AMMAN — One year and a half after the closure of the al-Yaroubiah crossing, northeast Syria lingers in medical neglect amid severe shortages of supplies and funding.
Last month, the medical INGO Doctors Without Borders (MSF) warned that hospitals in the region controlled by the Kurdish-dominated Syrian Democratic Forces (SDF) were running out of testing kits, protective equipment and oxygen. At least two COVID-19 treatment centers stopped their activities due to the lack of supplies.
These supply challenges are largely aggravated by the lack of a cross-border mechanism to deliver aid. In its absence, northeast Syria depends on the regime’s willingness to authorize aid shipments, leaving the region “woefully underserved,” according to MSF.
The shortcomings of cross-line aid in northeast Syria cast a dark shadow for northwest Syria, where four million people brace for a similar fate should Russia veto the renewal of the cross-border aid mechanism, set to expire on July 10.
The early death of Al-Yaroubiah crossing
Northeast Syria used to receive much of its medical aid through al-Yaroubiah crossing at the border with Iraq, used by the UN to bring aid into the region without transiting it through Damascus.
In 2014, the UN agreed to establish a cross-border mechanism to reach all areas of Syria despite the lack of consent from the regime. It consisted of four crossings: Al Yaroubiyah in the northeast, Al-Ramtha in the south, and Bab al-Salam and Bab al-Hawa in the northwest.
From the first UN shipments in early 2018 until its closure in January 2020, 19 UN shipments crossed through al-Yaroubiah, comprising 109 trucks of mostly medical supplies. At least fifty medical facilities were supplied solely through cross-border shipments, the UN reported, and many more relied significantly on al-Yaroubiah to get supplies.
In 2019 alone, 210 tons of medical equipment were shipped through the crossing. In parallel, 451 tons of medical equipment were delivered by air from Damascus, but many facilities in northeast Syria “could not be reached with supplies sent by air from Damascus,” a UN report revealed.
One and a half years after the closure of al-Yaroubiah, the dire situation in northeast Syria clearly shows that cross-line is no alternative to cross-border aid.
“The Yaroubiah border crossing was the most reliable, the most regular, and the most cost-effective mechanism for bringing medical supplies to northeast Syria,” Alexandra Matei, Advocacy Director for the INGO World Vision’s Syria response, told Syria Direct.
But in January 2020, al-Yaroubiah closed, with dire impacts on NGOs and UN agencies operating there and on 1.4 million people in need.
“Since the closure of the Yaroubiah crossing, there have been immense challenges at all stages of program cycles,” Kelly Petillo, Middle East and North Africa Programme Coordinator at the European Council on Foreign Relations (ECFR), told Syria Direct.
“The closure of al-Yaroubiah basically resulted in the direct closure of 19 health facilities and has seen Syrian authorities stripping medical supplies that were headed across the lines,” she added. Beyond supply chain challenges, several dozen NGOs were impacted by the loss of new UN funding for the cross-border response in northeast Syria.
In June 2020, around twenty INGOs unsuccessfully urged the UN Security Council (UNSC) to reopen the crossing. “Only about 31% of the healthcare facilities that were previously supported through al-Yarubiyah have been supplied,” they stated, “and NGOs are unable to fill the gaps.”
The Russian agenda
Since its direct military intervention in Syria in 2015, Russia has pushed to close one crossing after the other, successfully removing al-Yaroubiah and al-Ramtha from the UN cross-border resolution in January 2020, followed by Bab al-Salam in July 2020.
Through increased aid flows, the Assad regime hopes to attract foreign currencies and siphon part of the funding.
Bab al-Hawa, the last crossing that remains – described as a ‘lifeline’ to four million people trapped in the last opposition-held enclave in northwest Syria – is now poised for the same fate as Russia threatens to veto the renewal of Resolution 2533 (2020), set to expire on July 10.
Russia claims that cross-border aid violates Syria’s sovereignty, and proposes to channel aid through Damascus via three government-controlled crossings. This stems partly from the desire to extract concessions from Western counterparts at the UNSC, and from economic interest on behalf of the regime.
Through increased aid flows, the Assad regime hopes to attract foreign currencies and siphon part of the funding by imposing unfavorable exchange rates on humanitarian organizations working through Damascus.
At the same time, cross-line aid “will help revive the economy and create business opportunities through subcontracting and local procurement, which have a tendency to be seized by powerful regime-connected actors,” Aron Lund, a fellow with the New York-based Century Foundation, told Syria Direct last year.
A failing alternative
However, one and a half years after the closure of al-Yaroubiah, the dire situation in northeast Syria clearly shows that cross-line is no alternative to cross-border aid.
In the year following the closure of the crossing, only one UN road convoy successfully made it from Damascus to the northeast. More recently, it took over a month for the government of Syria to ship around 17,000 vaccine doses to the areas controlled by the SDF-affiliated Autonomous Administration.
Aid deliveries suffer repeated delays because all cross-line convoys require approval from Damascus. This is a painstakingly slow process averaging three to four months according to the UN, and which can take up to 16 months according to a report by NGOs working cross-line.
The convoys are also subjected to the unpredictability of humanitarian access in a territory controlled by a plethora of armed groups. “Many times, some INGOs trying to reach the northeast cross-line were completely turned around at government checkpoints,” Petillo stressed.
It took over a month for the government of Syria to ship around 17,000 vaccine doses to the areas controlled by the SDF-affiliated Autonomous Administration.
Humanitarian organizations also denounce the lack of transparency of cross-line deliveries, and repeated diversion of aid committed by regime officials at all stages of the supply chain.
Past experiences with cross-line aid in other parts of Syria, such as in besieged East Ghouta, show that the international community is powerless against such attempts.
“The UN can only do so much. They can load all the supplies on the trucks, but Syrian military and intelligence services could do what they want with those trucks,” John Dautzenberg, the head of advocacy for the Syrian American Medical Society (SAMS), the largest medical NGO in northwest Syria, told Syria Direct.
“Our experience in Eastern Ghouta is that cross-line aid was a failed experiment,” Dautzenberg stressed. “Because when you transition to solely cross-line assistance, then humanitarian aid becomes controlled by men with guns.”
The scale of needs
Even if the regime really wanted to facilitate cross-line assistance, no one believes this would meet the scale of the needs in northwest Syria.
“Right now, you have 2.4 million people being reached every month by cross-border aid,” Dautzenberg added. “The current estimates are that maybe NGOs can scale up and help 300,000 people.”
“Not one single food basket has made it cross-line to northwest Syria. How are we to believe that, starting a month from now, they will be able to send [hundreds of thousands of] food baskets each month ?”
The logistical role played by UN agencies in northwest Syria is enormous. The World Food Programme (WFP) supports over 1.4 million people with food baskets every month and provides around eighty percent of the food assistance in northwest Syria.
“To this day, we have not had one single cross-line delivery from Damascus or any government area into northwest Syria. Not one single food basket has made it cross-line to northwest Syria,” Dautzenberg highlighted. “How are we to believe that, starting a month from now, they will be able to send [hundreds of thousands of] food baskets each month when they haven’t been able to send one in the past years?”
The stakes are particularly high as a second WHO shipment of vaccines is set to reach northwest Syria in July. Approximately 53,000 doses were delivered in April through Bab al-Hawa, and the possibility to deliver the second batch is entirely contingent on whether the crossing remains open.