Open letter to the Member States of the High Level Group on Syria

Your Excellencies,
Médecins Sans Frontières has been providing assistance to victims of the Syrian conflict since April 2011. We welcome the diplomatic negotiations which are needed to address the urgent humanitarian needs in this extremely violent conflict. But we would like to draw your attention to the vital subject of cross-border aid for the population living in opposition controlled areas. There is an urgent need to significantly increase this cross-border assistance and to address this issue in the negotiations on humanitarian aid. If the government of Syria remains the sole distribution channel for international humanitarian relief efforts, then millions of Syrians will continue to be deprived of adequate assistance, in particular essential medical services.
The situation today is that almost all international humanitarian aid transits through the Syrian capital. The United Nations agencies and the international aid organisations providing this aid are subjected to strict control measures by the government. Syrian authorities greatly limit the number of international staff in Damascus and rarely authorise them to travel outside the capital. They also impose aid to be distributed through state controlled bodies – mainly the Syrian Arab Red Crescent (SARC) – which alone evaluate the needs and select the beneficiaries.
Without doubt, SARC volunteers and employees have demonstrated exemplary dedication and professionalism in their work. They are nevertheless under great pressure from the Syrian government, whose policy is to limit or prohibit the distribution of humanitarian aid – particularly medical - to areas controlled by the opposition. Further obstacles in getting assistance across frontlines are the intensity of fighting, as well as the fragmentation of opposition groups and their deep suspicion of foreigners and of aid deliveries sanctioned by the government. The hostage-taking of humanitarian workers in opposition controlled areas has also clearly been detrimental.
These obstacles have lead to the almost complete blocking of aid for people in enclaves
controlled by the opposition groups and surrounded by government forces. This is the case in the besieged neighbourhoods of Homs and Ghouta where 200,000 people have struggled for months to survive with little to no assistance.
In the opposition-held areas situated close to Syria’s neighbouring countries, five to seven million Syrians receive no medical assistance from Damascus and very little relief aid. They are less isolated than the enclaves, largely because of the humanitarian role of neighbouring states, especially Turkey. Turkish hospitals treat hundreds of wounded every month. Turkish authorities have allowed the transfer of food, drugs, tents and blankets by international NGOs and by Syrian organisations that work in opposition-held territory, despite the objection of Damascus. However, this assistance still falls far short of urgent needs.
For example, in Aleppo and Idlib Governorates, tens of thousands of displaced people are
crammed into tented camps that have no adequate sanitation facilities. Field hospitals and
ambulance services have been targeted since the beginning of the crisis and lack both
personnel and medical supplies to care for the hundreds of people wounded daily in
indiscriminate bombardments. The destruction and closure of district hospitals has deprived countless patients of vital medical care. The public health system has collapsed. The national immunisation programme has been suspended and there is a polio outbreak spreading across the country.
Fewer than a dozen international NGOs, including MSF, are able to provide assistance
through neighbouring countries to the populations living in these opposition controlled areas. The UN agencies do not provide such cross-border aid, fearful that their operations in Damascus will suffer reprisals. The complex and insecure environment also limits the
provision of assistance; for example some armed groups block aid access to Kurdish and
isolated Shiite communities. However, the work of international NGOs, including MSF,
shows that it is indeed possible to engage with opposition groups—even the most radical – in order to directly help the sick, wounded, and displaced.
Although the needs increase on a daily basis, the meagre cross-border assistance risks grinding to a halt. The few international NGOs present are faced with increasing difficulties to bring teams and equipment across borders into Syria. UN agencies appear to have given up negotiating cross-border access to people living in opposition-held areas.
We therefore urgently call on you to support efforts of all humanitarian organisations,
whether they are working from Damascus or from neighbouring countries. It is essential to help humanitarian organisations in Damascus overcome blockages to deliver assistance to enclaves and hard-to-reach areas. It is just as vital to increase the provision of humanitarian aid across borders directly to the population living in opposition held areas, particularly from Turkey.
We also ask you to recognise the important humanitarian role played by Syria’s neighbours, who bear the brunt of this humanitarian crisis, and to encourage them to facilitate the transit of humanitarian teams and material across their borders.
Finally, we call on you to prompt the UN agencies to do more to help the populations living in opposition-held areas, at the very least by providing stocks, food, medicines, winter tents, blankets and other basic necessary items at the borders of Syria.
We thank you for your attention to this urgent matter.
Dr. Joanne LIU
President of MSF International