Access for What? Elevating Civilian Protection and Quality Access for Humanitarian Action in Syria

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The Issue

  • Engaging Damascus to secure humanitarian access is a hard reality in 2019 given the Syrian government’s deliberate targeting of civilians, curtailing of civilian freedom of movement, and withholding of assistance since 2011. However, even in opposition-controlled areas, humanitarian organizations have encountered access challenges. Donors, the United Nations (UN), and non-governmental organizations (NGOs) must coordinate action with firm adherence to the principles of neutrality and impartiality and put Syrian civilians first, even as the United States and its allies chart political objectives to counter the Syrian government and its supporters.
  • Globally, humanitarian access is increasingly politicized. Syria represents an acute case, with severely heightened risks to civilians. Donors, the UN, and NGOs must collectively elevate the importance of meaningful access—to conduct needs assessments, monitor distributions and services, prioritize the most vulnerable, deliver assistance, prevent the diversion of humanitarian aid to unwanted actors, and evaluate impact—thereby improving civilian protection with sustained humanitarian access and presence.
  • Even amid a dire humanitarian crisis, innovations in front-line negotiation, diversion mitigation, and access planning provide important lessons for global humanitarian action.

Crisis Context and Why Access Matters

The Syrian conflict has produced humanitarian consequences of harrowing and tragic proportions. With an estimated 500,000 Syrians killed, the war has prompted the world’s greatest refugee flow since World War II.1 There are 6.2 million internally displaced persons (IDPs) within Syria and 5.3 million refugees in neighboring countries (a total 13 million people affected—for context, the total population estimate for pre-war Syria was 20 million). From January to December 2018, there were an estimated 1.6 million population movements.2 Civilian protection is the most important focus for international humanitarian efforts given the complexity of the Syrian conflict, myriad state and non-state armed actors involved, and continuing incentives for parties to the conflict to use humanitarian access as a political tool.

2018 marked a decisive phase of the conflict. The Syrian government, backed by Russia and Iran, captured the south, parts of the northwest, and the Damascus suburb of East Ghouta, and now stands on the brink of taking Idlib in the northwest. Russia and Turkey brokered a demilitarized zone surrounding Idlib last year and are reportedly preparing joint patrols for the area; yet, the Syrian army and Russia have stepped up attacks on Idlib in the last several weeks. Russia, Turkey, Iran, and the Syrian government are exploring options for a “limited intervention” this spring that, even if calibrated to minimize civilian harm, will likely galvanize support for extremist organizations such as Hayat Tahrir al-Sham, al-Qaida affiliates, and the dispersions of these groups throughout Syria and beyond. Cross-border humanitarian access from Turkey remains vital to the Idlib area. Given Turkey’s constriction of NGO operations, ban on additional Syrian refugees entering Turkey, and lack of transparency regarding its occupation efforts in northern Syria, humanitarian organizations have expressed concern about Turkey controlling further territory in Syria.

In December 2018, President Trump announced his intent to drawdown U.S. forces from northeastern and eastern Syria after weakening significant portions of ISIS territorial control, despite clear indicators of persistent insurgency. Eastern Syria depends upon cross-border humanitarian access from Iraq. Turkey has signaled its intent to extend its occupation beyond northern Syria to northeastern Syria, ostensibly to constrain Kurdish expansion, which is likely to exacerbate internal displacement and humanitarian need.3

The crisis is unlikely to abate in 2019. The UN estimates that 11.7 million Syrians will need continued humanitarian support this year, considering increasing constraints to humanitarian access in the country.4 The terrible consequences for civilians in Syria must prompt an assessment of ongoing access challenges by the global humanitarian community and the production of recommendations and lessons for improving access.

Why Humanitarian Access Matters
The UN defines humanitarian access in two parts:

1. “Humanitarian actors’ ability to reach populations in need”; and
2. “Affected populations’ access to assistance and services.”5

Humanitarian access is important for five reasons.:
1. It enables independent and impartial needs assessments and analysis, which is vital to the credibility, design, and efficacy of any program;
2. It facilitates humanitarian action, including providing life-saving assistance on the ground;
3. It informs prioritization to reach the most vulnerable;
4. It may help provide protection for civilians from armed actors by the very presence of humanitarian personnel; and
5. It enables monitoring and evaluation of assistance programs to ensure donor priorities and objectives are met and reassures donors that their contributions are reaching its intended beneficiaries.

Ensuring that the needs of civilian populations are met and creating conditions conducive to timely and impartial humanitarian operations requires regular and constructive dialogue with humanitarian, armed, and civilian policy actors at all levels. Access has been politicized since the beginning of the Syrian conflict by both state and non-state actors. Quality humanitarian access must continue to be delivered on principled bases of neutrality, impartiality, and adherence to internatonal humanitarian law (IHL).As one stakeholder put it, “the same child in Eastern Ghouta under opposition control yesterday is still the same child under government control tomorrow.”

“The same child in Eastern Ghouta under opposition control yesterday is still the same child under government control tomorrow.” - Humanitarian provider in Syria

Obstacles to Humanitarian Access in Syria

The United Nations Office for the Coordination of Humanitarian Affairs (UNOCHA) has identified nine categories to monitor the constraints to humanitarian action in conflict zones such as Syria, including denying the existence of humanitarian need, using restrictive bureaucratic tactics, and employing restrictions on movement, coercive intimidation, and physical dangers or impediments.7 The Syrian conflict notably presents ample examples for each category. Moreover, the unique and noxious blend of politicization of humanitarian action and deliberate targeting and deprivation of civilians and civilian targets strongly suggests that a tenth criteria be explicitly included at the top of the list of considerations: lack of sustained access to meaningful humanitarian assistance. The siege of Eastern Ghouta and one-off aid convoys to Rukban camp provide devastating examples. The diplomatic suasion, persistence, and tenacity of Syrian national aid workers has enabled emergency humanitarian response to millions of affected people.8 Given these conditions, UN Security Council Resolution (UNSCR) 2165 and its subsequent renewals enable humanitarian actors to provide cross-border relief without having to obtain Damascus’ consent; some humanitarian organizations chose not to operate cross-border and have negotiated access through Damascus throughout the duration of the war. However, the difficulty of sustaining this response and the degree to which Syrian civilians have been deprived of meaningful humanitarian support is heightening significant civilian protection concerns; lack of sustained humanitarian presence can invite harmful behavior by local actors. It is also constraining humanitarian actors from performing needs assessments and program monitoring and evaluation—ever important for growing concern among donors about return on investment and potential diversions to unintended beneficiaries, whether they are sanctioned groups or individuals perceived as linked to sanctioned groups. In addition, lack of sustained, meaningful humanitarian assistance for years is yielding deeper structural consequences for overall civilian health, education, and wellbeing that will take decades to recover. Several factors unique to Syria affect humanitarian access, as well.

Impact of the Impending U.S. Troop Drawdown

Coalition and U.S. forces present in eastern Syria advising the Syrian Democratic Force have been important in mitigating protection concerns for civilians fleeing ISIS and for continued relief efforts by humanitarian organizations and workers.9 The coalition has highlighted via private channels to the SDF issues concerning freedom of movement of internally displaced people, the recruitment and use of children as combatants, and the treatment of women and children suspected of affiliation with ISIS fighters. However, limited U.S. military involvement, prioritization on kinetic operations, the proliferation of other armed groups beyond the SDF umbrella, and lack of real-time, actionable information about protection concerns have inhibited coalition advising. The formidable challenges of removing the remaining improvised explosive devices from ISIS and unexploded ordnance and rubble removal from Russian, Syrian, and coalition operations will take years. Increased tensions between Arab and Kurdish groups, compounded by Turkish perceptions of the threat posed by Kurdish leadership of the SDF, intensify instability and abuses by all sides and hamper humanitarian action and operational access to northeastern Syria. Intense hostilities in southeast Deir ez-Zour have severely constrained humanitarian access and elevated civilian protection concerns.

If the Trump administration follows through on a rapid drawdown of U.S. forces from Syria, it risks not only exposing the displaced civilians to violence yet again but also placing the safety of humanitarian workers and their ability to continue working in the east at risk. Areas currently under the control of U.S.-backed opposition groups may be recaptured by the Assad government, or armed groups, which may result in further constraints to—if not outright denial of—access to humanitarian assistance, including the end of cross-border operations.10 The potential for Turkey to extend its presence in northeastern Syria raises concerns about its relative capacity and prioritization of civilian protection and humanitarian access in occupied areas. Turkey risks overextending itself to address security concerns regarding Kurdistan Workers’ Party (PKK) terrorist operations; a lack of capacity and concern for civilian protection can result in a lack of due diligence and care to prevent harm to Kurdish civilians. Turkey may also replicate its model for northern Syria, pushing international NGOs out and insisting on providing its own assistance efforts, which falls short of civilian needs by international standards.

Although humanitarian groups operating in eastern Syria have not yet taken any drastic measures to leave, experiences in Afghanistan and Iraq point to the likely scenario of troop withdrawals being followed closely by potential humanitarian personnel withdrawals from the region, especially for humanitarian organizations that rely upon cross-border access. This may particularly affect organizations that do not have the resources to guarantee the security of their workers or those unable or unwilling to register their organizations with the government in Damascus. Finally, pending civilian casualty investigations from the  coalition's counter-ISIS operations will become more difficult to pursue following a withdrawal, narrowing the possibility of redress to civilians if the United States or its allies were responsible.

The Crisis in Rukban

The Rukban refugee camp, located in an opposition-held zone along the Syria-Jordan border, houses between 40,000 and 50,000 displaced Syrians from other regions.11 The camp reportedly consists of 80 percent women and children and faces an increasingly acute shortage of food, water, and medical resources.12 The Syrian government regularly denies humanitarian access to the camp, citing concerns about the presence of ISIS members. With Jordanian authorities having sealed the border near Rukban following a suicide bombing in 2016, and the presence of armed non-state actors surrounding the camp, Rukban was blocked from all sides.13 It took significant international pressure, extensive international negotiations, and months of delays to enable a joint Syrian Arab Red Crescent and UN convoy to access Rukban in November 2018. The UN identified serious protection concerns, with significant numbers of women, children, and elderly persons living in fear of criminality, violence, and lack of access to basic services with the onset of winter. Most people reportedly expressed desires to leave the area along with concerns about security in the region of origin, lack of freedom of movement and documentation, fears of arrest, and high costs.14 Political expectations from all parties on linking access to return of the displaced were heightened following the November delivery, making a next delivery difficult to negotiate. Negotiations delayed the second aid delivery by months, finally reaching Rukban on February 6, 2019.15 Meanwhile, winter effects heighten the stakes for civilians trapped in Rukban. Fifteen children—including eight infants—have died from the cold temperatures.16

The United States retains a garrison at al-Tanf on the Baghdad-Damascus highway, roughly 20 miles from Rukban, serving as the southern point of its support for coalition’s operations and, by default, extending a 50 km zone of deterrence for Iran-linked activities between Iraq and the Levant17 Reported plans for the U.S. withdrawal of forces from Syria include options for maintaining the al-Tanf garrison but likely continuing without plans to assist any future humanitarian operations in or around Rukban. However, U.S. relationships with Jordan and local non-state actors will remain vital for brokering access.

Cross-Border Operations

Cross-border assistance, originally authorized by UNSCR 2165, remains a critical component of humanitarian action in Syria. Approximately 38 percent of people in highest severity of needs—1.9 million people—live outside of Syrian government control in Aleppo and Idlib.18 The Russian-Turkish agreement to stave off a Syrian government offensive in Idlib prevented a humanitarian catastrophe in 2018, but the Syrian government is likely to move into this territory in the coming months. Idlib is almost entirely dependent on cross-border assistance from Turkey, which made the renewal of UNSCR 2165 in December 2018 vital. Response efforts delivered from Iraq and Turkey are often the only way to reach millions of Syrians in need and continue to save lives.19

The Syrian Government’s “De-escalation and Reconciliation” Campaign

The Syrian government has pursued a strategy of so-called “de-escalation and reconciliation” when it retakes territory from opposition forces. In reality “de-escalation" zones have had two outcomes: freezing fighting in the area to allow time for government forces to organize and launch large-scale, concentrated offensives on one pocket of opposition control at a time; and decreasing humanitarian access, forcing both fighters and civilians to surrender or starve under bombardment.20

Following its retaking of southern Syria, the Assad government led a campaign claiming a desire for the so-called “de-escalation” of tensions with opposition groups, promising amnesty to citizens who laid down their arms and signed reconciliation waivers. These waivers consisted of individuals admitting to their past associations with armed opposition groups and international organizations—including humanitarian organizations, as aid workers providing assistance to citizens opposing Assad were just as complicit in Damascus’ view—and providing details of their activities and associates. It became clear fairly shortly that these “de-escalation and reconciliation” campaigns were a front for intelligence collection, resulting in the detention of many humanitarian workers who signed these waivers and the forced conscription of many more, which hindered further relief efforts. The Syrian government may potentially pursue similar strategies in the northwest and northeast.

Operating in Government-Controlled Areas

The main operational constraints for humanitarian organizations inside Syrian government-controlled areas are safety and security, visa restrictions, geographical reach to communities that are the most vulnerable (versus those that the government will let them access), and the ability to access banks and transfer money. Humanitarian organizations operating in government-controlled areas must register in Damascus, as in any sovereign state; however, the Syrian government places unique restrictions on organizations upon registration. When the Assad government reestablished control over southern Syria, it reiterated a mandate that all humanitarian agencies wishing to operate within its area of control had to work through the Syrian Arab Red Crescent (SARC) or the Syria Trust for Development (STD) to carry out any humanitarian action efforts. The government has also restricted access for international humanitarian workers seeking to enter Syria by increasing scrutiny when approving visas. Given questions over SARC and STD’s independence and impartiality due to their close ties to the Assad government, many humanitarian organizations have either been refused registration or have decided on principle not to seek registration with Damascus to protect their staff and the integrity of their missions, therefore choosing to no longer operate in government-held areas. Others who have obtained registration in Damascus use the governmental channels available to deliver necessary assistance to those in government-held areas and therefore help maintain some of the few vital humanitarian access links remaining in southern Syria. The few registered organizations that are allowed to operate, however, are not permitted to do so across conflict lines.

Given the ongoing complexity and constraints of humanitarian access and security risks in government-controlled areas, the Syrian government’s call for Syrian refugees or IDPs to return to these areas is premature and risks endangering civilians further.

Lack of Accountability, Transparency, and Coordination

The unique and often competing objectives of donors and parties to the conflict, as well as the complexity of the Syrian conflict itself, have prompted donor concerns about the accountability and transparency of humanitarian activities and assistance. The Syrian government is largely responsible for this opacity: local aid workers are threatened by retribution from the government—which operates with impunity. Furthermore, international response efforts are constrained by visa restrictions and limited by their ability to operate almost exclusively through SARC and STD in Syria, leading several international NGOs to decide not to seek registration in Damascus. The international humanitarian community must also be cognizant of and continually improve accountability and coordination measures to maintain the support of donors and ensure demonstrable impartiality and neutrality.21

For important national security, legal, and accountability reasons, the U.S. government and other donors have implemented reviews and restrictions to prevent the diversion of humanitarian aid to terrorist organizations. However, implementers report that these restrictions pass all of the risk to NGOs (donors encouraging them to access complex areas where civilians and violent extremists are intermixed while compelling them to guarantee that there will be no aid dispersion to extremists) and have severely impeded assistance delivery to critical areas and access to local civilians, thereby increasing the uncertainty of operational continuity. The hawala system is critical for operations in these areas, as humanitarian organizations otherwise struggle to pay staff or deliver supplies; however, donors have determined that certain hawalas are ineligible for funding without identifying alternatives.22 Rigorous monitoring and evaluation of programs, internal mechanisms for oversight, due diligence, and diversion mitigation are inherent features of successful humanitarian organizations and necessary for navigating conflict-affected areas. U.S. interagency should strive for greater dialogue with humanitarian organizations, better transparency on the rationale and process for restrictions, and increased capacity to review programs to ensure timely response, so as to enable changes in the field resulting from a restriction being upheld or removed.

In addition to concerns about the diversion of humanitarian assistance toward unintended recipients, there is a need for stronger monitoring and evaluation mechanisms with buy-in from both the donor and implementer levels, mutually agreed-upon standards, and the sharing of best practices between donors and implementers. This could include adherence by donors to the principles of Good Humanitarian Donorship, which says that aid should be allocated based on the needs of the population and that donors should coordinate their aid efforts to ensure gaps are covered without duplication.

Lessons and Innovations

Syria has yielded important lessons and innovations from the field that should be harnessed in shaping future access considerations in this region and beyond.

Humanitarian Diplomacy with State and Non-State Actors

The Humanitarian Task Force and Like-Minded Group discussions in Geneva on Syria’s humanitarian needs have been critical for the identification of humanitarian requirements and constraints, even among staunch opponents in the conflict. However, lack of progress on the political front has stymied preventative action and forced humanitarians to play “catch up” throughout the crisis. There is limited ability to influence decisions about access in government-held areas, where Russia and Iran have greater sway. If the United States and Russia were to agree on a common humanitarian objective in Syria, it could enable greater humanitarian access and responsiveness.

To Engage or Not to Engage Damascus

Engaging Damascus to secure access is a hotly debated but hard reality in 2019. Particularly with the south now under government control, a near-inevitable retaking of Idlib by the government, and the winding down of coalition operations in the east, humanitarian organizations increasingly will be faced with the challenge of negotiating access through Damascus to reach Syrian civilians. Operating in government-held territory also means registering with the government and working through the SARC and STD. This has coercive and deterrent effects on the local population; NGO personnel are fearful of being on the Syrian government’s radar and subsequently possibly facing retribution. The Syrian government is reinforcing the “all roads lead to Damascus” dynamic by promoting a false narrative that it is safe for refugees and internally displaced Syrians to return. Communicating among donors, the UN, and NGOs and combining approaches to circumventing cross-line restrictions may be effective. Such approaches include: dual-track efforts coordinated among offices operating in or via Damascus and those operating in opposition-held areas; and leveraging networks, credibility, and the principle of neutrality while engaging the Syrian government. The UN has comparative advantages in reaching civilians in government-held territory, but NGOs have access where the UN does not.

In brokering access with non-state actors, code of conduct agreements to ensure there is understanding, respect, and accountability for humanitarian access and operations have been successful in both the northwest and northeast, with more compliance and acceptance than one would expect. However, humanitarian organizations have had to weigh significant internal concerns about possible repercussions from the Syrian government if they chose to engage opposition actors. If humanitarian organizations engage with these groups, it does not mean that they receive political recognition; it is understood to be within the bounds of humanitarian interests solely. The key actors in brokering these agreements are civilian protection advisors and civil-military liaisons, along with local leaders that have the incentives and power to uphold the agreements. The most difficult arrangements are those involving a non-state actor who holds territory and a state-based actor who holds adjacent territory. The most successful examples of these types of agreements have been in the northeast; they require trust from two parties who otherwise have strong reasons to not trust each other given ongoing hostilities or political and economic incentives. These agreements may be at risk with the pending drawdown of U.S. forces.

Facing restrictions in working through SARC and STD, NGOs with historic ties and community trust through relationships with civic, religious, and vocational organizations may open new avenues for access. In addition, businesses may share incentives for mine and rubble clearing in order to improve access.

Mitigating Risks of Diversion

The diversion of humanitarian aid to unintended beneficiaries, including armed state and non-state actors, has been a strong concern for donors, resulting in additional requirements for implementers distributing assistance. Disclosing these incidents early, immediately after they happen, is vital to prevent an abrupt or larger reduction of assistance. Transparency and ongoing dialogue is essential, as is confidentiality in meetings to ensure trust with local implementers so that they bring forward disclosure more readily. At the same time, the donor community must foster a culture of trust with implementers on the ground and build in flexibility for remediation for individuals or groups that may be more indirectly linked to sanctioned groups. This can help ensure that reporting diversions will not result in extreme negative repercussions such as funding cuts. Signing code of conduct agreements between implementers and local community or militia leaders have also been helpful in facilitating communication, setting expectations and accountability, and following up with a robust message. There have been incidents when donors have suspended aid because of diversions, which gives implementers a position of leverage in relationships with local leaders, reinforces messages about respect for impartial humanitarian aid, and helps to prevent incremental slippage in local arrangements and mechanisms to facilitate aid delivery.

Planning Access in Uncertainty

Several lessons should inform planning for access in uncertainty. Due to shifting conflict lines and constrained operating and access environments, continual and context-specific needs assessments remain vital to informing the prioritization of delivery to the most vulnerable populations. To mitigate the impact of cross-border access restrictions, working with local networks to leverage internal aid procurement, where possible, has been effective in some areas and for some services. Enabled by scenario planning, putting equipment and staff in place in anticipation of conflict lines shifting or an uptick in hostilities may mitigate risks of diversion and loss of life. The suddenness of the Syrian government takeover of south Syria resulted in ad-hoc scrambles, best practice sharing, and creative measures by NGOs to provide duty of care to local Syrian staff under difficult circumstances. NGOs should take measures now—preferably with the help of donors and the UN—to provide guidance to local staff on how to prepare for line control shifts in the northwest and northeast to ensure duty of care.23 The anticipatory positioning of humanitarian goods and staff in uncertain conflict conditions will, however, always be a high-risk endeavor, especially if a position is overrun before any goods can be distributed or duty of care adequately provided. Therefore, proper planning, continuous context analysis to identify the causes and drivers of uncertainty, and flexibility to adapt to the changing environments are essential for scenario planning and minimizing risk.

Integrating Tools and Action

Pressure, common talking points, and media exposure bring attention to access challenges but with low impact on those obstructing access. Humanitarian actors must increase their level of coordination with the donor, diplomatic, and NGO communities. Lessons learned from circumventing (albeit temporarily) the exacerbation of crises in Idlib and Rukban highlight the importance and combination of diplomatic suasion, local military forces reinforcing perimeters to facilitate access, and civil society advocacy to prevent humanitarian catastrophe. Such synchronization of tools and action will be vital in the coming months in Idlib, eastern Syria, Rukban, and areas under government control that are inaccessible to outside parties. In addition, occasional conflation of donor stabilization and humanitarian efforts in Syria over the course of the conflict has exacerbated the politicization of humanitarian action (stabilization being an inherently political activity).


Reaching 13 million Syrians in need of humanitarian action in 2019 will require several key steps by parties to the conflict, donors, NGOs, implementers, and the UN. These actions will have wide-ranging implications for the global humanitarian community and should therefore be taken in concert with broader international, regional, and local initiatives. These steps include:

UN Agencies and Member Nations

  • Validating regional security and safety to avoid and counter forced refugee and IDP returns until the UN and other third parties assess it is safe; and
  • Fostering agreement between the United States and Russia on a common humanitarian objective in Syria to facilitate ongoing UN negotiations.
    • For the government of Syria, this includes: allowing unfettered and sustained humanitarian access to all areas of the country; registering all humanitarian organizations that apply without overly prescriptive restrictions on activities; facilitating visas and permits for humanitarian staff; permitting use of alternative avenues of humanitarian access via non-traditional, non-government networks; and not seeking retribution against humanitarian workers and organizations who operated in opposition-held territory.

NGOs and Implementers:

  • Elevating quality, meaningful access, and the civilian protection aspect of access in strategy, planning, and access negotiations;
  • Identifying and leveraging opportunities with non-traditional, non-government networks, including religious, civic, and vocational groups and businesses, to find new avenues for access; and
  • Establishing common operating guidelines with donors for operating in territory held by the Syrian government.

Donor States

  • Foster a culture of trust with implementers on the ground and build in flexibility for remediation to ensure that reporting diversions will not result in severe repercussions such as future funding cuts, particularly if implementers provide prompt and transparent reporting;
  • Establishing common operating guidelines with NGOs and implementors for operating in territory held by the Syrian government;
  • Working with NGOs and implementers to avoid hawala systems that support terrorist organizations while identifying acceptable ones through financial network analysis;
  • Differentiating between engagement on the basis of humanitarian principles of independence, impartiality, and neutrality and “working with” Damascus, so as to pursue political objectives to counter the Syrian government in parallel; and
    • Donor governments should not use humanitarian aid for political ends.
  • Recognizing and confronting tensions in their policies, including addressing the long-term impact on Syrian civilians of implementing sanctions and withholding assistance (including reconstruction or stabilization assistance) in government-held areas.

United States and Allies

  • Planning and executing U.S. troop drawdown to include:
    • Clear handoff of responsibilities for civilian protection measures to local authorities or other coalition members; and
    • Strong diplomatic measures with the governments of Turkey, Russia, Iraq, and Syria to prevent conflict escalation and human rights abuses.
  • Sustaining diplomatic engagement toward Syrian political settlement at all levels, ensuring that securing humanitarian access is a central focus in negotiations, even if the outcome seems elusive; and
  • Building the evidentiary basis for violations of international humanitarian law and war crimes to prevent further erosion of international norms and legal foundations that have been swept aside in Syria.

Melissa Dalton directs the Cooperative Defense Project and is a senior fellow and deputy director of the International Security Program at the Center for Strategic and International Studies (CSIS) in Washington, D.C. Hijab Shah is a research associate with the International Security Program at CSIS.

This brief was produced as part of the Humanitarian Agenda program and was made possible by the generous support of the U.S. Agency for International Development (USAID).

CSIS Briefs are produced by the Center for Strategic and International Studies (CSIS), a private, tax-exempt institution focusing on international public policy issues. Its research is nonpartisan and nonproprietary. CSIS does not take specific policy positions. Accordingly, all views, positions, and conclusions expressed in this publication should be understood to be solely those of the author(s).

© 2019 by the Center for Strategic and International Studies. All rights reserved.

[1] The Humanitarian Agenda Program at the Center for Strategic and International Studies (CSIS), supported by the Cooperative Defense Project in the CSIS International Security Program, conducted a research trip to Amman, Jordan from December 4-6, 2018 and stakeholder interviews from November 2017 to January 2018 to inform this policy brief.
[2] Megan Specia, “How Syria’s Death Toll Is Lost in the Fog of War,” New York Times, April 13, 2018,
[3] In addition, in 2017, 70 percent of worldwide documented attacks on health facilities took place in Syria. 2018 saw an estimated 30 percent more attacks on health facilities than the previous year, according to UN sources: Regional Office for the Eastern Mediterranean, “Attacks on Health Care on the Rise throughout Syria in First Half of 2018, Says WHO,” WHO, August 19, 2018,
[4] Sarah Dadouch and Gulsen Solaker, “Turkey Determined to Push East of Euphrates ‘as Soon as Possible’,” Reuters, December 25, 2018,
[5] “2019 Humanitarian Needs Overview: Syrian Arab Republic.” UN Office for the Coordination of Humanitarian Affairs. March 1, 2019,
[6] “Humanitarian Access,” UN Office for the Coordination of Humanitarian Affairs, Accessed February 8, 2019,
[7] Under IHL, state and non-state parties to a conflict have an obligation to ensure the well-being of civilian populations under their control, including their access to supplies and services necessary for their survival. Impartial humanitarian organizations may offer their services to provide relief to civilians suffering from the effects of conflict regardless of which sphere of control they fall under. Parties should consent to humanitarian operations and, while such humanitarian operations are subject to the parties right of control, they should facilitate the rapid and unimpeded passage of relief goods and access by humanitarian personnel to people in need of assistance without any adverse distinction. Consent for relief operations and access to people in need may not be arbitrarily denied. Even when humanitarian operations may be delayed or suspended due to reasons of military necessity, this may only be temporary. Humanitarian personnel are civilians and must be respected and protected. Humanitarian personnel and their assets and facilities may not be targeted in attacks and precautions should be taken to avoid unintentional harm.
[8] The nine-point UNOCHA framework includes: 1. denying the existence of humanitarian needs or entitlement of assistance to certain Syrian communities in need of assistance; 2. restrictions on international organizations conducting cross-border humanitarian operations into Syria; 3. restrictions on international and local organizations conducting humanitarian operations across domestic lines of control within Syria (e.g., crossing from government-held regions into opposition-held regions, and vice versa); 4. armed conflict impeding humanitarian operations; 5. security and political threats to humanitarian staff, assets, and facilities; 6. external interference from the government, opposition groups, or third-party governments in humanitarian implementation; 7. presence of mines and unexploded ordinances; 8. geographical constraints to providing humanitarian assistance (including infrastructure constraints); and 9. impeded access of affected populations to assistance.
[9] “OCHA Access Monitoring & Reporting Framework,” United Nations Office for the Coordination of Humanitarian Affairs, May 2012,
[10] Louisa Loveluck, “In Syria, Aid Groups Seek Safer Ground after Trump Plans to Withdraw U.S. Forces,” The Washington Post, December 20, 2018,
[11]Ibid.; “Backgrounder Hay’at Tahrir Al-Sham,” Center for Strategic and International Studies, October 4, 2018,
[12] “U.N. Aid Convoy Reaches Remote Rukban Camp in Syria,” Reuters, February 6, 2019,
[13] Aisha Han, and Rachel Rossi, “Why the Situation in Rukban Is Deteriorating,” Atlantic Council, December 5, 2018,
[14] Ibid.
[15] “Report of the Secretary-General,” United Nations Security Council, December 11, 2018,{65BFCF9B-6D27-4E9C-8CD3-CF6E4FF96FF9}/s_2018_1104.pdf.
[16] “UN in Syria and SARC Deliver Humanitarian Assistance to 40,000 People in Rukban,” United Nations, February 6, 2019,
[17] Bethan McKernan and Nadia Al-Faour, “Displaced Syrian Infants Dying from Lack of Healthcare, UN Says,” Guardian, January 15, 2019,
[18] “Al-Tanf, Syria,” International Crisis Group, January 16, 2019,
[19] “2019 Humanitarian Needs Overview: Syrian Arab Republic,” UN Office for the Coordination of Humanitarian Affairs, March 1, 2019,
[20] Implementation of Security Council resolutions 2139 (2014), 2165 (2014), 2191 (2014), 2258 (2015), 2332 (2016), 2393 (2017) and 2401 (2018): “Report of the Secretary-General,” United Nations Security Council, December 11, 2018,{65BFCF9B-6D27-4E9C-8CD3-CF6E4FF96FF9}/s_2018_1104.pdf.
[21] Sara Kayyali, “The Tragic Irony of Unlawful Attacks on Civilians in Syria’s De-Escalation Zones,” Human Rights Watch, January 10, 2018,
[22] Ben Parker, “Q&A: Top US Aid Fraud Investigator Defends Tough Counter-terror Stance,” IRIN, February 04, 2019,
[23] Hawala is an alternative or parallel remittance system. It exists and operates outside of or parallel to banking or financial channels as a cost-effective alternative or related to existing business dealings. The components of hawala that distinguish it from other remittance systems are trust and the extensive use of connections such as family, tribal, community, or regional affiliations. Hawala is primarily used for legitimate purposes, but the U.S. Treasury Department and other intelligence and financial institutions reportedly have found evidence that some hawala exchanges can be linked to money laundering, threat finance, and other illicit activities.
[24] Duty of care provided by a humanitarian organization typically includes “psychosocial support, health, human resources and administration and, safety and security” for its personnel. See “Duty of Care,” United Nations System: Chief Executives Board for Coordination, Accessed February 8, 2019, See also “Cluster Coordination Performance Monitoring, Jordan Final Report,” OHCA, October 3, 2018,