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11 March, 2016

Living and dying in besieged areas of Syria

There are snipers shooting at anyone on the road, and landmines in the fields. Checkpoints stop everything coming in – food, medicine, fuel; everything needed for life. They stop people leaving, even sick children in need of medical help. Homes and schools lie in ruins from bombing. Children are starving and the markets are empty. It’s the 21st century but here it’s like hundreds of years ago. This is what it means to live under siege.” - Syrian aid worker, Jan. 2016


The report is based on interviews and focus groups with people living and working in besieged areas of Syria.

Key points:

  • In 16 of the 17 adult focus groups, people reported that children in their community have died from illnesses because medicine or adequate healthcare is unavailable as a result of the siege.

  • People in all 22 focus groups said they have had to cut the number of meals they eat in a day by half or more. In seven of the groups (32%), people said they are sometimes unable to eat even one meal a day, with four of the adult groups (24%) reporting that local children have died from lack of food.

  • All five children’s focus groups said they live in con stant fear of ongoing bombing and shelling, with all 17 adult groups observing significant changes in their children’s behaviour over the period of siege. 14 groups (82%) reported their children becoming more aggressive, withdrawn or depressed.

  • In half of the groups there were children who are unable to attend school, mainly for fear of bombing.

  • Humanitarian access to besieged areas has diminished over the past two years, despite UN Security Council resolutions demanding aid be allowed in. UN agencies, the International Committee of the Red Cross (ICRC), and the Syrian Arab Red Crescent (SARC) regularly apply for permission from the Syrian government to access these areas. This is seldom granted – the UN reports that less than 10% of its requests in 2015 to bring aid into hard to reach or besieged areas were approved, with many not even getting a response. Some areas receive official aid once every 9–12 months, while people in Darayya have received no UN assistance since October 2012.

  • The siege of civilian areas can be a lucrative business for parties to the conflict and private profiteers. Commanders at checkpoints can make a small illicit fortune from the siege, and traders with links to armed groups can sometimes pay bribes to smuggle supplies in and out. The result is a black market economy with astronomical prices far out of reach to ordinary families.

  • In 16 of 17 adult focus groups, people reported that children in their community have died from illnesses because medicine or adequate healthcare is unavail able because of the siege.

  • All 17 adult groups said that some essential medicines have run out, while 14 groups said there is a shortage of medical facilities or doctors.

  • 15 of the 17 adult groups said that local health facilities have been attacked or destroyed.


  • Some deaths resulted from malnutrition and others from the lack of medications and vaccines. Children here have died of rabies because the vaccine was not available. Skin and stomach diseases have spread because the regime cut off the water supply and people rely on surface water wells which are often polluted with sewage. Children are particularly affected by lung inflammation and infections from the large amount of smoke emitted from the explosions.

  • 'The only solution [when a child gets sick] is to go to Damascus for good treatment. But going to Damascus needs good relationships with the right people. If you don’t have good connections there will be no treatment, and he will be waiting for a certain death.'

  • 'Doctors can’t do blood transfusions because they don’t have the bags. They had to amputate a friend’s injured leg because they didn’t have the material to treat it. A young child lost both his eyes after a bombing because they didn’t have the facilities to extract the fragments. These would all have been avoidable if we were allowed to have even basic equipment and resources.'

  • Many of Syria’s professional classes have been killed, arrested or fled. In the same way that traders can sometimes pay bribes at checkpoints to be allowed to sell food in besieged areas, some people can leave – if they can afford ‘fees’ of $1,500 or more. Many healthcare professionals choose to stay, but others make the under standable choice to flee with their families to safety. Many doctors have also been killed in the conflict. In their place are volunteers and amateurs thrust into positions of enormous responsibility.

  • Frequent barrel bombing and shelling has forced key parts of life underground. In besieged areas across Syria there are clinics, hospitals, schools and factories running as best they can in cellars and basements, where they hope to stay safe from airstrikes. One school manages to teach more than 1,300 pupils in a web of underground classrooms. It used to operate above ground until two missiles directly hit one of the busy classrooms, killing several pupils and wounding many more. The school shut down while teachers looked for an alternative – eventually setting up a small room in a bunker, then expanding every term. Many of the children are orphaned or separated from their parents.

Full report:

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