Syria: an ‘urban’ humanitarian crisis

Za'atri refugee camp, Jordan

By Jeremy Shoham, ENN editor

Events in Syria have arguably led to the largest humanitarian crisis for the past 20 years. The number of displaced within Syria are estimated to be over 4 million with a further 2 million plus seeking refugee status in surrounding countries. There are an estimated 776,902 refugees in Lebanon, 534,418 in Jordan, 500,237 in Turkey, 127,411 in Egypt and 194,644 in northern Iraq¹. The majority of these refugees live out of camps in towns and cities, whilst the size and density of some of the refugee camps that have been necessary effectively mean that these have become urban conurbations. Za’atri camp in Jordan hosts 120,000 Syrian refugees and is currently the second largest refugee camp in the world. It would therefore have been remiss of the Field Exchange team not to highlight this largely urban crisis in this special urban issue of Field Exchange. However, given the complexity of this crisis and enormous challenges posed by it, as well as the substantial learning already taking place through the response, the ENN have decided to devote a special issue of Field Exchange to the Syria crisis which will be published mid-2014. This short article therefore is intended mainly to inform readers of our plans and to encourage you and your colleagues working in the region to consider writing up programme experiences over the coming months for this special issue.

Initial discussions with Caroline Wilkinson and Marian Schilperoord from UNHCR and access to the UNHCR portal on unfolding events in the region indicate that there is much learning that is taking place by those agencies involved in the response and that a great deal of this is new. At this early stage there appear to be at least seven broad areas related to nutrition where lesson capture in Field Exchange could help support the sector. These are as follows:

1. The nature of nutritional problems amongst this refugee population is not typical of many refugee crises. While there are problems of micronutrient deficiency (particularly anaemia) and infant feeding challenges (partly related to how to assess and manage non-breastfed and artificially fed infants), prevalence of global acute malnutrition (GAM) is low. Yet, there has arguably been an overemphasis on dealing with acute malnutrition given the limited scale of the problem and lack of attention to other key areas especially prevention of malnutrition in all its forms. What is different about this refugee crisis may be the chronic health and nutrition related problems that were endemic amongst this population before the crisis, e.g. diabetes, obesity and coronary heart disease, and providing support services to address these health issues. It will also be of interest to document how the general ration and cash/voucher programmes have managed to accommodate the needs of this vulnerable sub-group of the refugee population.
2. There may be considerable learning with respect to how the various nutrition and food security assessments that have been conducted have supported the response. There appear to be emerging learning around the need for standardising assessments across the region, the need to include certain types of information that may not typically be included in nutrition or food security assessments, and the demographic focus of the surveys. Furthermore, given the enormous comp- lexity of targeting often scarce resources amongst a large displaced population living in a dense urban area alongside non-refugees, the assessments have been challenged to define and refine vulnerability criteria.
3. The food ration, cash and voucher programmes in the region have evolved over time in order to meet the emerging needs of the refugee population. Perhaps the greatest challenge for these programmes has been targeting in a context of scarce resources. There have also been challenges and learning around monitoring, i.e. of multiple retail outlets, and the need for flexibility in relation to events like Ramadan. Given the socio-economic, age demographic and health profile of this population, it will also be interesting to determine what has been learnt about optimal programme design.
4. Providing access to health care has been, and remains, particularly challenging for humanitarian actors working with this displaced population. There are substantial differences between the refugee host countries. For example, health care in Lebanon is provided within a highly privatised health care system, so that agencies have had to find ways of subsidising and increasing access for refugees, e.g. mobile clinics, targeting particularly vulnerable areas. Access to health care in Jordan has been far more straightforward, although the vast numbers of refugees have put an enormous strain on the government system and there remain differences between registered and unregistered refugees. In Iraq and Turkey, the respective Ministries of Health are greatly involved.
5. Livelihoods programming in the different country contexts has also been enormously challenging. The need for, and capacity of, refugees to pursue livelihoods and generate income has depended on the amount of humanitarian aid received, legality of working in the host country and the type of livelihood programming support from international and national agencies. The coping strategies employed by refugees both in the camps and out of camp have provided a good indicator of the success of these programmes.
6. Provision of shelter, although not usually perceived as relevant to nutrition, becomes more pertinent where there are seasonal extremes of temperature. There are lessons from this emergency around the successes and challenges of the shelter programme in a context of such rapid and largescale refugee influx.
7. The importance of adequate water, sanitation and hygiene (WASH) to nutrition and health is recognised. There are lessons about providing services in large camps as well as enabling access to safe water and sanitation for out of camp populations. viii) The funding environment and reliability of the food and resource pipelines have been a major challenge for this population. At this point in time, approximately 40% of funding needs have been met. This has resulted in projected and realised pipeline breaks, as well as the need to target existing resources more stringently. The funding environment has consistently been insecure. The reasons behind the resource shortfalls and how these have been addressed are of considerable interest to the humanitarian sector.

In order to maximise learning from this crisis, time is of the essence. We want to capture the detail of programming and the decision-making happening now behind the scenes before these are lost with turn-over of staff and the start of new project cycles. Over the coming months, the ENN will be making contact with UN and NGO HQ, regional and country programmes and plan to undertake some field trips to support a more ‘real time’ lesson capture. We welcome any suggestions and contributions - these can take the form of an email, telephone call or sharing a report and of course, newly written material. As needed, we will treat information sensitively and in confidence.

Contact the Field Exchange team at: marie@ennonline.net or call +44 (0)1865 249745

¹Source: data.unhcr.org/syrianrefugees/Syria.php accessed on 4th October 2013