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Beirut, Lebanon – A critical United Nations Security Council vote in July may shut down the last humanitarian lifeline for some 4.4 million Syrians in opposition-controlled areas in the northwest.
The Bab al-Hawa border crossing at the Turkey-Syria border is the last crossing with a UN mandate allowing aid to be delivered directly to regions in need without passing through the Assad government in Damascus. About 1,000 trucks carrying humanitarian aid go through every month.
“We rely entirely on aid,” Dr Hamzeh Hassan of the Bab al-Hawa Hospital, the largest medical facility in the area, told Al Jazeera. “We’re short on medicine and surgical equipment but when we get it, it’s delivered through Bab al-Hawa.”
Four humanitarian border-crossings into war-torn Syria were set up by the Security Council in July 2014 but in subsequent renewals of that mandate, the number was reduced by Assad allies Russia and China who used their veto powers to discontinue three crossings: al-Ramtha near the border with Jordan, al-Yaroubia in the northeast between Iraq and the Kurdish-held al-Hasakeh province, and the Bab al-Salam crossing between Turkey and northern Syria.
“We’re now at the second wave of COVID and cases are growing exponentially,” Dr Hassan, who is waiting for medical aid to save more patients, said. “Some more equipment and medicine should arrive soon – but if the border closes, we will have a human catastrophe.”
Idlib’s vaccination rollout has also been slow. “Just over 17,000 people are vaccinated, mostly front-line workers,” Dr Fadi Hakim of the Syrian American Medical Society Foundation (SAMS) told Al Jazeera. “If we reach the peak, God forbid, we won’t be able to handle it.”
Over the past decade, hundreds of thousands of Syrians were killed and millions displaced. Idlib today is Syria’s last opposition stronghold, under the control of former al-Qaeda affiliates Hay’et Tahrir al-Sham (HTS) and Turkey-backed rebel groups.
Syrian and Russian forces have pounded Idlib in recent years to reclaim the province, routinely bombing hospitals, schools, markets, and homes, causing a humanitarian crisis. The COVID-19 pandemic has also worsened the already dire situation.
The United States is adamant about keeping Bab al-Hawa open. In a telephone press briefing, Deputy US Ambassador to the UN Jeffrey Prescott said the impact of closing Bab al-Hawa would be “incalculable”.
“It’s literally a matter of life and death,” he said.
But Russia, a key ally to the Assad government on both the front lines and on the international stage, is keen to end Bab al-Hawa’s mandate for good and replace it with deliveries through the government in Damascus.
“Since July 2020 when this resolution was adopted, the crossing capacity there was increased significantly,” said Russian Deputy Foreign Minister Sergey Vershinin in March, referring to the last Security Council resolution that renewed the crossing’s mandate.
“But despite this, the humanitarian situation in the northwest of Syria is going from bad to worse,” he said, and accused HTS of obstructing aid.
Moscow has repeatedly accused the US and Europe of politicising humanitarian aid by supporting the continuation of cross-border aid delivery without going through government channels in Damascus.
“All this is being done to undermine the sovereignty and territorial integrity of Syria for political reasons due to displeasure with the country’s leadership,” Vershinin said.
US President Joe Biden and Russian President Vladimir Putin are set to meet in less than a week in Geneva, with a handful of items on the agenda. Some reports have said Biden will press Putin to expand humanitarian aid.
But according to Senior Fellow Natasha Hall of the Center for Strategic and International Studies, what really matters will be the Biden administration’s strategy compared with his predecessors, who have taken similar positions on the humanitarian border crossings, but were unsuccessful in convincing Moscow to budge.
“It’s about how much this administration is willing to devote resources to this kind of negotiation,” Hall told Al Jazeera.
Russia will likely continue to advocate replacing the cross-border system with aid deliveries via Damascus – often referred to as cross-line delivery – something that has never happened in Idlib.
“To date, there has not been a cross-line UN delivery into northwest Syria,” a UN spokesperson told Al Jazeera. “The UN continues efforts and advocacy, however, the conditions to deploy the first cross-line convoy to northwest Syria are not in place.”
But many, including Dr Hakim, reject that proposal altogether based on past experiences in besieged areas.
“When we tried to do cross-line deliveries in East Aleppo or Ghouta, at least 90 percent of the convoys were rejected,” he said, adding his organisation had to get at least seven approvals from security and government agencies in Damascus. “And if even if you get the approvals, the convoys might be sent back at checkpoints and many of the items would be removed from the trucks. It’s a nightmare.”
The UN and partner organisation convoys often struggled to reach besieged or “hard-to-reach” areas, primarily laying the blame on government checkpoints. And even the assistance that eventually does arrive could be rendered useless.
“In some cases you see packages … with just a couple of disposable gowns and shoe covers but that was considered ‘reached’,” Hall explained. “And all of these delays and interruptions imposed by the government in Damascus led to a lot of medicines being disposed of, because they’re expired by the time they get to the clinics.”
But even in the northeast, where the Syrian government and allies are not as actively engaged in conflict, NGOs have decried the limited reach of aid through cross-line mechanisms after closing the al-Yaroubia border crossing.
“Since the border has been closed to the UN, only a handful of medical shipments have made it to the region through alternative routes,” 42 NGOs said in a statement on Friday, adding that hospitals lack the medicine and equipment needed to treat COVID-19.
“In al-Hol camp, NGOs have reported that approximately 30 percent of patients with chronic diseases cannot be covered through the medication available in the camp.”
Much of the fighting has subsided in Syria, but the COVID-19 pandemic has exacerbated an already harrowing humanitarian crisis. In Idlib, the prospect of shutting down the only channel of delivering aid horrifies Dr Hassan.
“Believe me, if this [border crossing] ends, we’re going to see more suffering,” he said, his voice trembling. “Medical centres could go on for about a half a year, but I don’t think there will be enough food for more than a month if the crossing closes.”