Every Minute We Are Expecting Our Deaths: Yarmouk Needs Assessment

June 2015

ACKNOWLEDGEMENTS

This assessment was commissioned by SREO to analyze the humanitarian and

security situation in the Yarmouk Camp in Damascus. SREO would like to thank the

respondents in Yarmouk for taking the time to provide honest and forthright

testimony about the challenges facing their community, as well as our field

researchers, who undertook data collection at significant risk in a highly dangerous

environment.

Max Marder, Daniel Seckman, and Matt Trevithick authored this report.

Photo Credit: Majdi Fathi

2

CONTENTS

Executive Summary………………………………………………….…………….6

Introduction………………………………………………………….……………8

Objectives..………….……………………………………………………………11

Methodology..…………………………………………………………………….12

Geographic Scope and Sample..………………………………………….……..12

Data Collection….…………..…………………..……….…….………..………12

Respondent Demographics…………………………………….………..………..14

Findings………………………………………….……………………………..…16

Humanitarian Access..………………………….………..…………….………..16

Water and Sanitation..………………………..…………..…………….……….17

Health.…..…….….……..……………….……………………….…….………18

Food Security and Livelihoods……..……….……………..……….……..…..……20

Security.…….……….……..………………….…….…………….……………..22

Electricity.……….…………………………..………….……….………………25

Most Urgent Needs.……….…….……….……….…..…….….………..……….26

Conclusion……………………………………………………………………….27

References……………………………………………………………………….29

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ABOUT SREO

SREO is an independent, non-partisan research center based in Gaziantep, Turkey.

SREO’s team of researchers includes Syrians, Turks, Europeans, and Americans who

have all spent significant time in Syria and the Middle East. Its researchers speak

local languages and are dedicated to providing objective analysis of what is

transpiring inside of Syria as well as in the host communities of neighboring

countries.

SREO provides monitoring and evaluation services along with needs assessments

and feasibility studies to organizations involved in the Syrian humanitarian

response. Together, the SREO team has more than two decades of research

experience from Afghanistan, Pakistan, Iraq, Syria and Turkey.

Contact: communications@sreo.org

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LIST OF ABBREVIATIONS

Aknaf Aknaf Beit al-Maqdis

SYP Syrian Pounds

!5

EXECUTIVE SUMMARY

Besieged for more than two years, the approximately 18,000 civilians remaining in

the Yarmouk Camp in Damascus are among the most at-risk population in all of

Syria. Without electricity for two years, and without clean water for nearly a year,

residents of Yarmouk are also caught in the crossfire of a three-way conflict

between the Syrian government, the Islamic State, and Aknaf Beit al-Maqdis, a

Palestinian faction allegedly tied to Hamas. The resulting situation, with

respondents trapped and starving in a compact combat zone, makes Yarmouk one

of the most dangerous places in the world to live.

This assessment utilized 100 household surveys, conducted in Yarmouk at

considerable risk to SREO’s researchers, to assess the humanitarian and security

situation in the camp. The evaluation team was particularly interested in residents’

ability to access basic services, the types of coping mechanisms residents of the

camp have employed, the changes in the camp since the Islamic State’s offensive in

April, and the makeup of the armed groups fighting in the camp.

Respondents, often unanimously, confirmed the validity of recent reporting on the

situation in Yarmouk: the Syrian government has completely cut off access to

municipal water and electricity systems, no organization or group is currently

permitted to deliver humanitarian aid in the camp, and residents are struggling

daily to survive. All one hundred respondents indicated high concern for their

physical safety.

The situation in Yarmouk has only deteriorated further since the Islamic State took

control of parts of the camp in April 2015. Aid organizations, whose presence in the

camp was not government-approved in the first place, fled as the Islamic State

attacked water distribution points and medical centers.

Residents have generally adopted desperate coping mechanisms to adapt to their

situation. Most residents eat one meal per day and both children and pregnant

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women were found to often skip meals. Without clean sources of drinking water,

residents often consume well water knowing full well that it is contaminated with

sewage. For lighting, residents use rechargeable lamps, but only when necessary

due to the high cost of the generators and fuel needed to charge them. With no

large functional medical facilities, parents have taken to treating their child with ad

hoc first-aid and traditional medicine.

While a slim majority of men surveyed were generating income, almost no women

had jobs. Trapped and under siege, livelihoods are in shatters. The average

household was surviving on less than $4 per day; the average person on well under

$1 per day.

The largest group fighting in Yarmouk according to respondents was Aknaf Beit al-

Maqdis, followed by the Islamic State and the Syrian government respectively. Eight

of the respondents were Aknaf fighters. Seven others had brothers or sons fighting.

The three most urgent needs reported by respondents were food, water and

medicine—without which they could not survive. Electricity was the fourth-most

urgent concern. Given the thin line between life and death in the camp, other vital

needs like education, shelter and livelihoods were considered luxuries.

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INTRODUCTION

Yarmouk, eight kilometers from central Damascus, is barely surviving a

humanitarian crisis. Despite camp residents’ neutrality in the first months of the

conflict, the violent crackdown by the Syrian government on predominantly

peaceful protestors and the highly politicized nature of the conflict inexorably

dragged the camp and its residents into the fray.

Before the conflict, the Yarmouk Camp, just two square kilometers in size, was

home to 180,000 Palestinian refugees from the conflict in 1948 and 1967, in

addition to hundreds of thousands of Syrian nationals. As of this writing, only about

18,000 civilians remain in Yarmouk, trapped, besieged and bereft of some of the

basic needs for survival. Those who stayed were disproportionately unable to seek 1

refuge elsewhere: the poor, the elderly, the sick, the injured and children. As of 2

March 2014, nearly two-thirds of Syria’s pre-conflict Palestinian refugee population

of 530,000 had been displaced for at least the second time. 3

The Syrian government’s siege of Yarmouk began in December 2012, prompting

over 150,000 residents to flee the camp. The government cut off the main 4

electricity power supply in April 2013, further increasing strain on households and

medical facilities. Since July 2013, the Syrian government has prevented the entry of

people, food, goods and medicine into the camp, with only small exceptions.

According to Amnesty International, by March 2014, 194 civilians had been killed

due to starvation, a lack of medical care or government snipers. Many others have

been brought to the brink of death by illnesses, caused by malnutrition and

contaminated drinking water, or injuries sustained as a result of the fighting in the

“Syria: Squeezing the Life out of Yarmouk: War Crimes against Besieged Civilians | Amnesty 1

International USA.” Amnesty International, March 10, 2014. http://www.amnestyusa.org/research/reports/syria-squeezing-the-life-out-of-yarmouk-war-crimes-against-besieged-civilians.

Ibid.2

Ibid.3

Ibid.4

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camp. Forces loyal to the Syrian government often targeted aid workers and

medical personnel, and many disappeared mysteriously. 5

The arrival of anti-government armed groups into the camp starting in May 2013

further complicated matters for civilians. Armed groups, including brigades aligned

with the Free Syrian Army, Jabhat al-Nusra, the Islamic State, raided medical

supplies. The groups’ presence has exposed civilians to higher levels of violence and

a further tightening of the siege by the government. According to Amnesty

International, however, armed groups were not preventing civilians from leaving the

siege area.

In January 2014, negotiations between the Syrian government, Yarmouk residents

and the Palestinian Authority produced an agreement under which the Syrian

government would allow sick and wounded residents to leave the camp, as well as

limited food parcels to enter the area. According to residents, the government has 6

since reneged on this agreement.

In early April 2015, the Islamic State launched its most significant offensive to date

in Yarmouk, engaging in heavy clashes with the main local Palestinian faction, Aknaf

Beit al-Maqdis, the latter of which is allegedly allied to Hamas and opposed to both

the Syrian government and the Islamic State. The Syrian government has 7

intensified shelling of the camp since the Islamic State gained a foothold. The head 8

of The United Nations Relief and Works Agency for Palestinian Refugees (UNRWA)

said these developments made the situation “more desperate than ever” for

trapped civilians in desperate need of food, water and medicine. 9

Ibid.5

Ibid.6

“ISIL seizes most of Syria’s Yarmouk Camp,” Al Jazeera and AP, April 5, 2015, http://7

www.aljazeera.com/news/2015/04/isil-seizes-syria-yarmouk-refugee-camp-150404135525226.html

Ibid.8

“Islamic State-controlled Yarmouk refugee camp conditions ‘beyond inhumane,’” The Telegraph, April 7, 9

2015, http://www.telegraph.co.uk/news/worldnews/islamic-state/11519106/Islamic-State-controlled-Yarmouk-refugee-camp-conditions-beyond-inhumane.html

!9

The siege of Yarmouk has continued, despite the passage of United Nations

Security Council Resolution 2139, passed in February 2014, which called for “all

parties to immediately lift the sieges of populated areas,” including Yarmouk. 10

United Nations Security Council Resolution 2139, passed February 22, 2014, http://photos.state.gov/10

libraries/syria/982645/wp-pdfs/N1424339_002.pdf

!10

OBJECTIVES

The objective of this assessment was to complete a timely and informed

assessment of the humanitarian and security situation in the Yarmouk Camp in

Damascus since the Islamic State entered the area. SREO’s evaluation team

prioritized analysis on five indicators of the humanitarian situation in the city:

electricity, livelihoods, health, clean water and security. Another primary objective

of this assessment was to uncover what civilians’ greatest and most urgent needs

were during this fluid period. Additionally, this assessment sought to analyze

civilians’ attitudes toward the three faction vying for control of the Yarmouk camp:

Aknaf Beit al-Maqdis, the Islamic State and the Syrian government.

!11

METHODOLOGY

Geographic Scope and Sample

Field researchers surveyed respondents throughout the entirety of the Yarmouk

camp. During the evaluation period, field researchers conducted 100 structured

interviews with camp residents throughout Yarmouk. The assessment strove to

achieve gender parity in its sample, and was successful in conducting interviews

with 51 women.

Data Collection

The data for this assessment was based on a 20-question survey designed by

SREO’s evaluation team in Gaziantep, Turkey. The majority of questions were close-

ended, but open-ended and qualitative questions were included to allow

participants a wider range of expression and to supplement the assessment’s

quantitative findings.

Three field researchers completed 100 surveys in total. Surveys were administered

on paper, and each took approximately 10-20 minutes to complete. Field

researchers later transcribed the interviews into Microsoft Word documents. Once

they obtained a reliable Internet connection, field researchers transferred data to

SREO’s evaluation team in Gaziantep to begin analysis.

Field researchers worked individually, enabling the three of them to cover a broad

area of the camp and avoid attracting unwanted attention. Field researchers could

not administer surveys openly for fear of the Islamic State. Aknaf Beit al-Maqdis

fighters consented to participate in the assessment.

Respondents were identified on a random basis in the streets. Field researchers

worked to collect a random sample and to interview the young and old, men and

women, fighters and civilians, and residents of both poor and relatively wealthy

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neighborhoods. Interviews were later conducted in the homes of the respondents

or field researchers to avoid the risk of arrest or detention.

Many residents were nervous and refused to answer the survey. However, the

majority of respondents were willing to participate in the survey once field

researchers assured that their identities would remain anonymous.

Of the 100 respondents, eight were Aknaf Beit al-Maqdis fighters. A handful of

fighters were selected in the sample given their visibility in the streets.

Field researchers faced several obstacles in their work. Many randomly selected

residents refused to participate in the survey out of fear. Mobility was often limited

by fighting and checkpoints, especially at night. However, field researchers

completed research without arousing the suspicions of armed groups. Occasionally,

when field researchers attempted to interview women, their male companions

spoke for them. Nonetheless, this evaluation managed to obtain gender parity.

!13

RESPONDENT DEMOGRAPHICS

The respondents for this assessment were evenly divided based on gender—49

men and 51 women.

Figure 1: Respondents by Gender

The average respondent was approximately 38 years old. The median age of

respondents was 37 years old, indicating a relatively normal age distribution.

Fourteen percent of respondents were under 20 years old and 12 percent were

over 60. Nearly three-quarters of the sample was between 20 and 60 years old.

Unsurprisingly, the age of the fighters trended younger. Six of the eight fighters

were 21 years old or younger. The oldest fighter was 36 years old.

Households surveyed tended to be large, with the average household containing

5.8 family members. Nearly half of the households surveyed (48 percent) contained

six family members or more.

14

Figure 2: Respondents by Age

Figure 3: Household Size

15

FINDINGS

The humanitarian situation in the Yarmouk camp was found to be among the most

dire in all of Syria. The camp has been under siege, blockaded by the Syrian regime

since July 2013. In April 2015, forces from the Islamic State entered the camp and 11

have taken partial control of Yarmouk, facing strong resistance from Aknaf Beit al-

Maqdis. Since then, the humanitarian situation has rapidly deteriorated. Aid

organizations came under attack from the Islamic State, which also attacked water

distribution points and medical facilities. In addition to humanitarian needs,

residents’ safety is highly at risk, as they are caught in a three-way fight between the

Syrian government, the Islamic State, and Aknaf Beit al-Maqdis.

Humanitarian Access

Residents of the Yarmouk Camp currently have no access to humanitarian aid.

Respondents were unanimous on this point: no organization or actor of any sort

was providing assistance in the Yarmouk Camp during the evaluation period.

Humanitarian organizations had been providing assistance in the camp until the

Islamic State arrived in April, 2014, and, according to respondents, prohibited

humanitarian assistance. Due to the threat posed by the Islamic State, which

included attacks both actualized and threatened, humanitarian actors fled to the

nearby suburb of Yalda. Several respondents indicated that even before the

cessation of assistance, materials provided were not sufficient to cover the needs of

Yarmouk’s residents.

Respondents also blamed the Syrian government for the lack of humanitarian

assistance in Yarmouk. They indicated that the government had reached an

agreement to allow humanitarian assistance into the camp, only to backtrack on

that promise once the Islamic State entered the area. The regime has imposed a

“Squeezing the Life out of Yarmouk: War Crimes Against Besieged Civilians,” Amnesty International, 11

March 2014, http://www.amnesty.eu/content/assets/Reports/Syria_report_Squeezing_the_life_out_of_Yarmouk.pdf

16

blockade on the camp, preventing the movement of people and goods, since July

2013. 12

Water and Sanitation

This assessment revealed that there is no access to clean water in the camp, which

has been without municipal water since late 2014. Several respondents knew

exactly how long they had been without tap water — 260 days. Aid organizations

had previously been providing water for camp residents to make up for the

shortage caused by the state’s cuts, although respondents indicated that the water

supplied was never enough to meet the needs of the camp.

Figure 4: Main Source of Drinking Water

Forty-two respondents reported having no access to any water at all. The remaining

58 respondents said that their only source of water were public wells, which were

well-understood by residents to be contaminated and unsafe for drinking. Pipes

and other water infrastructure had been damaged in the fighting, tainting the well

water with sewage. Respondents reported that disease and epidemics were

common due to the dirty water, and that sickness had been spreading throughout

Ibid.12

17

the camp given the lack of medicine. However, respondents indicated they had no

alternative. Eight respondents indicated that residents also collect and drink rain

water. However, precipitation is sparse in the camp during the spring and summer

months.

Health

Out of the 100 respondents surveyed for this assessment, 78 reported that

Yarmouk had no access to functioning health facilities of any kind with two

kilometers. The remaining 22 respondents said that there was a medical point—a

small one-room health facility—but that it was ineffective because of

insurmountable capacity constraints and a lack of medical equipment, medicine

and personnel.

Figure 5: Functioning Health Centers Within 2km

Many respondents reported that there had been a hospital in Yarmouk, the

Palestine Hospital, which had been functioning until recently. However, the Islamic

State bombed the hospital after it entered the camp in April 2015, killing several

18

medical personnel who had been working there. Many doctors have subsequently

fled Yarmouk.

Figure 6: : Respondent Knowledge of Medical Personnel in Yarmouk

Only 20 out the 100 respondents reported knowledge of male doctors working

anywhere in the camp, and just two respondents knew of any female doctors

currently practicing in Yarmouk. Forty respondents knew of midwives operating in

the camp, and 57 knew of nurses. However, many of these respondents indicated

that there were only two of each currently active in the camp. Thirty-one

respondents had no knowledge of any health staff currently operating anywhere in

Yarmouk.

In lieu of formal medical services, several respondents reported that residents had

been performing “primitive” medical procedures on the sick and injured, as well as

applying first-aid.

Given the blockade imposed by the government, medicine is largely unavailable in

Yarmouk—all the more worrying because of the prevalence of disease caused by

residents drinking contaminated well water. Medicine was cited as the third-most

oft-cited concern among respondents.

19

Food Security and Livelihoods

Figure 7: Number of Household Meals per Day

Residents in the Yarmouk camp did not have easy access to food items, and not a

single respondent surveyed reported that members of their household ate three

meals per day. Sixty-three respondents said that their household only ate once per

day, while the remaining 37 respondents said their family ate two meals per day.

Households in the Yarmouk camp are unable to provide three meals per day for

their children. Eighty-seven respondents expressed that children in their household

were forced to skip meals, as opposed to only six respondents who said that their

children did not skip meals.

Figure 8: Percentage of Households in Which Children Skip Meals

20

The remaining seven respondents did not have children living in their household

during the evaluation period. Pregnant women were similarly forced to skip meals.

Twenty-four respondents reported that pregnant women in their household did not

eat three meals per day.

Figure 9: Number of Respondents Currently Working

Besieged and blockaded, income-generating opportunities in Yarmouk were

difficult to come by. The employment rate was much higher for men than for

women. Thirty of the 49 men surveyed were currently working at the time of the

assessment, compared to only five of the 51 women. Men were most commonly

fighters or owners of street stands. Women were most commonly teachers or

midwives.

Respondents’ average household expenditures, on food and other basic needs, was

709 Syrian pounds per day. When dividing household expenditures by number of

family members per household, daily expenditures averaged 142 Syrian pounds per

person. Using May 2015 exchange rates (1 USD= 188 SYP), this totaled less than $4

per day spent on items for the household and less than $1 per person per day.

21

Figure 10: Household Expenditures per Day (SYP)

Figure 11: Household Expenditures per Person per Day (SYP)

Security

The security situation in Yarmouk— characterized by fighting between the Syrian

government, the Islamic State and the Palestinian armed group Aknaf Beit al-

Maqdis— is extremely dangerous. All 100 respondents indicated that they were

concerned about their safety.

On the balance, Aknaf Beit al-Maqdis was the largest armed group fighting in the

Yarmouk Camp according to respondents, 64 of whom reported that Aknaf was the

largest group fighting in the camp, while 18 said it was the second-largest faction.

22

Eight members of the sample were Aknaf fighters while seven others said they had

relatives who were members of the group. It is possible that affinity for Aknaf Beit

al-Maqdis caused respondents to inflate its size.

Figure 12: Three Largest Armed Groups Fighting in Yarmouk

The Islamic State was the second-largest group fighting in Yarmouk according to 74

of this assessment’s respondents. A minority of 22 respondents expressed that the

Islamic State was the single largest group fighting in the camp, while only five

respondents said it was the third-largest group.

The Syrian government, according to 77 respondents, was the third-largest group

fighting in the camp. Fourteen respondents said the government was the largest

23

fighting group and eight reported that it was the second-largest group. However,

the Syrian government is still a major player in Yarmouk—despite it’s relatively

smaller presence inside of the camp, it exercises control in the area surrounding the

camp and has imposed on blockade on Yarmouk for almost two years.

Figure 13: The Syrian Government Prevents Households from Leaving Yarmouk

The vast majority of respondents (92 out of 100) reported that the Syrian

government did not allow households to leave the Yarmouk camp. Numerous

respondents indicated that government forces shot residents attempting to escape

from the camp.

Relative to the Syrian government, the other armed groups in Yarmouk were more

flexible in allowing residents to leave the camp. Only 40 of 100 respondents

indicated that armed non-government groups prevented households from fleeing,

indicating that it was likely the Syrian government, as well as old age, infirmities,

and injuries, which represented the main obstacles to residents’ ability to escape.

24

Figure 14: Armed Groups Prevent Households from Leaving Yarmouk

Electricity

Respondents were unanimous in reporting that Yarmouk residents do not have

access to electricity from the national power grid, which the Syrian government cut

off in April 2013. Forty-one respondents indicated that generators represent an 13

alternative electricity source for Yarmouk residents. However, the high cost of fuel

for the generators render them unusable by the majority of the camp’s residents.

Several respondents reported that camp residents could access rechargeable lamps

for light. However, the lamps could only be recharged by using generators, the cost

of which prevented residents from using them except when absolutely necessary.

Respondents reported that access to fuel has only become more difficult since the

Islamic State entered the camp in April 2015.

Ibid.13

25

Most Urgent Needs

Residents of the Yarmouk Camp are in desperate need of basic goods for survival.

Food (84 of 100 respondents) and water (74 of 100 respondents) represented the

most-frequently cited needs of this assessment’s respondents. Over half of the

respondents (53 out of 100) expressed that medicine was an urgent need,

particularly because of the prevalence of disease linked to the consumption of

contaminated well water. Thirty-seven respondents mentioned the need for

electricity. While all respondents face electricity shortages, it is likely that the lack of

basic goods for survival took priority.

Smaller proportions of respondents expressed an urgent need for other items and

conditions, including: security and an end to the fighting in the camp (13 percent);

education (six percent); fuel (six percent); a return to normalcy (six percent); the exit

of the Syrian government and the Islamic State from the camp (five percent);

livelihoods (three percent); baby milk (three percent); and shelter (two percent).

Again, while it is likely that the vast majority of Yarmouk residents have the above

needs, most prioritized the most basic items for immediate survival—food, water,

and to a lesser extent, medicine.

Figure 15: Most Urgent Needs

26

CONCLUSION

After living under siege for two years, the situation for residents in the Yarmouk

Camp has continued to worsen, reaching some of the most desperate levels of

subsistence in Syria. The situation is characterized by a lack of access to basic needs

for survival, removal from the public water and electricity grids, and exposure to

extreme violence. The Islamic State’s offensive in the camp in early April 2015

brought a further deterioration, with the Syrian government tightening an already

tight siege while intensifying the bombardment of a trapped population dying of

starvation and disease.

Yarmouk’s residents have been without publicly provided electricity for over two

years and without municipal water for eight months. While residents have access to

generators, the high cost of fuel and lack of income generation prevents its use

except in the most necessary situations. Without any source of clean water since

relief organizations fled Yarmouk in April, residents have been drinking from wells

that they know are contaminated.

The average Yarmouk resident eats one meal per day, has no access to electricity,

clean water or medical services, and subsists on less than $1 per day. If they are

male, they probably have a meager income generating opportunity, and if they are

female, they are probably unemployed, unless they are one of the rare exceptions

that work as a teacher or a midwife.

Respondents reported that there are currently no humanitarian actors working in

Yarmouk Camp. While the Syrian government agreed in January 2014 to allow

supplies into the camp, it has since backed out of this agreement. Aid organizations

working without the permission of the Syrian government fled from the camp after

some of them came under attack from the Islamic State in April 2015. Even while

assistance was available in the camp, it was not nearly enough to cover the needs

of all of Yarmouk’s residents.

27

In the months since the Islamic State captured significant territory in Yarmouk,

residents have been caught in the middle of a triangular fight between the

Palestinian Aknaf Beit al-Maqdis, the Islamic State and the Syrian government. The

Palestinian faction was reported to by respondents to be the largest of the three

operating inside of the camp, and the Syrian government the smallest. However,

the Syrian government still has enough power concentrated around the outside of

the camp to continue to impose control over most of what comes in and out of the

camp. Indeed, 92 percent of respondents indicated that the Syrian government still

does not allow civilians to leave the Yarmouk Camp, in violation of UN Security

Council Resolution 2139.

In many ways, the Yarmouk Camp represents a microcosm of the Syrian conflict,

featuring routine violations of human rights law, reneged agreements, denied

access, inaccessible services, and no end in sight as intractable fighting between

bad and worse groups catches civilians in the crossfire.

28

REFERENCES

“ISIL seizes most of Syria’s Yarmouk Camp,” Al Jazeera and AP, April 5, 2015, http://

www.al jazeera.com/news/2015/04/ is i l -se izes-syr ia-yarmouk-refugee-

camp-150404135525226.html

“Islamic State-controlled Yarmouk refugee camp conditions ‘beyond inhumane,’” The

Telegraph, April 7, 2015, http://www.telegraph.co.uk/news/worldnews/islamic-state/

11519106/Islamic-State-controlled-Yarmouk-refugee-camp-conditions-beyond-

inhumane.html

“Syria: Squeezing the Life out of Yarmouk: War Crimes against Besieged Civilians |

Amnesty International USA.” Amnesty International, March 10, 2014. http://

www.amnestyusa.org/research/reports/syria-squeezing-the-life-out-of-yarmouk-

war-crimes-against-besieged-civilians

United Nations Security Council Resolution 2139, passed February 22, 2014, http://

photos.state.gov/libraries/syria/982645/wp-pdfs/N1424339_002.pdf

29

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