In 2011, forces loyal to Syrian president Bashar al-Assad occupied the public hospital in the Syrian town of al-Qusayr. When suspected rebels arrived at the hospital in need of medical attention, regime forces detained, interrogated, tortured, and often executed them. In response, private citizens established an underground clinic to provide medical care in secret. Dr. Abd ar-Rhim Amir provided care in that clinic. When he was eventually tracked down by Syrian intelligence forces, Amir was summarily executed (Littell 2015).
Published in The Ploughshares Monitor Volume 38 Issue 3 Autumn 2017 by Sebastian Murdoch-Gibson
In 2014, the pro-opposition town of Beit Sahem agreed to a truce with the Assad regime following a months-long siege. After the truce, Syrian Arab Red Crescent food aid began arriving in the starving city. Residents subsequently expelled remaining opposition fighters from the city out of fear that their presence could jeopardize the truce and interrupt the flow of aid (Martinez and Eng 2016).
Humanitarian aid: A tool of war
What do these stories have in common? They show armed forces using the basic needs of a local population to consolidate control over that population. This approach has led the Assad regime to use what are traditionally viewed as humanitarian goods—emergency food aid and medical care, for example—as strategic tools. If the regime can ensure that it remains the only agent capable of providing—or permitting—reliable supplies of food and medicine, then civilians will capitulate to its rule out of physical necessity.
There is evidence to support the belief that the regime thinks in these terms. The events that unfolded in al-Qusayr and Beit Sahem are far from exceptional. The regime has pursued an aggressive program of targeted assassination of doctors operating in rebel-held areas; it has even made illegal the practice of providing medical care to rebels (Fouad et al, 2017). The regime has used its capacity to distribute food and, more importantly, its capacity to withhold food, to break down the strength of opposing factions.
Of a total besieged population in Syria of 624,000, approximately 509,000 are besieged by forces loyal to the regime (UN 2017). Assad’s prolific use of siege tactics that choke off the flow of food and medicine to opposition-held towns is known as the “kneel or starve” policy. This strategy is complemented by the targeting of rebel bakeries to undermine autonomous food production and by the regime’s generous food subsidies in compliant territories. The calculus the regime seeks to impose is brutal in its simplicity: surrender and eat.
The regime’s attempts to restrict access to humanitarian services have inspired opposition parties to invest in preserving capacity for humanitarian assistance. All these actions indicate the value of aid in armed conflict.
As the Assad regime attempts to preserve its monopoly on medical care through a campaign of attacks on hospitals and doctor assassinations, the Islamic State releases well-produced recruitment videos asking foreign doctors to assist the “Islamic State Health Service” and promises free medical training to foreign volunteers. As blockades and sieges choke off the flow of medical supplies to Eastern Ghouta, residents have organized a “factory” for the production of normal saline. The city of Deir Ezzor, encircled and besieged by the Islamic State since 2014, has been sustained to a large extent by an ambitious program of humanitarian airdrops carried out by the United Nations. A UN humanitarian convoy en route to the opposition town of Urem al-Kubra came under attack from three Syrian helicopter gunships and was largely destroyed.
These events illustrate the efforts to selectively restrict and preserve the flow of humanitarian goods that have become a major characteristic of the Syrian conflict. We might even say that Syria is host to parallel conflicts: parties contend for a monopoly on the provision of care while they compete for a monopoly on the use of armed force. The victor in the contest for superior humanitarian assistance will enjoy greater popular legitimacy, will be able to more easily control the areas under its influence, and will have an advantage in combat.
In such a context, aid organizations must carefully examine the influence of their activities on the course of the war. In 2013, Médecins Sans Frontières released a statement condemning what they called an imbalanced distribution of aid: “The areas under government control receive nearly all international aid, while opposition-held zones receive only a tiny share” (MSF 2013).
Subsequent UN Security Council resolutions have authorized the delivery of humanitarian assistance across the Turkish and Jordanian borders to improve access to parts of Syria controlled by opposition groups. However, many commentators continue to allege that the disproportionate allocation of UN humanitarian aid to regime-held areas is handing a military advantage to Assad, enabling him to divert funds and resources from the provision of essential services to the conduct of war (Martinez & Eng 2016).
The boundary between humanitarian assistance and military assistance has become blurry in the Syrian conflict. States, nonprofit groups, and individuals motivated by the desire to alleviate human suffering often inadvertently support the military objectives of parties to the conflict.
An accountable humanitarianism must dispense with the fantasy that intervention to mitigate suffering can be devoid of political content. Conditions on the ground and the political preferences of those providing aid structure decisions on who is assisted, when, and how. In a state of civil war, these decisions play a role in determining military outcomes. An accountable humanitarianism would seek to openly justify these decisions rather than cling to the pretense that they can be avoided.
Sebastian Murdoch-Gibson was an intern with Project Ploughshares in Summer 2017.