Severe acute malnutrition is one of the most serious forms of hunger and if left untreated, particularly in young children, can lead to severe and far reaching consequences. Such a reality, after a decade of explosive violence in Syria, is a very real concern among vulnerable populations there.
It is universally acknowledged that good nutrition is the foundation for every child’s growth and development; without a healthy diet and adequate quantities of food, the consequences manifest in micro-nutrient deficiencies and deficiency diseases, obesity, chronic malnutrition (stunted growth), and acute malnutrition (wasting). Stunting can badly impact physical and cognitive growth. Children under five who suffer both stunting and wasting are more likely to die as their immune systems are severely weakened and are less resistant to common childhood diseases.
It is this devastating impact of malnutrition that has become one of the Syrian conflict’s most harmful realities and legacies. Against the backdrop of barrel bombs and the indiscriminate bombardment of civilians by air and artillery, the use of hunger as a weapon of war to terrorise and subdue rebellion has been central to the suffering of vast swathes of the Syrian population.
Two-and-a-half million people, or ten percent of the pre-war Syrian population, have been victims of sieges, including areas such as Eastern Ghouta, Idlib, western Aleppo, Yarmouk, Daraya and Madaya. As a consequence, near-famine conditions have been widespread since the outbreak of conflict. In December 2017, UNICEF reported that 11.9 per cent of children in Eastern Ghouta were suffering from acute malnutrition. In Madaya and Eastern Ghouta, and displacement camps such as Rukban and Al-Hol in eastern Syria, haunting photographs of malnourished children have emerged.
“These harrowing images represent the tip of the iceberg,” decries Phillip Luther, Director for the Middle East and North Africa at Amnesty International. “Syrians are suffering and dying across the country because starvation is being used as a weapon of war.”
This tactic of starvation continued unabated in Iblib throughout 2019 and 2020. In July and October 2019, Channel 4 News in the UK published two reports; the first focused on children scavenging through rubbish to find food in the besieged city of Idlib, the second examined the strategic bombardment and subsequent burning of farmland by the Syrian army to starve opposition and their populations into submission.
Agricultural infrastructure in Syria has also been targeted, leading to irrigation canals and grain depots being destroyed. In 2016, it was reported that storage facilities of state seeds had been so badly damaged across the country that it had reduced seed distribution to farmers across the country to one-tenth of the amount prior to the conflict.
Food markets have also been targeted regularly by airstrikes. On 20th August, 2015, four strikes by Syrian State aircraft on a marketplace in the town of Douma killed over 112 civilians and wounded over 550. The Douma market bombing was one of the deadliest airstrikes of the entire war.
In 2017, 84 people were killed when an Idlib marketplace and police station were hit by Russian or regime airstrikes. The bombardment of markets continued throughout 2019 and 2020, including in Maarat al-Numan and Idlib. With marketplaces regularly impacted by explosive violence, it is little wonder that civilians – particularly those living in besieged enclaves – have been unable to access food for a healthy diet. Without a proper diet, different forms of malnutrition inevitably follow.
Resulting harm exacerbated by the destruction of health infrastructure
While siege tactics have led the headlines, the use of explosive weaponry has been integral to driving up child malnutrition in Syria in several different ways and has predominantly come through the destruction of the country’s economic infrastructure, its agro-industry and, most importantly, its hospitals. At the World Health Organisation, guidelines specify that children with severe acute malnutrition who do not have health complications that require hospitalisation, must receive special, high-energy food and antibiotics to treat infection. Families often need guidance to administer treatment and access to hospitals.
The systematic targeting of Syria’s healthcare system, however, has hampered the ability of medical personnel to treat malnutrition; a process which doesn’t take long to diagnose but months to treat. Between 2011-2019, over 900 medical personnel were killed in Syria (54 per cent of these deaths a result of shelling and aerial bombings). In Aleppo alone, 95 per cent of physicians fled the country to avoid a similar fate to their colleagues. Out of 588 attacks on 350 separate facilities, 530 have been conducted by the Syrian army and its allies and in 83 incidents, barrel bombs were deployed by the regime to target hospitals. Such a wholesale attack on healthcare systems invariably has led to cases of malnutrition being untreated.
The ferocity of fighting in Eastern Ghouta, for example, ‘severely restricted children’s access to health and nutrition services.’ As civilians struggle to access medical and treatment centres, either because they are too far away or difficult to access from displacement, camps or because a walk to the hospital could mean death by airstrike, aid workers (international and local) are also struggling to reach homes to treat malnutrition. Agencies are often unable to reach those who are malnourished with ready-to-use therapeutic food (RUTF) because they are under siege.
Food supplies have also been targeted by airstrikes. The most glaring example being the Russian aerial attack on a humanitarian aid convoy of Syrian Red Crescent trucks carrying UN food supplies to a rural area west of Aleppo city. The airstrike decimated the convoy and killed over 20 aid workers. Without supplies, malnutrition cannot be effectively treated in the home. With medical facilities being bombarded, complications cannot be addressed and assessments cannot be conducted. Fighting malnutrition in Syria faces such a double-edged sword.
Pregnant and nursing mothers are also vulnerable. In conflict zones, pregnant women, nursing mothers, and children under the age of five are extremely vulnerable to malnutrition. In 2017 it was reported by the Department for International Development that iron deficiency anaemia was highly prevalent among 24 per cent of pregnant or lactating women in Syria, while 7.8 per cent of young mothers were suffering from acute malnutrition, impacting the health of their children.
In Eastern Ghouta during the regime offensive, when malnutrition spiked to its highest level of war, anxiety and trauma further inhibited the ability of mothers to support their children’s nutrition needs.
“Mothers are not able to breastfeed or nurse their children,” said Juliette Touma, UNICEF’s chief of communications in the Middle East: “They’re either malnourished themselves, or they are stressed or tired because of the violence.”
With health services, markets, doctors and aid workers being shelled by artillery, aircraft and helicopters, and humanitarian workers often denied access to the most vulnerable in their homes directly, the levels of malnutrition increased.
Syria’s malnutrition crisis is one which is worsening with each passing year of the war. In 2020, food insecurity remains at critical levels and has been compounded by the total collapse of the Syrian currency and ongoing sanctions imposed by foreign powers. According to the Famine Early Warning Systems Network, ‘high food prices were predicted to continue to drive extreme levels of food insecurity, and that famine would be likely in the prolonged absence of humanitarian food assistance.’
According to the International Rescue Committee the Idlib offensive has also triggered “the largest displacement in the country’s nine-year-old war” with an estimated one million men, women and children estimated to have been displaced. In the one week of early February 2020 alone, dozens of children perished due to the terrible conditions within the displacement camps, including lack of access to food and medicine.
Syria Relief and Development, a charity supporting Idlib’s internally displaced persons (IDPs), have warned that famine on the scale of the one in Yemen could hit northwest Syria. The future looks bleak. The outbreak of a famine in Syria, a direct consequence of the use of explosive weapons, would be catastrophic.
What is clear is that, in the long-term, the impact of malnutrition will have a severe impact on future Syrian generations. And such harm was absolutely and unequivocally exacerbated by the use of explosive weapons with wide area effects in populated areas.
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