Raqqa relief: Improvised by necessity

The two cities should have much in common: Mosul and Raqqa have been the Islamic State group’s major strongholds in Iraq and Syria since 2014. Both have spent the last three years in isolation, cut off from outside aid and assistance. And after months of anticipation, both are now the sites of fierce military campaigns to dislodge ISIS from metropoles where hundreds of thousands of civilians are trapped.

Yet for aid and relief groups, the logistics of managing the twin humanitarian crises could hardly be more different. Where the Mosul response was planned months in advance, with camps built and supplies pre-positioned to welcome displaced civilians, Raqqa has been improvised — by necessity.

A snarl of security concerns, government restrictions, border controls and geography have complicated relief efforts and any attempts to plan for an outflux of civilians from Raqqa and its environs. International groups and their local partners have only sporadic access to many of the areas where civilians are fleeing to. Also in part due to security, internally displaced people movements are shifting, with makeshift displaced settlements arising and folding weekly.

“In Mosul, there were camps waiting for people to come out. In Raqqa you couldn’t do that. You can’t go into ISIS-held territory and build camps and wait for people to come out,” said Scott Craig, spokesperson for Syria for the Office of the United Nations High Commissioner for Refugees.

Aid goods themselves are also in limited supply. Food, medicine, shelter and other supplies must be airlifted from Damascus to the city of Qamishli, where they are sent along an arduous five-hour journey by road toward Raqqa.

The complexity of the operation has inherently limited its scale. Some 170,000 civilians have been displaced by fighting in and around Raqqa since April, but only roughly 10,000 people are now in the two transit camps where UNHCR has the most regular access, Mabrouka and Ein Issa. On top of the current IDPs, the U.N. estimates that another 430,000 people in Raqqa are in need and out of reach.

“You know [the humanitarian crisis is] coming but you also know you can’t get things in position in advance,” said Craig. “So you are responding to people’s needs on the ground as soon as it is physically possible — desperately trying to figure out how to get the rights things to the right places.”

Stories of despair

The military campaign to retake Raqqa began in earnest on June 6, when a coalition of rebel forces known as the Syrian Defense Force began to push toward the city. The SDF have been backed by airstrikes from a U.S.-led anti-ISIS international coalition.

Conditions inside Raqqa deteriorated rapidly. There is no regular electricity in the city and diesel fuel for generators is running low. The water supply has been offline since the beginning of the month, according to the U.N. Watchdog organizations and local reporters have reported heavy damage from coalition airstrikes, including high civilian casualties and damage to schools and hospitals.

“The situation in the city is very bad,” local reporting group Raqqa is Being Slaughtered Silently wrote on June 18. “The messages coming from Raqqa are mixed with fear, sounds of shelling and grief. No water, no electricity, no communications and no safe place at all.”

ISIS has tried to stop civilians from leaving the city: IDPs have described watching fighters shoot or detain fleeing civilians. Should they escape, civilians must pass through heavily booby-trapped territory.

“People are arriving tired, hungry — they’ve been subjected to violence, airstrikes, active conflict. They’ve crossed minefields,” said Sophie Désoulières, humanitarian affairs adviser for Médecins Sans Frontières, who recently returned from the area.

The majority of IDPs documented so far are women, children and elderly. Working-age men face greater scrutiny for their travel both inside Raqqa and from outside forces, which may suspect them of working with ISIS. Males are also at risk of mandatory conscription into the Syrian army if they come into contact with government forces.

A network of settlements

Depending on the path they’ve taken to leave, IDPs flee to a range of informal settlements and transit points in and around the city. Some of these resemble established displaced camps, with tents, kitchens and water access. Many smaller and more ad hoc way stations, however, have more precarious conditions.

At one point called At-Tuwayhinah, for example, IDPs have only Euphrates river water to drink. With no facilities or infrastructure, hygiene is poor and “health services are limited, with only an INGO running a mobile clinic for a few hours per day,” the U.N.’s Office for the Coordination of Humanitarian Affairs reported on June 10. The only food to be found comes from flour and vegetables that IDPs carried with them as they fled.

The health picture for emerging IDPs offers a glimpse of their myriad needs. At MSF’s stabilization point and mobile clinics in the area, doctors are receiving trauma cases from warfare.

“But we are also getting a population that has not had much access to healthcare and that’s traveled in complicated situations, in Ramadan, with the heat and the dryness of the weather right now,” said Désoulières. “You’re getting a lot of urinary tract infections, respiratory infections, also just noncommunicable disease patients — people with diabetes who have not had access to medicine for a while. There’s low immunization coverage.”

IDPs from Raqqa have often been displaced multiple times before they arrive at a transit site such as Mabrouka, where there is infrastructure and an ongoing UNHCR presence. Even here, there is rapid turnover with families arriving and departing quickly.

Managing a response

The fragmented flow of IDPs itself raises the first challenge in the response: No one is sure exactly how many people are in which locations, and whether or when more will come. Unlike in Mosul, humanitarian groups have refrained from announcing any estimates of how many people could flee during the offensive to dislodge ISIS.

The response is instead governed by flexibility. MSF, for example, is planning to set up additional stabilization points along the main highway out of Raqqa, with clear referral pathways to clinics in transit point and MSF-supported hospitals further afield.

“It’s such a fast move situation, with frontlines that are moving,” said Désoulières. “The challenge is to anticipate where people are going to flee to and then to position yourself in the best possible manner so that you have the max impact.”

U.N. agencies are coordinating along the traditional cluster system, providing what’s possible when a window opens. UNHCR staff are regularly able to access Mabrouka and Ein Issa transit points. Other less-formal settlements, such as a growing site called Karma — where as many as 70,000 could be sheltering — are mostly out of reach except for occasional distributions.

Local NGOs are essential to delivering relief and expanding the range of places where international agencies and NGOs have access.

Aid groups are hopeful that they could be able to bring more supplies to the area soon. The World Food Program, which leads logistics for the U.N. in Syria, on June 8 received government permission to open a road route within Syria to send supplies from the capital along the Damascus-Aleppo highway toward Raqqa. The route, which will now undergo testing for safety, could expand the scope of goods aid groups can provide.

The U.N. is also hoping to start an additional daily flight from Damascus to Qamishli, bringing the total to three trips daily, six days a week, said Craig.

All this will only reach the population that has fled ISIS-controlled areas. Access is for now still far off for the nearly half a million civilians inside Raqqa.

Update, July 30, 2017: This article has been updated to clarify that MSF has one stabilization point open and plans to open others.

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