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Syria: Russian Veto Would Shut Down Last Aid Lifeline

UN Should Reauthorize Crucial Help from Neighboring Countries

Millions of Syrians risk losing access to lifesaving aid, including during the Covid-19 pandemic, if Russia vetoes reauthorizing the only remaining UN aid corridor from Turkey into opposition-held northwest Syria, Human Rights Watch said today. The United Nations Security Council should reauthorize full cross-border operations into the region and authorize a resumption of aid flows from Iraq to northeast Syria when the Council’s current resolution expires on July 10, 2021.

The UN humanitarian chief has said that shutting down this gateway into northwest Syria, which is under the control of anti-government groups, would be “catastrophic.” Non-UN aid groups in northeast Syria, which is mostly under the control of the Kurdish-led Autonomous Administration, a quasi-autonomous authority, say they have been unable to bring in enough aid since the UN was forced to stop its cross-border operations between Iraq and Syria in January 2020. As of May 31, only 17,500 Covid-19 vaccine doses for healthcare workers and only limited other supplies to respond to the pandemic have reached the northeast from Syria’s capital, Damascus, and no aid reaches the northwest from there.

“Shutting down the only remaining UN lifeline into northwest Syria would cut off millions of people from aid and unleash a humanitarian calamity,” said Gerry Simpson, associate crisis and conflict director at Human Rights Watch. “The people of northwest Syria, and millions of others in the northeast, should receive help, including Covid-19 vaccines and other crucial healthcare supplies, through all possible routes.”

Between April 14 and May 6, Human Rights Watch interviewed 11 aid workers from 10 different international and local nongovernmental organizations operating or supporting operations in northwest and northeast Syria about the humanitarian situation there and the obstacles they faced in assisting people. Human Rights Watch sent questions on May 31 to the Syrian government, but as of June 10 had not received a reply.

UN Security Council (UNSC) negotiations on an extension of cross-border aid access to areas in northwest Syria are underway. But in February, Russia signaled its intention to shut down the final remaining crossing, through Bab al-Hawa, when it comes up for a Council vote ahead of the July 10 expiration.

Ten years of conflict have decimated Syria’s infrastructure and social services, resulting in massive humanitarian needs and making millions of people reliant on aid. About 13 million Syrians needed humanitarian assistance as of early 2021.

Most of northwest Syria’s population of about 4 million, including at least 2.6 million displaced people, depend on humanitarian aid. As of mid-April, about 55,000 doses of Covid-19 vaccines had reached the northwest region through Turkey. The UN has said that it is unclear how vaccines would reach the region if the Security Council does not reauthorize the Bab al-Hawa crossing.

In January 2020, the Security Council canceled the authorization for the UN to use the Yarubiyah border crossing between Iraq and northeast Syria. This has reduced aid groups’ ability to support the struggling healthcare system there and to address the Covid-19 pandemic. Available statistics show that between about 11,000 and 16,000 people have been infected by the virus in the northeast, but aid groups and the UN say the real number is most likely much higher due to the limited availability of testing. In early May, Doctors Without Borders (MSF) said that “many hospitals are raising alarms and requesting basic essential support for items like oxygen, antibiotics, and personal protective equipment to cope with the increasing numbers of Covid-19 patients.”

The Syrian government has a long history of obstructing what is known as “cross-line” aid, supplies crossing from government-held parts of the country into non-government-held parts in the northwest and northeast. Russia has been unable or unwilling to pressure Damascus to allow aid to reach the northwest and to increase aid to the northeast.

In 2014, the Security Council recognized the Syrian government’s “arbitrary and unjustified withholding of consent to relief operations and the persistence of conditions that impede the delivery of humanitarian supplies” and authorized UN agencies to take supplies from Turkey, Iraq, and Jordan into northwest, northeast, and southern Syria respectively.

However, responding to Russia’s threat to veto the mandate, on January 10, 2020, the Security Council officially removed two of the authorized border crossings, halting all UN cross-border aid into northeast and southern Syria. In July 2020, the Council also removed the Bab al-Salam crossing point, leaving the Bab al-Hawa crossing point as the only UN-coordinated option for aid groups into northwest Syria.

The 2014 resolution also authorized UN agencies to receive emergency funds for UN and international and Syrian nongovernmental groups’ aid programs, and to coordinate aid operations there. A senior UN official told Human Rights Watch that if the Security Council does not renew the July 2020 resolution authorizing the flow of aid from Turkey to northwest Syria, UN agencies will no longer have official authorization to procure supplies or carry out or finance others’ aid work.

Aid workers told Human Rights Watch that non-UN agencies have nowhere near the UN’s capacity to buy supplies and transport them into the northwest. They said that shutting down UN aid supplies through Bab al-Hawa and ending UN funding, including for thousands of doctors’ and nurses’ salaries, would deny aid to millions of people. The UN has repeatedly echoed those concerns in numerous reports and briefings to the Security Council, including at the end of May.

All aid workers Human Rights Watch interviewed said the simplest solution to the ongoing restrictions on aid from Damascus to northeast Syria involves reauthorizing aid, including Covid-19 vaccines and other supplies, through the Yarubiyah crossing.

Under the laws of war, Syria has an obligation to allow and facilitate the rapid and unimpeded passage of humanitarian aid for civilians in need and may not withhold consent for relief operations on arbitrary grounds. All other parties to the conflict, including Russia, and other relevant countries, must also allow and facilitate such aid.

Syria also has an obligation under human rights law to ensure the right to health, and to an “adequate standard of living,” including to food and shelter. Although limited resources and capacity may mean that this right can only be fully realized over time, the authorities are still obliged not to discriminate between various parts of the population, and they must justify any aid delivery limitations. The authorities must also ensure a “minimum core” standard of living for everyone at all times, including adequate food.

In July, the UN Security Council should reauthorize cross-border operations into northwest and northeast Syria and grant explicit permission for cross-border aid delivery to those regions through Bab al-Hawa, Bab al-Salam, and the Yarubiyah border crossings for one year.

International donors should press the Syrian authorities to facilitate the transfer of aid into all parts of northeast Syria and into the northwest, and not to block access on arbitrary or discriminatory grounds, or on the pretext of bureaucratic delays.

“It is shocking that the idea of abandoning millions of aid-dependent Syrians is even on the UN Security Council’s table,” Simpson said. “All of its members, including Russia, should focus on saving lives, not sacrificing them for political gain.”

Massive Humanitarian Response in Northwest Depends on the Turkey Crossing

As of the end of March, 75 percent of the 4 million people in northwest Syria depended on aid to meet their basic needs and 85 percent of them receive it via about 1,000 trucks crossing the border each month from Turkey, according to the United Nations. A UN document obtained by Human Rights Watch shows this includes basic aid such as food, medical supplies, and shelter materials, which UN and non-UN agencies distribute throughout the region.

Aid workers told Human Rights Watch that non-UN international and local aid groups would be unable to buy, bring in, and distribute anywhere near the same amount of aid as the UN currently supplies to northwest Syria. In 2020, the UN World Food Program brought in and distributed emergency food aid to 1.4 million people a month on average. One aid worker said that under the best-case scenario, under which aid groups might receive a significant increase in their funding, as well as procurement and logistical support, they could reach about half that number.

UN humanitarian aid trucks enter northwest Syria through the Bab al-Hawa border crossing with Turkey on June 1, 2021. © 2021 Associated Press

According to three aid workers, the UN’s budget and resources allow it to purchase far greater amounts of aid at a time than aid groups can, and only the UN can purchase some supplies, including anaesthetics and medicines to treat tuberculosis and leishmaniasis, a parasitic disease which can affect internal organs and cause skin sores.

Aid groups said that the UN gave US$300 million in 2020 for aid to northwest Syria, including $190 million under the multi-donor Syria Cross-Border Humanitarian Fund (SCHF), which funded 204 projects. Of this, $90 million funded the work of Syrian groups that would lose this support if Bab al-Hawa were not reauthorized. 

Aid workers said that while international aid agencies could try to replace some of this funding through private donors, many Syrian aid organizations are not allowed to receive funds from non-UN international donors due to internationally-imposed financial and legal restrictions on their work. The most senior health official in Idlib governorate, the health coordinator, Dr. Salem Abdan, said that the UN pays the salaries of Idlib’s 800 doctors and 2,000 nurses, either directly or through partner organizations. An aid worker said that UN funding procedures allow aid groups to apply for, and rapidly receive, additional UN funds to respond to emerging crisis situations affecting a large number of civilians, such as the periodic Russian-Syrian offensives in the region, whereas other donors are less flexible in releasing emergency funding.

On March 29, Mark Lowcock, the UN under-secretary-general for humanitarian affairs and emergency relief coordinator, said that months of negotiations with the Syrian authorities to allow what is known as “cross-line” aid – sent from government-held territory to territory held by armed groups – to reach northwest Syria from Damascus had been unsuccessful. On May 26 he expressed hope that “at least an initial set of convoys” could soon cross. As of June 10, this had not happened.

Even if the authorities in Damascus were to agree to let some cross-line aid reach the region, the government is known to regularly impose severe restrictions on aid and humanitarian access to opposition-held areas in northeast Syria. It is also known to favor areas perceived to be pro-government in territory under its control. Most aid groups working with the UN in the northwest to distribute aid are not registered, or allowed to register, in Damascus. This means that even if the UN could bring aid to the region from Damascus, it would have no way to distribute it because the Syrian authorities prohibit the UN from having direct contact with non-UN aid groups working in nongovernment-controlled areas. According to two aid workers, authorities in northwest Syria also refuse to allow Syrian government-affiliated local organizations from operating in areas under their control.

In January, the offices of the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) in the Turkish city of Gaziantep, which work on the aid response in northwest Syria, submitted an application to the COVAX facility for Covid-19 vaccines. COVAX is a global vaccine initiative created to help low- and middle-income countries access vaccines by sharing risk and pooling procurement. It began delivering vaccines to participating countries and economies in February, but has only been able to deliver 78 million vaccine doses to 129 participants by June 3, barely enough to cover 1 percent of their combined populations.

The UN Security Council’s cross-border authorization means that UNICEF and the WHO in Turkey have been able to get vaccines from COVAX and deliver them to northwest Syria, demonstrating how critical continued cross-border authorization is to people’s lives and health. As of April 21, 53,800 doses of Covid-19 vaccines had been delivered. On May 1, UNICEF and the WHO began to coordinate a three-week vaccination campaign there targeting healthcare workers.

Aid workers said that if UNICEF and the WHO are no longer able to bring Covid-19 vaccines in from Turkey, the vaccination process will stop entirely as they are the only agencies currently authorized under the application to COVAX to receive and distribute the vaccines. Aid workers said that UN agencies are also responsible for setting up the infrastructure – including for cold chains that prevent supplies from spoiling while being transported from warehouses to their final destination – that are needed to deliver vaccines, and that non-UN agencies do not currently have the capacity or mandate to do so.

In late April, Lowcock, the UN humanitarian chief, said that “it is not clear how future [Covid-19 vaccine] deliveries could reach northwest Syria unless you confirm the re-authorization of UN cross-border access.”

Aid Through Iraq Needed to Address Covid-19, Other Health Needs in Northeast

Health Needs in Northeast Syria

As of April, 1.8 million people living in nongovernment-held parts of northeast Syria needed humanitarian assistance, with over 70 percent of them in “extreme need.”

The region’s healthcare system, run by the Kurdish-led Autonomous Administration for northeast Syria, has been heavily affected by 10 years of conflict and Turkey’s October 2019 military offensive. Lowcock said that as of March, 70 percent of the population is considered to be in extreme need because “the availability and accessibility of health care in the north-east is insufficient,” and because “few health issues are adequately addressed due to the limited functionality and capacity of health-care facilities, the lack of adequately trained medical staff, and shortages of essential medicines.” In late May he said the region “continues to lack essential health supplies, including to prevent, test and treat Covid-19 infections.”

End of UN Aid from Iraq to Northeast Harms Covid-19 and Broader Healthcare Response

Between 2014 and early January 2020, the UN Security Council authorized UN agencies to deliver aid to northeastern Syria through a single border crossing, from Rabia village in Iraq to al-Yarubiyah town in northeast Syria, without the Syrian government’s permission.

Due to security concerns, the UN’s cross-border operations only started in April 2018. Aid groups said that throughout 2019, their healthcare programs in northeast Syria heavily depended on supplies from the WHO, UNICEF, and the UN Population Fund (UNFPA) through al-Yarubiyah. The UN secretary-general’s February 2020 report on cross-border aid to northeast Syria also said that in 2019, only a limited number of healthcare facilities in northeast Syria received supplies from agencies or the authorities in Damascus and that most relied heavily on supplies received from the UN in Iraq, delivered through al-Yarubiyah.

The UN Security Council deauthorization of the Yarubiyah border crossing in January 2020 resulted in an immediate end to the UN cross-border operations from Iraq into northeast Syria. Since then, UN agencies based in Damascus are only authorized by the Syrian authorities to provide aid from government-held parts of the country to some parts of the northeast.

Aid groups said that since 2015, the Kurdistan Regional Government in Iraq has also allowed them to use other commercial border crossings from the Kurdistan Region of Iraq to deliver aid, including some healthcare supplies and personnel, to northeast Syria and that this has continued since January 2020. However, they also say that they have been unable to match the amount of aid the UN used to deliver through al-Yarubiyah and have been unable to respond adequately to the health needs in northeast Syria since the UN ended its supplies.

According to aid groups, al-Yarubiyah’s deauthorization meant that 19 out of 50 UN-supported healthcare centers were forced to close between 2020 and March 2021. They said that between March and August, aid groups taking medical supplies into the region through commercial border crossings were unable to buy medication in, or import medication into, the Kurdistan Region of Iraq due to Covid-19-related transport restrictions there. This caused shortages of some essential medicines, including anesthetic and insulin.

The same aid agencies also said that since March 2020, problems in bringing in coronavirus testing kits have repeatedly caused the only coronavirus testing laboratory managed by the Autonomous Administration’s Department of Health, in Qamishli, to run out of kits. In early May, Doctors Without Borders said that the laboratory had only a two-week stock of coronavirus testing supplies.

Aid groups also said that they and other groups have struggled to supply healthcare centers in the region with certain types of drugs, including insulin, psychotropic medicines, and medicines for noncommunicable diseases. They say this is because they are unable to guarantee the cold chains needed to take the drugs to their final destination due to unpredictable administrative and transportation delays involved in using commercial border crossings between the Kurdistan Region of Iraq and northeast Syria. They say that because of this and the UN’s inability to reach many nongovernment-held areas through cross-line aid, regular vaccination programs have faced serious interruptions in some areas, including in Kobani and Manbij sub-Districts.

Aid groups said it has been extremely difficult for them to bring in nutrition supplies and reproductive health kits because they have not been able to buy them in the Kurdistan Region of Iraq and because it is too expensive to bring them in from elsewhere.

In April and May, Lowcock said non-UN aid agencies working in the northeast “have been clear … that the loss of … al-Yarubiyah has left the region woefully underserved in health services” and that the “overall, the [humanitarian] situation has worsened since the removal of the Yarubiyah authorized border crossing in January of last year.” In late March, he said that those agencies reported “imminent stock-outs of critical medicines like insulin, and cardiovascular and antibacterial medicines in multiple facilities” and that “neither cross-line support [from Damascus] nor increased cross-border shipments by NGOs [nongovernmental organizations] have since proved a sufficient replacement” for the aid the UN used to supply through the Kurdistan Region of Iraq.

An aid worker said that the closure of al-Yarubiyah meant UN agencies had to stop funding aid groups in nongovernment-controlled parts of northeast Syria, including through the Syria Cross-Border Humanitarian Fund, and that as a result those groups lost $26.8 million in funding overnight for their work in 2020 in northeast Syria. Aid groups said that private and bilateral donors stepped in to help reduce the loss of funds but that between September and December, they still had a budget shortfall of about $7 million.

Aid groups also said that as the humanitarian situation in northeast Syria deteriorates, they require more financial support, but that their funding is decreasing and that a re-opening of the Yarubiyah crossing would help fill this gap by allowing the UN to resume its funding of aid operations in the northeast.

In late March, Lowcock said that “available resources will only cover 40 percent of estimated health supply needs for north-east Syria for 2021” and that “at least nine NGO-supported health facilities will close in the coming months if additional funding is not secured.”

As of April 4, the authorities in the northeast had reported 10,509 Covid-19 cases, 450 of them fatal, with cases rising dramatically in March. According to statistics collected by non-UN aid groups and healthcare workers across northeast Syria responding to the Covid-19 pandemic, at that time there were at least 15,000 positive cases. The same statistics show that 42 percent of coronavirus tests since July 2020 were positive. Aid workers said that this indicates a high likelihood of under-testing in the region, while Doctors Without Borders said that “it is clear that many cases have gone unidentified due to limited testing capacity in the region.”

The January 2020 closure of al-Yarubiyah means UN agencies cannot fund Covid-19-related work by aid groups in northeast Syria that are not registered in Damascus, those groups said. Some groups said that the resulting funding cuts have led to a severe shortage of personal protective equipment and other medical supplies in healthcare facilities designated for treating Covid-19, including testing kits and oxygen.

In early May, Doctors Without Borders said that the lack of supplies to prevent and treat Covid-19 in the region was “shocking.” One aid worker said that in one case, a non-UN agency had tried to bring 10,000 PCR tests from the Kurdistan Region of Iraq but that administrative and logistical delays meant that the kits were almost expired by the time they were ready to ship, which led the testing laboratory in Qamishli to reject them before they had even left Erbil.

Three aid workers said that the funding cuts also forced aid agencies in March and April to stop supporting 12 out of 20 facilities designated to treat Covid-19 in northeast Syria, as well as a vaccination center in Manbij and the city’s main hospital’s vaccination department. According to numerous aid agencies working in northeast Syria, two others were also forced to shut in March and May, leaving only six open. This includes a facility in western Deir al-Zour under the control of the Autonomous Administration that an aid worker said is due to close on June 20 due to a lack of funds.

The same aid groups said that as of early May, only Hassakeh governorate had facilities to treat severe Covid-19 cases, with none in the other three governorates of Aleppo, Deir al-Zour, and Raqqa. They also say Raqqa and Deir al-Zour governorates, under the control of the Autonomous Administration, only had two Covid-19 treatment facilities each, with one in Deir al-Zour likely to close on June 20 due to a lack of funding.

An aid worker said that the funding cuts also mean non-UN aid groups have had to reduce their support to the testing laboratory in Qamishli.

Limited Aid Reaches Northeast Syria from Damascus

When Russia threatened to veto the Security Council’s renewal of the entire cross-border aid mandate in December 2019, it contended that it was no longer necessary as those areas were under the Syrian government’s control and could be reached from Damascus and that aid had been previously taken by “terrorists.” When Moscow again threatened to veto the entire mandate in January 2020, it said that the Yarubiyah crossing point from Iraq into northeast Syria was “totally irrelevant because humanitarian assistance to that region is coming from within Syria.”

However, the amount of healthcare aid reaching northeast Syria from Damascus is significantly lower than the amount that reached the region through the Yarubiyah border crossing before the UN stopped using it in January 2020.

Statistics seen by Human Rights Watch make clear that in 2019, the total storage space the UN used in all parts of northeast Syria was 4,680 metric tons, but that this decreased to 1,600 metric tons in 2020. A UN staff member said that it roughly reflected the decrease in aid received in the region from the UN.

In April, Lowcock said that “while the UN has scaled up cross-line deliveries, needs continue to outstrip our ability to respond. Many medical facilities remain short of the necessary supplies and equipment.”

Two aid workers said that UN agencies in Damascus still do not have permission from the authorities there to work in most nongovernment-held parts of northeast Syria. Another aid worker said that the WHO and UNICEF support government-held parts of northeast Syria, but that the amount of aid they provide to nongovernment-held parts of the region is limited to supporting other aid groups in a number of formally recognized camps for internally displaced people and to outreach work in a few urban areas.

They said this means that the vast majority of people in nongovernment-held parts of the region receive no healthcare-related aid from the UN and that aid groups not registered with Damascus supply those areas with aid from the Kurdistan Region of Iraq. An aid worker confirmed that those groups still cannot receive supplies directly from UN agencies in Damascus.

An aid worker said that WHO and UNICEF healthcare supplies transferred through al-Yarubiyah until January 2020 were taken to Kurdish Red Crescent (KRC) warehouses in northeast Syria from where non-UN aid groups collected the supplies. A second aid worker confirmed that the Kurdish Red Crescent remains those groups’ largest partner in the region and is responsible for most aid distribution there. A third aid worker said that in contrast, the UN in Damascus is often unable to get healthcare supplies to the Red Crescent, resulting in shortages of pediatric and noncommunicable- disease-related supplies in UN-supported primary healthcare centers. She also said that the UN in Damascus struggles to deliver supplies to the northeast Syria Autonomous Authorities’ Department of Health, particularly in Raqqa, Manbij, and Kobane, with the vast majority of supplies going instead to government-run hospitals or health committees in the region.

An aid worker said that aid groups working in northeast Syria that are registered in Damascus continue to face significant longstanding obstacles in transporting materials and personnel from Damascus to non-government-controlled areas of northeast Syria.

Another aid worker said that the WHO only sporadically supports one laboratory in one government-run hospital in Qamishli with PCR tests, and that the hospital carries out about 15 coronavirus tests a day. He also said that neither the WHO nor UNICEF deliver coronavirus testing materials from Damascus to the main laboratory in Qamishli, managed by the Autonomous Administration’s Department of Health, which carries out about 500 coronavirus tests a day with the help of non-UN aid groups, and do not support Covid-19-related case management, surveillance or mobile testing there because the Syrian government has not given them permission.

Aid workers also said that aid groups have no insight into whether supplies arriving in the northeast from Damascus are going to health facilities in areas controlled by the government in the region or nongovernment actors.

Covid-19 Vaccination Gaps in Northeast Syria

The Autonomous Administration in the northeast has not attempted to make its own application to the COVAX facility for Covid-19 vaccines. As a result, people in the northeast can currently only receive Covid-19 vaccines under Syria’s National Vaccination Deployment Plan, which says the authorities in Damascus and various “sub-national committees” are responsible for distributing them. Just over 350,000 doses of Covid-19 vaccines had reached Damascus by late April. An aid worker said that as of early June, 17,500 had been transferred to the northeast. According to the National Deployment and Vaccination Plan for Syria, they were transferred to the Qamishli airport with the WHO’s support. An aid worker said that those doses are supposed to be distributed to healthcare workers in government and nongovernment-held parts of al-Hassakeh governorate and to nongovernment-held parts of Deir al-Zour governorate.

Three aid workers said that as of early June, there was no arrangement for the authorities in Damascus to hand over any of the vaccines to the Autonomous Administration in northeast Syria. However, one said that the Syrian authorities are considering a procedure under which health workers in nongovernment-held areas could register with Autonomous Administration-run hospitals to receive a “vaccination slip,” which they could present at designated hospitals in both government and Autonomous Administration-held areas.

According to two aid workers, nongovernment-held parts of northeast Syria that the UN in Damascus is not allowed to serve as of early June include Kobane sub-District, with a population of about 90,000 and Manbij sub-District, with a population of about 250,000. They also said that the Syrian authorities’ prohibition on the UN having direct contact with non-UN aid groups working in nongovernment-controlled parts of northeast Syria means those groups cannot help the UN reach Kobane, Manbij, and other areas that are off-limits to the UN to distribute Covid-19 vaccines.

Recommendations

The UN Security Council should immediately reauthorize cross-border operations into northwest Syria through Bab al-Hawa and authorize such operations through Bab al-Salam to the northwest and through al-Yarubiyah to northeast Syria by granting explicit permission for cross-border aid delivery for one year.

Russia should not oppose a UN Security Council reauthorization and authorization of border crossings to the northeast and northeast, especially as cross-line delivery of healthcare-related supplies from Damascus to northeast Syria remains insufficient, and there is no cross-line delivery of aid to northwest Syria. Russia should also use its influence to pressure the Syrian authorities to allow UN and non-UN aid agencies unimpeded humanitarian access to all areas in Syria, including areas not under the Syrian government’s control.

The Syrian government should immediately facilitate unimpeded access for UN and international aid agency staff to all areas of Syria, including areas not under Syrian government control. It should also ease restrictions that create undue bureaucratic delays around medical supplies and other aid reaching northeast Syria and allow aid groups to conduct independent needs and rights assessments and assist people on the basis of need, without any political constraints.

The WHO, the UN secretary-general, the UN under-secretary-general for humanitarian affairs and emergency relief coordinator and the resident humanitarian coordinator in Syria should continue to press the Syrian authorities to allow WHO and other UN agencies in Damascus to provide aid supplies and personnel to all parts of Syria in an equitable manner and based purely on an objective needs assessment. They should also support international aid groups’ ability to procure urgently needed medical supplies that may not be commercially available in the region or elsewhere by providing access to the UN’s preferred vendors and supply chains. They should also explicitly and publicly advocate reauthorization and authorization of all three cross-border aid points in northern Syria, two in the northwest and one in the northeast.

International donors to the UN, including the US and the EU, should press the Syrian authorities to allow medical supplies and personnel to reach all parts of northwest and northeast Syria. Donors should also ask the UN resident coordinator in Damascus to provide regular updates of how many requests the UN, WHO, and international aid groups have submitted to the Syrian authorities to take aid from Damascus into the northwest and northeast, how many have been refused and on what grounds, how swiftly the rest have been approved, and how many of the supplies and staff have reached areas under government and non-government control. Such updates  should specify how the aid provided compares to  humanitarian needs in each area.

Donors should ask the UN Security Council to reauthorize UN agencies’ use of all available border crossing points to help supplies and staff reach northwest and northeast Syria. The secretary-general and emergency relief coordinator should continue to press the council to do so, while exploring ways to continue to ensure that lifesaving aid continues to move across borders if the mandate is not fully restored.

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