Transcript: Humanitarian evidence session

Monday 23rd November 2015, 11am–1pm, House of Commons Committee Room 11.

The speakers were Max Hadorn, United Nations Office for the Coordination of Humanitarian Affairs; Rouba Mhaissen, Sawa for Development and Aid; Amal Kaoua, Save the Children; Dr David Nott; Dr Fadel Moghrabi; Aula Abbara, Hand in Hand medical team; Wael Aleji, Syrian Network for Human Rights.

Chaired by Jo Cox MP.

View and download a PDF of the transcript.

Max Hadorn:
Thank you for inviting me. I am going to do a very short presentation, actually the presentation will have a handout to look at. You will probably have two documents: one is the presentation, the other is the statistics on cross-border operations under Resolution 2165 and 2191, so cross-border operations from Turkey into Syria and from Jordan.

In my presentation I will be fairly short, I will focus on four areas.

So to start with, I think it it is important to report that we are now in the fifth year of the Syrian crisis, there is no viable peace process, the situation continues to deteriorate, and the result is the world’s largest humanitarian protection crisis. Violence continues, and has become more intense in the recent weeks.

Just some numbers to see the magnitude of this humanitarian crisis. So people in need is actually people who need some form of help, assistance from the humanitarian community. 13.5 million people need assistance, this means without this they cannot meet their basic requirements, and among them you have 6 million kids. Internally displaced people: 6.5 million. Palestinian refugees: 450,000. Iraqi refugees: 32,000. The estimated number of deaths since the beginning of the conflict, the estimate is 250,000 people killed, and there are more than 1 million people injured. Also to mention the 4.2 million refugees registered in the neighbouring countries. Also to show how far Syrian livelihoods have decreased, poverty now affects 4 of 5 Syrians in the country, and more than two-thirds of the population is under the poverty line according to UNDP. The unemployment rate is extremely high. And there are at least 2 million children and adolescents that are out of school.

So this graph shows where the people who we need to assist are. The biggest concentration in the country, so you see in the western part, especially Aleppo, Damascus, rural Damascus, where you have the biggest circle, is where there is the highest number of people. And as I said there are almost 4.2 million refugees in the region.

Now I will be talking more specifically about four issues. Starting with the next slide. Syria is in the first place a protection crisis. This is our greatest concern. Syrians are exposed to human rights violations, they have a high number of indiscriminate attacks in civilian populated areas. There is absolutely no respect for the Syrian population. People are also targeted according to their ethnicity, religion or place of origin. There is a high number of extra judicial killings and forced disappearances and so on. There are also a very high number of issues related directly to the rights of children, child labour, child soldiers; all these are very well documented. Also to mention that there is a high, very high, incidence of gender based violence. Women are also very often victims of violence.

Next, and directly related to this for the population in Syria, I think we should remember that Syria was a middle income country with quite sophisticated institutions etcetera. So four years or five years later we have a total break down of the medical system which quite often has been a target of military operations. Medical facilities are hit. A very high number of medical health workers have lost their lives—they estimate it is more than 670 people who were killed. A high number of medical structures destroyed. And added to this, we also have a lot of medical workers who left the country, and the medical system as a whole has broken down. Without the courage of mainly Syrian NGOs, with the support of UN agencies, we don’t know where this medical system would be now.

And we see also 2 million children are out of school. One out of four schools destroyed. 70% of the population has no regular access to drinking water. Many populated areas have no electricity and millions are now living without adequate shelter, which is a major concern with the winter coming.

Now moving to aid delivery. Aid delivery is a major challenge for a number of reasons: insecurity, also obstruction by the parties to the conflict, and long administrative procedures that are put in place by the government in Damascus. So the blocking, you can say the blocking of humanitarian assistance has become a tactic of war. And as I said the very dangerous environment, I was mentioning the health workers but there are also 81 international workers in SARC and the Syrian Refugee Society who where killed, and a high number, we don’t have the exact numbers, of Syrian aid workers who were killed.

So the main areas of concern, there are actually two: I will go to the next slide. In pink you see the areas where we have the most difficulties to have access. The bigger part is where the areas are controlled by ISIL, where very limited number of organisations are still able to work—it’s only really a few—the Syrian Red Crescent society is able to to some work, there are some Syrian NGOs able to do some work. But there are more than 4,500,000 people that we have a lot of difficulties to access. Half of them are actually living in this pink area on the right hand side of the slide and the others they are living in, mainly in, the disputed areas. So in the areas where you currently have fighting going on, the areas of Aleppo, Hama, rural Damascus, Daraa. So it is on this front line that actually fighting is taking place in extremely populated areas. When we say we have difficulty to access, some of these areas there is actually almost no access, in besieged areas for example in rural Damascus, eastern Ghouta, we have a number of localities where access really every three or four months, but in very limited quantities. When it comes to provision of medical aid, most of the time it is denied, systematically denied by the government.

Next, to address this situation the humanitarian community has embarked on an approach which we call the whole of Syria, which is basically we have humanitarian organisations in all these five spots. So we operate from within Syria, from Damascus into the government controlled area, from there we are also doing cross-line, which I will come to in a few minutes, and from especially from southern Turkey, and from Amman, but also to some extent from Iraq and from Lebanon, we are doing cross-border operations.

When I say we it’s United Nations but by far the biggest actors there are the Syrian NGOs crossing the borders everyday, some inside Syria, and some, quite a high number also, international NGOs.

So what we are looking at is to cover as much of the need as we can through the safest route. So for some areas, some areas can be reached only through cross-border operations, others can be reached from within Syria. It’s quite a complex organisation but it is absolutely necessary. And this was facilitated to quite some extent, at least for the UN agencies, with the passing of the Resolution 2165 more than a year ago. You probably know that the Security Council in December will have to discuss the extension of this resolution for cross-border operations, which is now 2191. So with this approach we could reach quite a high number of people.

Just to provide a few numbers on what we where able to do—I won’t go through all the details, but when it comes to food, it is almost 6 million people who can be reached every month with food, so either from Damascus or through cross-border operations. It’s 5 million people who are provided with safe drinking water. It’s almost a million kids that are reached with education intervention. And it is 4.3 million people who are reached on a monthly basis with non food items, so it could be clothing, it could be kitchen utensils etcetera for displaced people. It could also be shelter material, usually quite important.

So I come to my last point. I will start with commenting this slide by really thanking all the governments, in particular the UK, for their generosity. Maybe you know, maybe you don’t, but the UK for the Syria response inside Syria is the second biggest donor after the United States, and for the response in the neighbouring countries the UK is the third biggest donor after the United States and Germany. Just to show on this slide that in spite of the generosity of the donors we are far from meeting funding requirements. You can see that the response inside Syria at this point is funded 40% only, and for the regional refugee resilience response plan, it is funded 51%. So we are below the needs but again we must say that if we look at the global level, the requirements we have for humanitarian funding is just increased in recent years really dramatically, and the funding available from the main donors, this amount is not being increased. So we have a gap globally that is very big, you see it not only in Syria.

The last slide, of course for us we can only say that we need additional funding. It is quite urgent also because we have large number of people displaced and the winter is coming or is already there and a high number of Syrians that are living in conditions that are definitely not appropriate for winter. We have major issues with health, shelter, but also with food.

I will just conclude with maybe one positive, let’s say one encouraging development. Since October there have been Vienna talks. Of course it’s not—we know that the road will be very long until peace will come to Syria but the mere fact that there are now talks at foreign minister level between the main member states on the Syrian crisis is already a positive development. Of course we as humanitarians have always been saying we can do that much only short of any political solution or any peace process. We can only be firefighters asking for increasing support from donor countries and in the end it is not really sustainable.

So, if there is one message here, definitely we recognise the support of the UK government, not only in terms of the contribution but also on the political level. Definitely what is really key in this crisis is that as soon as possible there should be a reduction of the intensity of the fighting, there are ceasefires, people can push for ceasefires that is already positive, a positive step. But also this should be viewed in the longer term for a long lasting solution. Thank you.

Thank you Max. We’ll take a few questions after a couple of other speakers. Rouba, are you okay to go next?

Rouba Mhaissen:
Hi everyone, my name is Rouba, I am half Syrian half Lebanese. I just completed my PhD in development but I founded an organisation in 2011 that works with refugees in Lebanon. I have also been highly involved in lobbying and advocacy for refugees since 2011, in Europe mainly but also in America.

I think my colleague said a few points on the end which I would like to start with actually. The first thing that needs to be said is that this crisis is not a recent crisis, is not a current crisis. In the media we have seen a lot of the word current crisis, current refugee crisis, European refugee crisis but we need to first frame it as the refugee crisis which started in 2011. What happened today in Europe was predictable, a lot of organisations from neighbouring countries were talking about it since the beginning of the crisis, so this is one thing that I wanted to start with.

The second is the importance of always looking back at the root causes and what is causing all of this influx into neighbouring countries and into Europe. I mean the first policy recommendation which of course all of us know, I don’t know how much agency we have over it, is that peace needs to happen as soon as possible. This is what Syrians want; nobody wants to be in neighbouring countries. No one wants to be in Europe. Everyone wants to stay in Syria if they could. I don’t know if you guys are familiar with the work of Planet Syria but I really urge you to have a look at it, in which the most active civil society organisations inside Syria have called for a no-fly zone and have been advocating for it. I mean we can take hours to discuss how easy or not easy it is to implement this no-fly zone, especially now with the complexity of Russia intervening etcetera, but this is just to highlight there is nothing we can do (as my colleague mentioned) except you know dealing with the wounds, but really addressing the root cause is to have peace in Syria.

The second issue to address the refugee crisis is to look at the neighbouring countries. The situation in neighbouring countries is becoming more critical by the day. When people asked me how was the situation in Lebanon, or Turkey and Jordan a few years ago and then if I compare it with today we have to recognise that yes, we thank donors, we thank the US, the UK, and all of the generous donors who have been pouring money into the region and to neighbouring countries. We do need more funding of course in the region, however we need to realise that these countries also have capacities. Lebanon is a country of 4.5 million, it hosts 1.1 million registered refugees and almost 2 million unregistered Syrian refugees. Of course we are not talking about the 800,000 Palestinians, we are not talking about the fact that the country itself is suffering a lot. There is no president, there is no infrastructure, there is no proper support. So yes, more funding is needed.

Where is this funding going is another question we need to ask ourselves. It is very important to continue supporting grassroots and local organisations, who employ in majority Syrians who have themselves fled out of Syria. I can speak for myself, in our organisation—Syrians don’t have the right to work in Lebanon but there are a lot of ways of having cash for work—so in our organisations around 80 or 90% of the staff that we employ are from the Syrian refugee communities themselves. So here we are talking about agency, about you know ownership, about doing the work bottom up, and all of these things that unfortunately sometimes, because of the scale that international organisations have to deal with, cannot be done in international organisations. So more funding needs to be done with these grassroots organisations.

We would love to be invited more with OCHA and others to sit round the tables when decision making is being made, not only as implementing partners, as grassroots local organisations.

But finally we need to also start thinking that humanitarian money is important but we need to focus now on livelihood and development. A lot of the young people that I have spoken to that have been on boats, and that have been, some of their families and themselves, almost drowned or had some of their families drowning, did not leave from Syria; they left from Lebanon and Turkey which means they have been there for a couple of years, and which means they reached a point in their life where everything they could do is just be on a boat because they can’t live all their lives just waiting for the food basket. So turning the funding into development and livelihood is something that is really important. It has been happening but more focus should be there.

The third thing which flows from the incapacity or the over population of neighbouring countries is to push a lot and put a lot of our lobbying and efforts into resettlement plans, and into lobbying for example in the UK our MPs, lobbying governments in Europe and others, and of course someone in the public will ask me now what about Saudi? Don’t we have to lobby Saudi and the Gulf States? Yes of course, continue lobbying even the Gulf States into accepting more refugees. And I talk about resettlement and relocation because it’s not simply important to stop the Dublin Convention and tell refugees we accept you in the same way that Germany has done or the same way that Sweden has done, which is really accepting a lot of refugees, but without providing enough safe routes for refugees to arrive. Because by that we are pushing people into the sea and we don’t want to be doing that. So safe routes for refugees.

I do believe in—I don’t believe in the political agency at this point of each and every one of us but I do believe in our agency in lobbying for refugees. What we see today in Germany, the signs welcoming refugees etcetera, this was not born out of the blue, this was born out of years of popular demands from local citizens pushing their governments to accept more refugees.

Which brings me to another point, which is my final point really, not directly related to the refugee crisis if you want to talk just about the refugees, but I have recently been lucky enough to go to a few countries in Europe and America to have a look at refugee camps and to talk to local communities, to organisations that are dealing with host communities, and we really need to start putting more effort into also the host communities, not only in Lebanon, Jordan, and Turkey, but also in Europe, in increasing understanding of who are these refugees. We cannot talk about the refugee crisis without addressing the issues of anti-refugee sentiments and anti-Muslim sentiments, which also some people like to call Islamophobia, but what it really is is anti-Muslim sentiment which is increasing especially now after the Paris attacks.

This happens through really raising awareness about who are these refugees? Why are they leaving? And who is ISIS? And why does ISIS exist today? And how is ISIS able to recruit more and more Syrians and Arabs into ISIS? Which is really addressing three main points, the three strength points of ISIS on the ground nowadays.

The first one is that for a lot of Syrians who have been calling out to the world in the past 5 years, ISIS today stands as one of the main oppositions to the Assad regime, so this is one very strong point for ISIS, for the youth feeling that there is still someone fighting the Assad regime today and if it is anyone then it is ISIS, although this is just a rhetoric. We can go politically and speak to that.

The second is going into why people become radical and all the causes of injustice and inequality and feeling isolated, which is also what ISIS is playing on in its rhetoric of defending Islam against people who hate Islam.

And the third thing is of course the personal gain, which links back to what my colleague has been saying on the lack of funding inside Syria: I mean of course if you fight with the Syrian army you get a middle kind of salary, if you fight with FSA you get very little but if you fight with ISIS it’s a whole package, it’s really a very good package for people for people who have been suffering for a few years with lack of funding.

So really my main message is stop the mass killing, support more local initiatives and neighbouring countries, push for more resettlement and call Islamophobia through building more understanding and dialogue in Western countries.

Thank you very much. And now Amal from Save the Children. So, just to challenge you a little bit Amal, we know that the Prime Minister is going to bring something that looks like a comprehensive strategy of sorts to the House, to the Foreign Affairs Committee on Thursday; it would be really interesting to know from your perspective what do you think should be in there from a humanitarian perspective.

Amal Kaoua:
That’s fine, actually when preparing this today I did actually zone in very much on the UK response and some recommendations for aid and policy. I might just go straight into that and then we can see if there are any questions afterwards. Save the Children obviously works very, very closely with DFID and we’re quite a big implementing partner, so I thought it was interesting for me speaking to you today to give a little bit of that perspective as a big recipient of very generous UK assistance in helping Syria, and I did actually focus as well on the work inside Syria as opposed to the region, so I’ll hopefully complement some of the things Rouba has just mentioned.

First of all, I have kind of divided it up, so the first thing I want to look at is what the UK could be doing better in relation to the actual aid itself and how it’s spent. The first thing to say is that we work very, very closely with DFID and we are really remiss not to thank them, they are just a fantastic team, the generosity is amazing, they are the second biggest donor. But our key, I suppose we are at the end of a funding stream so this is actually a very timely session in terms of this discussion around aid and the policy that goes with it, because there are some lessons learned and the first big one is the need for very much a country focused response and a move away from programmatically trying to approach the region as one. And we think that the ongoing aid review that is happening at the moment is a very important milestone in the process, given the very different needs inside Syria to the different neighbouring countries.

The second major point that we have learned, and that we would like to work more closely with DFID on, is the need to flexible and adaptable in terms of how the aid is used. As most of you probably know, Save the Children isn’t Damascus based. We chose very early on to do primarily our work cross-border, and this was based on an evaluation on how we would best get to those we wanted to reach. But as a result, there are complications of course that come with this way of working, so we are saying very clearly that in the context of these difficult borders and security, operations need to be agile.

And this comes onto what sounds like quite a technical recommendation in that there needs to be a rolling response, and what actually that means is the objective when assigning an amount of money for particular programme, there needs to be that flexibility to update that regularly so that we continue to meet the most urgent needs on the ground and if those are slightly different to the ones we started out with at the beginning of the programme cycle then it is important that we be allowed to make those changes.

The other interesting point that came up when I was speaking to some of my colleagues who very much manage the grants and the awards and the programmes, was the challenges that we actually share with government departments as a very big organisation, and the constraints of the financial year. I suppose one of the questions that I think would be really interesting to tease out with the group, and maybe for your own report afterwards, is how a government department like DFID working in a context of a fragile state or conflict situation can be agile and yet maintain the sort of requirements under financial regulations.

A recommendation is that senior management in DFID and the Treasury will somehow find a way to accept the kind of agility that is required in terms of forecasting and numbers reached and what areas and what kind of programmes versus what is actually practical on the ground, and is it OK for an organisation to say we where given this amount of money for example for tents or shelter, to make it really basis, but actually what is desperately needed now is water here. Can we do that? And how can we do that and meet the requirements? It sounds quite technical but that is actually really important on the ground in a very very practical way.

And then another major recommendation, which I tease out a little bit more when we talk about the policy side, is that we move away from short term funding for Syria. This is a protracted crisis and we need to be looking at multiyear funding mechanisms, and in this respect we really welcome what seems to be the focus of the London Conference that is planned for February, and we really encourage the UK, not just as a really a really innovative and actually really really good donor itself, but also as a convener and a chair of that conference, to try and help move their peers also to looking at more long term sustainable funding options for Syria.

And this brings me into the policy recommendations, and I think a little bit like you mentioned, we are really talking about trying to build what we call resilience. And what that basically means is if you have families that have been displaced two or three times, they were working on farms or they had a business, they are now no longer there, savings are dwindling, children are out of school, what do we do in Syria beyond the immediate (which will always be needed) humanitarian emergency response to try and build those communities ability to cope themselves?

One of the big things is this community led provision and actually working with the people there, and as Rouba mentioned there is a lot of capacity, there are some excellent people, but they will need support, they need support technical but also funding, and we need to be looking at, again, more long term investment in local communities and supporting what they can do. An example of this is we have actually taken this approach in our support for education in northern Syria. So as well as training and supporting the teachers and giving books and desks and things, we actually also work quite hard to build and strengthen community led education systems. The recognised government structures that are there, we need in the short and medium term to build their capacity, and again this comes back to the point about multiannual funding because it is just not a quick process and for us to deliver really robust capacity building community level ability to respond, then it needs to more than just short term immediate reaction funding that is available.

Second big recommendation for the UK and for other major donors is support for key workers, and I am sure you will hear from some of the really excellent medical speakers on the need for support to doctors, nurses, and teachers. And some this again comes back to capacity and training, but it is also things like renumeration, and making that available where there’s actually no structure to pay salaries anymore. And again that is quite different from what you would probably expect a humanitarian relief organisation to be asking for, but actually in the Syrian context after this many years these are the kind of things we need to be looking at if we are going to avoid a dependency or have people losing skills even, and getting out of touch with their own community support.

And then the next big one is obviously livelihood support. If we are looking at 6.5 million people internally displaced and on multiple locations, we really need to look at building up livelihoods and how do people sustain themselves and support themselves. Before the conflict, 8 million Syrians were farming, and now the agriculture sector is pretty much decimated. We have a figure of nearly two billion US dollars worth of losses, fields left unattended, equipment looted, power cuts, lack of fuel, everything that you would expect. So what we are saying is that there needs to be an absolute shift away from the one size fits all approach, to looking at how we can have targeted assistance to promote opportunities for labour, integrated market activities, and then renewing the agricultural sector to move away from this dependence on food aid and food dependency, which is obviously as we know and have seen, those of us working in Syria with the World Food Programme and the cuts this year, it’s actually quite an unsustainable model and very expensive to do that kind of food coverage in that way.

And then another suggestion is to look, again I think DFID are quite innovative in this, but we think more could be done on cash and voucher based programming. We have actually begun to pilot this kind of voucher programme as part of our livelihoods project, and we are planning to use vouchers for winterisation. Again it’s about doing proper analysis of the markets, seeing what is available and trying to support those markets as well as you can.

The final main point that I wanted to make in terms of recommendations for what we can be looking at for the next generation response around child resilience, obviously. We feel that today there hasn’t been sufficient investment in actually developing integrated programming to target children. I have statistics and very sad statistics of psychosocial distress. We are known for our reports on education and how much education programming we do in Syria. We have started talking about the attacks on schools. All of this means that we need to invest in interventions, be they education but also then training teachers to also identify and work with signs of psychological distress, providing funding for basement schools for example. As we know, huge numbers of children have had to leave their schooling in Aleppo in recent weeks because of the increase in airstrikes, and without basements UNICEF and those running schools, have had to shut them down. So there is a real need to look at what we would call the ‘no lost generation’ initiative and really consider seriously investing in the children.

So those are the main points around the aid and the policy that we would like to see as the aid review finishes up and there is a real look at what I think is being called the new generation of response for Syria.

Thanks Amal. On the aid review, that’s the DFID aid review on Syria?

Amal Kaoua:
Yes, they’re doing a bilateral aid review—I’m not sure if it’s worldwide because I’m completely entirely focused on Syria—but they’re doing Syria and the neighbouring countries as well, so they’re reviewing their approach to Jordan and Lebanon as well. Previously, in a very programmatic way I think, funds were given for the regional response, which obviously if you’re then asked to do a particular programme it doesn’t work because you have very different needs in Lebanon to Jordan, to inside Syria, so there is a shift in that, and they’re really looking at being more strategic in their intervention, about this kind of multiannual, about a look at livelihoods and resilience. So a lot of these things are underway at the moment, but I think it’s really important that at the end of that process we do actually see that shift, and that focus, and that zoning in to what’s needed in particular areas. And a little bit more long term thinking.

We’ll just take a quick pause to see if there are any questions. I just have two: Winter’s arriving, is the humanitarian aid community geared up to deal with what that means for Syrians, for refugees in the region? And the second thing, what are the implications, particularly in terms of humanitarian access, of the UN Security Council Resolution passed on Friday? Max, you talked about there needing to be a new UN resolution to renew access provision? Are you planning for any fallout from Friday evening’s resolution? And obviously conversations are happening now around UK airstrikes, and an enhanced effort against IS.

Amal Kaoua:
On the winterisation, again I think it’s very much an issue around funding. Certainly for us we have started all our different preparations, and as I said we’re looking at voucher systems and ways of coping. But it’s massively been affected by the increase in airstrikes, because we’ve seen I think in the last two months the 130,000 figure I was given of extra people displaced towards camps in the border with southern Turkey, so it’s really really difficult to respond.

In terms of readiness. I think there’s a high level of preparedness but again it comes back to what our OCHA colleague was talking about, it’s funding as well. So we have this discussion every year, do we need to do a separate winterisation appeal, how do we cope with this? And I think it’s really an issue around money and how the funding gets through, and then capacity to scale up and to respond quickly.

So I would hope that for the most part the community sees this coming and prepares really really well, but there are limits to what can be done in response to very rapid changes of population. And this is the big issue, obviously as humanitarian organisations we don’t make strong comments about the political situation, and that’s just not within our public remit to talk about these things, but what we can say is that there is a massive increase in displacement, and my understanding from recent reports is that we’re talking about another million people by the end of the year? I think it was the regional humanitarian coordinator maybe who said that on Universal Children’s Day? So this is the background to the winterisation response. So there is no easy answer.

On the access, again for us the access is constrained, and has continued to be, and it is largely because of the security situation. So I know from speaking to—in preparation for today I spoke to some of those who work in southern Turkey and coordinate efforts in northern Syria, and northwestern Syria in particular, it is really really difficult now to have access. And again it’s a security issue around access rather than changes in borders.

Rouba Mhaissen:
I can just say a few words on winterisation. I agree that the main problem is funding, but for a grassroots organisation it’s also different because the funding first has to reach the big organisations, and then by the time it reaches the calls for winterisation, for the grassroots organisation it’s already in the middle of the winter. We launched an appeal called ‘Before the Storm’ this year from our side but it didn’t get a lot of attention because the funding was still not there, but then suddenly the donor gets emergency funding, and they call it emergency funding and so we have to spend it within two months, and of course there’s all the beaurocracy for this emergency funding.

It’s true it’s called emergency funding but then you have to go through all the paperwork and the beaurocracy of the international organisations, and then through the banks, and increasingly the banks have been very very difficult in the way to receive the money in Lebanon, so this is also something that we need to think about, how are banks dealing with all these transactions with regards to access to money in these neighbouring countries.

And the other thing is on displacement, sometimes we have to move a camp two or three times because of lack of infrastructure in the country, so we should also start thinking about working more closely with the states on rehabilitating the infrastructure system, for example in the Bekaa Valley, or in Akkar, I’m talking about Lebanon but also about other countries.

Max Hadorn:
On the first part on winterisation, as I mentioned humanitarian partners are ready to do the work. They need more funding. It’s quite clear that we have a major gap this year as we had last year. I was recently in Turkey where the response was to the new waves of displacement, and there I could see that donors including DFID were mobilising quite quickly to support the humanitarian effort.

The other issue we have as my colleague mentioned is the security environment, and the security environment is getting worse. It’s limiting access. The resolution on cross-border is absolutely necessary. We really rely on it. Syrian NGOs and international NGOs were doing cross-border well before, but with the resolution, it gives more flexibility in terms of the response to reach people in the safest manner, which is extremely important in this very fluid environment where the front lines can change very quickly, where you can access an area from Point A today but tomorrow you don’t know, so you need to have this flexibility.

Any questions? Yes?

Baroness Hamwee:
Sally Hamwee, House of Lords. A figure that really surprised me from your presentation was not that 57% are unemployed but that 43% were employed, and I wondered if you could comment on what people are still managing to do by way of employment, and also, a related question, the impression that I had is that a very large proportion of refugees from Syria are people who are skilled, a lot of them highly qualified, and I wonder what this is doing for the future of the country, in that so many people with considerable skills are being, as it were, lost to the country.

Max Hadorn:
On the first part, the 43% people still employed, of course it’s not only people who are employed formally by an employer, it’s also small shops, small jobs, people who have some income to meet their basic requirements. One should not forget that Syria before the war was extremely developed, had extremely developed institutions, so there is still something remaining of this.

The major concern, and this is your next question, is that so many highly qualified staff left their country. On the medical side it’s a really major concern. In education we are talking of a lost generation, so it’s really a huge issue.

Rouba Mhaissen:
I just want to comment, one of the ways to overcome that is giving organisations more core funding, because a lot of Syrians are being headhunted by international organisations, or are being you know welcomed in other countries because local organisations who are working with Syrian and Lebanese and Turkish and Jordanian local organisations cannot sustain these talents within the region, because they don’t have enough core funding to provide and pay for the salaries. So this is one thing that we also need to reconsider, a lot of calls for proposals allow local organisations to include the 7% core funding, but a lot of them don’t, so this is something that really needs to be highlighted.

Any other last questions?

Zaki Kaf Al-Ghazal:
In the past there have been two United Nations resolutions, 2165 and 2191, which both authorise humanitarian aid distribution within Syria, even without regime consent, but one of the issues is, as you’re probably aware, that it’s not been properly enforced. How can you make sure this can be enforced?

And we’ll also take another.

Howard Mollett:
It’s sort of a question to the panellists, but also a response to your question about the comprehensive strategy due to be presented later this week. My name’s Howard, I work for Care International. We’re an NGO supporting Syrian partners inside Syria as well as working with refugees and host communities in neighbouring countries.

On the vote, obviously as a humanitarian organisation we don’t have a position on whether or not to have a military intervention against one or another armed group, but I think there are humanitarian questions around respect for international humanitarian law, as well as a sustained commitment to allowing aid to be delived wherever there is need, and we’ve seen in other conflict situations, and also inside Syria with other donors, not so much the UK so far, pressure on agencies to direct aid to communities in areas controlled by factions that are the allies of the donor, and what with this whole momentum around the ‘War on Terror Mark II,’ that’s a real concern.

And then the other issue with the—in terms of IHL concretely—if we look at other conflicts like Afghanistan, the UK and the US in 2001 and 2002 took so long to work out systems to monitor civilian casualties and trying to establish some sort of accountability and compensation around that, and it’s still not perfect.

We look at the occupied Palestinian territories, and there OCHA, the UN humanitarian body, has quite a sophisticated system for monitoring violations of IHL as well as access issues. I think we’re going to really struggle in Syria because of the complexity on many levels, but these are the kind of things that could be highlighted at the time of discussing this strategy and potential UK military involvement.

The other aspect on resilience and the London Conference, DFID has made a big thing out of its interest in empowering the private sector in development and humanitarian work, and so I think there are some questions around how could DFID reach out to business on how it could invest in local communities, both for host communities in those countries accepting refugees, be it Jordanians, Turkish, Lebanese, or others, as well as the refugee communities, because there is this sensitivity just as there is here, perhaps actually even more acutely in those countries that have accepted so many more refugees than we have.

And it does also link to the resettlement issue, because obviously those states hosting refugees neighbouring Syria rightly challenge the donor countries including the UK on their performance.

Thank you. Any reflections on the points, and a couple of specifics on implementation of previous UN Security Council resolutions, Max, any thoughts?

Max Hadorn:
Maybe I should recall that there is a resolution before 2139 where, this is very odd, I’ve never heard this in any other context, that a Security Council resolution decides to tell member states that they have to respect what actually they have signed, ratified, in international humanitarian law. It’s strange that the Security Council has to decide this.

Now, coming to 2139 and 2165, the text of the resolution doesn’t say specifically what should happen inside Syria when organisations are doing cross-line, but put yourself in the shoes of people who do cross-line, and without the consent of the parties to the conflict it’s just suicide. The security environment, it’s so dangerous, you need in a way to have security guarantees from the parties that are involved in the area. If you go from Damascus to rural Damascus, and you want to enter an area where there is a front line with fighting going on, where you have maybe mines or whatever, you cannot just say, OK we notify and then we go. No, we need to have definitely the parties that are involved there giving the clearance, yes. If you can go it means that the aid workers going there, they will be safe to operate. And also the civilians.

So this is an interpretation we can do, but on the practical level we need still to have the acceptance and the security guarantees from the parties. It’s slightly different when it comes to cross-border operations, but there it’s only to some extent. Once the border is crossed, the NGOs working in the area, they are dealing with those who are the stakeholders that are in the area. Also currently with the increase in airstrikes, it’s also quite important that whoever carries out the airstrikes is informed about this movement.

Amal Kaoua:
Just a little bit on the enforcement of the resolutions, obviously this is something the humanitarian organisations have been grappling with since the beginning of the conflict, and 2139 and then 2165 were massively celebrated on one hand, but of course then in practice, what actually happened on the ground, and the ability of the current configuration of the Security Council for all their own political reasons to actually enforce that has fallen far short. There is a report called ‘Failing Syria’ that a few of us co-wrote last year, and if you’re interested you can see all the different points that were made around that.

The reality is of course that people are still doing cross-border and cross-line. We support some incredibly brave organisations doing cross-line work, but it is very much like my UN colleague mentioned, they’re taking their lives into their hands every single day. Does this mean we should or shouldn’t support them? I would say it means we absolutely should be supporting them, and in fact the more present this sort of assistance is, then the better chance we have of increasing it.

I’m obviously talking about in areas that are hard to reach or besieged, and that work is going on and absolutely we should continue to support it. But the risks alongside are absolutely awful, and I would never be allowed for example to name the partners for that reason, which will tell you the kind of level of risk we’re talking about.

I just wanted to pick up one of Howard’s points which I think is really really important, and this is arount the concern for not just the impartiality of assistance, but also that IHL be respected in any decisions on the military, or foreign affairs, or political side. We don’t programme in ISIS-held areas, I know some organisations do, but—obviously for strong professional purposes but also for personal interest—I’ve been following some of the Syrian human rights organisations who do have eyes an ears in Raqqa and places like that. You’re looking at a population of half a million people who are not allowed leave. They’re not ISIS fighters, they’re not affiliated with any political group, they’re probably the people who were that bit more vulnerable and weren’t able to leave, the elderly, or families with small children, or people with medical conditions.

So I think it’s really important that Howard’s point around IHL and around protection of civilians is at the fore in every one of the discussions that are going to be taking place here in the coming weeks, and that we don’t allow the very quick reaction to understandable shock and shared suffering that we feel for France and for Paris, and the reaction to, well, how should we respond, that we keep in mind also the IHL and the populations in the areas, because I think it’s very very difficult with increrased airstrikes to make sure that we’re not also resulting in huge numbers of deaths of civilians.

Thanks Amal. Thank you very much the three of you. Do stay with us.

Dr Nott, can you give us a perspective on the work you’ve done, and for the UK, what you think a comprehensive plan might look like.

David Nott:
Thank you very much for inviting me. I have a direct experience of working in Syria over 2012, 2013, and 2014. In 2013 I went through the border between Turkey and Syria, crossed about ten lines of ISIS check points on route to Aleppo where I worked for six weeks.

The situation then was that the hospitals in Aleppo were working, but you must remember the hospitals are not medical hospitals; no diabetes was being treated, gastrointesinal diseases are not being treated, cardiovascular diseases aren’t being treated. There are no physicians there anymore. The only hospitals that run are trauma hospitals. They are trauma hospitals because of sniper wounds and air attacks and such and so forth.

So I spent six weeks of my time in Aleppo teaching and training the surgeons how to deal with these injuries. And then I went home and came back in 2014 to a completely dire situation, far far worse than I had every really expected. Again it was easy to cross the border between Turkey and Syria, the road down to Aleppo this time was easier because ISIS were not there. But Aleppo was barrel bombed to extremis. We were facing barrel bombs six to eight a day coming in by Syrian helicopters.

I was targeted personally by a Syrian jet when I went for a wander around Aleppo itself. And not only that, most of the doctors were.

I want to do a double act with my Syrian surgeon colleague who has the statistics he will tell you about. So, it was very very very dangerous, and not only dangerous for the people who were working there. The hospitals were being targeted and so most of the hospitals were underground in Syria last year when I was working there, rather than being overground, because lots of hospitals where being targeted. International humanitarian law is non existent in Syria.

It is also extremely dangerous to cross the border now. I was going to go back this year but I think my changes of survival for six weeks this year would be negligible, probably 10%. Luckily there was only one road out of Aleppo last year which was being targeted by the Syrian regime. That road if closed is the only road which provided humanitarian support as regard to equipment, anaesthetic equipment and surgical equipment and so on.

Again the only hospitals that are working are the ones that deal with trauma, and I would just like to bring in my colleague as we have a slight idea of how to solve this problem in UOSSM [Union of Medical Care & Relief Organisations] which is the united Syrian medical fraternity, the Syrian British Medical Society, and I work for Syria Relief.

If you draw a line really from Idlib all the way round to the southern part of Aleppo and take that back up to Turkey, it’s quite a significant area and if you go down through that area there is lots and lots of land, lots of land. We are talking about big areas, hundreds of square miles, which could be used to bring back Syrian refugees, back into their country. And our idea was that—perhaps it should be with the United Nations—would be to police that area with UN support, to police this safe haven which would allow Syrian people to come back in.

Now if there are United Nations people there, the biggest problem in Syria, the reason why I can’t go back there anymore, is because of airstrikes and bombing, because it is being bombed constantly all the time, and one way of organising this would be to stop, rather than having a no-fly zone which is fair enough, but actually have a no bombing zone. And if it’s a no bombing zone that’s the thing, planes can fly over but they mustn’t bomb the whole area. They mustn’t target civilians on the ground. They mustn’t bomb the hospitals in the surrounding areas that involve humanitarian people. That is what we should do, really, a no bombing zone, and that’s what we’re trying to suggest.

The other thing—I’d just like my colleague to come actually—just to say, since three months ago, you have now more statistics about how bad it is.

Fadel Moghrabi:
Hello, Thanks for the opportunity. My name is Dr Fadel Moghrabi I am a surgeon, cardiovascular surgeon working in this country for long years, but also I am Syrian as well and I have been to Syria several times. I have been to the same hospital David has been to and I worked with my colleagues as well for a few weeks over there. I have been several times and in the last year or so it has become increasingly difficult and dangerous to do the trip and we have been very worried that if we get there we will never come out.

And that is the situation not because of ISIS or because of the opposition or anything. The situation is because of barrel bombs. The barrel bombs have been dropping on a daily basis in Aleppo, making the situation very very hazardous.

I can tell you about some statistics up to October 2015. At the moment 97.4% of the Doctors have left the country—97.4. And I can tell you why they have fled the country, it is because thousands and thousands of doctors have been detained and have fled for their life. I can tell you up to October there is 686 medical doctors have died in Syria and the majority of them died because of barrel bombs targeting hospitals, or because they were detained and tortured to death, or because of forced disappearance.

So all of this has systematically been targeted by the government. We are not talking about ISIS here, we are not talking about opposition here, we are talking about systematic targeting by the Syrian government, mainly for hospitals, for doctors, for all of the health system.

I can tell you there are 329 medical facilities that have been attacked across the country, and the majority of those attacks are by the Government. In 2015 alone—this was the worst year in the whole conflict—there is 105 medical facilities that have been attacked since the beginning of 2015.

And I can tell you that in October alone, about 16 medical facilities have been targeted and attacked. And unfortunately, 10 of these facilities have been destroyed by the Russian jets, so instead of improving the situation, unfortunately, we are going backward. The majority of those 10 medical facilities where around Aleppo, and around the south area of Aleppo, where the Russian jets now have been bombing for the last month.

So unfortunately, when they are talking about this cover up, that Russia has been involved to attack ISIS or maybe to push ISIS out, that is completely a false play. It has been systematically targeting the opposition side, the Free Syrian Army, the medical facilities as well.

I can tell you that over 90% of those medical facility attacks have been carried out by the government. Now we talk about the UN Security Council Resolutions 2139 and 2165, we know that the bottom line of these resolutions is to end unlawful attacks on civilians and respect medical neutrality, but that has never happened at all and I am not sure how we can enforce that.

If we are looking at why this is really going on in Syria, what is the end point of this, I believe it is still because there is a wide support for the regime so far by Russia, by the Chinese, by the Iranians as well, who has been fully involved and operating on the ground on behalf of the Syrian government.

There is some publication that I think has been released by The Syrian Campaign about listening to the refugees and they are talking about 70% of the refugees have fled because of the barrel bombs and 70% of those have no intention to go back as long as Assad is still in power, because barrel bombs have not been stopped and have been threatening civilians everywhere in the country. Only 8% of those refugees will stay on the outside if the barrel bombs are stopped. The majority of them, 92% of them, they will go back home if the international community is to guarantee safe havens for them.

So there is a majority of Syrians who don’t really want to leave the country, don’t want to sustain the misery of getting driven out of their homes, driven out of their land to become refugees with no work or no future. The majority of them want to go back to their country as long as there is a safe haven for them.

Really helpful statistics, thank you very much for sharing them. I’m just going to introduce my fellow co-chair of the APPG Friends of Syria, Andrew Mitchell MP, who has obviously been an incredible advocate on the safe zones. Andrew?

Andrew Mitchell MP:
I think what we’ve heard in the short time I’ve been able to be here has been very interesting and helpful. This is a very rapidly moving situation. The point I would make is that the new UN Resolution seems to me to be enormously helpful on a whole series of levels. As I understand it, it’s just as strong as a Chapter Seven resolution in terms of what it authorises. And in a fast-moving situation we need to keep optimistic and hope that at long last some progress will be made.

Thanks Andrew. Dr Nott, would you like to say anything else?

David Nott:
Just one thing on the comment earlier about the massive amount of intellectual expertise that’s out there amongst the Syrian refugees, from a surgical point of view, a medical point of view, there are lots of doctors now that are in refugee camps that aren’t using their skills and aren’t using their experiences, and it seems a great shame really that that is allowed to happen, and I think that certainly the Syrian British Medical Society is trying to look to see which doctors can possibly be involved in clinical attachments in this country, or can possibly have some medical help to keep their skills as valuable as possible, because they’re the ones that are going to have to go back in the country.

There’s no point in having surgeons that can’t operate, that aren’t allowed to operate for five or six years, and so that needs to be really looked at. It’s a really great point, and the Syrian British Medical Society are looking at that at the moment, to try and isolate those doctors which we can help, and perhaps go back to the government as well to say we need some funding to try and get those doctors to have some clinical attachments in hospitals in the UK, so they can keep getting clinical support.

Thank you, Aula, over to you.

Aula Abbara:
My name is Aula, I am an infectious diseases and general medicine registrar training in London. And I have been working with Hand in Hand for Syria on the medical team from September 2012, initially in Idlib and then more recently in Turkey. I also work with the Syrian American Medical Society and I will pick up on some of the points that David Nott has made because they are doing a lot of work training health workers with task shifting, which is something that is very important in the current context.

I was born to Syrian parents in London and my family is actually from Houla, which is where one of the worst massacres happened on 25th May 2012, with 108 people killed, 48 of whom were children. And I have seen first hand the devastation that this conflict has caused to everyone, to every Syrian.

Hand in Hand for Syria is a UK registered organisation that was founded in the aftermath of the conflict, and this is one of the small, Syrian, UK organisations that are really struggling in this conflict. We struggle to get direct DFID money, for reasons that I think are known to many of you, and we also struggle to get money and funding and also credibility in being able to sit on the decision making councils when they occur.

We are predominantly medical but also we are humanitarian. We have paediatric and maternity hospitals in Idlib and in Jabal al-Zawiyah. And most recently we have got impressive water and sanitation programs providing water inside Aleppo, and also a new sanitation initiative.

Unlike many of the larger organisations who have spoken about cross-border aid, we are able to reach 95% of the country, and we work with larger organisations, some of whom get money from DFID, and we act as their implementing partners.

What I was going to speak about is Syria’s health system before the conflict, because I think it is important to understand how this conflict differs from other refugee situations. This is a very different situation from for instance sub-Saharan Africa, it’s different from Afghanistan, it’s different from many other contexts.

Before the conflict, Syria was a middle income country with a good level of health care. It wasn’t perfect, but as we know from the NHS there is no perfect health system. It was predominantly government run hospitals and primary care facilities. There was advanced medical care in major cities, particularly in Damascus and Aleppo, and that was growing, and also in Homs, that was growing too. In rural areas there where insufficient facilities and human resources, and actually they suffered with the drought in the years running up to the conflict and that had an impact.

The Ministry of Health was the main provider and was actually mandated to provide health for the population. There was an increase in private sector providers, and an increase in public-private partnerships within some areas, particularly in Aleppo with more than 25% of these public-private partnerships providing care for the people.

And there was a drift from communicable to non-communicable diseases, and that’s an important thing that we’re seeing now in the context of this conflict, the reason being that Syrians have hypertension, cancer, diabetes, stroke, and complex medical problems, which makes it very difficult to manage in the neighbouring heath system, and NCDs are certainly something that’s being spoken about a lot more, and something that really needs to be addressed.

In addition to that we’re seeing more communicable diseases which are foreign to Syrians. We didn’t see cholera, we didn’t see polio; we’re now seeing it. We did see leishmaniasis [before], but certainly not in the scales that have now occurred inside Syria, inside Lebanon, and neighbouring countries. And as many of you will know, in Yarmouk refugee camp there’s been an increase in typhoid cases due to the lack of sanitation, and the lack of medical care, and the malnutrition occurring in those areas.

So we have spoken about some of the statistics and I wont go over them. One thing we haven’t mentioned so far is Syria used to provide 90% of its own pharmaceuticals. Now there has been a 70% fall in pharmaceutical production with factories directly destroyed and many people having left those areas. And that has been a significant problem for Syrians inside Syria.

The other thing we do struggle with is a lot of the neighbouring countries won’t let us import medicinal products, from other countries. They want us to buy in country. If you think about somewhere like Jordan or Lebanon that is a lot more expensive than if you’re able to get it elsewhere.

There are fuel and electricity shortages, and we have spoken about the attacks on medical personnel and facilties and the most recent Physicians for Human Rights report, focused very much on Aleppo, last week said that more than 95% of physicians in Aleppo have now either fled, been tortured, been killed, and they are not able to function.

So this is one of the hospitals that we are speaking about. Three years ago I was an intensive registrar at St Thomas’ Hospital, so for me to look at this, it is exactly as though someone would have bombed St Thomas’. This is a direct and devastating attack on a medical facility.

This is one of the scenes at one of UOSSM’s sponsored hospitals. This is from the Russian attacks in the last four or five weeks. I am sure my colleague will be able to tell me, this was Aleppo I think, rather than Hama, because I know there’s been bombing in Hama lately as well. And again it is important to remember more than 88% of the physicians that have been killed, have been killed by the government forces, and more than 90% of the hospital facilities that have been attacked have been attacked by government forces, not by other actors.

So other effects of the conflict have been the complexity of managing non-communicable diseases. So inside Syria we struggle with for instance haemodialysis and other chronic medical conditions. There is poor access to health care and I don’t think there has been recent data inside Syria addressing this for obvious reasons.

I think at this point I will speak about something we have spoken a little about, and that I know my colleague from OCHA has mentioned. The difficulties coordinating the response inside Syria and in neighbouring countries has been very challenging. We are making small headway, but there is a lot of duplication. There’s a lot of holes in the response and that is something that really needs to be addressed.

Alongside that is data. So we don’t know exactly what is going on inside the country and the studies from academic institutions, NGOs, UN organisations, that are coming out, aren’t necessary rigorous or complete and that makes it very difficult to act and actually to approach larger funders.

We have spoken about the direct human toll. I put the figure at more than 350,000 from some of the latest reports, but we haven’t spoken that much about those who have been injured. I have seen dozens and dozens of amputees from three month old babies right up to seventy year old men with both arms damaged, and I’m sure my medical colleagues will corroborate. And it’s about finding ways that they can be rehabilitated and have a quality of life as they move forward.

I spoke to a Syrian teacher last week who said that the one challenge for her, she was working inside Aleppo, is that one of the children had his arm amputated and it was for her to think how can I help this child learn to write and continue with his education.

What we haven’t said today is probably one of the most stark statistics, that life expectancy in Syria five years ago was 75.9, it is now 55.7 years, and I think that says it all. That says a lot about the number of children that have been killed, and it says a lot about the suffering of civilians.

What we have now, as we have said, is a patchwork of health systems, with public, private, UN, NGO, and ‘informal’ here is the Syrian organisations who I think do fantastic work. Certainly Hand in Hand for Syria are doing what we can to support the different organisations, but I know for instance The Syrian American Medical Society support dozens of organisations, and do innovative projects, for instance with telemedicine for their intensive carers.

I don’t want to speak for too much longer, but I tried to summarise the challenges of delivering humanitarian aid and I know we have spoken about some of them. So population displacement is probably amongst the biggest, so in Iblib in the last few weeks there have been 120,000 new refugees coming up towards the Turkish border.

There has been a disruption of disease control programmes, and we see the direct result of that not just with leishmaniasis but also with polio, with typhoid, with hepatitis A, and I could go on and on about the communicable diseases that are once again becoming a problem, and they include measles which is probably amongst the most infectious of them all.

There’s poor surveillance and EWARN. There wasn’t a robust health information system in Syria before the conflict and that’s what we struggle with. We struggle with good data collection, we struggle with implementing the health information systems, and I know my colleagues in MSF have the same problem trying to implement the HIS in their hospitals and facilities.

There is restriction of movement. The environmental conditions now as we enter the winter, but also with the heat of the summer as well, with the lack of sanitation, is also a problem, and then impeded access. So there was a very good report from the Syrian American Medical Society in February of this year discussing the needs of the hundreds of thousands in Damascus suburbs and other areas, and also Yarmouk, who are under siege in a very difficult situation where they are not able to access anything from the outside of those areas.

And the other major challenge is the sheer size and complexity of this problem. I see Syria as unique because it is personal to me, also but I think it is unique for other people who work in the NGO sector. This is the latest, so we have said about 6.5 million displaced, it is now 7.6 million, with the majority in neighbouring countries.

So, I tried to think about recommendations and there are many, but I tried to pick the ones I felt most important, and I’m very pleased that my medical colleagues have already picked up on the UN Security Council resolutions which look great on paper but sadly haven’t been implemented, and there has not really been much of an outcry when, I think it was, February 2014 when 2139 came out, and actually in those weeks there was an increase in bombings, which seemed rather ironic.

But it is also the medical neutrality with respect to international humanitarian law. We can’t bomb hospitals. We can’t leave attacks on medical infrastructures and humanitarian workers as being the new normal. The attack in Kunduz on the MSF hospital on the 3rd of October was very stark but actually we have been dealing with that in Syria from a few weeks into the conflict.

The second recommendation is surrounding delivery of humanitarian aid. We speak about a no-fly zone but I do rather like the concept of a no barrel bomb zone. I was in Turkey last week and the Syrians look at me and say, “But why can’t you guys make the barrel bombs stop? Can’t you put pressure to stop the barrel bombs?”

And something very specific about barrel bombs is they can affect every single part of the body, and worse than that, if you don’t die from the initial impact, the dust and the shrapnel and everything else from the blast gets into the lungs so you have a slow protracted painful death from respiratory complications after. And that’s not to mention that barrel bombs, they destroy whole buildings, as I understand, unlike other missiles which might take out one floor of the building, and I would say that the war has to stop but certainly barrel bombs are direct attacks on civilians and they really really need to stop.

I have mentioned data, more is being done on this, and I know there are some Wellcome Trust R2HC applications, and some DFID work is going into this, but this is something very fundamental both inside Syria and in the surrounding countries, because it is important we know what the facts are so that we can act on them.

And then most importantly is the support for health workers. I was in Turkey last week teaching on a course for anaesthetic technicians, surgeons, and other health workers, some of whom were physicians and some of whom weren’t, but they are the people doing the work, and it’s about salaries for them, and it’s very difficult for us a Syrian NGO because it seems odd to talk about salaries, but actually there is something very important, because of the few remaining physicians and health workers in Syria we need to do what we can to support them to stay there, because we do need them there and actually they do want to leave and it is very understandable that after five years of working in very difficult circumstances that they need to think about their families and their futures.

The other issue that we have touched on with Syrian physicians—one of the people I met last week was a radiologist in Turkey who is unable to complete her training so she’s working as a secretary for one of the NGOs—is the complete waste of talent for these very talented people who have so much to contribute and actually want to contribute.

And finally, I just wanted to mention the Syria Health Network which is an academic-NGO collaboration that is there to stimulate discussion about different aspects of health, so our last session was in September and that was about mental health, and that was followed up with Home Office discussions about two weeks ago, discussing what can be do with regards to Syrian mental health for Syrian refugees arriving in the UK in the coming months. Our next one is on the 18th January, and that will be on how we can support the health systems in Lebanon and Jordan particularly, who are bearing the brunt of the refugee crisis, so if you do want to know more about it, do let us know. Our idea is that we come up with a policy brief, and I’m happy to share the last one with you, so we can have discussions about specific health topics.

Thank you very much, very good. Wael, if you could give us the last overall perspective, and then we’ll have questions and comments.

Wael Aleji:
Thank you very much. My name is Wael. I am the spokesperson for the Syrian Network for Human Rights. In my spare time I am a medical doctor and a psychologist with a special interest in narrative analysis. The Syrian Network for Human Rights is one of the main organisations monitoring and documenting the human rights situation in Syria. We issue monthly reports and we also issue specialised ones focusing on certain issues or incidents.

Our statistics indicate that the regime is responsible for 96% of civilian casualties. This number includes 160 doctors, 105 paramedics, and 56 pharmacists. 3,270 medical staff where arrested, amongst which 650 doctors. We also documented 31 medics tortured to death.

Our report about children casualties was issued yesterday. We documented the names and photos of 18,858 children killed by the regime, 582 of whom where killed by snipers. 10,413 children where arrested. 159 died because of torture. We also documented in our report details about children killed, arrested, or mistreated by other warring parties; this includes different opposition factions and the self-management Kurdish administration.

The Syrian Network for Human Rights is highly recognised by the UN, Amnesty International, and other international organisations because of our robust methodology and our research standards, despite our limited financial and human resources. I don’t know if this is something the UK could help with. We are mostly volunteers. Our data is verified strictly and cross-matched using the appropriate methods, then processed and checked for any errors using appropriate software.

This of course doesn’t come without challenges. Counting and documenting human rights abuses in conflict zones is a challenging and risky task. Differences between different organisations’ body counts is partly attributed to the varying level of presence of different organisations across Syria.

Other challenges include distinguishing civilians from combatants. Different methodologies have different ways of distinguishing combatants from civilians.

Human rights workers and researchers are not very popular for anybody fighting in Syria, they are routinely targeted and many have lost their lives. I knew some of them personally.

The director of research at the Human Rights Data Analysis Group says that data sets that from these organisations are however similar enough to be equally plausible. She agreed that all the groups were probably undercounting the number of casualties.

The US former Ambassador at Large for War Crimes said “It is great that something is happening and that we are collecting information. If you have very strong evidence it is hard to push it under the rug.”

The Syrian Network for Human Rights was part of the Geneva consultations led by the UN envoy to Syria, Mr Staffan de Mistura. In our paper we recommended that the Geneva communique should be the cornerstone for any political solution, and any attempt to create an alternative to the Geneva communique would extend the conflict and complicate it further.

We recommended that if a national ceasefire across Syria at the beginning of the political process was not viable then the UN should work towards local ceasefires. I would like to take the opportunity of having Jo and Andrew here to say maybe the UK would push for this.

So local ceasefires: the UN should work toward local ceasefires coupled with large amounts of humanitarian aid and political assistance via a UN stabilisation mission and peacekeeping mission. We have been advocating for a UN peacekeeping mission and a UN stabilisation mission; this has been done in different parts of the world, including Bosnia and Congo so we can’t see why it can’t be implemented in Syria. These missions would help with local government, provision of services, rule of law, disarming and reintegrating armed groups, and reforming the security sectors.

Any plans for local ceasefires should contribute to the protection of civilians. The UN should make sure that any plans for local ceasefire should contribute to the protection of civilians, and ending enforced disappearances, and lifting sieges, and stopping arbitrary detentions. The plan should also generate measureable improvements in humanitarian access to civilians. Again, I urge UK MPs to advocate for these issues.

The plan in our opinion should also aim to develop in great robust mechanisms to monitor parties respect of international human rights and humanitarian law. Drones have been used in this respect in other parts of the world, including Ukraine, and it has been successful to monitor the situation on the ground.

The Syrian Network for Human Rights recommends that UN presence and assistance would be needed also during the transitional period to prevent further sectarian division and violence. Finally, we recommend that for elections, that the UN would organise and monitor parliamentary elections. These elections should be planned, organised, administered, and monitored by the UN, by the UN’s electoral electoral assistance division at the UN department of political affairs.

Thank you Wael. Any comments of reflections from anyone here gathered? I have just one, on local ceasefires, my understanding is they are happening, they have happened, is that right Wael? And are there negotiations the UN could build on, get more involved in?

Wael Aleji:
Well, they have been tried but they have failed. In Moadamiyeh for example, and they have been tried in Homs, and they have failed because the regime didn’t respect the articles and the conditions of the treaties.

David Nott:
I think there was no respect either for UN ceasefires, no respect at all.

Wael Aleji:
No respect at all. And there were no robust mechanisms to monitor the warring parties with respect to such ceasefires and truces.

And just building on that then, do you think therefore that we have to wait for the Vienna process to deliver a national ceasefire rather than build bottom up, so this is the argument for top down.

David Nott:
People talk about boots on the ground but if you got UN people on the ground then it would be very difficult for Russia and Assad to start bombing some sort of coalition force there. It would be a start to stop the bombing because they’re not going to bomb, they’re not going to get involved in the killing of Western people.

Wael Aleji:
It has been tried, the bottom up process, and it didn’t work. That’s why we suggest UN stabilisation and peace enforcement missions. I think it would be a good idea to start advocating it.

David Nott:
Two years ago, I suggested humanitarian corridors, to Aleppo or wherever. If that could be—if the UN put soldiers there of some sort, to at least police an area, then that’s a start.

Max Hadorn:
In the first place, the involvement of the UN with a stabilisation mission needs a UN Security Council resolution.

Just on the ceasefires, there are some ceasefires still holding. There’s a ceasefire in Fuaa and Kafriyeh, and Moadamiyeh. One should not be naive, but this ceasefire, what was agreed is that there was a humanitarian part, and that the implementation of the humanitarian part would be by the UN, so we could organize convoys to Zabadani, Madaya, and Fuaa and Kafriyeh, with food, and also with surgical and medical items.

Which—surgical and medical items, to take them cross-line from government held territories to opposition controlled areas, it had always been impossible because these items are removed from the convoys, but in this case it worked. We were able to take through the Syrian government positions, we were able to take surgical items. Which to me shows at least if there is a will somewhere between the parties there is a possibility to do things. I am not naive to say that this will lead to major developments, but at least it shows something, that if the parties are ready, they can agree on issues like this one.

Before we finish then, just one last reflection from all of you, in terms of your red line if you like for the Prime Minister, the thing you would most like to see. You’ve all shared helpful recommendations, but what would be the one thing that you would expect has to be in there if the UK contribution is going to be grounded in reality and have impact?

Aula Abbara:
For me it’s two things. First and foremost it’s diplomatic and political pressure to stop the barrel bombs, and also for the UN Security Council resolutions to actually be respected.

Very helpful, thank you.

Wael Aleji:
I think the Prime Minister has been very supportive to the cause of the Syrian people. I would like to see the Prime Minister, the Government, and Parliament, actively talking and advocating for more UN involvement in Syria, including a stabilisation mission and peace enforcement mission.

David Nott:
I think the development of a safe haven which incorporates a no-bombing zone, and is policed by the UN.

It’s been incredibly helpful. Thank you all for attending, and thank you all speakers.