The United Nations warned on Friday that Syria’s Idlib could be faced with a humanitarian calamity not yet seen in the country’s seven-year war should the regime launch an offensive on the northwestern province.
"A worst-case scenario in Idlib will overwhelm capacities and has the potential to create a humanitarian emergency at a scale not yet seen through this crisis," John Ging, who heads operations and advocacy for the UN's humanitarian coordination office told the Security Council this week.
Its hospitals are battered, residents heavily dependent on aid and escape routes to neighboring Turkey sealed.
A regime offensive could overwhelm already struggling health facilities, cut off food and medical supplies to desperate civilians, and prompt massive levels of displacement, the United Nations has warned.
UN chief Antonio Guterres said on Wednesday he was "deeply concerned about the growing risks of a humanitarian catastrophe in the event of a full-scale military operation in Idlib".
Moscow and Ankara are in talks to try to thrash out a solution that would spare the three million people living in opposition territory.
They include tens of thousands of opposition factions and civilians evacuated to Idlib from other areas recaptured by the regime.
Since Syria's conflict erupted in 2011, more than 350,000 people have been killed, more than 11 million have fled their homes and medical infrastructure has been systematically targeted.
In the first six months of this year, there were 38 attacks on medical infrastructure in the province, most of them blamed on the regime or its Russian ally, according to OCHA.
The World Health Organization warned that less than half of Idlib's health facilities were still functioning "across areas that may soon witness increased violence."
"The remaining facilities are neither properly equipped nor prepared for a massive influx of patients," said Pawel Krzysiek, spokesman for the International Committee of the Red Cross in Syria.
"Any offensive will make an already precarious situation even worse," he told AFP.
In the event of a chemical attack on the densely populated province, hospitals will likely struggle to cope.
Western powers have warned the regime could use toxic substances against the civilian population as it seeks to recapture Idlib.
Earlier this year, the UN began sharing the GPS coordinates of health facilities with Russia and the United States in a bid to protect them but four have been struck since.
The UN and humanitarian groups are also deeply worried about the food, medicine and other aid they truck in through the Bab al-Hawa and Bab al-Salam crossings to some two million people in need in Idlib and adjacent areas.
"Cross-border operations provided a lifeline for civilians in regard to food supplies and other daily life products needed," said Krzysiek. "If border crossings with Turkey are to shut down, hundreds of thousands of people will be affected."
Aid operations could also be disrupted if key staff are caught up in the offensive, said OCHA's spokeswoman in Damascus, Linda Tom.
"The potential displacement of humanitarian staff would further contribute to gaps in the response," she told AFP.
In addition, more than a million Syrian children are at risk in the event of a regime assault, said the UN Children’s Fund (UNICEF) on Friday.
Manuel Fontaine, UNICEF director of emergency programs, said that the agency has drawn up contingency plans including providing clean water and nutritional supplies to some of the estimated 450,000 to 700,000 people who could flee an attack.
“It’s more than one million kids... When you hear the kind of military rhetoric about an offensive and all that, I think it’s important to remember that it’s not just against a group of armed men,” Fontaine told Reuters in Geneva.
“It’s actually a very large proportion of women and children who have no stake in it, and elderly men and others,” he said.
Many families in Idlib have been uprooted multiple times, evacuated as front lines shift, Fontaine said.
“There’s some children who have been displaced seven times already, going from one place to the other. It means that their coping mechanisms, their resilience is very drained at the moment so they are particularly vulnerable. That’s a major concern obviously.”