Both opposition and government groups have been responsible for the killing of civilians and attacks on hospitals and doctors. The government of Syria has systematically withheld life-saving aid from crossing enemy lines. Agreements to deliver aid through front-lines or across the border from neighboring countries have never been reached. Everywhere, civilians suffer appallingly.
As the war rages on, the multi-million dollar humanitarian aid effort by United Nations agencies is quietly being crippled and hijacked by the political agendas of the warring factions. The absence of public debate and lack of scrutiny of the aid deadlock inside Syria is partially explained by the fragility of negotiated agreements with warring parties on the ground. The questionable nature of some of the compromises being made in Syria, however, threatens the credibility of humanitarian aid and does a terrible disservice to the Syrian people.
The chances of a person receiving life-saving health care inside Syria today are defined by which side of the front-line they happen to find themselves on. This is not just a matter of luck. It is the consequence of deliberate choices made by those who hold the guns, and also of the operational compromises accepted by aid agencies themselves.
The current outbreak of polio is a telling example of the problem. Polio paralysis is incurable once it has been contracted, even though a simple oral vaccine is enough to prevent infection. But while the WHO and UNICEF finally announced a regional vaccination campaign to combat the disease in Syria and neighboring countries across the region, doctors on the ground know that the most pressing need now is to contain the outbreak at its epicenter in Deir-ez-Zoor, in opposition-controlled areas of northeast Syria.
As in many other cities, Deir-ez-Zoor is divided across a front-line, and in areas under the military control of the government, Syrian authorities are already vaccinating children with the support of UNICEF, claiming more than 2 million children have received the first round of polio vaccination. In most opposition-controlled areas however, the outbreak response has been delayed leaving hundreds of thousands of people outside the scope of this effort.
This critical detail is conveniently omitted when describing the regional polio effort, about which UN communications only refers to vague “security or capacity limitations” in unspecified areas.. The truth is that the Syrian government has prevented timely efforts to vaccinate children in opposition-controlled areas by refusing to allow the use of polio vaccines not obtained under its own delivery system. Working in cooperation with Damascus, the UN has been forced to abide by this situation.
MSF has tried to buy polio vaccines directly from the manufacturer. However, the supply is controlled by UNICEF and importation requires authorization from Damascus. The Syrian government continues to refuse authorization for MSF to operate, ultimately paralyzing our efforts to respond to the polio outbreak by distributing of polio vaccines through medical networks inside Syria, including in Deir-ez-Zoor.
The consequences are immediately clear: children on the wrong side of the front-line cannot be protected from polio. There are either no vaccines available or no agencies authorized to vaccinate them. There are 62 registered cases of polio so far and this figure is likely to reach 160 by the end of the month. Moreover, since a minimum vaccination rate of 95% is necessary to prevent the spread of the disease, a ‘regional’ vaccination effort which ignores the reality of Deir-ez-Zoor and the other contested areas is fatally flawed. Unless things change, young children will continue to be punished by the cold logic of war and the deadlock of political agendas. We must challenge this and act before it is too late.
Providing aid in conflict always requires political negotiations with people in control of that territory. However, pragmatic compromises can only be justified as a means to do the right thing. Authorization to operate, granted by a warring party, cannot come at the cost of neglecting the other side. As a humanitarian agency, we have the duty to stand up for impartial delivery of aid and call on the warring factions to lift the scandalous blockade imposed on humanitarian efforts in Syria which continues to cost lives every day.