DISASTER NEEDS ANALYSIS 21 June 2012

UPDATE SYRIA CONFLICT

Crisis Overview
Internal conflict has escalated over 16 months into a situation that, according to the ICRC, amounts to a non-international armed conflict in some areas. There are daily armed clashes between the military, pro-government militias, and a loosely organised opposition in civilian centres. Civilians believed to support the opposition have been trapped in towns and cities under heavy bombardment. In recent weeks protection concerns and humanitarian needs have increased. There have been over 16,000 reported killings since March 2011. The UNHCR has registered around 77,000 people who have fled Syria. However, the actual number of refugees is estimated to be much higher. Estimates for the number of IDPs range between 300,000 to 500,000.

Conflict affected areas

Clashes and casualties have been reported in the provinces of Idleb, Homs, Hama, the country side of Damascus, and Dara, and to a lesser extent in Aleppo, Damascus city, Lattakia and Dayr Az Zor. The northern provinces of Al- Hassakeh, Raqqa, the southern provinces of As Suweida, Al Qunaytirah and the eastern provinces of Tartous have seen modest demonstrations but have had little violence.

The impact of economic, finance and trade sanctions on Syria has increased as had been projected in the ACAPS scenario in February, crippling the economy and reducing access to food and basic services. The deepening economic crisis is expected to further erode livelihood opportunities and reduce access to basic goods. Concerns that pre-existing regional tensions will be aggravated by the conflict in Syria are increasing. Cross border incidents, abductions of nationals and foreigners, and refugee flows to neighbouring states have grown proportionally with the increasing violence. In Lebanon, simmering tension fuelled by the revolt in Syria has led to clashes in the northeast. The Joint Special Envoy of the UN, Kofi Annan, and the League of Arab States introduced a six point peace plan, which includes a ceasefire that should have taken effect on April 12 but did not take hold. In April, the UN Security Council established a UN supervision mission with 300 observers. Due to the intensification of armed violence, the observer mission was suspended on the 16th of June. An international intervention remains a valid option, although a disputed one. More support has been voiced over the creation of a buffer zone or humanitarian corridors.

Priority concerns
Poor access to basic commodities and essential services for the civilian population in

besieged areas.
Insecurity and economic sanctions have contributed to inflation and high food and

commodity prices, impacting food security nationwide.

Restricted humanitarian access in conflict affected areas. Lack of access to health care in conflict affected areas. Medical personnel and

patients have been subjected to torture and arrest.

Violence against children, indiscriminate attacks on populated centres, torture, sexual

abuse and extra judicial killings are major protection concerns.

Refugees and IDPs lack access to livelihood opportunities and are dependent on

humanitarian aid. Shelter is a pressing issue for the displaced Syrians.

Limitations on information on humanitarian needs.

Information Gaps and Needs

Information on the specific areas under attack and neighbourhoods under siege as well as information on the distribution of control over the different areas. Numbers of IDPs, their priority needs and their locations. Information on level of food insecurity, particularly for areas affected by conflict. Data on refugee numbers and location within Iraq, Jordan, Lebanon and Turkey. Data on needs of separated and unaccompanied children and other vulnerable groups. Information on the extent of sexual and gender-based violence. Capacity and coverage of existing health facilities. Information on use and availability of water sources.

UN vehicles are frequently shot at. At least two roadside bombs have targeted UN convoys (UN 2012/06/07). On January 25, the SARC Secretary General was killed while traveling in a vehicle clearly marked with the Red Crescent emblem (SARC, 2012/01/25).

Logistical constraints Aid workers have questioned whether the UN would have the capacity to deliver if full access to affected areas was granted; they point to challenges recruiting the right people, a lack of aid infrastructure in Syria, and heavy restrictions imposed by UN security rules (IRIN 2012/06/08). Delays in receiving GoS approvals and tax exemptions for receiving food and nonfood items have previously occurred (LogCluster 2012/01/17). However, the GoS has promised to lift bureaucratic blockages to aid, delays in issuing visas, and to improve clearing of shipments at customs (IRIN 2012/06/08). Within the conflict affected areas, movement for civilians is limited and obtaining relief supplies can be dangerous due to shelling and the presence of snipers.

Humanitarian framework
Humanitarian Access The ICRC and Syrian Red Crescent (SARC) recently reported access to "almost everywhere" in Syria (AJ 2012/06/11).The SARC is coordinator and exclusive channel for all humanitarian assistance in Syria. (IFRC 2012/06/14). The Government of Syria (GoS) has recently granted nine UN agencies and seven international NGOs access to conflict areas. GoS also allowed the UN to set up field offices in four locations: Dara, Dayr Az Zor, Homs (also covering Hama) and ldlib. Reconnaissance missions for the establishment of these presences were deployed on June 3 (IRIN 2012/06/08, UNOCHA 2012/06/05). However, new international NGOs have not yet been allowed to enter Syria to scale up aid. NGOs like Save the Children and Mdecins sans Frontires, which have repeatedly tried to gain access to Syria, remain outside the country (IRIN 2012/06/08). 44 specific projects have been allowed, with the GoS maintaining a strong level of control in all relief operations (IRIN 2012/06/08).

During military operations, electricity and communications are cut off for days at a time disrupting communication and operations in health centers (IRIN 26/09). Means of telecommunication are limited (PI 2012/06/20).

On-going and Planned Assessment

WFP and FAO are currently conducting a food security assessment in several governorates (PI 212/06/18). UN teams will work together with SARC to assess needs in Dara, Dayr Az Zor, Homs) and ldlib (UNOCHA 2012/06/05).

Recommendations for Further Assessments

Rapid multi-sectoral assessment in accessible conflict affected areas. Displaced populations can function as key informants on the situation in non-accessible areas. Mapping of on-going and planned assessments (Survey of Surveys) IDP profiling Sex and age disaggregated data is needed to improve the analysis of specific needs of sub-groups of the population.

Safety of humanitarian workers Humanitarian workers in Syria face threats to their lives (UN, 2011/10/2). Medical personnal are deliberatly targeted and subject to arrest and torture by the security forces (Amnesty 2012/06/14).

Displacement Profile
IDPs Estimates of IDPs displaced by the current unrest range between 300,000 and 500,000 (UN 2012/05/29, Syrian Arab Red Crescent 2012/05/30). However, there is a lack of information on the exact number, location and needs of the IDPs in Syria. It is likely that displacement follows sectarian lines, with Alawites and Christians fleeing to the relatively safe provinces of Tartous and Lattakia on the west coast.

April. This can be attributed to increasing smuggler fees and tightened security control over the Syrian border with Iraq (MAG 2012/06/13, UNHCR 2012/06/18). The main concerns of the population in Domiz camp are the lack of employment and livelihood opportunities, leaving them fully dependent on humanitarian aid. The few that have access to informal jobs are exploited by the employers and often denied salaries (UNHCR 2012/06/5). No major health concerns were reported amongst refugees in Iraq, except for some cases of diarrhoea, skin diseases, and respiratory problems (UNHCR 2012/06/5). A lack of adequate water and sanitation services has been reported in the Domiz camp (IOM 2012/06/12). The medical unit providing aid to refugees in Domiz camp reports that maternal care remains a major need (UNHCR 2012/06/5).

Regional Demography all registered refugees Since the start of the uprising in March 2011, more than 77,000 refugees have been registered in Turkey, Jordan, Lebanon and Iraq (UNHCR 2012/06/18). The numbers depicted in this chapter reflect the number of refugees Source : UNHCR 2012/06/12 officially registered by UNHCR. The actual number is believed to be much higher. In addition, many refugees have assets and do not require assistance at this time. As assets are depleted, more refugees will likely register (RI 2012/06/05, PI 2012/06/21). Of the host countries, only Turkey has ratified the 1951 Geneva Convention relating to the Status of Refugees and its 1967 protocol. Hence, refugees in Jordan, Iraq and Lebanon do not receive refugee status. The Syria Regional Response Plan, launched in March 2012, stipulates the response and coordination structures for these refugees (UNHCR 2012/03/23).

Jordan There are around 25,000 refugees registered in Jordan. However, it is estimated that between 30,000 and 50,000 Syrians have crossed into Jordan since March 2011
(UNHCR 2012/06/05, PI 2012/06/20).

There are currently three official transit sites operating in the north of Jordan: Bashabshe, Cyber City and the King Hussein Stadium. A fourth site is close to completion in King Abdullah Park (OCHA 2012/06/01). There is little information on the food security status of refugees in Jordan. They have limited livelihoods opportunities and are dependent on aid. The MoH has pledged to provide free access to public healthcare centres to registered Syrian refugees (UNHCR 2012/05/24). There are no reports of major health concerns. Syrian refugees are accused of draining Jordans meagre water resources, which is one of the world's 10 driest countries. The majority of Syrian refugees live in the northern cities of Mafraq, Irbid, Ramtha, Jerash and Ajlun. All areas already suffer from water shortage. Increased populations put additional strains on already scarce resources, particularly in relation to water availability and consumption, waste management, sewage systems, energy, health and education (AFP 2012/06/01). Shelter has been reported as a concern, including for those that currently reside in rented accommodation, as it becomes more difficult to access resources needed to pay the rent (PI 2012/06/20).

Iraq Around 5,000 Syrian refugees, primarily Kurds, have been registered in Iraq (UNHCR
2012/06/05).

Most refugees are in the Dohuk governorate, the Kurdistan region of Iraq. Some have found temporary shelter with host families and in mosques, but the majority reside in the Domez refugee camp about 40 miles inside the Iraq border (Reuters 2012/06/13). According to local authorities, an estimated 15 to 30 people cross the border per day. The overall number of arrivals in June remains low in comparison with the month of

Lebanon There are around 27,000 Syrian refugees in Lebanon (19,000 registered individuals, an additional 3,000 Syrian refugees in Tripoli, and 5,000 in Bekaa pending registration) (RI 2012/06/05, UNHCR 12/06/08). The refugees primarily reside in the north of Lebanon, including Tripoli, and Bekaa Valley in the East (UNHCR 12/06/08). Refugees in Lebanon do not receive formal refugee status (which allows for the issuance of work permits), cannot travel freely and do not have access to Lebanese social services. The Lebanese Government recognises incoming Syrians not as "refugees" but as "displaced Syrians" (AJ 2012/04/19). Refugees live in a mix of host families, rented accommodation and public buildings. There are no refugee camps for Syrian refugees. Inadequate shelter conditions and overcrowding is a concern and host family capacity is reaching saturation point (UN
2012/03/01).

Overview map

Syrian migrants in Lebanon, work primarily in construction. If the Lebanese economy continues its downturn, these migrants may register as refugees which could possibly overwhelm current assistance structures (PI 2012/06/18). 78% of refugees depend on humanitarian assistance, ad hoc charity, sharing host families resources and using credit to meet basic needs. Many live with host families who themselves struggle to make ends meet (WFP 2012/04/24). Preliminary findings from a gaps assessment in the north of Lebanon suggest an above normal occurrence of diarrhoea among children, linked to unsanitary conditions and water contamination (UNICEF 2012/06/07). A WASH assessment among Syrian refugees and host communities in North Lebanon discovered alarmingly poor levels of water quality (ACTED 2012/05/24). Recent assessments in Bekaa Valley point to the need for family planning and prenatal care, including nutrition (UN 2012/06/16).

Turkey The number of registered refugees stands at 27,400 (UNHCR 2012/06/12). The refugees are accommodated in Turkish Red Crescent camps in the south eastern provinces of Hatay, Gaziantep, Sanliurfa and Kilis (AFP 2012/06/13). Similar to Jordan, there is no specific data available on the food security situation. Refugees have limited access to livelihood opportunities and it can be assumed that they will be dependent on humanitarian aid for their food needs. There are no reports of major health concerns.

Humanitarian Profile

Affected
Non-Displaced 1,000,000 (UN 2012/06/05)
IDPs 505,000 1,158,000
IDPs displaced by current unrest 300,000 - 500,000 (UN 2012/05/29, Syrian Arab Red Crescent 2012/05/30) Protracted IDPs 205,000-658,000
1982 Hama 10,000-20,000 (IDMC 11/11) Kurds 1965-1976 60,000-140,000 (IDMC 11/11) Golan 1967 70,000-433,000 (IDMC 11/11) Drought Induced 2007/8 and 2008/9 65,000 (ODI 12/2011)

Displaced 1,322,000 2,479,000

Refugees and asylum seekers 1,321,000
Registered Syrian refugees fleeing current unrest (UNHCR, 2012/06/18) 77,199
Turkey: 27,405

Registered refugees and asylum seekers in Syria in 2011 (UNHCR, 2012/06/01) 757,340
Iraq: 750,900

Lebanon: 20,702

Afghanistan: 1,970 Somalia: 2,640

Jordan: 24,151

Iraq: 4,941

Sudan: 870

Yemen: 110

Humanitarian Profile
The humanitarian profile attempts to account for the number of people having humanitarian needs arising from a given emergency. It is a count of the number of affected people in the emergency. Different groups are identified within the humanita rian profile, such as displaced, non-displaced, IDPs and refugees and asylum seekers. Source: IASC 2011 Estimated figures are represented as . The lower ranges presented are based on conservative estimates. Available figures did not allow for the displacement figures to be mutually exclusive. For example, population displaced due to 2011 protests may consist of people that also belong to a protracted IDP group (e.g. drought induced displaced). Secondary and tertiary displacement is not represented.

Various: 850
Palestinian: 486,946

Scenarios
Probability level
Highly unlikely Unlikely Likely Very likely Almost certain

Challenges in assessing needs of IDPs and refugees in diverse urban environments.

Impact level
No impact Impact does not exceed local capacities Impact is likely to exceed local capacities Humanitarian intervention needed Large scale humanitarian intervention needed

Emergency food distribution, targeted food assistance to the most vulnerable Priority needs
groups such as Iraqi refugees, women and children, and IDPs as well as targeted assistance to affected rural populations and livelihoods support. Provision of impartial and safe access to medical care, including providing access to essential emergency medical services. Registration and needs profiling of IDPs and refugees

The scenarios developed for this update can be simultaneous, and are not mutually exclusive. Some of the assumptions have already proven to be certain and are currently realised. The objective of the scenarios is to project the probable development and humanitarian impact of these assumptions in the upcoming months. Increasing Impact of Economic Sanctions Scenario Timeframe: 3 months Finance and trade sanctions coupled with strong depreciation of currency and lack
of credit facilities negatively affect Syrias ability to import food and non -food items, reducing access to and availability of food. Pressure on international partners to implement sanctions further contributes to reduced access to food, fuel and medicine (Alertnet 19/06, Economist 18/02, BBC 11/2011, GIEWS 2012/04/12). There is a sharp drop in consumption, massive cash withdrawals, capital outflow, unpaid loans, failing currency, a tumbling stock market, negative growth, inflation as high as 50%, a sharp decline in Government revenues, and high unemployment (ICG 7/2011). Reduced access products to control pathogens, including certain viruses, bacteria and toxins further impact the health sector (Alertnet 15/06/2012). Sharply increasing prices of cooking and heating oil and gas will reduce access to these commodities, impacting severely not only transport but also the means for cooking and heating. Cross-border trade is hit hard by transport delays caused by security-related road closures and increased costs of petrol and oil (FT 04/2011).Loss of Government control over price of key agricultural products and lack of means to maintain current food subsidies. fected by high food prices. GoS is unable to import food to cover the needs and to sustain provision of basic services. Lack of trading and livelihood opportunities in urban centres and rural areas are affected by closed shops and markets limits the availability of food and basic survival items. assistance in conflict centres and bordering areas affected by tensions and insecurity. Limited space for humanitarian operations, including emergency cash transfers. Challenges in maintaining food and medicine stocks and keeping them safe from raids. Probability level Impact level

Guerrilla warfare in urban areas Scenario Timeframe: 6 months up to protracted crisis

Probability level Impact level

X X

Opposition forces (FSA) establish better command and organisation lines and Assumptions
increasingly gain pockets of control focusing on strategic urban areas through guerrilla attacks. Regime forces are unable to suppress the opposition which successfully asserts its position (CSIS 08/02). Heavy bombardment in cities, sniper-fire and gun battles cause a high number of non-combatant casualties. Increased mutual mistrust and resentment between members of opposing camps. Frequent clashes induce resettlement of groups in like-minded areas, confirming a worrying pattern of sectarian segregation (Iraq scenario) (Economist 28/01). In line with the international pressure on the regime, sanctions, punitive measures and official condemnation of violence there will be an increasing number of international actors willing to support the opposition (Reuters 16/02). Neighbouring countries and/or allies facilitate supply of weapons to opposition forces. Communications are strategically disrupted. Displacement in villages and cities before and during clashes. Destruction of houses and property causing long term displacement. Population trapped between the conflict lines, unable to flee and access basic services or humanitarian assistance during the clashes. Where power struggles persist, whole neighbourhoods face ghettoization along the lines of affiliation with either of the conflict parties and ultimately along sectarian lines. Limiting access to food, water and basic services in specific areas could be used as a strategic element of warfare and demoralisation. A potential implication of the struggle for power could be the break-up of the country into areas of influence (Yemen scenario). Internal displacement increases rapidly including urban to rural displacement, urban to urban displacement and displacement along sectarian lines. Looting and the grabbing of property increases in urban areas and further fuels tensions among affected civilians. Security services and proxies are subject to ever-increasing attacks. Regime forces progressively lose mobility and control over portions of the country, forcing retreat. There no longer is a permanent loyalist military presence in parts of Idleb, Hama and Homs governorates, enabling the armed opposition to further regroup and organise. Governorates of Dayr Az Zor and Deraa follow a similar path. As defections mount and the army is under ever greater stress, the regime cannot muster sufficient military resources to reverse the trend. Cross border movements into Lebanon, Turkey and Jordan increase, with long-term

X X

Assumptions

The impact of conflict concentrated in urban centres is twofold:

The overall economic crisis severely impacts food security, which is already afImpact Impact

Escalating violence inhibits humanitarian organizations to deliver food and medical Operational constraints

displacement of refugees in camps and host families.

Population trapped in conflict areas and cities with violent clashes face major food
shortages and gaps in medical service provision. Protection for affected population. Emergency health care and secondary surgical care for the injured. WASH and food assistance. Emergency assistance to displaced population in the border regions. Registration and needs profiling of IDPs and refugees.

Operational constraints

Insecurity increases inaccessibility for humanitarian actors. Challenges to monitor urban areas create lack of awareness of needs. Humanitarian actors prone to attacks by armed militia groups. Populations trapped in conflict areas with heavy fighting face protection risks, especially women and children. Emergency health and surgical care for the injured. Emergency assistance to displaced and conflict affected populations, including food assistance. Registration and needs profiling of IDPs and refugees.

Priority needs

Priority needs

Spill-Over Scenario Timeframe: protracted crisis

Probability level Impact level

X X

Sectarian allegiances mirroring the conflict lines within Syria will intensify cross Assumptions
boarder fighting, opening space for groups not directly involved in the conflict to use violence to remedy existing grievances (Alertnet 19/06/2012). Political groups affiliated with either side of the conflict will increase domestic tensions and trigger protests, which erupt in violent clashes. This could contribute to a shock to fragile domestic power balances in Lebanon and at the stake of re-fuelling internal uprisings. Establishment of safe havens for opposition forces in neighbouring countries intensifies tensions in the region and between countries. Opposition forces regroup in neighbouring countries recruiting allies along sectarian lines and allegiances. Fundamentalist fighters and proxies report directly to foreign parties. The regime grows weaker and more violent, involving neighbouring countries as diversions. from Syria into neighbouring countries exposing the fleeing population to the risk of being targeted by the Syrian security forces. This could result in a high number of people trapped in border regions with no access to humanitarian assistance. Regime retains considerable manpower and that support base is radicalised even as it narrows. Reorganised around a hard-core elite composed of ruling family members and loyalists whose determination to fight has only heightened as their involvement in months of repression has grown. Humanitarian supply chains are disrupted as well as the provision of humanitarian assistance to populations in refugee-hosting countries and from neighbouring countries into Syria. The continued smuggling of diesel and weapons from neighbouring countries into Syria - needed by armoured vehicles as well as by industry and farmers - could hamper efforts to isolate fighting and prevent spill-over to more areas.

Increased measures of border security will impede the flow of displaced persons

Impact

Operational constraints

Inaccessibility for humanitarian actors Logistical constraints Selective procedures at the borders restrict most vulnerable groups from entering Water and electricity can be cut off, disrupting communication channels and supply
chains. and accessing essential services.

Livelihoods and Food Security

Priority Concerns
Most affected areas An estimated one million people need humanitarian assistance, including food assistance, due to the impact of the prolonged social unrest on household economies and food distribution channels across markets. Even before the violence broke out in Syria, 1.4 million people struggled to meet their daily food needs.
In conflict-affected areas, insecurity has disrupted trade networks and basic food

In February 2012, the Government doubled customs duties and imposed an additional 30% tax on goods imported from Turkey, which has put further pressure on domestic prices (GIEWS 2012/04/12). Syria's two most vital sectors - tourism and oil have been hard hit by the unrest and economic sanctions. A continued decline in economic activity is expected for the duration of 2012 (BBC 2012/04/09). The value of the Syrian pound has crashed to its lowest level in black-market trading. Even against official exchange rates, the Syrian pound has plummeted by more than 60% against the US dollar (BBC 2012/04/09). In 2008, food subsidies were 2.1% of total GDP in Syria, the highest of the region. Syria's deficit has increased due to declining Government revenues and loss of oil exports hit by sanctions. This deterioration of the Governments fiscal position can have implications for these subsidies (WB 2009).

items are scarce. Of particular concern are the besieged areas, such as Homs, where movement is highly restricted, food supplies are running low and humanitarian access is limited.
Unemployment is estimated to have risen to more than 20% since the uprising

began. This has been coupled with soaring food prices across the country and high inflation.

Livelihoods and food insecurity

Even before the violence broke out, 1.4 million people struggled to meet their food needs. Many are now living in areas which have become conflict hotspots such as Homs, Hama, rural Damascus, Dara and Idleb and the concern is that they have become even more vulnerable (GIEWS 2012/04/12). Since the unrest began, livelihoods across the country have been impacted.

Key characteristics
Economy and Food prices
Inflation is increasing rapidly and is currently at 30%, mainly due to sharp increases in food prices and fuel shortages.
(GIEWS 2012/04/12, Reuters 2012/06/13).

Consumer Price Index - bread and cereals Central Bureau of Statistics

o o o

o o

The joint UN-OIC analysis of the Government-led assessment mission found that food prices had risen by between 30% to 60% in most localities visited, and by up to 80% in some localities, such as Hama (PI 2012/06/18). This will further reduce access to food for poorer households.

An estimated 300,000 small farmers and herders in the north-eastern provinces are affected by the loss of opportunities from seasonal labour migration to the south and east (GIEWS 2012/04/12). The continuing instability and the volatile security situation have rendered breadwinners unemployed (WFP 2012). Civil insecurity prevents farmers from accessing their farmland during the harvest. There is limited availability and access to fertilizer and seeds (GIEWS 2012/04/12). The unrest is affecting pastoralists by restricting mobility of herds, with negative effects on access to water and pasture, and reducing the access to veterinary drugs and other supplies (GIEWS 2012/04/12). Increasing insecurity and criminality is affecting livelihoods and trade, as people are unwilling to carry the large amounts of cash needed to obtain commodities (PI 2012/06/18).

Food Availability
Basic food, such as bread, is becoming scarce in affected areas (BBC 2012/06/08, IRIN 2012/03/27). In the besieged city of Homs, people are reportedly running low on food supplies (AFP 2012/05/24). The outlook for the 2012 winter cereal crops and for harvest from May is uncertain given disruptions in overall agricultural activities (GIEWS 2012/04/12). Normally, Syria relies on food imports for almost half of its total domestic use. FAO estimates that the Government has to raise cereal imports by a third (from 3 to 4 million) to offset a loss in output due to the current unrest. The main barleyproducing areas are Homs, Hama, Aleppo and Idleb, all areas where fighting has been heavy (Reuters 2012/06/13, WFP 2012/03/15). Although there are no sanctions in place against food commodities, economic and trade sanctions imposed by the international community together with the strong depreciation of the local currency and lack of credit facilities are negatively affecting the countrys ability to import food commercially. A lack of payment mechanisms and growing issues with discharging at Syrian ports limit the possibilities to import large quantities of food commodities (Reuters 2012/05/17, FAO 2012/06).

Health and Nutrition

Priority Concerns
There is a lack of access to health care in conflict-affected areas. Medical facili-

ties and personnel are directly targeted and the distribution of medicines is disrupted.
Medical personnel and patients have been subject to torture and arrest in hands

of the security services. Patients refrain from visiting official medical facilities.
Areas that host IDPs, such as Tartous and rural Damascus, face an increased

burden on their health services.

Key characteristics
Access and coverage In some conflict affected areas, basic health services are completely disrupted. Limited access to health services also results from difficulties for both health personnel and patients in safely reaching hospitals and health centres (WHO 2012/03/14). Supply and distribution of medicine, medical supplies and equipment is disrupted due to limited access and the effect of sanctions on international procurement (WHO 2012/03/14). There is a large increase in weapon-related injuries (WHO 2012/05/06). There is an increase in complicated and delayed obstetric emergencies (WHO 2012/05/06). The influx of populations moving from affected areas to rural Damascus, Tartous and Damascus has increased the burden on health services, while facilities in affected areas are underutilized due to security concerns (WHO 2012/05/06). The interruption of all preventive services including vaccination has been reported. The vaccination coverage rate has decreased in affected areas (RI 2012/03/14, WHO 2012/03/14). Stakeholders including the MoH, local NGOs and SARC report a need for: o Strengthening/restoring the trauma management capacity and referral system in affected areas. o Addressing the lack of medicines and supplies, especially in relation to trauma care and chronic diseases. o Ensuring the ongoing provision of basic health services, with particular emphasis on child health, maternal health, and chronic diseases.

Poverty Incidence per Governorate (2004) (UNDP 2004)

Strengthening health workforce with mobile clinics and fixed health posts
(WHO 2012/03/09).

Protection
Priority Concerns
Violence against children is widespread and a major protection concern. Torture, extrajudicial killings, and indiscriminate violence have impacted both

A number of detainees relatives have raised concerns regarding the ability of their family members to obtain adequate medical treatment in detention (HRW 2012/05/13). Targeted attacks Physicians are required by law to immediately notify security services of the arrival of any wounded person at a health facility, regardless of the severity of injuries (IFRC
2011/10/24).

Doctors and wounded patients are directly targeted and risk torture and arrest at the hands of the security services. Injured people taken to military hospitals are being tortured and beaten during interrogation (UN Cte Torture 2012/05/06). Even if the resources and infrastructure are there, the fear and risks of capture are so great that doctors hesitate to treat patients or only provide basic first aid. Doctors reported that 'being caught with a patient is worse than being caught with a weapon' (MSF 2012/05/17). Medical facilities have been directly targeted (UN Cte Torture 16/05/2012). Communicable diseases At the start of May 2012, there were no reports of communicable disease outbreaks. As the unrest continues into the summer and temperatures rise, the interruption of water and sanitation services results in an increased possibility of disease outbreaks. There is a need to strengthen Syrias early warning surveillance system (WHO 2012/05/06). Lessons Learned As a result of impaired access to healthcare, conflict affected populations face higher risk of disease and are more likely to be severely affected if they fall ill (ICRC 2004). Individual immunity decreases due to malnourishment, inadequate shelter and exhaustion (MSF 1997). Malnutrition increases the susceptibility of individualsparticularly childrento respiratory infections, malaria, diarrhoeal diseases and measles and is an important cause of death (HSRP 2009).

adults and children, with men and boys being predominately targeted and vulnerable to violence and sexual abuse in detention. Impunity for such violations remains widespread.
A lack of information on GBV makes timely and appropriate emergency medical

and psychological response to victims of sexual violence and abuse difficult.

Child Protection Violence involving children

Children, aged 8-13 years, have been forcibly taken from their homes and used by soldiers and militia members as human shields, illustratively, children are placed in front of the windows of buses carrying military personnel to raid villages (Alertnet 12/06/2012, Economist 12/06/2012, UNGA 2012). Children are victims of military aggression by Government forces, the Syrian Army, the intelligence forces, and the Shabbiha militia. Children have been killed by sniper fire in residential areas, and some have been maimed while taking shelter in their own homes. Among the violations are the recent summary executions of children in Houla and Taftanaz (HRW 11/06/2012, UNGA 2012). Government forces continue to use violence against children in areas where members of FSA or other armed opposition groups are present, where deserters are allegedly hiding, or if they are seen fleeing the country to seek refuge (UNGA 2012). Deserting army officers have reported that they were ordered to attack protesters regardless of their age (HRW 11/06/2012). Schools have been regularly raided and used as military bases and detention centres (HRW 11/06/2012, UNGA 2012). According to the Syrian Revolution Martyr database between the start of the uprising and 10 June 2012, 1226 children aged 16 years or younger have been reported killed. Of these 76% (933) were boys, and 24% (293) were girls (SRMD 14/06/12).

Child Recruitment
There are credible reports of children being recruited by the Free Syrian Army to help with frontline medical duties and act as messengers, increasing their risk of attack by Government forces (Economist 12/06/2012, UNOHCHR 07/06/2012).

10

Psychosocial Needs
As of 20 June 2012, 77,199 people have fled the violence in Syria and registered with UNHCR in neighbouring Jordan, Lebanon, Turkey and Iraq. Around 25% of all displaced Syrians are children and adolescents who face interruption of schooling, limited access to basic services, and psychosocial distress caused by witnessing violence and displacement (UNICEF 04/06/2012, 11/05/2012).

Women and Gender-Based Violence

According to the Syrian Revolution Martyr database, around 16,000 persons have been killed between the start of the uprising and 11 June 2012 (SRMD 15/06/12). Of these 93% (15,300) were men and 7% (1,160) women (SRMD 15/06/12). Syrian Government forces and pro-Government armed militias have used sexual violence to torture men, women, and boys detained. Soldiers and pro-Government armed militias have sexually abused women and girls as young as 12 during home raids and military sweeps of residential areas and in detention facilities (HRW 15/06/2012). Methods of torture include: sexual abuse, forced witnessing of sexual abuse in detention, rape, penetration with objects, sexual groping, prolonged forced nudity, and electroshocks and beatings to the genitals (HRW 15/06/2012). The stigma in Syria surrounding sexual violence makes victims reluctant to report abuse. Even when they wish to seek help, survivors of sexual assault have limited access to emergency medical care, psychological services, legal assistance, and social support. Survivors who have fled to neighboring countries also face obstacles in seeking treatment, including limited service options and inability to access services that are available due to the stigmatization of sexual abuse, families restricting their movement, and the fear of being subjected to so-called honour crimes (HRW 15/06/2012). Detention facilities where male and female detainees have reported sexual torture include Military Intelligence Branches (known as Palestine Branch) in Damascus; the Military Intelligence facilities in Jisr al-Shughur, Idleb, and Homs; the Political Security branch in Latakia; the Air Force Intelligence branches in Mezze, Latakia, and Homs; and the Idleb Central Prison. The majority of cases however has been reported from Homs (HRW 15/06/2012).

Torture and Detention

Children as young as ten years have been tortured while in detention. The Shabbiha militia was reportedly involved in the detention and torture of children during military operations and using makeshift detention cells in schools. Most child victims of torture describe being beaten, blindfolded, subjected to stress positions, and whipped with heavy electrical cables (UNGA 2012, Economist 12/06/2012). Detainee children have been kept in solitary confinement and denied medical treatment, adequate food, and water (HRW 11/06/2012). Detainees overwhelmingly men and boys are routinely tortured and forced to make incriminating and false confessions such as possession of weapons or involvement with the armed opposition (AI 14/06/2012). Men and boys report sexual torture and rape during detention, including beatings of genitals, forced oral sex, electroshock treatment, being burned by cigarettes (UN Cte Torture 16/05/2012, UNOHCHR 07/06/2012). Detention facilities are overcrowded, forcing detainees to take turns to sleep (UN Cte Torture 16/05/2012, UNOHCHR 07/06/2012). Injured people taken to military hospitals were tortured and beaten during interrogation. Numerous methods of torture have been identified. Those methods included severe beating with batons and cables, forcing detainees into stress positions for hours or even days in a row, electroshocks, and deprivation of food, water and sleep (UN Cte Torture 16/05/2012, UNOHCHR 07/06/2012). Obstruction and denial of medical assistance to the injured and sick, and the systematic arrest and torture of wounded patients in State hospitals is a grave concern. Individuals suspected by the GoS of setting up and operating alternative medical care or providing medical supplies were also subjected to arrest and torture by the security forces (UN Cte Torture 16/05/2012, UNOHCHR 07/06/2012). Security force members, government supporters, former members of the Syrian armed forces, and those identified as members of pro-government militias are subject to kidnapping, detention, torture and execution by armed opposition groups (HRW 20/05/2012).

Human Rights Violations

Although men and boys have been the primary targets of extrajudicial executions, hundreds of bystanders not directly involved in the conflict have been killed and injured from indiscriminate shooting and shelling by Syrian armed forces (AI 14/06/2012).

Blockades and Urban Insecurity

Blockades and curfews have been imposed on cities such as Homs, Hama, Dara and Idleb. During blockades, residents have been unable to obtain water, food and medical supplies. National security forces reportedly have targeted residential water supply systems, and the blockades have made it difficult to get the injured to hospitals (UNSG 22/05/2012).

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 The use of explosive weapons in populated areas, as in Homs and Idleb, has had profound humanitarian consequences, including damage to buildings and essential infrastructure and threats posed by explosive remnants of war (UNSG 22/05/2012). Bomb attacks reportedly carried out by armed opposition groups in Damascus and Idleb have also claimed civilian lives (UNSG 22/05/2012). Criminality is on the rise, with increasing reports of widespread looting and theft (IRIN 2012/06/19). Two oil pipelines have been attacked by the opposition forces: one of them linking Homs and Damascus and one in the eastern province of Dayr az Zor. Pumping is expected to resume in the next few days, although the same pipeline had been targeted twice in the last two weeks (Alertnet 19/06/2012).

WASH
WASH for the affected population in Syria has not been stated as a priority need. However, National Security Forces have reportedly targeted water supply systems, which, if continued, will affect the basic water needs of the population. Water availability in Syria has been further affected by power cuts. (UNSG 22/05/2012). WASH needs are highest among the Syrian refugee populations in neighbouring countries. The irrigation canal flowing through fields, connecting the Homs district to the reservoir sited 12km south-west of Homs is largely dried up. Temperatures in Syria can exceed 40C (104F) in summer, and locals accuse the Syrian army of deliberately shelling and rocketing vulnerable water tanks on rooftops to deprive residents of drinking water. The situation has been exacerbated by rumours that the remaining water supply has been contaminated, leading to a rush on bottled water. The districts of Al-Qusoor, Baba Amr, Bayada and Asherah have had no water or electricity service for two months now (BBC 2012/06/08). An opposition activist reported that there was no electricity in the besieged town Rastan, central Homs province, and a shortage of food and water (AFP 2012/05/24). In several areas, waste removal has been hampered by the insecurity, creating hygiene problems and an increase in water borne and skin diseases (PI 2012/06/18).

Security in the border areas

Government forces have reportedly prevented civilians from leaving the country at Lebanese and Turkish borders. All men aged 18-42 are banned from traveling outside Syria without prior authorization (AFP 27/03/2012). To reach northern Lebanon, Syrians must navigate heavily mined areas and avoid being shot by Syrian soldiers (RI 14/03/2012, Alertnet 2/03/2012). Refugees trying to cross into Lebanon have reported Syrian border police confiscating their belongings, arrested them, or shooting them (RI 05/06/2012). Armed cross-border clashes erupted at the northeastern Lebanese-Syrian border. The Lebanese Army has since deployed its troops in the area and is monitoring the situation (UNHCR 08/06/2012). Syrian forces are laying mines near the Turkish border, especially in the southern Idleb region, in an attempt to block the flow of refugees out and supplies for insurgents (Reuters 06/04/2012, Alertnet 13/06/2012).

Lessons Learned
Exposure to armed conflict is a principal risk factor for the development of mental disorders and Post Traumatic Stress Disorder (PTSD) in particular. Children are the most vulnerable group to develop PTSD and related mental disorders (ICRC 1996). Among women, rape is the assault that has the highest probability to lead to PTSD (Resnick et al 1993).

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Timeline

Source : Al Jazeera 2012/06/18

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Key background documents

Amnesty, Deadly Reprisals: Deliberate Killings and Other Abuses by Syrias Armed Forces, 14th of June 2012, http://www.amnestyusa.org/research/reports/deadly-reprisalsdeliberate-killings-and-other-abuses-by-syria-s-armed-forces

FAO, GIEWS -Special Alert 331 - Civil unrest raises grave concern for food security, 14th of March 2012 http://reliefweb.int/node/482868 HRW, Syria: Stop Grave Abuses of Children, 11th of June 2012, http://www.hrw.org/news/2012/06/11/syria-stop-grave-abuses-children HRW, Syria: Activists Arrested, Held Despite Pledge to Annan, 13th of May, http://www.hrw.org/news/2012/05/13/syria-activists-arrested-held-despite-pledge-annan UN, Syria Regional Response Plan, March 2012, http://data.unhcr.org/syrianrefugees/uploads/SyriaRRP.pdf UN Committee against Torture, Committee against Torture considers situation in Syria in the absence of a report, 16th of May 2012, http://reliefweb.int/node/497095 UNGA, Children and armed conflict, Report of the Secretary-General, 26th of April 2012, http://reliefweb.int/sites/reliefweb.int/files/resources/Full_Report_4118.pdf UNHCR, Syria Regional Refugee Response Information Sharing Portal, http://data.unhcr.org/syrianrefugees/regional.php WHO, The Syrian Arab Republic crisis Meeting humanitarian Health Needs, 13th of March 2012.
http://reliefweb.int/sites/reliefweb.int/files/resources/syria_donor_alert_13march2012.pdf

WHO, Syrian Arab Republic unrest, Situation report #6, 8th of May 2012, http://reliefweb.int/sites/reliefweb.int/files/resources/Syria_sitrep_6.pdf

Methodology This desk study presents estimations of scale, severity and likely impact of a disaster. It
aims to inform decision making for preparedness and emergency response and intents to complement and integrate assessment-related data from other agencies. Feedback to improve the DNA is welcome (dna@acaps.org). ECB and ACAPS thank agencies and NGOs who have shared data and analysis.

Update: This DNA is an update of two earlier DNAs (December 2011 and February 2012) and the information within this report should be seen in light of the information provided in these earlier DNAs. The previous versions of the Syria DNA can be found here.

Disclaimer Information provided is provisional as it has not been possible to independently verify field
reports. As this report covers highly dynamic subject, utility of the information may decrease with time.

References Please note that all sources are hyperlinked (in brackets) and that an accompanying glossary is available here. Information sourced as PI refers to personal interviews with experts in the field.

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