'Starvation on the Way': Border Crossing Decision Weighs on Northwest Syria

A road sign that reads Welcome to Bab al-Hawa crossing is seen at Bab al-Hawa crossing at the Syrian-Turkish border, in Idlib governorate, Syria June 10, 2021. (Reuters)
A road sign that reads Welcome to Bab al-Hawa crossing is seen at Bab al-Hawa crossing at the Syrian-Turkish border, in Idlib governorate, Syria June 10, 2021. (Reuters)
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'Starvation on the Way': Border Crossing Decision Weighs on Northwest Syria

A road sign that reads Welcome to Bab al-Hawa crossing is seen at Bab al-Hawa crossing at the Syrian-Turkish border, in Idlib governorate, Syria June 10, 2021. (Reuters)
A road sign that reads Welcome to Bab al-Hawa crossing is seen at Bab al-Hawa crossing at the Syrian-Turkish border, in Idlib governorate, Syria June 10, 2021. (Reuters)

Hussein Mahmoud, a displaced farmer from Syria's Hama province who now lives in a camp in northern Idlib, divides the basic items in a food basket he receives monthly amongst his wife and 13 children.

By mid-month, the bread, rice, lentils and other essentials he gets as aid are nearly scarce but Mahmoud now fears this little support that has provided a lifeline for his family might end.

"If this food aid stops, where do we go? What do we do?" he said. "Starvation is on the way."

Millions of people living in northwest Syria, many of them displaced from elsewhere in the country's decade-long conflict, face Mahmoud's fate should the United Nations fail to approve an extension to cross-border humanitarian operations this July.

Access for cross-border aid from Turkey was reduced last year to just one crossing point after opposition from Russia and China - permanent Security Council members - to renewing other crossings. A new showdown is likely next month when the operation's mandate must be renewed.

Idlib province, Syria's last rebel stronghold, is home to around 3 million people, more than half of whom depend on food aid.

All of that filters through the Bab al-Hawa crossing where currently around 1,000 UN trucks enter a month through Turkey.

"Right now there is a plan for if no renewal happens and alongside our partner the World Food Program we are stockpiling for three months until the end of September," said Bassil al-Dirri, Idlib area manager for the Turkish Humanitarian Relief Association (IYD).

"But after that there will be nothing."

Surging food prices
President Bashar al-Assad has survived the insurgency against him, and now holds sway over around 70% of the country, helped by Russia's military and Iran's Shiite militias.

But Turkey still controls territory in the northwest and there are growing concerns that Russia, Assad's ally, will veto a decision to keep the crossing open.

Should that happen, UN coordinated aid would have to re-route operations through Damascus.

"I ask all the humanitarians in the world to stand up against Russia to not make this happen," said Abdelsalam al-Youssef, director of Teh displaced camp in northern Idlib.

"There will be a humanitarian catastrophe if it does," he said as he attended a rally on the issue in the camp.

Some in Idlib warn of looming price rises should basic items grow scarce as demand for staples like bread and rice increases and supply remains limited.

"Traditional trade routes can't cope with the needs of the market... so from an economic perspective, there will be an insane increase in prices" Dirri said.

"We are talking about basic items for each family, not luxuries... no family can go on living without them," he said.

Food prices in Syria have jumped by more than 200% in the last year alone, a March assessment by the WFP found.

The study found that a record 12.4 million Syrians, more than 60% of the population, suffer from food insecurity and hunger, double the number of 2018.

Some of the country's poorest and most desperate, having abandoned homes and land to flee war, live in Idlib's squalid camps like Mahmoud.

His family's fate and millions of others now hangs on the July 10 decision.

"We are asking God first and then the authorities to please make this continue for us," he said.



Sudan's Doctors Bear Brunt of War as Healthcare Falls Apart

(FILES) A Sudanese army soldier mans a machine gun on top of a military pickup truck outside a hospital in Omdurman - AFP
(FILES) A Sudanese army soldier mans a machine gun on top of a military pickup truck outside a hospital in Omdurman - AFP
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Sudan's Doctors Bear Brunt of War as Healthcare Falls Apart

(FILES) A Sudanese army soldier mans a machine gun on top of a military pickup truck outside a hospital in Omdurman - AFP
(FILES) A Sudanese army soldier mans a machine gun on top of a military pickup truck outside a hospital in Omdurman - AFP

Sudanese doctor Mohamed Moussa has grown so accustomed to the constant sound of gunfire and shelling near his hospital that it no longer startles him. Instead, he simply continues attending to his patients.

"The bombing has numbed us," the 30-year-old general practitioner told AFP by phone from Al-Nao hospital, one of the last functioning medical facilities in Omdurman, part of greater Khartoum.

Gunfire rattles in the distance, warplanes roar overhead and nearby shelling makes the ground tremble, more than a year and a half into a grinding war between rival Sudanese generals.

Embattled health workers "have no choice but to continue", said Moussa.
Since April 2023, Sudan has been torn apart by a war between army chief Abdel Fattah al-Burhan and his former deputy Mohamed Hamdan Daglo, leader of the Rapid Support Forces (RSF).

The war has killed tens of thousands and uprooted 12 million people, creating what the International Rescue Committee aid group has called the "biggest humanitarian crisis ever recorded".

The violence has turned the country's hospitals into battlegrounds, placing health workers like Moussa on the frontlines.

Inside Al-Nao's overwhelmed wards, the conflict's toll is staggering.

Doctors say they tend to a harrowing array of injuries: gunshot wounds to the head, chest and abdomen, severe burns, shattered bones and amputations -- even among children as young as four months.

The hospital itself has not been spared.

Deadly shelling has repeatedly hit its premises, according to medical charity Doctors Without Borders (MSF) which has supported the Al-Nao hospital.

Elsewhere, the situation is just as dire. In North Darfur, a recent drone attack killed nine at the state capital's main hospital, while shelling forced MSF to evacuate its field hospital in a famine-hit refugee camp.

- Medics targeted -

Sudan's healthcare system, already struggling before the war, has now all but crumbled.

Of the 87 hospitals in Khartoum state, nearly half suffered visible damage between the start of the war and August 26 this year, according to satellite imagery provided and analysed by Yale University's Humanitarian Research Lab and the Sudanese American Physicians Association.

As of October, the World Health Organization had documented 119 confirmed attacks on healthcare facilities across Sudan.

"There is a complete disregard for civilian protection," said Kyle McNally, MSF's humanitarian affairs advisor.

He told AFP that an ongoing "broad-spectrum attack on healthcare" includes "widespread physical destruction, which then reduces services to the floor -- literally and figuratively".

The national doctors' union estimates that in conflict zones across Sudan, up to 90 percent of medical facilities have been forced shut, leaving millions without access to essential care.

Both sides of the conflict have been implicated in attacks on healthcare facilities.

The medical union said that 78 health workers have been killed since the war began, by gunfire or shelling at their workplaces or homes.

"Both sides believe that medical staff are cooperating with the opposing faction, which leads to their targeting," union spokesperson Sayed Mohamed Abdullah told AFP.

"There is no justification for targeting hospitals or medical personnel. Doctors... make no distinction between one patient and another."

- Starvation -

According to the doctors' union, the RSF has raided hospitals to treat their wounded or search for enemies, while the army has conducted air strikes on medical facilities across the country.

On November 11, MSF suspended most activities at Bashair Hospital, one of South Khartoum's few functioning hospitals, after fighters stormed the facility and shot dead another fighter being treated there.

MSF officials say they believe the fighters to be RSF combatants.

In addition to the endless stream of war casualties, Sudan's doctors scramble to respond to another threat: mass starvation.

In a paediatric hospital in Omdurman, across the Nile from Khartoum, malnourished children arrive in droves.

Between mid-August and late October, the small hospital was receiving up to 40 children a day, many in critical condition, according to one doctor.

"Every day, three or four of them would die because their cases were very late stage and complicated, or due to a shortage of essential medicines," said the physician, requesting anonymity for safety concerns.

Sudan has for months teetered on the edge of famine, with nearly 26 million people -- more than half the population -- facing acute hunger, according to the UN.

Adnan Hezam, a spokesman for the International Committee of the Red Cross, said there must be "immediate support in terms of supplies and human resources to medical facilities".

Without it, "we fear a rapid deterioration" in already limited services, he told AFP.

To Moussa, the doctor, some days feel "unbearable".

"But we can't stop," he said.

"We owe it to the people who depend on us."