Syria Complex Emergency - Fact Sheet #2 FY18

Speeches Shim

December 08, 2017

Intensified SARG aerial and artillery attacks in Eastern Ghouta result in more than 200 civilian deaths

Health organizations stress urgent need for improved medical resources amid deteriorating humanitarian conditions

Explosive hazard contamination in Ar Raqqah causes multiple returnee casualties

Despite insecurity, interagency convoys reach conflict-affected populations

Since mid-November, Syrian Arab Republic Government (SARG) attacks have killed at least 200 civilians and exacerbated dire humanitarian conditions in the SARG-besieged Eastern Ghouta region of Rif Damascus Governorate, international media report. Relief agencies operating in the region have highlighted the urgent need for emergency medical evacuations, and report that Eastern Ghouta residents are resorting to extreme negative coping mechanisms, including skipping meals, eating expired food, begging, or consuming animal fodder and refuse, as a result of deteriorating food security conditions. Despite access and security challenges, three humanitarian convoys reached Eastern Ghouta—one of the four de-escalation zones established in August by the Government of the Islamic Republic of Iran, the Government of Turkey (GoT), and the Government of the Russian Federation—in October and November with emergency relief commodities and food assistance for approximately 68,300 conflict-affected people, or more than 17 percent of the region’s total estimated population.

Explosive hazard contamination in Ar Raqqah Governorate’s capital city of Ar Raqqah continues to pose significant risk to individuals voluntarily returning to the area, humanitarian organizations report. Médecins Sans Frontières staff working in hospitals located near Ar Raqqah report having treated more than 100 patients with blast injuries since fighting subsided in mid-October, and the UN has recorded at least 200 civilian casualties due to improvised explosive devices. According to the UN, an estimated 34,000 people have returned to areas near or in the city since Syrian Democratic Forces (SDF) recaptured Ar Raqqah from the Islamic State of Iraq and Syria on October 20.

Numbers At A Glance

13.1 million

People in Need of Humanitarian Assistance in Syria

6.1 million

IDPs in Syria

4 million

People Reached per Month by USG Assistance in Syria

5.4 million

Syrian Refugees in Neighboring Countries

3.4 million

Syrian Refugees in Turkey

1 million

Syrian Refugees in Lebanon


Syrian Refugees in Jordan


Syrian Refugees in Iraq


Palestinian Refugees in Syria

Humanitarian Funding

To Syria Humanitarian Response
FY 2012 - FY 2018

USAID/OFDA $1,448,918,764
USAID/FFP $2,297,390,024
State/PRM $3,736,575,196
TOTAL $7,482,883,984


In September, Needs and Population Monitoring—an initiative of the International Organization for Migration (IOM) and the UN Office for the Coordination of Humanitarian Affairs (OCHA)—conducted a comprehensive, countrywide assessment to identify internally displaced person (IDP) intentions to return to areas of origin, relocate, or remain within host communities. Assessment findings indicated that approximately 27 percent of surveyed households intended to return to areas of origin, nearly 18 percent of households planned to remain within host communities, nearly 5 percent of households intended to leave Syria, and approximately 4 percent of households planned to relocate to other locations in Syria by 2019. Nearly half of surveyed households—47 percent—were undecided regarding movement intentions. IDPSs reported security conditions in both areas of origin and areas of displacement as the main factor influencing future movements. In addition to security conditions, IDPs also cited access to services, shelter, and economic opportunities as key factors in their decision-making processes.

Central and Southern Syria

Since mid-November, SARG attacks have killed approximately 200 civilians in Eastern Ghouta, international media report. Despite the region’s inclusion as one of the four de-escalation zones established in August, SARG aerial and artillery attacks have intensified significantly in recent weeks, according to relief agencies, with international media reporting more than 180 airstrikes in Eastern Ghouta during mid-to-late November.

Northern Syria

An increase in military clashes in northern Hamah Governorate’s As-Saan, Hamra, and Oqeirbat sub-districts and southern Idleb Governorate’s Tamanaah sub-district prompted the displacement of more than 90,000 people during October and November, according to the Camp Coordination and Camp Management (CCCM) Cluster—the coordinating body for humanitarian CCCM activities, comprising UN agencies, non-governmental organizations (NGOs), and other stakeholders.

Military offensives in Dayr az Zawr Governorate continue to result in population displacement from and within the governorate. According to OCHA, unconfirmed reports indicate that conflict may have displaced as many as 270,000 people in Dayr az Zawr during the month of October alone. Meanwhile, the CCCM Cluster reported the displacement of nearly 228,600 people within and from the governorate between July and early December.

Displacement has also increased in Ar Raqqah, with the CCCM Cluster registering approximately 330,900 primary and secondary displacements from or within the governorate since November 1, 2016. According to the cluster, the figure includes approximately 92,500 people displaced since early July.

In November and late October, USG partners the UN Children’s Fund (UNICEF) and the UN World Food Program (WFP) participated in three interagency convoys to locations in the SARG-besieged Eastern Ghouta region, reaching the city of Douma and the towns of Kafr Batna, Nashabiyeh, and Saqba with life-saving food, health, and nutrition supplies. Facing strict access restrictions to the region, humanitarian agencies last reached Douma and Nashabiyeh in July and Kafr Batna and Saqba in June. Combined, the recent deliveries of humanitarian aid to Eastern Ghouta are sufficient to meet the needs of approximately 17 percent of the region’s estimated 393,000 residents. However, relief agencies report that a SARG-led military operation on November 15 damaged a warehouse storing humanitarian items in Douma, including approximately one-third of the relief commodities delivered by the interagency convoy to Douma on November 12, potentially decreasing the amount of aid available for distribution. In addition, WFP reports that mid-November airstrikes damaged distribution points managed by a local WFP partner in Douma, resulting in the destruction of food stocks sufficient to feed 90 households—approximately 540 people—for one month.

Meanwhile, an interagency humanitarian convoy carrying assistance for approximately 92,750 people arrived in Homs Governorate’s UN-identified hard-to-reach city of Talbiseh and nearby village of Tal Ahmar on November 1, according to relief organizations. The convoy was the first to reach Talbiseh since June 15.

The UN reports that the number of interagency convoys delivering aid to populations in UN-identified besieged and hard-to-reach areas decreased by 38 percent in July–September compared to the same period in 2016 due to increasingly restrictive access constraints. Concurrently, SARG security forces removed nearly 300,000 medical treatments, including equipment and supplies, from all 13 interagency convoys in July–September—the most items removed from interagency convoys in the history of the conflict.


On November 12, the highway between Hamah’s SARG-controlled Suran town and opposition-controlled Murak town re-opened for commercial use, relief organizations report. SARG-affiliated media report that the re-opening of the highway follows an agreement reached by the GoT and SARG during the October 31 peace talks in Astana, Kazakhstan; the agreement and subsequent re-opening of the corridor aim to facilitate civilian movement and improve commercial and humanitarian access in the region.

With USAID support, the Logistics Cluster facilitated five interagency humanitarian convoys to besieged and hard-to-reach locations in Damascus, Rural Damascus, and Homs governorates in November. The convoys transported life-saving food, nutrition, health, shelter, protection, and water, sanitation, and hygiene (WASH) assistance on behalf of five humanitarian organizations. The cluster also continued to coordinate the cross-border operations of USG partner IOM and six UN agencies, facilitating the crossing of more than 200 trucks from Jordan and nearly 460 trucks from Turkey into Syria.

From November 2–9, WFP distributed ready-to-eat (RTE) food rations to 500 new arrivals from Dayr az Zawr at Al Hasakah Governorate’s Al Hol camp. The distribution of RTE rations for an additional 2,500 IDPs from Dayr az Zawr continued in Al Hasakah’s Mabroka IDP site as of November 13. Since August, WFP—in close coordination with the Whole of Syria Food Security Sector—has reached an estimated 93,000 IDPs across Dayr az Zawr, Al Hasakah, and Ar Raqqah with RTE rations.

The SARG siege on Eastern Ghouta continues to deteriorate food security conditions. According to WFP, the price of a standard food basket in Douma increased by approximately 29 percent from October to mid-November—a change that coincided with the early October closure of Eastern Ghouta's Al Wafideen checkpoint, which effectively suspended commercial access to the region. As of mid-November, the average price of a food basket in Douma was nearly 15 times more expensive than the price of a food basket in the Syrian capital city of Damascus, located approximately nine miles away, while the cost of bread was 85 times more expensive. As a result of increasing prices, diminishing food availability, and a lack of cooking fuel, Eastern Ghouta residents are resorting to negative coping mechanisms, including skipping meals, eating expired food, begging, or consuming animal fodder and refuse.

Civilians in Eastern Ghouta and across southern Syria will likely face increased expenditures on food and other essential commodities in the coming months due to decreased fuel availability, as well as newly imposed local taxes on all goods entering opposition-controlled areas in Dar’a and Quneitra governorates from SARG-held areas, relief agencies report. As of early November, the Dar al-Adel court—the main judicial body in opposition-controlled areas of southern Syria—had begun levying the taxes, which range between 2,000–4,000 Syrian pounds, or approximately $4–8, per truck. Dar al-Adel reportedly plans to use the tax revenue to support local police services, likely due to the discontinuation of financial support to armed opposition groups supporting Dar al-Adel law enforcement efforts.

Health organizations operating in Eastern Ghouta report an urgent need for emergency medical evacuations, as well as increased medical services, staff, and supplies, amid worsening humanitarian conditions in the region. As of early December, the UN had identified an estimated 500 patients, including 167 children, in need of urgent medical evacuation from Eastern Ghouta—an increase from the 430 patients requiring medical evacuation as of November 10.

A severe lack of operational health care facilities in northeastern Syria remains a critical concern across the region, USG partner the UN World Health Organization (WHO) reports. As of September, more than 90 percent of health facilities in Ar Raqqah were non-functional and approximately 60 percent of health facilities in both Dayr az Zawr and Al Hasakah were partially functional. According to WHO, only two health care facilities were fully functional across the three governorates as of September—one in Al Hasakah and one in Ar Raqqah. Despite the region’s lack of operational health care facilities, WHO continues to reach vulnerable populations with essential medical assistance. With USG funding, WHO-supported health facilities and mobile units conducted nearly 29,600 primary and secondary health consultations, including for populations sheltering at seven IDP sites and informal settlements located across northeastern Syria, from July to September.

As of December 6, WHO had reported 70 laboratory-confirmed cases of vaccine-derived poliovirus in Syria, 67 of which originated in Dayr az Zawr. WHO is coordinating with UNICEF to support the response to the outbreak, and reports that health officials have conducted two mass vaccination campaigns to vaccinate more than 255,000 individuals in Dayr az Zawr and 140,000 individuals in Ar Raqqah against poliovirus since the outbreak began in early June.

In September, violence in Hamah’s Oqeirbat sub-district displaced more than 10,800 people. In response, Health Cluster organizations provided more than 5,300 medical consultations, as well as medical referrals and immunizations, for newly displaced people. Health Cluster members also supported 25 ambulances to evacuate patients to four hospitals in western Aleppo and Idlib governorates and established 11 mobile clinics along evacuation routes to provide critical medical care.

Members of the Turkey-based Health Cluster—including USAID/OFDA partners—conducted nearly 937,400 outpatient consultations, facilitated an estimated 24,500 hospital admissions, and provided approximately 6,400 disabled individuals with rehabilitation services in northern Syria during the month of September. As of September 30, Health Cluster members were operating in 275 communities and supporting 374 health care facilities, including 80 mobile clinics, in northern Syria.

State/PRM partner the UN Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) is continuing to restore services for Palestinian refugees residing at the Sbeineh camp near the city of Damascus. In coordination with the SARG, UNRWA is conducting maintenance and reconstruction activities, including rubble removal and restoration of electricity and water networks, at the camp. In mid-September, the agency also commenced water trucking to provide safe drinking water to refugees at the site until the water network is operable. Palestinian refugees have continued to return to the camp since the official re-opening of the site on August 30; the SARG had previously closed the camp to civilians in 2013 due to conflict in the area. As of November 1, approximately 2,500 Palestinian refugee households had returned to the camp, according to UNRWA.

Throughout Lebanon, UNRWA provided cash-for-food assistance to more than 32,000 Palestinian refugees from Syria in September and more than 32,000 Palestinian refugees from Syria in October. Additionally, approximately 20,000 Palestinian refugees from Syria benefited from multipurpose cash assistance provided by UNRWA during September and October.

Syrian refugees residing in Lebanon are experiencing worsening economic conditions, according to preliminary findings of the annual Vulnerability Assessment for Syrian Refugees in Lebanon released by USG partners the Office of the UN High Commissioner for Refugees (UNHCR), UNICEF, and WFP. Per the assessment, the number of Syrian refugee households below the Lebanon poverty line increased from 71 percent to 76 percent from 2016 to 2017. Approximately 91 percent of Syrian refugees experienced food insecurity in the last year, primarily as a result of limited income and economic opportunities. In addition, household debt among Syrian refugees remained high in 2017, with an estimated 87 percent continuing to rely on borrowing to sustain their households. While economic indicators demonstrated deteriorating conditions, assessment findings indicate a positive trend of increasing primary school attendance, with 63 percent of primary school-aged Syrian refugee children in Lebanon attending school in 2017 as compared to only 52 percent in 2016. As of June 30, Lebanon was hosting more than 1 million Syrian refugees.

Following the commencement of peaceful demonstrations against the SARG in March 2011, President Bashar al-Asad pledged legislative reforms. However, reforms failed to materialize, and SARG forces loyal to President al-Asad began responding to demonstrations with violence, leading armed oppositions groups to retaliate.

At a November 2012 meeting in Doha, Qatar, Syrian opposition factions formed an umbrella organization—the National Coalition for Syrian Revolutionary and Opposition Forces, also known as the Syrian Coalition. The USG recognized the coalition as the legitimate representative of the Syrian people on December 11, 2012. On March 19, 2013, the Syrian Coalition established the Syrian Interim Government, which opposes the SARG and is based in decentralized locations throughout opposition-held areas of Syria.

On July 14, 2014, the UNSC adopted UN Security Council Resolution (UNSCR) 2165, authorizing UN cross-border and cross-line delivery of humanitarian aid to conflict-affected populations without SARG approval. The resolution permits the UN’s use of four border crossings from Turkey, Jordan, and Iraq—in addition to other crossings already in use by UN agencies—for delivery of humanitarian assistance into Syria. The resolution also establishes a monitoring mechanism under the authority of the UN Secretary-General and with the consent of neighboring countries to ensure that deliveries across these border points contain only humanitarian items. The UNSC has subsequently adopted several resolutions renewing the mandate of UNSCR 2165, most recently in December 2016 with the adoption of UNSCR 2332, extending the authorities granted until January 2018.

Prior to the start of the conflict, UNRWA had registered approximately 560,000 Palestinian refugees in Syria, with more than 80 percent living in and around the city of Damascus. Intense fighting in and around some Palestinian camps and neighborhoods has significantly affected Palestinian refugees in Syria. UNRWA estimates that approximately 60 percent of Palestinian refugees are displaced within Syria, with a further 110,000 Palestinian refugees displaced in neighboring countries. Syria also hosts an estimated 24,000 Iraqi refugees and asylum seekers, primarily in the greater Damascus area, as well as more than 3,200 refugee persons of concern from other countries.

The most effective way people can assist relief efforts is by making cash contributions to humanitarian organizations that are conducting relief operations. A list of humanitarian organizations that are accepting cash donations for disaster responses around the world can be found at

The USG encourages cash donations because they allow aid professionals to procure the exact items needed (often in the affected region); reduce the burden on scarce resources (such as transportation routes, staff time, and warehouse space); can be transferred very quickly and without transportation costs; support the economy of the disaster-stricken region; and ensure culturally, dietary, and environmentally appropriate assistance.

Last updated: March 08, 2018

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