This Situation Report covers developments in north-west Syria and Ras Al Ain – Tell Abiad. OCHA Türkiye prepares this report with the support of Cluster Coordinators and the Humanitarian Field Officers (HFO). The data/information collected come from both sources.
Hostilities and violence have escalated across north-west Syria since 14 October, with the first series of airstrikes reported in three months. At least 122 attacks have been reported in the first three days, 115 of which struck Idleb and western Aleppo including residential areas, local shops and farmland.
Since the start of the escalation on 14 October, at least 12 civilians, including three children aged one, three and eight, have been killed by hostilities across north-west Syria. At least 43 others have been injured, according to local health authorities as of 16 October.
On 17 October, the Deputy Regional Humanitarian Coordinator issued a statement calling for all parties of the conflict to “take all necessary measures to ensure that civilians and civilian infrastructure are protected” and ensure the “safety of humanitarian workers.”
Since the start of 2024, at least 46 civilians, including 12 children, have been killed due to hostilities and 180 others, including 67 children and 21 women, have been injured, as verified by local health authorities as of 18 October.
On 14 October, three airstrikes struck close to a tent settlement in Ma'arrat Misrin, a few kilometers away from where a UN delegation, led by Deputy Regional Humanitarian Coordinator David Carden, was overseeing a World Food Programme (WFP) distribution to displaced families.
On 15 October, two airstrikes hit a power station west of Idleb city, causing electrical outage in two water stations that serve as the main water source for 30,000 people in 17 surrounding villages. Water pumping has since halted due to a technical failure in one of the generators, and humanitarian partners are working to bring in alternative diesel generators. Two power station employees injured in the airstrikes have been treated at a hospital supported by the Syria Cross-border Humanitarian Fund (SCHF).
During the same period, artillery shelling continued to impact northern Aleppo in addition to clashes that erupted on 16 October, affecting schools – including the injury of four students and their teacher in Jarablus - and numerous displacement camps. Several families living in camps near the fighting zones have reportedly fled to schools, agricultural lands and olive presses.
The fighting led to the temporary suspension of schools in Azaz and humanitarian activities, including services in at least ten health facilities on 16 October. The IDP Task Force reported that an estimate of 1,951 families have been temporarily displaced from 14 to 17 October.
A temporary humanitarian ceasefire was agreed the afternoon of 17 October to allow for the evacuation of civilians, pathways for ambulances and the treatment of those injured. By 18 October, many of the displaced families have reportedly started to return.
The recent escalation of hostilities in north-west Syria emerged against a backdrop of strained resources and increasing displacement.
Over 4,000 people have fled the conflict in Lebanon since the escalation of hostilities started on 23 September, and arrived in north-west Syria, according to UNHCR as of 16 October. This is on top of the 3.5 million people who are already internally displaced in north-west Syria, 2 millions of whom live in camps and informal settlements.
With less than three months left until the new year, the humanitarian response remains severely underfunded. As of 18 October, the 2024 Humanitarian Response Plan for Syria has received only over a quarter of the funding needed. Consequently, humanitarian activities and facilities have continued to be suspended in north-west Syria on a weekly basis.
The Health Cluster reported that 60 health facilities had run out of funds as of the end of September. If this funding trajectory continues, 50 per cent of all functional health facilities in north-west Syria will fully or partially cease operations by December 2024.
Each month this year, the UN and its partners are reaching 1 million people in north-west Syria on average with assistance – but this is a significant drop from the 2.5 million people reached monthly in 2023.
In light of the recent hostilities that started on 14 October, the UN and its partners are continuing to closely monitor the situation and track displacement.
In case of mass displacement, there are aid pre-positioned aid inside north-west Syria ready to be released, including 10,000 ready-to-eat rations (RTEs), as well as stocks of tents and non-food items sufficient to meet the needs of around 5,000 households.
However, humanitarian partners flagged that the amount is insufficient in the case of prolonged displacement. The Food Security and Livelihoods (FSL) Cluster reported that an additional 50,000 RTEs are needed in Idleb, and an additional 30,000 in northern Aleppo at minimum, to respond to such an event. The Shelter and Non-Food Items (SNFI) Cluster noted that temporary shelter solutions will also be needed in that scenario.
Gaziantep, 17 October 2024
I am alarmed by the escalating hostilities and violence in north-west Syria since 14 October. At least 122 attacks have been reported in three days, 115 of which struck Idleb and western Aleppo, including residential areas, local shops and farmland.
Among the attacks were the first series of airstrikes in three months. On 14 October, three airstrikes struck close to a tent settlement in Idleb, where families were receiving food assistance. The families spoke with UN staff on the ground, expressing their feelings of insecurity and fear. The following day, two airstrikes struck a power station west of Idleb city, disabling two water stations that serve 30,000 people in 17 villages.
During the same period, artillery shelling and clashes have also been reported in northern Aleppo, affecting schools and displacement camps.
Since the start of the recent escalation on 14 October, 12 civilians, including three children under 10 years old, have been killed in north-west Syria, and at least 27 others have been injured, according to local health authorities. The fighting has also halted critical humanitarian activities, including services provided by ten health facilities.
I offer my deepest condolences to the families of those affected. The UN continues to call on all parties to the conflict to take all necessary measures to ensure that civilians and civilian infrastructure are protected, in accordance with international humanitarian law, and to ensure the safety of humanitarian workers.
Years of conflict, repeated displacement and economic hardship have taken a toll on the mental well-being of the people in Syria. In north-west Syria, over 1 million people, or 20 per cent of the population, suffer from mental health conditions, including 230,000 who suffer from severe disorders. This is far higher than the global average (1 out of 8 people) estimated by the World Health Organization (WHO). Prolonged exposure to conflict has left individuals facing chronic stress, grief from the loss of loved ones, and the trauma of violence and displacement.
The groups most vulnerable to suicide risks in north-west Syria are unemployed individuals, displaced women, young adults between the ages of 18 to 38 - a significant portion being female, residents of crowded homes, and married women with children. This is according to recent research conducted by GIZ, the Mental Health and Psychosocial Support Technical Working Group (MHPSS TWG), and Suicide Task Force.
Nearly 300 suicide cases and attempts have been reported across Idleb and northern Aleppo in the first half of 2024, per the data provided by the MHPSS TWG, averaging at least one suicide attempt every day. Last year, the number of cases and attempts was over 260. According to data specifically collected by hospitals in Idleb and northern Aleppo, 38 suicide cases have been recorded from January to 4 September 2024 - 64 per cent were women and girls who ended their lives. Given the sensitivity and stigmatization of the issue, many cases are likely underreported.
In the face of these challenges, the mental health capacity in north-west Syria is severely overstretched, with only three psychiatric hospitals (Azaz, Sarmada and Al-Bab), 450 psychosocial workers, 78 trained doctors, 50 psychologists and two psychiatrists available to serve a population of over 5 million people. There are also no specialized child psychiatrists.
The situation has been further exacerbated by severe funding shortages in 2024, which led to a significant drop in humanitarian assistance including health services. By the end of September, 60 health facilities, including primary health centers, maternal and specialized hospitals, had run out of funds. Without increased funding, 230 health facilities – or half of all functional health facilities in north-west Syria – will have to suspend operations by the end of December, depriving over 1 million people of access to essential, life-saving, and emergency healthcare.
On 25 September, UN Deputy Regional Humanitarian Coordinator David Carden led an interagency mission with WHO and OCHA to the only mental health hospital in northern Aleppo, a governorate of 1.7 million people. The Azaz Mental Health Hospital, supported by Physicians Across Continents (PAC) and WHO, provides comprehensive mental health services for epilepsy, depression, psychotic disorders, and other conditions, including care for chronic and severe mental health patients.
Last year, the first Substance Use Disorders Unit in north-west Syria was established in the Azaz Mental Health Hospital. The unit, which also faces the risk of closure, has since helped over 150 patients complete six months of withdrawal and community re-engagement through case management services.
During the visit, the UN delegation met with health workers and staff operating inside the facility, including cooks who were preparing meals for patients, and the outpatient clinic. The outpatient clinic, which has over 5,000 registered patients, is currently operating partially with PAC’s resources, having lost all financial support by the end of August. Many staff are working for free, with no clarity about what the coming months will bring. Sustained health funding is needed to keep health services running without interruptions.
Unlike in many other contexts around the world, healthcare services in north-west Syria are almost completely dependent on humanitarian funding.
The equivalence to a public health system does not exist and much of the operations of health facilities, including staff salaries, are backed by humanitarian organizations. After 13 years of conflict, the health workforce in north-west Syria is understaffed and fragmented due to insecurity, brain drain and unregulated labor conditions, among other reasons. There are less than 11 health workers per 10,000 population – far lower than the standard of 22 health workers per 10,000 people. Some areas are facing more critical shortages of doctors, nurses and midwives than others.
In times of funding shortages, mental health is one of the first services to be deprioritized. To address this issue, the MHPSS Technical Working Group, comprised of over 60 organizations and led by WHO, is working to integrate mental health and psychosocial support into the healthcare system and other sector programmes in north-west Syria. Doctors, nurses, and psychosocial workers are being trained in MHPSS interventions, with 82 primary health centers now integrating these services into their operations.
The MHPSS Technical Working Group is also leading the Suicide Task Force which adapts and translates international guidelines, develops training materials and key messages, coordinates suicide prevention activities, collects suicide data and oversees assessments. The Group emphasizes the importance of a comprehensive intervention approach, as suicide is not only a mental health issue but also a cross-cutting challenge that affects all Clusters, with significant implications for community resilience and recovery. The Group is also leading the substance use thematic group, as part of a global network, working to adapt materials and pilot the training for humanitarians on substance use detection and referral. At present, 100 aid workers from different fields are targeted for this training.
In 2024, WHO, in partnership with an NGO, is running a programme that addresses suicide prevention largely through education and awareness-raising efforts. This includes a four-day training for 500 medical staff at primary and secondary health facilities, as well as workshops on suicide prevention targeting media influencers, community leaders, school managers, and parents.
In 2024, the humanitarian community in the cross-border response has been discussing and implementing increasingly early recovery interventions, guided by a newly updated Early Recovery Strategy and Action Plan for north-west Syria. During an interview, the Early Recovery and Livelihoods Cluster Coordinator under UNDP, Wouter De Cuyper, shared his thoughts on this development, the challenges faced by partners and its potential implications on Syrian communities.
Early recovery is quite a technical term. How would you describe this type of work and why is it critical in the context of north-west Syria?
Wouter De Cuyper: Significant efforts toward early recovery have already been made in the cross-border response the past years to decrease communities’ dependency on aid, moving beyond providing temporary arrangements to more lasting solutions. This has been especially critical and challenging in a context such as north-west Syria with the protracted humanitarian crisis where the armed conflict has persisted for over 13 years.
Early Recovery is an approach that addresses recovery needs that arise during the humanitarian phase of an emergency, using humanitarian mechanisms that align with development principles. It enables people to use the benefits of humanitarian action to seize development opportunities, strengthens resilience, and establishes a sustainable process of recovery from crisis. It is a vital element of any effective humanitarian response and planning for early recovery should start when the crisis begins.
In north-west Syria, this has translated into early recovery programming related to livelihoods, basic infrastructure and rehabilitation, governance and capacity-building under all humanitarian clusters and sectors, including Food Security and Livelihoods, Health, Protection, Shelter/NFI, and so forth.
The humanitarian community completed the second review of the Inter-Cluster Early Recovery Strategy and Action Plan for North-west Syria in July. Could you tell us more about it?
Wouter De Cuyper: The overall early recovery strategy is to take an inclusive approach that is complementary to the two-year Humanitarian Response Plan (HRP), with all sectors integrating early recovery into their strategies to address current needs and prevent future ones through a balanced combination of emergency and early recovery assistance. The strategy and its four objectives were developed in consultation with affected communities in north-west Syria. All early recovery actions are shaped by guiding principles and standards, obligations resulting from international human rights conventions and international humanitarian law, with the centrality of protection, linkages to climate change and disaster risk reduction, and considerations of gender equality, social inclusion and local ownership.
What would you say are the key challenges faced by the Early Recovery and Livelihood Cluster in 2024?
Wouter De Cuyper: There are several challenges that the Cluster and its partners have been facing, including decreased funding from donors, coordination with other Clusters at the field level, community-based organizations and the private sector, and integration of issues related to environment and climate change . Reduced donor funding this year has been affecting our partners' capacity and reach significantly. We have seen a reduction in activities related to both livelihoods (employment creation) and infrastructure rehabilitation (roads, schools, health facilities) compared to 2023. In our June survey, over 60 per cent of our partners reported a reduction of funding between 25 per cent and 75 per cent for 2024. Over a third of our partners reported having to reduce the number of people supported by 50 to 75 per cent due to reduced funding.
In 2024, the ERL cluster only received 18 per cent of the funding (out of $90.3 M). How has this affected your activities so far and what is at risk if this funding trajectory continues until the end of the year?
Wouter De Cuyper: Without early recovery projects restoring services and supporting sustainable livelihoods, we can expect prolonged poor economic conditions for people in north-west Syria, resulting in worsening emergency life-saving needs, deteriorating services, and higher risk of reliance on negative coping mechanisms, including borrowing resulting in debts, child labour, increased exposure to sexual exploitation, etc. to make ends meet. Reduced access to livelihood opportunities will widen the gap between income and expenditure required to meet basic needs. Reduced access to essential services, including affordable access to electricity, will jeopardize the positive impact of livelihoods programming. Lack of funding for both access to livelihoods, ability to meet basic needs, and the availability and affordability of infrastructure and services will threaten the resilience and social cohesion.
“I was terrified and desperately searched for a well-trained doctor who could handle my case”, said Khansa Harbeh, 35 years old, a mother of two children.
Mrs. Harbeh had recently experienced a severe case of placental abruption in north-west Syria, a life-threatening condition where the placenta detaches from the uterus prematurely, endangering both the mother and the baby.
In north-west Syria, cases like this are particularly critical, as ongoing conflict and instability severely disrupt daily life, straining medical supplies and overwhelming the capacity of healthcare workers.
Dr. Abdul Aziz Hamza, an obstetrician at the hospital, was part of the team that treated Khansa. “Placental abruption is a serious emergency that requires immediate intervention,” Dr. Hamza explains. “We knew we had to act fast to save both the mother and her baby. The situation was critical, but we were prepared.
“I found that the Idleb Maternity Hospital had everything I needed for my case. They assured me that the required blood tests and check-ups were available there ", said Khansa.
Mrs. Harbah shared, “Without this hospital, I don’t know what would have happened to me and my baby. The doctors and staff monitored us closely at night, checking both my and my baby’s vital signs.”
Dr. Ikram Haboush, Director of the Specialized Maternity Hospital in Idleb, states, "Many women in north-west Syria lose their lives while being transferred between hospitals in the absence of essential supplies for critical conditions like placental abruption."
Khansa’s story is just one of many in Idleb, where maternity care is often different between life and death. The hospital, supported by UNFPA, provides essential reproductive health services to women in one of the most challenging environments.
Reproductive health in north-west Syria is facing severe resource shortages, leaving the needs of vulnerable women and newborns unmet. As of September 2024, 59 Emergency Obstetric and Newborn Care facilities were operational. However, 30 of these facilities are already out of funds
UNFPA’s support is crucial in this dire situation. Approximately $23 million is needed annually to address the funding gap for 30 hospitals facing suspension. This vital funding provides essential resources and ensures that facilities like Idleb Maternity Hospital can continue to deliver life-saving care to women in need.
With 50 per cent of maternity hospitals in northwest Syria suspended this September, 2024, the severe resource shortfall will leave pregnant women facing the grim reality of giving birth without essential medical care. This will also affect 1.3 million women, significantly limiting their access to reproductive health services.
The Syria Cross-border Humanitarian Fund (SCHF) has allocated $38.1 million in its its first Standard Allocation of the year to help 1.7 million people in north-west Syria. 68 per cent of the fund went to national NGOs, either directly or through sub-granting. Since the start of 2024 and as of mid-October, the SCHF received over $55 million in paid contributions with the support of 13 donors.
As of 16 October, the UN has completed 633 cross-border missions to north-west Syria since the first interagency visit to Idleb on February 14, 2023 – 314 of these missions were conducted in 2024.
Since the beginning of 2024 and as of 17 October, a total of 483 trucks carrying humanitarian aid by seven UN agencies crossed the Bab Al-Hawa and Bab Al-Salam border-crossings.
To mark World Mental Health Day on 10 October, UNICEF and child protection partners organized "Lego Day" for children in displacement camps in Azaz. This initiative is part of a “Play and Learn” project under the partnership of UNICEF and the Lego Foundation which aims to promote physical, emotional, social and cognitive development in children.
In anticipation of the winter season, the humanitarian community launched a 2024-2025 Winterization Plan on 17 September. The plan targets 1.4 million people in need of urgent winter assistance. Key interventions include providing fuel, stoves, winter clothing kits, and winterization kits, including thermal blankets and carpets, to keep families warm amid freezing temperatures. Where markets are functional, cash and voucher assistance are critical, allowing families the flexibility to purchase what they need while stimulating local businesses.
As of 18 October, the 2024 Humanitarian Response Plan for Syria, which asks for $4.07 billion, is less than a third funded.