Last hours of Aleppo battle turn city into humanitarian catastrophe, aid groups say

One square-mile is the only territory that remains at stake in the battle for Aleppo, but for that prize, the Syrian government and its allies are displacing tens of thousands of civilians, who now risk abduction, assault or even death after months of living under a brutal siege, aid groups say.

The fighting to control what was once Syria’s economic center has horrified many around the world, even as members of the U.N. Security Council have been unable to negotiate more than fleeting cease-fires. International NGOs condemned combatants and the international community alike for the heavy toll on the civilian population.  

“The warring parties are ultimately responsible for civilian deaths and suffering. But the international community, in particular the five permanent members of the U.N. Security Council, also bear a grave responsibility for what is happening in Aleppo,” Nick Finney, Save the Children’s North-West Syria country director, said in a statement.

Other groups called for an immediate end to the fighting so that aid groups can work to help civilians. “We appeal to the parties to put humanity ahead of military objectives,” Marianne Gasser, the International Committee of the Red Cross’s head of delegation in Syria, said in a plea “to all sides to spare human life,” issued on Dec. 13.

Médecins Sans Frontières described the humanitarian catastrophe as almost unprecedented in recent years. “This is one of the worst crises MSF has witnessed in years,” Teresa Sancristoval, head of MSF’s emergency unit for Aleppo, said in a statement. “We remind all sides that even war has rules. It is paramount that all parties allow people to flee to safety, allow the evacuation of sick and wounded, and facilitate the provision of protection and humanitarian assistance to those that are caught on the front lines.”

Rebel-held east Aleppo has been subject to a complete blockade since October, and conditions have only grown more difficult as the Syrian government and its allies, including the Russian military and Lebanese-Shiite militia Hezbollah, have pushed to retake the last of the city. Daily aerial bombardment, shelling, and sniper fire add to the starvation and collapse of medical care.

On Wednesday and Thursday, a series of on-and-off breaks in the fighting allowed some civilians to escape and fighters to surrender. Dozens of buses and ambulances were being allowed to enter the besieged city; the Russian government said its soldiers were helping facilitate the evacuations. But even that brief reprise has been marred by violence. On Thursday, an ambulance convoy came under fire from government-allied forces as it left the east, killing at least one.

Here is a summary of where the situation stands and the primary concerns in the coming hours.

The situation: Fragile and swiftly evolving

The end of the battle for Aleppo appears near, but the toll from the fighting is far from over.

The Syrian government and its allies began a rapid push to retake the city at the end of October, accelerating after the U.S. election. Rebels who once threatened to control the entire city are today in total retreat.

“During the last 48 hours, we have seen an almost complete collapse of armed opposition front lines, leaving them with only 5 percent their original territory in the city,” U.N. Secretary-General Ban Ki-moon told the U.N. Security Council on Dec. 13.

U.N. special envoy to the Syrian conflict, Staffan de Mistura, believes the territory in rebel control is now “very few kilometres, 4 or 5 kilometers maximum but even less than that,” he told reporters.

Despite the small area, vast numbers of civilians are still trapped, in part because families from other parts of the city had been retreating within east Aleppo as fighting elsewhere accelerated. “There has been an estimation of up to 50,000 civilians and they are the ones we are particularly concerned about,” de Mistura said.

“As for the number of fighters, well there is an estimation that there are still 1,500 fighters of which probably 30 percent of them is Nusra,” he said, referring to the al-Qaida affiliate in Syria.

A lack of transparency in evacuations

Humanitarian groups have been calling for civilian evacuations for weeks, but even as they happen, aid groups say they have grave concerns about how they are conducted. Neither the U.N. nor NGOs and international aid groups have access to the sites where civilians are exiting east Aleppo.

“Bottom line from us is that we need access,” de Mistura said. “We don’t have access to the actual locations, we have been asking for that and we have not received it. We would like to be present when the evacuation of the civilians takes place and we would like to be present when the Armed Opposition is withdrawing.”

The lack of transparency is particularly concerning amid reports that some evacuees have been arrested or detained upon leaving east Aleppo.

In an interview with Devex over the weekend, Adib Shishakly, Syrian opposition representative to the Gulf Cooperation Council, said that his group had received numerous reports of evacuees disappearing, likely into government or militia control. He said concern over being apprehended by government forces was one reason civilians had been reluctant to leave the city, despite desperate humanitarian conditions inside.

“The international community must insist on independent observers (the U.N. or other external actors) to be present and for civilian evacuations not to be allowed to mask political objectives, such as population swaps,” a coalition of 25 local Syrian medical NGOs said on Thursday in a statement.

The numbers also tell a challenging story. The Russian government has said it has helped evacuate “over 100,000 civilians to leave eastern Aleppo neighbourhoods, including 40,484 children civilians,” according to the U.N.’s Ban. The timeframe for that number was not specified.

At least recently, however, the U.N. High Commissioner for Refugees has recorded smaller numbers of departures, with just 1,950 internally displaced people arriving to a temporary shelter on Monday and Tuesday.

Russian forces have also said they will help guarantee the opposition fighters and their families are able to move into rebel-held areas such as Idlib province. It’s difficult to know, however, if this is actually taking place. The U.N. refugee agency reported on Wednesday that 7,000 previously registered persons at the shelter had moved on and couldn’t be accounted for.

“They must be provided safe passage, yet there are well evidenced reports of arrest, detention, executions and disappearances of civilians,” NGO CARE said in a statement on Wednesday. “CARE calls for the deployment of independent monitors to ensure the safety and security of Aleppo’s civilians.”

Extrajudicial killings and executions in retaken territory

Equally alarming to aid groups are reports that government-allied forces have undertaken atrocities and summary executions as they enter newly captured territory.

“There have been bodies in the streets and in the squares including civilians like women and children,” de Mistura said. He said the U.N. could not be certain who bore responsibility.

But European Union High Representative Federica Mogherini called the situation in Aleppo “particularly the responsibility of the Syrian government and its allies” in a statement on Tuesday. “Those who perpetrate war crimes will be held accountable. The priority now, in these hours, is to protect civilians, guarantee them safe and monitored transit to a place of safety,” she said.

“Hundreds of children are also believed to still be in the middle of this battlefield with their parents, or alone if they have been orphaned by the bombing,” Save the Children’s Finney said. “With no ambulances, food or medical facilities, the situation is catastrophic and has been for months. People’s worst fears of revenge attacks appear to have become reality — the UN says it has confirmed that 82 civilians, including 13 children, have been shot at close range and there are ‘numerous’ bodies lying in the street.”

Access to medical care, both for IDPs and civilians still in East Aleppo

There are no operating hospitals inside the remaining rebel-controlled East Aleppo and only a handful of medics working largely without supplies.

At least 400 cases are in need of urgent hospitalization, according to Dr. Wael Al Raas, director of mental health at the Union des Organisations de Secours et Soins Médicaux, a coalition of local Syrian medical groups. “There’s hundreds of cases that are in need of services and operations, and according to the circumstances, we are expecting a high number who need to follow up because the medical services in Aleppo were decimated in the last month,” he told reporters in a press conference from the Turkish border on Thursday.

Médecins Sans Frontières is among the medical groups that says it has been unable to access those in need. Facilities inside the besieged territory haven’t been resupplied and have almost no access to key medicines and equipment, the group said on Dec. 13.

In one small glimmer of progress, the World Health Organization said on Thursday that it had reached a residence for 260 elderly and mentally disabled people in a recently retaken area of Aleppo for the first time in a year, restocking supplies and assessing basic needs.

The WHO has delivered enough medical supplies to treat 290,000 patients in the city, it says. Access, however, will be key.

This isn’t over

Perhaps the worst news of all from Aleppo is that, when the battle is over, the war continues. Warring parties and their foreign backers show no intention of moving to the table to find a political solution.

That means that for millions of Syrians, the horror that has briefly captivated international attention will continue.

Most immediately, analysts say: Watch Idlib province. The region has been a rebel stronghold for years and may now be the next target for the Syrian government and its allies. Idlib is already subject to near-daily aerial bombardment. The fact that rebel fighters from Aleppo are meant to be evacuated there could make it even more of a target. There is a long precedence in this conflict for the Syrian government to strike IDPs as they leave conflict-stricken areas.

“Escaping Aleppo doesn’t mean escaping the war,” the International Rescue Committee reminded in a statement on Dec. 14. “After witnessing the ferocity of attacks on civilians in Aleppo, we are very concerned that the sieges and barrel bombs will follow the thousands who arrive in Idlib.”

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