Amid chaos of war residents are going hungry

Beirut

In one Damascus suburb, food is so scarce that a 19-month-old girl, the daughter of a grocer, grew skeletal and died. In another, a woman with a son suffering from kidney failure makes her children take turns eating on alternate days. In a town outside Aleppo in northern Syria, people say they are living mainly on wild greens.

Aid workers say that Syrian refugee children are arriving in northern Lebanon thin and stunted, and that suspected malnutrition cases are surfacing from rebel-held areas in northern Syria to government-held suburbs south of Damascus.

Across Syria, a country that long prided itself on providing affordable food to its people, international and domestic efforts to ensure basic sustenance amid the chaos of war appear to be failing. Millions are going hungry to varying degrees, and there is growing evidence that acute malnutrition is contributing to relatively small but increasing numbers of deaths, especially among small children, the wounded and the sick, aid workers and nutrition experts say.

The experts warn that, if the crisis continues into the winter, deaths from hunger and illness could begin to dwarf deaths from violence, which has killed well more than 100,000 people, and if the deprivation lasts longer, a generation of Syrians risks stunted development.

“I didn’t expect to see that in Syria,” said Dr Annie Sparrow, an assistant professor and pediatrician at Mount Sinai Hospital in New York, who examined Syrian refugee children in Lebanon and was shocked to find many underweight for their height and age.

“It’s not accurate to say this is Somalia, but this is a critical situation,” she said. “We have a middle-income country that is transforming itself into something a lot more like Somalia.”

While the war has prevented a precise accounting of the number of people affected, evidence of hunger abounds. The government is using siege and starvation as a tactic of war in many areas, according to numerous aid workers and residents, who say that soldiers at checkpoints confiscate food supplies as small as grocery bags, treating the feeding of people in strategic rebel-held areas as a crime. Rebel groups, too, are blockading some government-held areas and harassing food convoys.

But even for those living in more accessible areas, what aid workers call “food insecurity” is part of Syrians’ new baseline. Inflation has made food unaffordable for many; fuel and flour shortages close some bakeries, while government airstrikes target others; agricultural production has been gutted. Although the World Food Programme says it is providing enough food for 3 million Syrians each month, its officials say they can track only what is delivered to central depots in various cities, not how widely or fairly it is distributed from there.

Lack of medical care

One aid worker - who, in a sign of the political challenges of delivering aid in Syria, asked that his organisation not be identified - said he had recently met Syrian health workers who reported a dozen cases of apparent malnutrition in a government-held Damascus suburb. He suspected that the situation could be far worse in rebel-held areas.

Lack of medical care and clean water exacerbates the problem. So does the fact that Syrians have little experience diagnosing or treating malnutrition. Particularly troubling, aid workers say, are reports of mothers who stop breast feeding, unaware that it is the best way for even a malnourished mother to keep her child alive.

Some aid groups are trying to train Syrian doctors to use simple tools that measure upper arm circumference to assess malnutrition, as convincing data on its prevalence could help spur a stronger international response.Aid workers caution against overblown claims that could discredit such efforts. Some government supporters even dismissed the images of bone-thin children from blockaded areas as propaganda after several thousand civilians were evacuated from the encircled Damascus suburb of Moadhamiya in recent weeks, looking exhausted, shellshocked and thin, but not on the verge of starving to death.

But an entire population does not have to appear skeletal for malnutrition deaths to be real, the experts say. Malnutrition, they say, strikes the most vulnerable first: babies and children; those suffering from diarrheal diseases; those who need extra nutrition to recover from wounds or manage chronic illnesses; and those who lack the money or connections to obtain the food they need.

In traumatic situations, cases may go unnoticed until they are advanced, when victims reach “a point of no return”. Unable to absorb calories, many do not recover without sophisticated medical care, even if given the food portions of others, said Dr Vincent Iacopino, a senior medical adviser to Physicians for Human Rights. Regardless, aid workers say, the fact that military blockades are preventing people in such acute need from receiving aid is in itself a human-rights violation. It matters little, they say, whether those suffering are technically the first victims of incipient famine, something no organisation has the access or data to determine, or simply sick people who need treatment.

“It shouldn’t have to take people starving to support these people,” an aid worker said.

The very unlikelihood of hunger in Syria galls those suffering from it.

“It’s very strange to know that the food is only five minutes away from you,” said Qusai Zakarya, a spokesman for a rebel council in Moadhamiya, who said he had recently spoken on the phone to a friend who was eating a cheeseburger in the wealthy neighbourhood of Mezze just a few miles away.

— New York Times News Service