homs, Aleppo, Damascus and many smaller towns have served as battlegrounds for government and rebel offensives, with tragic humanitarian consequences for their inhabitants. The battles for these cities have caused the breakdown of entire urban systems, destroying homes and public services and distorting urban markets and economies. Urban demographics have changed significantly as millions of Syrians have abandoned their homes. People displaced from one city to another or from rural areas to urban environments are forced into close proximity; to take just one example, one neighbourhood in Homs, Al Waer, has seen a four-fold increase in population since the conflict began, to 450,000 people, an estimated 80% of whom are internally displaced.+WFP Syria Crisis Response, Situation Update, 923 August 2013. This influx is exacerbating social and communal tensions and increasing the pressure on damaged or unmaintained water, sewage and energy services in urban areas. Although impossible to assess in detail, as a result of the conflict humanitarian needs in urban areas are clearly significant, but insecurity, access and logistical constraints and government and opposition obstruction have made it extremely difficult for aid agencies to respond at scale.
The challenges of urban programming
Insecurity and danger are the defining characteristics of operating in Syria in general, and in Syrian cities in particular. Part of the challenge confronting agencies stems from the nature of urban warfare itself. Conflict in urban areas typically involves the use of heavy artillery, snipers and small mobile groups familiar with the terrain. Fighting takes place in densely populated neighbourhoods rather than on an open battlefield, and heavy shelling is combined with street-to-street or even apartment-toapartment search and kill operations. People are forced to take refuge in cellars, and are often afraid to go out in search of water and food rightly so in Syria, given reports of government attacks on bread queues outside bakeries in Aleppo in 2012.+See http://www.hrw.org/news/2012/08/30/syria-government-attacking-bread-lines. Particularly in rebel-held urban areas, basic services have essentially ground to a halt as the conflict has undermined the authority (and revenues) of municipalities, destroyed infrastructure and killed or displaced skilled staff. Fighting has divided cities into areas controlled by the central state and those controlled by a constellation of different militias with neither the technical personnel nor the capacity to provide services in the areas they control.
Given this chaos and insecurity, humanitarian action in urban areas in Syria is extremely difficult and dangerous, and very few international agencies are operational on the ground. The bulk of assistance is being provided by Syrians themselves, either neighbour to neighbour or through the Syrian Arab Red Crescent (SARC) and other local charitable and religious organisations. Security conditions make classic urban search and rescue operations impossible, and it is very difficult to extract people from the rubble of bombed buildings, retrieve the wounded from the streets and set up triage and evacuation mechanisms. The high prevalence of unexploded ordnance (a result of extensive bombing of urban areas), combined with ambushes, sniper attacks and systematic booby-trapping, puts urban dwellers and humanitarian and rescue teams at huge risk.
Treating the high concentrations of wounded after each military operation requires surgical teams with specialised skills, as well as sufficient supplies of blood, anaesthetics, drugs and disinfectant. Electricity and water must be available to maintain cold chains and minimum hygiene standards, but supplies are erratic and power cuts common. NGOs providing medical and surgical assistance in urban areas in Syria report taking every opportunity to replenish medical and surgical supplies to maintain a minimal capacity to treat casualties, but blood supplies are either very limited or not available at all. Through the SARC and the handful of NGOs working in urban areas, the International Committee of the Red Cross (ICRC) has tried to provide enough drugs and equipment to support basic health and surgical care, as well as delivering food, water and household kits, renovating or upgrading public facilities and providing water treatment supplies, spare parts, pumps and generators. Médecins Sans Frontières (MSF) and Médecins du Monde (MDM) are working through small-scale structures which are either very mobile or very discreet, and with networks of Syrian practitioners (who are frequently assaulted by government security forces). These NGOs have to negotiate the movement of medical teams and supplies across borders and lines, which involves passing through checkpoints controlled by a range of different armed groups. The ICRC has also tried to negotiate with the Syrian government and insurgent groups for permission for the SARC to evacuate civilians especially the wounded, women and children from combat zones in Homs and Aleppo, but with limited success as many insurgent groups consider the SARC to be a tool of the government, and neither side is willing to cede control over territory and people to allow evacuations to take place.
For displaced families staying in schools and public buildings, and especially for those forced to stay outside in summer temperatures, water is the number one priority. The government has primary responsibility for ensuring access to water, with the private sector playing a supporting role, mostly in low-density residential areas. Many of these, such as peri-urban Damascus, now host large numbers of internally displaced people. UNICEF and a number of NGOs are trying to repair water systems and resupply some of the water treatment plants still operating with purification chemicals, and some are even trucking water. For example, in Damascus, where in summer temperatures can exceed 40°C, NGOs like Première Urgence-Aide Médicale Internationale (PU) and Secours Islamique France (SIF) have organised water trucking, with PU distributing 55,000 litres of water to 5,000 people every day. SIF trucks water to other parts of Damascus and is also implementing small-scale sanitation schemes.
In winter, warm clothes and blankets have been distributed to displaced people in makeshift shelters. However, as with medical assistance bringing large quantities of these much-needed goods into urban war zones in Syria has proved very difficult. In the absence of adequate assistance, survival strategies include staying with host families, renting or occupying empty buildings+UN-HABITAT, Urban Snapshots 1, June 2013, http://www.unhabitat.org/downloads/docs/UrbanSnapshots1.pdf. and public facilities, and even organising communal shelters. A UNHABITAT survey reports+UN-HABITAT, Urban Snapshots 2, June 2013, http://www.unhabitat.org/downloads/docs/UrbanSnapshots2.pdf. that, in the cities that it was able to access, 174,000 people were living in more than 800 collective shelters. These are highly mobile populations, moving from one location to another depending on the direction and spread of the fighting. Active fighting in urban areas means that IDP families are forced to move repeatedly, following the rhythm of military operations.
Responding to urban needs outside Syria
The conflict in Syria has triggered a huge outflow of refugees to neighbouring countries. What started as a trickle has become a flood, with almost 1.8 million refugees registered with UNHCR by the end of August 2013. UNHCR believes that the majority of refugees are living off-camp, in cities, towns and rural areas, not in the formal camps that have been the main focus of international attention. Many of these outof- camp refugees live in poor shelter, with precarious and uncertain access to basic services and livelihoods. They also face a range of protection threats, including domestic, sexual and gender-based violence, labour exploitation, including child labour, and recruitment by armed groups. According to an evaluation of the UNHCR response, Ensuring timely registration, outreach and access to services for such a vast and geographically dispersed refugee population has been particularly challenging.+Jeff Crisp et al., From Slow Boil to Breaking Point: A Real-time Evaluation of UNHCRs Response to the Syrian Refugee Emergency, UNHCR Policy Development and Evaluation Service (PDES), July 2013. In urban areas in Jordan, for example, over 120,000 Syrian refugees were receiving food assistance by the end of March 2013, and more than 37,000 were receiving regular financial assistance, but even so unmet needs remained considerable, with three-quarters of the off-camp population demonstrating a significant degree of vulnerability.+UN, Syria: Regional Response Plan, January to December 2013. Likewise, just one-third of the estimated 600,000 urban refugees in Jordan were expected to receive basic non-food items by the end of 2013, compared to 100% coverage in camps.+Ibid. As well as putting pressure on basic services, infrastructures and economies, the refugee influx into Syrias neighbours is having a destabilising effect on their social fabric, notably in Lebanon, where sectarian tensions have increased since the conflict began, prompting clashes and bomb attacks in Beirut and the northern city of Tripoli. Access for humanitarian actors in these highly sensitive areas is becoming increasingly difficult.
To effectively support conflict-affected people in Syrian cities means working in very complex, volatile, unpredictable and dangerous environments. Humanitarian agencies have to be agile, flexible, opportunistic and risk-taking. Classic operational modalities imposed by donor procedures or good practice guidelines, which require lengthy planning, standardised operational modalities and sophisticated accountability mechanisms, are of limited use in these highly volatile and complex urban contexts.+See UN-HABITAT, Meeting Humanitarian Challenges in Urban Areas: Review of Urban Humanitarian Challenges in Port-au-Prince, Manila, Nairobi, Eldoret, 2011; François Grünewald et al., Humanitarian Aid in Urban Settings: Current Practice, Future Challenge, Groupe URD, December 2011; A. B. Kyazze et al., Learning From the City: British Red Cross Urban Learning Project Scoping Study, 2012. Effective humanitarian response in conflict-affected urban areas in Syria requires a capacity to engage in strategic dialogue, firmly rooted in humanitarian principles, with a wide range of actors, including the government, political/religious factions and associated armed militias and what remains of municipal institutions. Such negotiations demand language and negotiation skills, a thorough understanding of both the urban and underlying socio-political context, the networks to facilitate the necessary connections and a willingness to accept relatively high levels of risk.
François Grünewald is Executive and Scientific Director of Groupe URD