The Syria crisis has reached its fifth anniversary. A conflict which many thought would stay within the confines of the region has had an impact all over the world leading to the biggest refugee crisis since the Second World War. Islamic Relief has provided over £130 million worth of aid and assisted 6.5 million Syrians since the conflict began.

Millions of Syrians have been displaced and lost their homes and livelihoods, with many making the dangerous and often life threatening journey to Europe. Those who have chosen to stay in Syria are amongst an entire generation of five-year-olds that have known nothing but war.

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We are running or supporting camps and providing livelihood programmes, education psychological and social support for refugees in Lebanon, Jordan and Iraq. In Europe our teams are assisting Syrian refugees in Greece, Italy, Macedonia and Germany.

Our operation inside Syria is difficult and dangerous and we have faced many challenges over the last five years. Our staff and volunteers have suffered a lot, with some killed or seriously injured in the line of duty as they deliver aid.

This report looks at our work in Syria, Jordan, Lebanon and Iraq over the past five years, as well our plans for the future and the challenges that we face.

In one week, the number of people living in camps at the Turkish border has increased by 30,000 to around 100,000 people. Many families were displaced from Azaz city, in the far north of the country, where hospitals and schools were the targets of airstrikes.

A further 40,000 people lost their home on Monday when Tell Rifaat, a city in the north, was targeted.

“Monday was a dark day for women and children in Syria,” said Ahmed Mahmoud, an Islamic Relief staff member working in Syria. “The people killed included pregnant women and new-born babies in incubators. This is simply unacceptable.

“Civilians have been displaced several times in the last five years, some of them for three, four or five times. These people left their homes because of bombardments and moved to displaced people camps; the camps were hit so they moved to collective centres in schools; the schools were hit and many of the injured people were taken to hospital. And then the hospitals were hit. So where else can people go to protect themselves?”

Ahmed Mahmoud speaking to BBC Radio 5 Live about the situation in Syria

The blast from airstrikes in Azaz blew out the windows of a kidney dialysis centre that Islamic Relief is running in the town centre. The machines are still functioning but many of the patients who desperately need the dialysis treatment are now too scared to come to the centre, which is the only functioning dialysis centre in northern Aleppo. Instead, dialysis will be provided through the night when airstrikes are less frequent.

Around Azaz, Islamic Relief has stopped distributing food parcels at centres as the risk of people being injured or killed while travelling to or gathering at the sites was too high. Instead of asking people to come to distribution sites, Islamic Relief teams are now distributing food parcels door-to-door.

Ahmed added: “Going door-to-door has increased pressure on the team as well as the cost of distribution, but it will protect the lives of the people who are possible targets to the airstrikes.”

“Leave no diplomatic stone unturned”

Many families at the border with Turkey have very little food, clothing and utensils with them. In the next few days, in coordination with the Turkish authorities, Islamic Relief plans to deliver 25 sanitation units to the new camps that have been set up inside Syria near the Turkish border. Each unit will include seven toilets and sinks and are designed to help with hygiene.

Islamic Relief strongly condemns the targeting of civilian infrastructure, such as hospitals, schools, markets and bakeries.

“All parties to the conflict must respect international humanitarian law,” says Ahmed. “Everyone can see civilians, health care workers and ambulances entering and leaving these hospitals. They are in highly populated areas, a long way from the frontline. The targeting of civilians has to stop right now.”

“This conflict has continued for five years. More than 11 million have forced to leave their homes and over 250,000 killed. The situation is dire and there seems to be no real prospect of a solution. The international community must leave no diplomatic stone unturned to find a solution to this conflict.”

Over the last year, Islamic Relief has provided food, medical items, warm clothing and shelter for more than 3 million people inside Syria.

The airstrikes that hit schools and hospitals in northern Syria yesterday killing up to 50 people marks a new low in the conflict, says Islamic Relief.

“Yesterday was a dark day for women and children in Syria,” said Ahmed, an Islamic Relief staff member working in Syria. “The people killed included pregnant women and newborn babies in incubators. This is simply unacceptable.”

“The civilians have been displaced several times in the last five years, some of them for three, four or five times. These people left their homes because of bombardments and moved to displaced people camps; the camps were hit so they moved to collective centres in schools; the schools were hit and many of the injured people were taken to hospital. And then the hospitals were hit. So where else can people go to protect themselves.”

The blast from the airstrikes that hit Azaz yesterday blew out the windows of a kidney dialysis centre that Islamic Relief is running in the town centre. The machines are still functioning but many of the patients who desperately need the dialysis treatment are now too scared to come to the centre, which is the only functioning dialysis centre in northern Aleppo.

Islamic Relief is continuing to deliver food aid, medical items, tents, shelter materials, toilets and wash basins in northern Syria but it is becoming more and more dangerous for the staff and the people Islamic Relief is trying to help. Recently, convoys carrying humanitarian aid have been attacked.

Islamic Relief teams are now delivering aid directly to individuals instead of expecting people to queue at various distribution points where they could be at risk from the intensified airstrikes. This puts extra pressure on the team, but ensures that aid is delivered to those who need it most.

“We are doing our best in a very difficult situation to maintain our operations in Syria,” explains Ahmed. “We have to; the needs of the people are becoming more and more desperate by the hour.”

Islamic Relief strongly condemns the targeting of civilian infrastructure, such as hospitals, schools, markets and bakeries.

“All parties to the conflict must respect international humanitarian law,” says Ahmed. “Everyone can see civilians, health care workers and ambulances entering and leaving these hospitals. They are in highly populated areas, a long way from the frontline. The targeting of civilians has to stop right now.”

“This conflict has continued for five years. More than 11 million have forced to leave their homes and over 250,000 killed. The situation is dire and there seems to be no real prospect of a solution. The international community must leave no stone unturned to find a political solution to this conflict.”

A global coalition of more than 90 humanitarian and human rights groups, including Islamic Relief, say world leaders must commit to an ambitious and transformational new multi-billion-dollar deal for both the refugees and host countries.

The coalition, representing organisations that also included Oxfam and the Malala Fund, said that to be a success, the conference – co-hosted by the UK, Germany, Norway, Kuwait and the UN – must deliver a bold new plan for Syrian refugees and the communities hosting them.

As the crisis enters its sixth year and ongoing suffering reaches historic proportions in scale and intensity, warring parties continue to commit war crimes, including besiegement and targeting of civilians. Over 13 million people inside Syria are in need of emergency relief and on average, 50 Syrian families have been uprooted from their homes every hour of every day since the conflict began in 2011.

“It will not be enough simply to pledge more money, though this is urgently needed,” said Dr Rouba Mhaissen, founder of Sawa for Development and Aid. “London must represent a step-change in the scale and ambition of the international response. Governments must do more to help Syrians lead more proactive, dignified lives and ease the strain on host communities in neighbouring countries. Refugees’ rights must be respected, and they should have the opportunity to work and educate their children.”

The coalition said that any new deal from the conference must:

• Deliver significant additional multi-year funding to meet immediate and longer-term needs of refugees and the countries hosting them.
• Call for increased protection of civilians inside and outside of Syria including an end to attacks on homes, schools and medical facilities, siege tactics and the obstruction of humanitarian aid;
• Enable refugee-hosting countries to remove barriers that prevent refugees from working and accessing basic, essential services such as health care;
• Commit to ensuring that all Syrian refugee children, and children in the communities hosting them, receive quality and safe education from the next school year;
• Pledge to harness the potential for international financial institutions and business leaders to invest in the region’s economic recovery and growth;
• Put in place coordination and accountability mechanisms so that the plan is delivered efficiently;

“Syrians are facing a war without law and a war without end,” said David Miliband, President and CEO of the International Rescue Committee. “The latest harrowing scenes from the besieged town of Madaya and the rising pressure on neighbouring states need to spur political leaders to act. The relentless suffering of the Syrian people should be a global call to action for humanitarian assistance to alleviate suffering and for political action to bring the war to an end.”

The UN is appealing for US$7.73 billion to respond to the Syria crisis, while regional governments’ national response plans require a further US$1.2 billion. Last year, the UN appeals were less than 60 per cent funded. Conference participants must do better this year and ensure the UN and host countries get the money they need to support those affected by the conflict, now and in future years. This money should be augmented by private sector investment and engagement by financial institutions to drive economic growth and create jobs.

“Only an end to the fighting and a negotiated political solution will stop the suffering of ordinary Syrians, which is why it’s important that international governments push for agreements in the Geneva Syrian Peace Talks,” said Jan Egeland, Secretary General of the Norwegian Refugee Council.

“But in the mean time it is imperative that we invest in hope, education and livelihoods for the civilian population and pave the way for a more stable future.”

A version of this article first appeared on www.islamic-relief.org.uk.

Food has been distributed to people in Madaya following donations to Islamic Relief from around the world.

Teams in the region are also continuing ongoing work to support people who are both in the country and seeking refuge elsewhere.

The crisis in Syria has been ongoing for nearly five years, and continues to deteriorate. The number of people in need inside of Syria is expected to reach 13.5 million in 2016. The number of Syrian refugees is now 4.3 million, including more than 440,000 Syrians who travelled to Europe. More than half of all Syrians have been forced to leave their homes, often being displaced multiple times.

Access is difficult

Humanitarian access to people in need is restricted by shifting frontlines, administrative and bureaucratic hurdles, violence along access routes and security concerns. Two million people are living in areas under siege.

Besieged areas include Madaya, Madamiyah, East Ghouta, West Ghouta, Daryya, and Southern Damascus suburb, in southern Syria near the capital Damascus, and Northern Homs Suburb, in west Syria.

In Madaya, at least 23 people are expected to have died of starvation since 1 December 2015, and a further 50 people a day are being hospitalised due to malnutrition and hunger. The cost of basic goods is very expensive and the harsh winter conditions are making the situation harder.

Last year, Islamic Relief supported 3.6 million Syrians who were living either inside the country or in one of neighbouring countries. We have distributed emergency food packs in Madaya as a priority.

Containing 1kg of rice, 1kg of flour, 1kg of meat, two cans of beans, and 1kg of hummus, they are designed to feed an average family size of five for two or three days.

Sharar Mahyub, who is coordinating the Syria response from Islamic Relief’s international headquarters, said: “The situation in Madaya is difficult and, because it is so cut off from the rest of the country, no supplies can get in and out. It means we need to source food from within the town, and this food is priced very highly. We have designed packages to meet immediate needs and hope to secure funding for a more long-term intervention.”

Islamic Relief is also supporting Syrians outside of Syria. In Jordan, which is now hosting 632,762 Syrian refugees (UNHCR, December 2015), teams are concentrating on distributing food and items to help them cope with cold winter temperatures, as well as offering health support. In Lebanon, the estimated number of displaced Syrians is 1,070,000 (UNHCR, November 2015), representing the world’s highest per capita concentration of refugees. There, Islamic Relief is currently concentrating on winter, health and protection (gender-based violence, child protection and psychosocial support) projects.

Since the Syria crisis started, Islamic Relief’s Iraq office has established camps and services and assisted in the distribution of food vouchers.