A Syrian child in a Lebanese refugee camp. Photo: Getty
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Four years in to the Syria conflict, how are we handling the biggest humanitarian crisis of our time?

This weekend marks four years since the start of the crisis in Syria.

This weekend marks four years since the start of the crisis in Syria. Four years of brutal, steadily escalating civil conflict have decimated the country, creating the biggest humanitarian crisis of our time.

The ever-growing numbers involved tend to wash over people now, inured as we are to the extremes of suffering in Syria, but they bear repeating: at least 210,000 killed; 12.2m in need of humanitarian assistance, including 5.6m children; more than three million refugees; 7.6m people internally displaced; and, 2.8 million children out of school. No one in Syria remains untouched by the horror.

A crisis on this scale has triggered a massive humanitarian response, with the United Nations, governments and non-governmental organisations throwing unprecedented resources behind the effort to help those in need both inside Syria and in the neighbouring countries.

Aid agencies are running refugee camps, clinics and education programmes that reach millions of people. As Syria’s infrastructure collapses, with schools, hospitals, water and electricity networks destroyed, the need for outside help grows ever greater. The 2015 Syria Response Plan, drawn up by the main humanitarian actors, says $2.9bn will be needed this year.

But the ability of the humanitarian system to reach everyone who needs assistance in Syria is in question. The war has exposed the cracks in an over-burdened, often inflexible system. A lack of funding, coordination and international political will to guarantee aid access has meant that many people are not getting the help they need, particularly in hard-to-reach areas inside Syria.

A new report out today by Save the Children, Oxfam, NRC and other leading NGOs titled ‘Failing Syria’ strongly criticises the UN Security Council for failure to deliver on three UN resolutions passed last year which promised to stop attacks on civilians and ensure humanitarian access in Syria. Instead of making progress, in almost all areas the situation has got worse. The parties to the conflict have ignored or undermined the resolutions and the international community has failed to enforce them.

This issue is not unique to the war in Syria. Humanitarians have known for some time that the system is badly in need of reform, if it is to meet the complex challenges of the 21st century.

We are facing ever-more emergencies – in the last 15 months alone Save the Children and other humanitarian actors have responded to Typhoon Haiyan in the Philippines, protracted crises in South Sudan and the Central African Republic, mass displacement in Iraq, the war in Gaza and the Ebola outbreak in West Africa, among many other smaller emergencies. This has left resources stretched hopelessly thin and, in some instances, coordination mechanisms between agencies faltering.

Though this series of crises is unprecedented, we cannot expect it to be a one-off confluence of extraordinary events. Climate change, population growth and the increasing multi-polarity of international relations means that we will see a growing number of emergencies in the future, both natural disasters and wars.

The trends are clear: Three times as many people around the world are in need of humanitarian assistance as compared to ten years ago. Over the past decade, the amount of money requested through humanitarian appeals has risen almost 600 per cent - from $3bn in 2004 to approximately $17.9bn today.

The humanitarian community must adapt fast to meet this challenge. It is possible to reform the system and move toward responses that work with and for people caught up in emergencies. We have to start by shifting power from donors to the people affected by crisis, preparing, training and resourcing them to be the first-responders in an emergency.

The sector should look at broadening its outlook to build effective humanitarian coalitions comprised of a wide range of actors, from NGOs and the UN to businesses, civil society and governments - as we have seen recently with the Ebola response. This process has already begun, but there is much more that can be done to harness the resources and know-how of those in corporate sector and elsewhere. Learning from their experiences in Sierra Leone, the UK is in a position to play a leading role in this.

As the world’s power structures fragment and conflicts become more complex, humanitarian actors must also pioneer new strategies to get help to civilians in hard-to-reach areas. This is particularly relevant for Syria, where traditional methods for reaching those in need are falling short in the face of extremism and arbitrary attacks. International NGO workers are increasingly targets, so organisations must work with local actors to build their capability and find innovative ways to deliver aid. Some extraordinary work has been done in Syria in besieged cities by local Syrian organisations and community groups.

Finally, the funding system needs to be reformed to ensure that the burden is better shared between countries and that donors’ priorities match the needs on the ground. Too often, funding is too inflexible and donor-led to be truly responsive to the changing needs of people affected by humanitarian emergencies.

These are just a few of the steps we can take to create a humanitarian system that will work for the future, one that harnesses all the resources and know-how of our shared planet effectively to save and improve lives. Ultimately though, while humanitarians must change the way they work, politicians must also take responsibility to address the root causes of these emergencies, whether wars or climate change. Syria has been a wake-up call – and everyone involved in humanitarian response must heed it.

Justin Forsyth is CEO of Save the Children, and a former senior adviser to two prime ministers on international development. He oversees an organisation that responded to over 120 humanitarian crises around the world last year, from the Ebola outbreak to the war in Syria. 

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Is anyone prepared to solve the NHS funding crisis?

As long as the political taboo on raising taxes endures, the service will be in financial peril. 

It has long been clear that the NHS is in financial ill-health. But today's figures, conveniently delayed until after the Conservative conference, are still stunningly bad. The service ran a deficit of £930m between April and June (greater than the £820m recorded for the whole of the 2014/15 financial year) and is on course for a shortfall of at least £2bn this year - its worst position for a generation. 

Though often described as having been shielded from austerity, owing to its ring-fenced budget, the NHS is enduring the toughest spending settlement in its history. Since 1950, health spending has grown at an average annual rate of 4 per cent, but over the last parliament it rose by just 0.5 per cent. An ageing population, rising treatment costs and the social care crisis all mean that the NHS has to run merely to stand still. The Tories have pledged to provide £10bn more for the service but this still leaves £20bn of efficiency savings required. 

Speculation is now turning to whether George Osborne will provide an emergency injection of funds in the Autumn Statement on 25 November. But the long-term question is whether anyone is prepared to offer a sustainable solution to the crisis. Health experts argue that only a rise in general taxation (income tax, VAT, national insurance), patient charges or a hypothecated "health tax" will secure the future of a universal, high-quality service. But the political taboo against increasing taxes on all but the richest means no politician has ventured into this territory. Shadow health secretary Heidi Alexander has today called for the government to "find money urgently to get through the coming winter months". But the bigger question is whether, under Jeremy Corbyn, Labour is prepared to go beyond sticking-plaster solutions. 

George Eaton is political editor of the New Statesman.