Between
two fires
Danger and desperationin Syria’s Al-Hol camp

Table of contents
03 Contents
05 Executive Summary
09 Context and legal framework
15	The journey to Al-Hol and the progressive containment and securitisation of the camp
21	“Between two fires” – violence and securitisation in Al-Hol
21 Extreme criminality and a pattern of killings
22 Extortion and threats
23 Lawlessness and lack of protection
24 Law enforcement practices and their impact on people’s health
24 System of detention in Al-Hol
27 Additional restrictions on population of the Annex
27	Violent separation of children and adolescents from their caregivers
28 Mental toll of insecurity and containment
28	Devastating consequences for children and adolescents
31 Limited access to healthcare
31	Obstructed referrals to health facilities outside Al-Hol
32	Additional obstacles to accessing healthcare for population of the Annex
35	Limited prospects for life outside Al-Hol and lack of long-term solutions
35	Syrian returns marred by bureaucratic barriers and corruption
37 Exploitation and protection challenges
37 Life after return: social and economic challenges
38 Slow and inconsistent Iraqi repatriations
38 Repatriation of foreign nationals from the Annex
41	Challenges of providing humanitarian aid in Al-Hol camp
45 Conclusion
48 Endnotes

Acknowledgements
MSF would like to acknowledge the many
people who contributed to this report.
To our staff in Syria, and elsewhere,
and especially to the people of Al-Hol,
we would like to sincerely thank you forsharing your time and stories with us.

Art direction, design + infographics
Sue Cowell | www.atomodesign.nl

Cover photograph ©Florent Vergnes

November 2022

2 | Between two fires

Boundaries and place names on maps inthis report do not reflect any position by
Médecins Sans Frontières (MSF) on theirlegal status.

Between two fires | 3

Executive summary
Under the auspices of the global fight against the Islamic State (IS)group, exceptional policies have been implemented involving theindefinite and arbitrary detention of women, children and men in
Al-Hol camp in northeast Syria.

The responsibility for implementing these measures wasdevolved by the US-led Global Coalition against IS to theAutonomous Administration of Northeast Syria (AANES), a defacto autonomous region in northeast Syria, and to the Syrian
Democratic Forces (SDF) – the military branch of AANES.
Members of the Global Coalition, as well as other countries
whose nationals remain held in Al-Hol, and other detention
facilities and camps in north east Syria, have failed to takeresponsibility for protecting their nationals or for identifying
long-term solutions to their indefinite containment. Instead,they have delayed or simply refused to repatriate all theirnationals, in some cases going so far as to strip them of theircitizenship, rendering them stateless. Overall, no measures
have been taken to ensure that the fundamental rights of thecamp’s population are protected.
Left to manage the largest camp in northeast Syria and its
more than 53,000 detainees of 60 nationalities, AANES andSDF have been ill-equipped and poorly guided to manage
these processes in a way that is in keeping with international
standards and law. Repeated breaches of human rights andrecurrent patterns of violence and exploitation have been
observed in Al-Hol camp. These have an enormous impact
on people living in and around the camp, affecting theirsafety, security, dignity and access to humanitarian aid.
They also impact the providers of humanitarian aid, who
are increasingly constrained and exposed to violence andcriminality.
Rather than taking steps to address the pervasive insecurity
and dire living conditions in Al-Hol, the Global Coalition has
outsourced the management of the situation by providing
funding to AANES and SDF for securitisation and containment
measures – measures which have so far failed to ensure safety
and security for people in and around Al-Hol. Residents havedescribed themselves as being trapped “between two fires”:
on the one side, the persistent threat of extreme violence
committed by armed groups in the camp, and on the other, theincreasingly harsh security measures implemented by campauthorities in an attempt to manage the situation in Al-Hol.
The containment of thousands of men, women and children
in Al-Hol is a short-term security measure which is unlikely toaddress the threat posed by the IS group until the immediate
safety, protection and long-term welfare of the people inside
the camp are addressed.
MSF calls on the all relevant parties – including the Global
Coalition, local authorities in northeast Syria, and states withnationals in Al-Hol – to assume responsibility for the welfare of‘Counter-terrorism policies havetrapped thousands of civilians
in Al-Hol camp in a cycle ofindefinite detention, danger
and insecurity’
4 | Between two fires© MSF

Panorama of Al Hol camp from phase 1 water tower.
Al Hassakeh Governorate

Between two fires | 5

people in Al-Hol. It also calls on the Global Coalition to support
local authorities in taking immediate steps to guarantee people’s
wellbeing, protection and fundamental human rights. This
includes investing in measures to reduce violence, insecurity
and criminal activity, in accordance with international law, andstrengthening capacity for providing humanitarian assistancein the camp, improving living conditions and identifying
sustainable long-term solutions for the camp’s population thatare in keeping with international standards and law.

A child runs through the streets of Al Hol camp innortheastern Syria, where around 53,000 people
displaced by the conflict in Syria, the majority ofthem children, are detained.

Purpose and scope of the reportCounter-terrorism policies have trapped thousands of civilians
in Al-Hol camp in a cycle of indefinite detention, danger andinsecurity, which permeates every aspect of their daily lives
and deprives them of their fundamental human rights. This
report documents and reflects on the impact of the pervasive
violence, exploitation and lawlessness in Al-Hol camp on its
population through their voices and experiences. It draws on
the testimonies of population of the Main Camp and Annex,
the first-hand observations of MSF frontline humanitarianstaff, and medical data from MSF health facilities in the campcollected between July 2021 and March 2022.
The report describes the personal experiences and accountsof our patients, the wider population of Al-Hol and our staff
testimonials. Through these accounts, Al Hol is portrayed asa detention camp, more than a humanitarian camp setting,where movement in and out of the camp is restricted, rights
and entitlements are stripped from people. They lack access tolivelihoods, and continue to be held in prison-like conditions
with very limited access to basic services and with no way out.

MSF activities in Al-Hol camp

© FLORENT VERGNESMSF launched a response in Al-Hol camp in January 2019,
initially providing emergency medical care in the reception areafor new arrivals and providing essential relief items. Currently,
MSF runs a clinic for patients with non-communicable diseases
and provides home-based medical services to the population of
the Main Camp who are unable to walk to a health facility. MSF
also provides outpatient consultations, women’s health services
and mental health support in the Service Area adjacent to theAnnex, where foreign nationals are held. MSF teams also run
mobile clinics within the Annex. MSF also provides emergency
water trucking to areas of the Main Camp and supplies water,
via a water network, to the Annex and to one of the most densely
populated sections of the Main Camp which houses more than
20,000 people.

6 | Between two fires

Between two fires | 7

Context andlegal framework
Al-Hol camp is situated close to the Syria-Iraq border. It was initially set upby the United Nations High Commissioner for Refugees (UNHCR) during
the 1991 Gulf war to house some 15,000 Iraqis,1 and was expanded further
during the US invasion of Iraq in the early 2000s.

Al-Hol town was controlled by the IS group in early 2014,
when it was on the main corridor and most prominent
supply route for IS from Iraq to Syria, specifically towards
southern Hassakeh and Raqqa. In October 2015, Syrian
Democratic Forces (SDF)2 launched an offensive tocapture the strategic town of Al-Hol and the surrounding
countryside from IS. On 13 November 2015, SDF forces
captured Al-Hol town. The Autonomous Administration of
North and East Syria (AANES) reopened Al-Hol as a refugee
camp in April 2016 to accommodate Iraqi refugees fleeing
IS advances. In 2018, the camp hosted some 10,000 Iraqi
refugees, but between December 2018 and March 2019 its
population increased to some 73,000 people after the fall of
Baghuz, the last stronghold of IS,3 and the resulting mass
influx of displaced people.
After the battle of Baghuz, thousands of alleged IS fighters
were detained by the SDF in makeshift prisons, including
many foreign nationals. Families of suspected IS fighters,
including some 11,000 foreign women and children, were
evacuated from Baghuz and taken to Al-Hol, where they
were kept in a separate annex of the camp, which had more
restrictions than other areas. The Baghuz influx brought the
total number of Iraqi nationals in the camp to around 30,000,4
making Iraqis the dominant nationality within the camp.
Currently, Al-Hol camp is divided into the Main Camp,
comprised of eight sections (known as ‘phases’) for Syrian
and Iraqi nationals; and the Annex, housing foreign nationals(neither Syrian nor Iraqi) from 60 different countries. The
Main Camp and the Annex are separated by a fence with little
to no movement allowed between the two areas. Following
some returns and repatriations, the total camp population
now stands at around 57,000,5 of whom 11,000 are foreign
nationals.6 A total of 64% of Al-Hol’s population are children,
while 50% of the camp’s population are under the age of 12.7
The Global Coalition has recognised that the 11,000 foreign
nationals held in Al-Hol are an “international problem”. As
a result, it has provided the SDF with financial support and

8 | Between two fires

equipment amounting to hundreds of millions of dollars
to manage the camp, and helps train local security forces
and improve facilities in the camp.8 Despite this, conditions
in Al-Hol are characterised by severe overcrowding, while
its population live in inadequate makeshift shelters withlimited access to food, clean water and basic services such as
healthcare and education. People in the camp are exposed
to high levels of violence, exploitation and abuse on a daily
basis, while children and other vulnerable groups bear thebrunt of the insecurity and deprivation.

Legal landscapeThis section touches briefly on the various bodies of public
international law that may be relevant to the situation in
Al-Hol camp, and illustrates in broad terms the different
standards, rights and obligations that exist in relation to
deprivation of liberty. What follows is therefore not an
exhaustive presentation of the existing legal framework.
The question of whether SDF has the authority to detain
individuals is beyond the scope of this section.9

International humanitarian law (IHL)

The conflict between SDF and the IS group in northeast Syria
could be classified as a non-international armed conflictwithin the meaning of Article 3 common to the 1949 Geneva
Conventions.10 IHL would thus be applicable provided that alink exists between the situation of such armed conflict andthe deprivation of the liberty of relevant individuals.
As per paragraph 1 of Article 3 common to the 1949
Geneva Conventions, each party to the conflict is obliged to,
as a minimum, treat humanely persons in detention in all
circumstances and “without any adverse distinction foundedon race, colour, religion or faith, sex, birth or wealth, or
any other similar criteria”.11 It should be noted that “[…] themeaning of humane treatment is context specific and has

Between two fires | 9

Other guarantees for persons deprived of theirliberty include:
Persons deprived of their liberty must be provided
with adequate food, water, clothing, shelter andmedical attention;

 Persons deprived of their liberty must be held inpremises which are removed from the combat zone andwhich safeguard their health and hygiene; Pillage of the personal belongings of persons deprivedof their liberty is prohibited; The personal details of persons deprived of their liberty
must be recorded; Persons deprived of their liberty must be allowed toreceive visitors, especially near relatives, to the degree
practicable.14

When it comes to internment,15 certain general principles
apply, including that: internment (i) is an exceptional
measure; (ii) is not an alternative to criminal proceedings;(iii) can only be ordered on an individual case-by-case basis
without discrimination of any kind; and (iv) must cease assoon as the reasons for it cease to exist.16
Women deprived of their liberty must be held in quarters
separate from those of men, except where families areaccommodated as family units, and must be under theimmediate supervision of women.17 The specific protection,
health and assistance needs of women affected by armed
conflict must be respected.18
Children affected by armed conflict are entitled to special
respect and protection.19 Children deprived of their liberty
must be held in quarters separate from those of adults, except
where families are accommodated as family units.20 In thisregard, family life must be respected as far as possible.21
The United Nations Security Council, through resolution
2427, “[…] emphasise[d] that children who have been
recruited in violation of applicable international law byarmed forces and armed groups and are accused of having
committed crimes during armed conflicts should be treatedprimarily as victims of violations of international law, and[…] encourage[d] access for civilian child protection actors tochildren deprived of liberty for association with armed forces
and armed groups” (emphasis added).22

International human rights law (IHRL)23

No one shall be subjected to torture or to cruel, inhumaneor degrading treatment, which is a non‑derogable rightapplicable at all times.24

10 | Between two fires

Everyone has the right to liberty25 and security of person,26
and no one shall be subjected to arbitrary arrest or detention
or deprived of his/her liberty except on such grounds and inaccordance with such procedures as are established by law.27
All persons deprived of their liberty have to be treated withhumanity and with respect for the inherent dignity of thehuman person,28 which is a non-derogable right applicable at
all times.29 This encompasses that persons deprived of theirliberty may not be subjected to torture or cruel, inhumanor degrading treatment or punishment, nor may they besubjected to “[…] any hardship or constraint other than that
resulting from the deprivation of liberty; respect for the
dignity of such persons must be guaranteed under the same
conditions as for that of free persons.”30
States have recognised the fundamental right of everyone
to be free from hunger and to enjoy the highest attainable
standards of physical and mental health.31
Regarding women, access to healthcare services on a basisof equality of men and women must be ensured, as well as
appropriate services in connection with pregnancy andadequate nutrition during pregnancy and lactation.32
With respect to children, several additional considerations
apply. Firstly, the best interests of the child must be theprimary consideration in all actions undertaken by,among others, administrative authorities and courts oflaw.33 In addition, children must not be deprived of theirliberty unlawfully or arbitrarily; any arrest, detention or
imprisonment must be in conformity with the law and be
used only as a measure of last resort and for the shortest
appropriate period of time.34 If a child is deprived of his/her liberty, he/she must be treated with humanity and in amanner that takes into account the needs of persons of his/her age.35
Children deprived of their liberty must not be subjected
to torture or other cruel, inhuman or degrading treatment
or punishment.36 They must be separated from adults unless
it is not in their best interest to do so;37 in that regard, it
is important to note that children must not be separated
from their parents against their will except in specificcircumstances.38 They have the right to education, to receive
adequate physical and mental healthcare throughout
the period in which they are deprived of their liberty,
and to maintain contact with their family and the wider
community.39 Children must be registered immediately
after birth and have the right, as of birth, to a name anda nationality.40,41
Other documents that reflect generally accepted
standards relating to deprivation of liberty can be found,for example, in the Body of Principles for the Protection of
All Persons under Any Form of Detention or Imprisonment(A/RES/43/173 (1988)), the United Nations Standard
Minimum Rules for the Treatment of Prisoners (theNelson Mandela Rules) (A/RES/70/175 (2016)), the United
Nations Standard Minimum Rules for the Administrationof Juvenile Justice (A/RES/40/33 (1985)), and the United
Nations Rules for the Protection of Juveniles Deprived of
their Liberty (A/RES/45/113 (1990)).

International refugee law (IRL)

IRL applies to refugees who, “owing to a well-founded fearof being persecuted for reasons of race, religion, nationality,
membership of a particular social group or political opinion,[are] outside the country of [their] nationality, and [are]unable to, or owing to such fear, [are] unwilling to avail
himself of the protection of that country.”42 Although Syria
is not a party to the 1951 Convention relating to the Status
of Refugees, the convention may serve as an illustration ofrights granted to refugees with respect to, among others,
rationing, housing, public education, public relief andfreedom of movement.43

Internally displaced people (IDPs)

IDPs are “persons or groups of persons who have been
forced or obliged to flee or to leave their homes or placesof habitual residence, in particular as a result of or inorder to avoid the effects of armed conflict, situations ofgeneralized violence, violations of human rights or naturalor human-made disasters, and who have not crossed aninternationally recognized state border.”44 Generally, IDPs
should be granted the same rights and freedoms as those
granted, under international and domestic law, to otherpersons in their country.45© MSF

to be considered in the concrete circumstances of each case[…]”.12 Violence to life and person, in particular torture,murder, and cruel treatment, is prohibited at all times and inany place, while the wounded and sick must be collected andcared for.13

Between two fires | 11

“Everyone here has adifferent story, not everyone
is IS (Islamic State)”© FLORENT VERGNES

Main camp resident

12 | Between two fire

Between to fire | 13

The journey to Al-Hol and theprogressive containment andsecuritisation of the camp
Al-Hol was once a humanitarian camp, designed to provide safe,
temporary accommodation and humanitarian services to civilians
displaced by the conflict in Syria and Iraq.

Many camp residents came to Al-Hol on the basis that
it was temporary and voluntary, and that the camp washumanitarian in nature. They were given assurances of safety
and that they would be provided with basic necessities such as
food, medicine, water and shelter. Many felt relief when theyfound a place of refuge in Al-Hol, but the changing nature of
the camp left them feeling confused, frustrated and trapped.

~ “In one word, what we are living through here ishorrible. We are in Al-Hol because they promised us
freedom, they promised us good conditions if we left
Baghuz and stopped the war. I was pregnant and I
had five children, so I decided to leave Baghuz. Now
I regret having left. I believed it would be true, that
we would be free, but nothing. If I’d known, I would
have preferred to die than come here.”

Main Camp resident
The influx of civilians from IS-controlled areas to Al-Hol
in 2019 46 led to the entire population of the camp being
perceived as affiliated with IS. The wives, children andother relatives of thousands of killed or detained IS fighters
were taken to Al-Hol camp, with many of them reportedly
continuing to maintain IS ideology.47 However, some female
camp residents have told MSF staff that they followed theirhusbands to IS-controlled territories for non-ideologicalreasons, including the desire to remain with their children.

~ “Everyone here has a different story, not everyone
is IS. My husband followed IS and took my children,and I was forced to follow him because my daughter

14 | Between two fires

was with him – what else could I do? I didn’t want to be
separated from my daughter and I wanted to protect her.
My family asked me not to go, and now they don’t evenwant to speak to me. I no longer have anyone outside
Al-Hol. I was forced to come to this camp as our family
abandoned us because we followed IS. I was livingin Raqqa with my husband and my daughter. Then
my husband took our daughter to Deir Ez-Zor. I went
looking for him in Deir Ez-Zor and I found my daughter.
I tried to run away with my daughter but they caught
me and sent me up in front of a judge. I could leavealone but my daughter had to stay. So I decided to stay.
Now I have a major responsibility for my children – they
have no family, no father, only me. My family no longer
accepts my children and me. At the end of IS, they told
us: 'Everyone that wants to leave, you can leave’. I got
divorced and I took my daughter and we started to walk.
It was cold and it was night-time and we didn’t know
where the mines were. Finally we found a house, but thenext morning a soldier found us and took us to Al-Hol[…]. When it was the end of IS, security forces asked all
the civilians to go to Al-Hol. They told us it would be abetter place to stay for a couple of days and after that we
could leave, and that there would be medical care andfood. They didn’t say it would be a place that we couldn’t
leave. If I had known, I wouldn’t have come. It was goodat the beginning; for the first month I was able to sleep alot, and I slept a lot, as we couldn’t sleep during IS. Thenthe murders and the robberies started, as well as theburning of tents. They all started at the same time.”
Main Camp resident

Between two fires | 15

The ideological demography of the camp’s population is far
more diverse than narratives regarding their affiliations
with IS suggest. Many of the camp’s population report having
been displaced multiple times as a result of conflict. Far fromidentifying with IS ideology, many say they were arrested
at checkpoints when trying to flee IS-controlled territories.
Many report that they were living in areas that later cameunder the control of IS and were forced to leave their homes
on IS orders. They say that if they chose to stay, they risked
being bombed by coalition forces or being accused ofsupporting IS by dint of their location.

~ “We escaped Deir Ez-Zor in October 2017. The~ “People were forced to leave their homes because

situation was bad there, there was lots of shellingand civilians were being targeted. Everyone wasdesperate to leave, everyone was waiting on theroad for transport out of there, cars and minitrucks were taking whoever they could. I took
10 people on the back of my motorbike with me.
It wasn’t like we could leave people behind. It took
us three days to get to Shadadi and then we werearrested at a checkpoint and taken to Al-Hol.
Pretty much everyone who left Deir Ez-Zor atthat time was arrested.”

mostly they were in the wrong place at the wrong
time. We were forced to leave our city and forced tostay in the city of IS, and we were forced to movefrom place to place by IS […]. In 2015, I came backto Syria to collect my mum so we could go back to
Turkey together. But IS was there, so I tried to run
away with her and I was arrested. They put me inprison for one month and they took everything wehad. I could not run away after that, and life wasgetting worse. IS forced us to go to Raqqa and thento Deir Ez-Zor. We couldn’t stay in the city because
the coalition was bombing everything and, if you
stayed behind, the coalition forces would accuse youof being from IS, so we were forced to move with
IS. Deir Ez-Zor is where we got to before eventuallyending up in Al-Hol. And finally here we are, andwe are still not safe. We thought we would be safe
here, but no."Main Camp resident

Main Camp resident
Due to the lack of due process to establish the legality of
their indefinite detention in Al-Hol, many camp residents saythey feel they have been found guilty without a trial. They
fear that both security conditions and living conditions willcontinue to deteriorate and that they may be stuck in Al-Hol
forever, if not by restrictions on their freedom of movement,
then by the crippling stigma they will face in terms of theirperceived association with IS resulting from their stay in thecamp. Such fears are an enormous mental burden and havebrought about an atmosphere of hopelessness among thecamp’s population.

~ “In Al-Hol, we are in a detention centre – it islike Guantanamo, it is a death camp, a prison. Once
my dad was at the main gate but they wouldn’t
allow me even to see him at the gate. This is when
I thought: ‘Yes, we are in prison.’ We need people tobe able to visit us, and we need to be able to interact
with the outside world. The media are not puttingout the right message about Al-Hol, with the resultthat one bad person affects all the people here.”environment shift around them: they note that the camp
was once open, with people able to leave the camp andearn money, but gradually it became more contained andrestrictive. Visits by family members, which were possible
in the past, were also suspended in 2020 as part of COVID-19
precautionary measures implemented by authorities. 48
Now, the camp population are not allowed to leave the campunless granted permission by the security forces, whichrarely happens.

~ “In 2017, Al-Hol was a camp; in 2019, it becamea prison. When we were first there, we could walkin and out, we could apply for permits to go to
Hassakeh or even Raqqa. There was cash in thecamp. If things had stayed the same in the camp,probably no one would have left. It was good backthen. There was no problem with security at all,there were loads of resources and distributions[of relief items] were good. NGOs were reallywell accepted.”

Main Camp resident
Barbed wire and fences have been erected and deep
trenches have been dug around the perimeter of the camp,while multiple checkpoints run by security forces control
all movement in and out of the camp. Armoured vehicles
frequently patrol the camp, with security raids and arrestsa regular feature of life. Repeated security incidents within
the camp have also justified more security investment fromthe Global Coalition against IS and increased restrictions on
the camp’s population, contributing to a spiral of security
solutions that have progressively undermined the civilian
character of the camp.

~ “I think we are in a punishment camp, it is aterrifying and horrible place. It is one big prison.
The only thing we are asking for is to go home andbe left alone. We can manage, even if we have to go
back to Government of Syria territory. I have been in
Al-Hol for three years now and it feels like 25 years.”

Main Camp resident© MSF

Main Camp resident

16 | Between two fires

Despite the heterogeneity of Al-Hol’s population, large-scale
containment and securitisation measures were put in place
after the arrival of people displaced from IS-controlled
territories in 2019. Camp residents describe feeling the

Between two fires | 17

“We are between two fires:the security forces and theextremists. It’s a kind of prison”

18 | Between two fire

Between to fire | 19

© RICARDO GARCIA VILANOVA

Main camp resident

“Between two fires” – Violence andsecuritisation in Al-Hol
Forced to live in a violent and dangerous environment, people in
Al-Hol are exposed to constant physical and psychological trauma
and an atmosphere of fear which penetrates all aspects of their lives.

Al-Hol has effectively become a legal black hole, conducive topatterns of violence and exploitation, where criminal activities
are treated with impunity. The indefinite detention of thecamp population, and the lack of due process and review of thelegality of such detention, have stripped them of their rights,
entitlements and access to protection under international law,and have greatly contributed to their exposure to extreme
criminality, violence and insecurity. Camp residents describe
feeling caught between two fires: on the one hand theincreasingly violent criminal groups, with opaque politicaland ideological affiliations and with access to weapons; and on
the other hand the excessively repressive and violent measures
implemented towards the population by security forces incharge of the camp and Global Coalition forces.

Extreme criminality and a pattern of killings
In 2021, the leading cause of mortality in Al-Hol was crimerelated death, which accounted for 38% of all deaths in thecamp.49 In addition to those 85 crime-related deaths, 30
attempted murders were also reported in the camp.50 The
majority of murder victims were Iraqi nationals.51 Aggressive
criminality and violence linked to extortion opportunities
by networks of armed groups have contributed to this highincidence of killings. Between January and August 2022,
there were 34 reported murders in the camp. 52

38%

In 2021, the leading causeof mortality in Al-Hol
was crime-related death,
which accounted for 38%
of all deaths in the camp

~ “Al-Hol is the most dangerous place in the world
because of the enormous number of [murder] cases
here. Four months ago, I was walking with a friend
at sunrise and we saw a blanket. In it there was adead body. We didn’t do anything because we were too
afraid of the security forces. But the body had no head.
The head was in phase 5 and the body in phase 1.”
Main Camp resident
The underlying causes of the criminality in the camp vary,
but contributing factors include a general sense of lawlessness
in the camp, damaged social fabric, limited community
structures, a lack of legitimate economic opportunities, anda returns and departure process littered with administrative
obstacles and opportunities for exploitation.

~ “There are many different armed groups andsleeper cells in the camps. Some of them are justextracting money, some are religiously motivated,and some are looking for information and control[…]. I would estimate that around 90% of thekillings in the camp are related to extortion andextraction of money, with only 10% related toreligious beliefs. The thing is, if you are approachedby one of these groups and asked to provide
information, there is not much you can do. If you
say ‘no’ you are going to be killed, if you say ‘yes’
then suddenly you are affiliated with these groups.
You can’t win. You just have to get out, but thenagain, only people with money can leave.”
Main Camp resident

20 | Between two fires

Between two fires | 21

and the extremists. It’s a kind of prison. There is no
freedom here. Why don’t they allow us to go outside
the camp? These murders that are happening, many
people don’t know why they are happening. And
because it is unknown and can happen for any
reason, it is very frightening. We don’t know why
they are killing people, and we can’t lock our door
– we don’t even have a door! They say they only kill
the spies who are going to the security forces, but thisis not true because sometimes there are killings forno reason at all.”Main Camp resident
Almost everyone in the camp has a story of a neighbour or
relative who has been directly impacted by these murders.
Some of the violence is clearly targeted and relates to allega­
tions of spying for the security forces, to extorting money fortaxes, or to social control related to having a 'bad reputation'.
Camp residents have reported killings of individuals who
have been subject to extortion for money and have refused or
been unable to pay. Other killings are perceived to be related
to the provision of sexual services as a survival mechanism.
Other instances involve individuals reportedly affiliatedwith IS who have been murdered due to their perceived
lack of adherence to cultural or religious norms within thecamp. However, other murders are seemingly random.
The indiscriminate nature of some of the violence creates apervasive atmosphere of fear and powerlessness.

~ “There is no safety here, we don’t feel safe. I havethree other boys, and I’m always worried because we
don’t know who is doing the killings or when they will
happen. Three years ago, one of my sons went to themarket one afternoon and never came back. After 51
days the security forces told me that eight people cameto the tent and killed him and buried his body under
the tent. I don’t feel safe because I’ve lost one boy andanother one is in prison. The one who was killed was
14 years old and the other one is 30 years old.”
Main Camp resident

Extortion and threats
Camp residents, who already face debilitating economic
difficulties and deprivation, are regularly threatened byarmed groups renowned for using violence and intimidation
to extort large sums of money.

22 | Between two fires~ “An armed group threatened me in the camp.

They asked me to pay money, but I didn’t pay
them. They accused me of working with the
Kurdish authorities in Al-Hol and my name wasshared [in an online group where names anddetails of threatened people are shared]. I tried toescape from the camp with my family after that.
I wasn’t successful; the security forces arrested us
as we were escaping.”

Main Camp resident
People who have been subject to threats are usuallydesperate to leave the camp, but protection pathways
for them are limited. ‘Safe zones’ designated by campauthorities to house individuals and families specificallytargeted by armed groups offer limited protection to people
at risk. For instance, on 12 November 2021, a group ofarmed men wearing uniforms entered a designated safezone – an area of the camp near the reception area, whichat the time housed around 60 individuals who had been
threatened. The men opened fire, killing two people andinjuring several others.53
Protection organisations, such as the UNHCR, provide
some limited pathways out of the camp for people
at imminent risk of being killed. However, even thisprotection mechanism is often too slow to save the lives of
those who are threatened. In many cases, the only option
for people being threatened is to find an illegal smuggling
route out of the camp. These routes are rife with risk:
people attempting to leave the camp in this way have beencaught by the security forces and arrested or killed in“crossfire”. Smugglers charge extortionate fees to get people
out of the camp, capitalising on their desperation andpricing safe passage out of reach of the most vulnerable incamp society.

Lawlessness and a lack of protection
Theft is a common occurrence for people living in the camps.
Valuable personal items are often taken from tents, whichlack lockable doors. Camp residents have described digging
holes under their tents to hide valuable items. Female-headedhouseholds, in particular, are vulnerable to this pervasive
criminality. When such crimes are committed, there are no
avenues for legal recourse, which contributes to a mentalityof self-protection and feeds into the economies of protection
rackets. Many households started hanging blankets andsheets around their tents to gain some privacy and to createa safe space for their children to play in, but security forces
have been removing these flimsy walls as part of theirsecurity procedures.

~ “Anyone can steal easily – they can open a tent

and steal. There is no security. If people are stealing,
there is no place to complain and ask for help. There
was a woman in another section of the camp; twomonths ago they stole from her. She woke up at 2 am
to find the thief in her tent. They told her they would
rob her and she couldn’t do anything about it or theywould kill her. No one can do anything.”
Main Camp resident
Faced with violence and crime, there is no one to turn to for
help. Camp residents say that security forces do not intervene
after a crime, do not conduct investigations and do not hold

Large View of Al-Hol Camp, Eastern Al- Hasakah
Governorate, Northeastern Syria.

~ “A female called me and told that I had to bringthe money and meet her. I didn’t go to the security
forces for two reasons: firstly, if they found out I wasin contact with the sleeper cells, they would kill me;
and secondly, I don’t think the security forces could
help me. I went there and gave her the US$300. She
just took the money and didn’t say anything. I had
no choice but to pay them, I needed to save myself
and my family, I could have been killed if I didn’t
pay. The same sleeper cell attacked my neighbour
because she didn’t pay.”

Main Camp resident© MSF~ “We are between two fires: the security forces

Between two fires | 23

individuals accountable for acts of criminality – or if they dointervene, they come too late. If someone calls the security
forces after a crime has been committed, the criminal groups
in the camp may accuse them of spying, which would put
their safety at greater risk.

~ “Twenty days ago, my brother was killed in

front of me and we couldn’t do anything. There isno security and there is no safety here. Everythingis difficult here. You are in your tent and you don’tknow if you’re going to be killed for no reason. One
night several people entered our tent and started toshoot at my brother. First one shot and then anothershot to his head to kill him. He was 16 years old.
Why did they kill my brother? Then they put a
gun to my head and pushed my mother, who had
been trying to protect my brother. The next day
they called us and they threatened to kill our wholefamily. The authorities didn’t come to investigate;
they didn’t even come to take his body.”
Main Camp resident
Many residents also report that inter-communal disputes
are often 'sorted out' by one party telling the security forcesthat the other party is affiliated with IS, resulting in them
being investigated and arrested. This has become a common
mechanism for addressing internal disputes. The arrestsin the camp often appear to camp residents as random andindiscriminate in nature, adding to the atmosphere of fear andlack of control.

~ “There are spies in the camp who help in thearresting of people, and a lot of those who arearrested are innocent. Tensions arise between people
in the camp, so they point each other out to thesecurity forces to settle personal disputes.”~ “When the security forces are doing the patrols,

they will take you, even if you have not done anything.
And they will arrest you easily, you will be punished,
you will be beaten and you will have to pay money.
They were not like that before, but in recent months
they have become stricter. I think the change of
behaviour is because of the murder cases in the camp.”
Main Camp resident
Security operations by authorities and shoot-outs
between armed groups and the security forces have on
occasion resulted in casualties among Al-Hol’s population,
including children.

~ “Four days ago, the security forces entered atent and shot them. It was part of a raid, they were
following someone in particular, but there were
women and children in the tent who got caught
in the middle and some of them are seriously
injured in the hospital in Hassakeh now. I don’t
understand why the women and children had to be
hurt. In my opinion, if they wanted someone, thenthey should have surrounded the tent and taken the
person they wanted.”

Main Camp resident
On 7 February 2022, following a fire in the Annex, a memberof the security forces opened fire at a group of unarmed
women and children.55 One child died instantly, threechildren and two women were seriously injured and several
others sustained less serious gunshot wounds. The fiveseriously injured patients sought treatment with MSF andrequired specialist medical follow-up care. The healthcare
provision in the Annex is not suitable for such severe injuries
and access to medical referral pathways to secondary healthfacilities out of the camp is limited and challenging.

Main Camp resident

System of detention in Al-Hol

In response to the pervasive insecurity and violence in thecamp, authorities have at times reportedly resorted to law
enforcement tactics that are not in keeping with international
standards.54 Al-Hol population report that security forces
sometimes act and react to the insecurity in the camp withexcessive use of force and frequently conduct arbitrary arrests.

24 | Between two fires

Camp residents report arrests and transfer of individuals todetention facilities in and around Al-Hol camp. As a result of
the lack of a formal criminal justice system governing thesepractices, there is no transparency around the fate of people
who are detained. Camp residents say that such arrests are
sometimes made in pursuit of ‘wanted people’ or as a resultof infractions such as being caught with contraband items(money, phones in the Annex, and weapons in the Main
Camp). In other cases, arrests have been made after attempted
escapes. Notably, one resident told MSF staff that she and© MSF

Law enforcement practices and impact on health

Between two fires | 25

her daughters had been kept in detention for six months as
punishment for trying to escape from the camp. She reported
that she and her children were denied access to healthcare forthe duration of their detention, despite having ongoing healthneeds. Others have reported that, whilst detained, they haveexperienced or witnessed physical violence, rape, verbal abuse
and solitary confinement for long periods in toilet blocks,
while being denied access to healthcare.

~ “I was in the prison and it was terrible. When you

are ill there is no medication, they don’t even care if
you are dying. They also took our long dresses away.
There are a lot of sisters in the prison, some have been
there for more than a year. I stayed in the prison for
four months. I saw one woman who had been in theprison for more than a year and she was locked in the
toilet for four months because she wouldn’t speak.”Main Camp resident
Relatives of people detained report that no information is sharedwith them for the duration of detention, while many report casesof family members 'disappearing’ whilst in detention.

~ “There are many patrols around the tents by
the security forces. It is frightening. They arrest
women all the time and we don’t know why, andthey raid the tents and take people away. One of myneighbours was arrested seven months ago and noone knew the reason. People are taken to the prisonand no one knows where they are. Her relatives
asked about her but no one gave them any answers.
She has kids and they have been left at home
without their mother. When we asked the security
forces about her, they told us that she doesn’t exist.
It is like she has disappeared. We are so mentally
tired; it is exhausting to be constantly on edge andfeel trapped and vulnerable all the time. Those
people who are arrested and taken away by the
security forces are tormented, some of them dieand some are severely beaten. The women who arearrested have water thrown on them, their hair ispulled and they are locked in the toilet without foodfor a week or 10 days.”

Additional restrictions on people in the Annex
Additional restrictions on freedom of movement and accessto services are imposed on the non-Syrian and non-Iraqi
women and children held in the Annex. They cannot leave
the camp at all. They can access a ‘Service Area’ where
MSF provides healthcare services only after obtaining
approval from security forces and passing through a security
checkpoint, where they are photographed with their faces
uncovered. The Annex’s population are not allowed topossess mobile phones or televisions and are forbidden from
communicating with anyone outside Al-Hol.

~ “Phones are forbidden in the Annex. We want toknow what is happening in the outside world, ourchildren don’t even know what a TV is. All of thesemodern things are strange for them. The children see
everything strangely; they live an abnormal life.”

Annex resident
The population in the Annex report regular and systematic
raids throughout the Annex, often at night, when security
forces routinely ‘confiscate’ items such as jewellery, food andmoney. People living in the Annex report often feeling thatthe security forces deliberately taunt them and treat them in a
way that is derogatory and purposefully humiliating. They also
report that being caught in possession of a mobile phone in the
Annex would result in several months in a detention facility.

Annex resident

Inside Al Hol Camp, Eastern
Al-Hasakah Governorate,
Northeastern Syria.

‘For the children, there is no future for them.
There are no schools. Before there were twoschools and the children were going there anddreaming about their future plans, but now there
is nothing: no schools, no future plans, nothing.’
Main camp resident

26 | Between two fires© RICARDO GARCIA VILANOVA~ “Sometimes at night when you just want to go

to the toilet and they see you, they take you to theprison. When we receive distributions, they beat us
and take us to the prison. I have one friend who hada shop. One day the security forces took everything
and now she is alone and poor. Another of myfriends was sitting at night with her neighbours
when the security forces entered her tent, took
her bag, threw out the clothes and started to beather. These were men with weapons so I could not
defend her. They pulled her hair, made her lie on
the ground and then took her to the prison for eightmonths. Now she is back in her tent. We are notafraid but it has been three years now and we are
tired of being here. I’m 35 years old but I feel more
like I’m 50.”

Annex resident

Violent separation of children and adolescents fromtheir caregivers
The practice of forcibly separating male children andadolescents from their caregivers has become routine andsystematic in the Annex56. Boys who look as if they are over 11
are regularly arrested by security forces during patrols andseparated from their caregivers. Large groups of boys are alsofrequently taken away by security forces from communal areas,such as the marketplace, during the day. The boys’ caregivers
often find out later, through second-hand sources, that theirchild has been taken away. Women report that children areoften taken away violently, without any of their belongings andwith no opportunity to say goodbye to family or friends. In somecases, the arrests appear more targeted, with security forces
going to specific tents and taking away specific children.
There is little to no transparency about where minors arebeing taken or what will happen to them in the long term.
Caregivers have limited, if any, contact with their children
after arrest. There are indications that children are being
funnelled into the criminal detention system or being sent to‘rehabilitation centres’ throughout northeast Syria; however,no official sources have been able to formally account for thewhereabouts of these children. According to the Independent
International Commission of Inquiry on the Syrian Arab
Republic, the boys are taken to SDF-managed detention
sites “without adequate judicial guarantees in a legal andadministrative limbo”.57 The impact of this practice on the
population of the Annex is profound, creating an atmosphereof fear, anxiety and anger.

~ “They are taking the adolescent boys from theirmothers. What right do they have to take our children
from us and then put them in prison? Two days ago,
they took the 12-year-old son of my friend. They
entered the tent at 2 am and they took the boy away. I
can’t describe to you the state his mother was in. You
speak about human rights, about children’s rights, butthese don’t exist here. We are in a prison, why?”

Annex resident~ “Mostly I worry about my nine-year-old boy andthat the security forces will take him when he getsolder. There are a lot [of mothers] whose boys weretaken off to prison by the security forces when theyturned 11 or 12, and they cry every day. I try as far
as possible never to be away from my children. My
children are always in my tent and I don’t want themto go outside.”
Annex resident

Between two fires | 27

The years of trauma, violence and deprivation and thecomplete lack of prospects for a life outside Al-Hol are taking
a toll on the mental health of people living in the camp andcreated overwhelming feelings of fear, hopelessness andfrustration, with residents consistently referring to Al-Hol
camp as a “prison”.

~ “When I look at my relatives outside Syria, they

are living a normal life in a safe place. I had many
dreams and everything has been destroyed. Al-Hol isa prison. Maybe according to the media it is a camp.
But a camp is for people who don’t have homes, notfor us. Everyone who is living here, their future has
been destroyed, whether they are children or adults.”
Main Camp resident
Caregivers draw attention to the staggering mental impactof the insecurity on their children, noting an increase innegative coping mechanisms, such as violent behaviour andaggression. At the same time, mental health services in thecamp are insufficient to meet the overwhelming needs ofthe population.

~ “The longer we stay here, the more it affects

our mental health. Life in the camp is difficult andI want to leave. But the problem is that Raqqa is
destroyed and everyone left, so there is nowhere togo. I don’t have family there, but we still insist on
leaving the camp because the security here is reallybad. There are murders going on in all sections of
the camp and we don’t know where we should go.
And it is not only us who are afraid – the children
are too, because they know that this is happening.
Now I have psychological problems: when I see people
in the market with guns, and security forces in themarket with guns, I’m afraid. The security forces
are doing the rounds and going inside the tents andthe children are afraid, and most of the people in thecamp are women. And then there are the other people:
the ones who kill you without any excuse, without
any reasons, without any fear. We are living in thedesert here, there is no education for our children, weare losing a generation here. And when we do leave
Al-Hol, people will not accept us because we are from
Al-Hol, so we’ll be forced to stay in the camp.”

Main Camp resident

28 | Between two fires

Devastating consequences of the lack of safety on children
and adolescents
Parents and caregivers express profound concern for the
wellbeing and psychosocial development of their children in
the context of the overwhelming insecurity and extremely
limited services in Al-Hol camp. In 2021, 35% of all people
who died in Al-Hol camp were children under the age of
16 – a total of 79 children.58 In the past six months, reported
fatal accidents include children being run over by water
trucks,59 children fatally injured in camp fires60 and children
drowning after falling into trenches full of grey water.

~ “For the children, there is nothing. There isno education at all and this will affect an entire
generation. I can’t control my children but I don’t
want them to go outside. We need a place to educate
them. Many children have been killed after being
hit by water trucks and others have been arrested by
the security forces. Also, there are the children who
fall through the holes in the rusty covers of the septic
tanks. We have complained a lot about this but
nothing has happened.”

Main Camp resident

35%

of all people who diedin Al-Hol camp werechildren under the age of
16 – a total of 79 children.

~ “They [the children] are also under a lot ofpressure. They don’t have access to education,a place to play, they just stay in the tent.
They are not getting to live the childhood they
deserve. Even when there is a school, this is noteducation: the children come and are mixed
between all the levels and all they do is play.
Because of the situation, our children also feela sense of responsibility and are already acting
as adults. Most of the Syrians suffer from this.
Maybe we all need psychological support. Whensexual violence happens, they blame the mother,saying: ‘You need to take care of your children’.
As for the boys, there is nothing for them to do,so they do bad things. If they were at school,
they wouldn’t be roaming the streets. People arestarting to feel bored. When the children are in
the streets they see bad people around who mayteach them bad things, for example that boys
aged 10 and over should not sit with women.
The daughters you can keep inside in the tent,
because they take care of the cooking and thecleaning. But the boys can’t stay inside, so weare more concerned about our boys. They can
become victims more easily.”

Main Camp resident

Caregivers also report the impossible dilemma they face ona daily basis: either they keep their children inside their tent
in an effort to protect them from multiple dangers, while
limiting their social interaction and access to education; orthey allow them to go out into the camp and risk injury, arrest
and even death.

~ “For the children’s sake, for my sake, I’m putting
my children in ‘prison’, as I’m paying a woman tokeep them in the tent. We feel really sorry for putting
our children in this situation. Their mental health isaffected; all the time they are tired and sad. The people
here are also so different; they teach aggressively andaccuse us of blasphemy. I don’t want my children tolearn that. I’m always sad and depressed.”
Main Camp resident~ “Because of the security situation, I don’t want

my children to go outside. But you can’t control them
all the time and you can’t force them to stay in all
the time. But I don’t want them to be outside, it isa different society outside and I don’t want them tolearn this. There are no jobs, no schools and there isnothing to do. I’m not making excuses for the young
children but there is nothing for them to do.”Main Camp resident
Al Hol camp is divided in to several
phases. In the picture, you see
phase 3 and it hosts Iraqi refugees.

Many residents report feeling helpless to protect their children
from the physical and sexual violence in the camp, from therisks of arbitrary arrest and from the destructive influence ofviolent groups within the camp on children’s behaviour. Camp
residents consistently highlight the limited access to education
services provided by humanitarian organisations as the reason
for losing “an entire generation” of children.

~ “The situation is really affecting our children.

I don’t know what it is happening with them: wecan’t control them. They may be very tired of thesituation. There is no education, only one level tolearn how to write and read. For five years they arein the same level. The whole generation will be lost.
We are also requesting education for adults.”© MSF

Mental toll of insecurity and containment

Main Camp resident

Between two fires | 29

Limited access to healthcare
Due to the combination of weak health systems in northeast Syria after
11 years of war and a lack of specialist healthcare available within the camp,
MSF teams report that a large number of people who are living with chronic
illnesses are not able to access the necessary medication and care.
Despite the existence of a number of primary health clinics
provided by other medical organisations. MSF has identified
approximately 1,800 individuals in the Main Camp who selfidentify as living with a non-communicable disease (NCD),
such as hypertension, diabetes, cardiovascular disease or
respiratory disease. People in the camp living with NCDs
(also known as ‘chronic diseases’) report inconsistent accessto medication, often accessing drugs at their own expense,
without a prescription and without medical oversight, via
truck drivers or private vendors. If left untreated or withinconsistent and inappropriate treatment, NCDs can become
more complicated and expensive to manage, resulting inincreased morbidity and mortality. This creates substantial
stress for people living in the camp. MSF has observed that theeffectiveness and impartiality of medical aid in Al-Hol havebeen compromised by the prison-like conditions in the camp.

Obstructed referrals
In 2021, MSF referred

381 patients

Obstructed referrals to health facilities outside Al-Hol
As a direct consequence of the securitised environment, MSF
often struggles to facilitate external medical referrals forpatients who require medical care beyond what is available
in the camp. For much of 2021, only lifesaving cases werereferred externally. This has persisted into 2022, often justified
by security concerns. In 2021, MSF referred 381 patients,
including 63 children, for secondary and specialist healthcare.
Due to services being unavailable or to the authorities
refusing to authorise a referral to an external facility, manyof the patients MSF referred did not receive treatment,
including patients in need of surgical, orthopaedic, dental
and ophthalmology treatments. Across the camp, there areapproximately 700 people on a waiting list for non-emergency
referrals. In 2021, a total of 286 medical referrals to external
health facilities were rejected by authorities, of which 205 (or72%) were due to “security reasons”.61
Patients who are referred are often refused authorisation
for a caregiver to accompany them. In addition, patients
report to MSF that they fear leaving their tents after dark or
during security operations, which causes delays in seeking
medical care, even in cases of medical emergencies.

30 | Between two fires

including

63 children

for secondary and specialist healthcare

Due to services being unavailable or to the authorities
refusing to authorise a referral to an external facility, manyof the patients MSF referred did not receive treatment,
including patients in need of surgical, orthopaedic, dental
and ophthalmology treatments.

Between two fires | 31

~ “Medical care and services have decreased a lot

since we arrived. With medical emergencies at night,
it is very complicated because the security forces are
doing rounds and they arrest and assault you if theyfound you out at night.”
Main Camp resident~ “One other difficulty is access to healthcare.

We don’t have treatment here so we have started
to smuggle treatment in. It is so difficult to get
medications in the camp and really it is hard forpatients with chronic diseases because there are
no drugs. Now referral outside the camp is almost
impossible. It is for life-threatening conditions only.
There are no drugs available for medical treatment.
If they allow us to go out, we can manage to findand pay [for the medications], but we are notallowed outside and no one is providing treatment
inside. They are not letting us out because they areafraid that on the journey out we will try to escape.
Because there are a lot of people that are asking toleave the camp. They just hope to leave the camp.”
Main Camp resident~ “For the children, there is no future for them.

There are no schools. Before there were two schools
and the children were going there and dreaming
about their future plans, but now there is nothing:no schools, no future plans, nothing. And we can’t
control the children all day, they leave the tent andare just out on the streets. Also, if they get sick,it is really hard for us to get them medication.
The water trucks are also very dangerous for thechildren – some have been crushed by them. I knowof one child who was run over and needed to go
to hospital but the procedure for referral was too
difficult and he died.”

Main Camp resident

humanitarian assistance in the ‘Service Area’, population of
the Annex have to cross a checkpoint, where security forces
register, body search and photograph everyone who passes
through. MSF staff report that this acts as a dissuasive factor
for patients wanting to access healthcare. MSF staff also
report reduced patient numbers following security incidents
in the Annex, as well as during distributions.62
In addition, some services and take-home equipment, such as
take-home blood pressure machines, which are available forpatients living in the Main Camp, are not available to thosein the Annex. There is also no access to healthcare services
after 1 pm, which means that in medical emergencies
patients have to walk through the Annex and approachsecurity forces at the gates to request help. Patients also
report that, due to an absence of transportation in the Annex(including an absence of stretchers), sick and injured people
are often forced to walk long distances through the camp or
be transported on makeshift stretchers or trolleys.

~ “I have been pregnant four times and every

Additional obstacles to accessing healthcare for the
population of the Annex
The healthcare on offer in the Annex is particularly limited.
There is just one static clinic, run by MSF in the ‘Service Area’of the Annex, and three mobile clinics for a population ofaround 11,000. These mobile clinics are regularly interrupted
in reaction to security incidents in the Annex and do notconsistently allow full respect for patient confidentiality as
consultations are conducted in makeshift settings. To accesstime I needed a caesarean. After three caesareans,
you cannot give birth naturally. My fourth birthhappened when I was here [in Al-Hol camp]. The
doctor gave me a date and they sent me to Hassakeh
National Hospital. There they told me: ‘It is not the
moment yet’, so I came back. Two days later thesigns of giving birth came back during the night
and it was very painful. I went to the gate to ask
the security forces and I was sent to the hospital in
Al-Hol and then to Hassakeh. I waited from 1 am
until 9 pm, in pain and threatening to give birth,
but the doctor did not come. They told me: ‘You can
wait’. Why? Two days after they did the caesarean,
I was discharged from hospital. They left me at
the gates of the Annex and then I had to walk one
kilometre with my baby. The pain was horrible.”

Al-Hol Camp - Eastern
Al Hasakah Governorate

32 | Between two fires© RICARDO GARCIA VILANOVA

Annex resident
For people living in the Annex, both internal and externalreferrals require prior approval from the security forces andthe camp administration, meaning that the final decision forreferral lies at the discretion of people who are not medicallytrained. This has led to unreasonable delays to lifesaving
treatment. Patients who require referrals outside northeast
Syria have also faced life-threatening delays to treatment
as they wait for the appropriate paperwork. Patients havealso reported being treated disrespectfully during externalreferrals; others have said that they cannot communicate
with medical staff due to language barriers.

In February 2021, a seven-year-old boy was admitted to an
MSF facility with second-degree burns on his face and upper
limbs. MSF referred the child for treatment outside the camp.
The referral took several days to complete due to security
procedures. By the time the child was referred to Hassakeh
it was too late to save him and he died alone, without his
caregiver. In July 2021, MSF referred a wounded patient for
amputation due to infection. The patient needed a referral toDamascus for surgery, which required additional paperwork
from UNHCR. This caused unreasonable delays and, by
August, the patient’s condition had deteriorated and he died
before he received the documentation.
In addition, patients are accompanied by an armed escort
for the duration of an external referral. Patients referredfrom the Annex are not allowed to be accompanied by acaregiver. This includes very young children and vulnerable
adults, which presents an unacceptable safeguarding riskthat has contributed to caregivers refusing to consent to
the referral of a child in need of treatment. For instance,in September 2021, a woman from the Annex brought her
six-year-old daughter, who was suffering cardiac problems,to the MSF clinic. A referral to Hassakeh for a cardiac
consultation was organised, but when the ambulancearrived, the security forces did not allow the mother toaccompany her daughter. Subsequently the mother did notgive permission for her daughter to be taken to Hassakeh forthe consultation.
As a result of this measure, children as young as two are
frequently referred to external health facilities under armed
escort without being accompanied by a caregiver.63 A numberof children referred without caregivers later died alone inhealth facilities, with extremely limited information sharedwith the bereaved caregiver. In May 2021, a five-year-old boy
was hit by a water truck and was referred alone to Hassakeh.
He died before reaching hospital. There was no formal
information-sharing process between the referral hospitaland the caregiver, meaning that the mother was not informed
in a timely way of the death of her son.

~ “When they take the children to the doctor in

Hassakeh, the child goes alone, no one from thechild’s family accompanies them. How can they
expect us to hand over our three and four-year-old
children to be taken by soldiers alone to Hassakeh?
This is too hard for us to bear. We wait for themat the main gate until they came back, asking for
updates from the soldiers or NGOs.”
Annex resident

Between two fires | 33

Limited prospects for life outside
Al-Hol and a lack of long-term solutions
Since October 2020, more than 1,300 families have left Al-Hol camp for
their areas of origin, but waiting lists are long and the process for getting
permission to leave is opaque.64
Syrian returns marred by bureaucratic barriers and corruption
Initially, Syrian nationals hoping to leave Al-Hol needed tomeet three conditions to be eligible: to be sponsored by atribal leader in their area of origin; to be in possession ofcivil documents; and to return to an area within northeast
Syria. The tribal sponsorship system was originally envisaged
as a scheme to support those caught up in the war against
IS to return to their home communities with guarantees
from figures who knew them personally.65 However, theimplementation of the system has been sporadic, and the
Syrian Democratic Council, the political wing of the SDF in
AANES, announced in October 2020 that all Syrians could
leave the camp through an official returns trip without theneed for sponsorship.66
Discussions with current and former camp residents haverevealed some deep-rooted challenges related to returns
from Al-Hol for Syrians, including significant bureaucratic
and cost barriers to leaving, corruption within the process,and challenges integrating and surviving economicallyoutside the camp environment.

~ “We have our documentation and we registered

two days ago for a return trip. It is a hard process;you have to wait a lot at the main gate. And there
is a second hand, an invisible hand, that is making
the decisions. I registered my family in the proper
way but we don’t know what the result will be. We
registered for Raqqa. I know a man whose leg was
amputated three months ago. He got a medical form
to get approval to leave, and finally it was approved,
and he was due to leave on the next trip, but wedon’t know if it ever actually happened. I saw
him going to the camp administration every day.
Because he is an amputee and disabled, no one is
responsible for him and his family. There are many
people like him that need to leave. There are many
people who are registering to leave but who thendon’t get the approval. To be approved, you need topass the military and the civil investigation. It isalmost impossible.”
Main Camp resident
The chaotic nature of Al-Hol camp and the experiences ofpeople prior to their arrival means that many people do
not have access to formal civil documents. For example,
documents may have been destroyed or lost during thefighting or when people were displaced from their homes;
marriages that take place within the camp are not always
officially recognised; and sometimes children born in thecamp lack formal documentation. Without documents,
Al-Hol population cannot leave, creating incentives to forge
documents or pay bribes to bypass the bureaucratic hurdles.
Gaining access to the camp administration to formallyregister to leave and to get information on the process is also

34 | Between two fires

Between two fires | 35

hard. Camp residents report waiting for hours outside thecamp administration office and complain about a lack ofclarity to the process. When these ‘legitimate’ processes fail,people may resort to using people smugglers to get them outof the camps in exchange for extortionate sums of money(reports vary from US$1,000 to US$13,000).

~ “I'm very angry about the process. It was reallydifficult and unfair. It was hard for some of us toprovide the documents needed and it was reallyslow. For example, I couldn't prove that my children
were mine to the camp administration, because not
all of them had documents. I have eight children
in total; four of them I managed to get registeredin Damascus through a contact, but for the otherfour I had to pay one million SYP [approximately
US$300] in bribes so that the camp administration
would let us leave without the documents.”~ “For now, there is no plan for us to leave.
None of us has any documents because when we
fled, we lost everything. I entered the camp andnow I can’t leave it without documents. Also, if
you leave the camp to live under Government of
Syria territory, you’ll definitely be arrested. At the
beginning, when we first arrived in Al-Hol, they
did an investigation and put a stamp with ourfingerprints on a piece of paper. So now everywhere
you go, they will discover that you are from Al- Holand you will be treated as a terrorist. The solution
needs to come from the international authorities
that are supporting NES. And it needs to comequickly, because people are starting to fight eachother more and more.”
Main Camp resident

Main Camp resident

Exploitation and protection challenges

Life after return: social and economic challenges

According to camp residents, the returns process from Al-Hol
resembles a mechanism for extracting resources from avulnerable population. The current process does not prioritise
departures for vulnerable people. Instead, it facilitates
departures for desperate people who have access to resources
and connections. This includes ‘legitimate’ fees such as paying
for the trucks to transport people and their luggage, as well as
bribes needed to access the camp administration and bribes
needed to bypass bureaucratic hurdles, for example if you lackthe appropriate documentation. ‘Vetting processes’ such as thetribal sponsorship scheme or security clearances have been
described as opportunities for resource extraction.

Some of camp population have discussed not having anywhere
to return to. Cities like Raqqa were completely demolishedin the fighting; many know that their houses are no longer
standing or that they no longer have communities or networks
in their areas of origin. Some camp residents report being
disowned by their families due to their perceived affiliation
with IS. Men in particular fear being arrested or killed if theyleave the camp. For other people, returning to their areas oforigin is fundamentally unsafe; if, for example, they camefrom a Government of Syria-controlled territory, they fear
repercussions from the government if they return.

~ “If you want to leave, you have to pay somemoney to a broker to even get to the campadministration. The official paperwork takes time,
and the camp administration makes it difficult andslow. It's like they are doing it deliberately: the moretime they take to process documents, the more people
will find money to pay the brokers, especially if you
fear for your safety. You don't really know where themoney is going, you don't even get documentation in
exchange for the money, you just get verbal approvalthat they will let you go.”~ “About returns, for myself I don’t think about it

because I have no one outside. For me, the problem
is that I have no documents and I don’t know
where to go. None of us can go back to Governmentof Syrian-controlled areas – we would be arrested
for sure. We would be arrested by IS or by theGovernment of Syria’s military. My family is in a
Government of Syria-controlled area, but I can’t go
there. My family has been asked about me; people
ask them: ‘Why is your daughter in Al-Hol?’. The
Syrian government went to them and asked them
about me; they told them that I would never be able
to leave Al-Hol.”

Main Camp resident
Main Camp resident
Many people seeking to leave Al-Hol are doing so in responseto receiving death threats. Most are unable to access protection
pathways to leave. Instead, they have to pay significant fees
to convince the camp administration to wave bureaucratic
barriers in order to expedite their departure and save theirlives. There are multiple examples of people losing their lives
due to protection failures in cases of threats and extortion.

~ “There was a 40-year-old man who wasthreatened by an armed group in May 2021 andasked to pay them US$1,000. He went to the security
forces for protection and to be listed on the departure
trip and they asked him to pay US$500, which hedidn’t have. He was shot dead in June 2021.”

A woman in the market of the Al Hol camp innortheastern Syria, where around 53,000 people
displaced by the conflict in Syria, the majority ofthem children, are detained.

36 | Between two fires© FLORENT VERGNES

Main Camp resident

Former camp residents who have now left Al-Hol also reportfacing crushing economic challenges in their new lives. Theyexperience difficulties finding work and struggle with highliving costs. This is indicative of a severe economic decline
in Syria due to the long years of conflict, which poses serious
problems for many ordinary Syrians living outside campenvironments; it is one of the pull factors for living in camps.
There have been minimal efforts to meaningfully reintegrate
people into society or support them with humanitarian
resources after leaving Al-Hol.

~ “Sometimes I think that people in the camp are ina better condition than us here. I can barely afford
day-to-day living costs outside the camp. It's reallyhard here, we have very little access to resources,
particularly food, water and fuel.”
Former Main Camp resident

Between two fires | 37

that, if he came to the tent door again, the family
should tell them immediately. Anyway, my sister’sdaughter-in-law ran away and tried to escape toanother section of the camp and no one has heard
anything from her since. These things are happening
all the time: people are being forced to pay money
for registering for departure trips and yet no one
seems to leave the camp. It just seems like a kind of
exploitation; it is all under the table.”
Main Camp resident

Slow and inconsistent Iraqi repatriations

Repatriation of foreign nationals from the Annex

In 2019 the Iraqi government announced that it would
repatriate Iraqi families from Al-Hol, but this plan was
pushed back and delayed as a result of local and community
opposition, indicative of the stigma surrounding the morethan 30,000 Iraqis in Al-Hol and the perception that they areassociated with IS. The first group of 381 individuals returned
from Al-Hol in May 2021 to Jeddah camp, located south of
Mosul in Iraq’s Ninewa province. Up until September 2022,
766 Households (3090 individuals) were repatriated from AlHol to Iraq, according to the Iraqi Ministry of Migration and
Displacement. While the recent increase of repatriations to
Iraq is encouraging, it is still a drop in the ocean comparedto the total number of Iraqis in Al-Hol. The process so far
has been slow and inconsistent, with many Iraqis reporting
challenges in registering, including corruption, lack of
information and exploitation by brokers. Many Iraqis havealso reported hesitancy about returning to Iraq due to fear of
the Iraqi security forces and concern over stigma.

Foreign nationals in the Annex of Al-Hol camp face a different
and complicated set of challenges in terms of their future.
Many of the women in the Annex say that they have noreasonable option for repatriation: that either their countriesof origin would not accept them back, or they fear they would
face prison, torture or death if they returned. Countries
such as the United Kingdom have stripped a number of theirnationals held in northeast Syria of their citizenship, leaving
them without documentation and with no opportunity tochallenge this measure.
Often the women in the Annex have husbands, fathers andmale children who are detained in northeast Syria, or they
have female relatives who have been taken to other camps,
and even if repatriation was offered to them, they would
not accept leaving without their family. This contributes
to growing resentment and frustration amongst both thedetained women and the detaining authority; the former
see a bleak and hopeless future for themselves in Al-Hol,the latter is increasingly uncomfortable with the risks andsecurity threat posed by their indefinite detention.

~ “My sister’s daughter-in-law tried to register

for a departure with US$1,000 that she paid to abroker. After he took the money, he told her that her
name is on the list as an IS member, so he asked for
US$13,000 to delete her name from the list on thecomputer so that she can register for a departure.
They [the family] didn’t agree because they didn’t
have the money, and now the broker comes with apatrol to her tent every day. He began to threaten
them, saying that he would take them to Qamishli
and would make them ‘disappear’. The family went
to the camp management and complained about
the threats they were receiving. The management of
the camp said that this was unacceptable, and thatwhen they carry out raids and arrest people, they
always take female security officers with them toenter the tents. They said that what this person was
doing was not part of the camp management and

38 | Between two fires'We are concerned about
returns, as we have no more
homes, no jobs, we want toleave but we don’t know where.
The one that left are in a campin Iraq now, so we don’t wantto leave to go to another camp.'
Main camp resident~ “When we arrived from Baghuz, the security

forces told us: ‘We will take you to your country’,
and we said: ‘No’, and so they told us: ‘We will keep
you in prison and we will kill you’. We know our
future will be prison in our country or else death,so we don’t want to go back. They come to us in thecamp and they threaten us, saying: ‘We will kill you
if you don’t go for departure’. As for repatriation,
the issue is that we have no information about myhusband and I don’t want to leave without him.”

Annex resident

Between two fires | 39

© RICARDO GARCIA VILANOVAThis situation has created resentment between the wider
community and people living in Al-Hol. The humanitarian
resources (food distributions, access to healthcare, cleanwater, fuel for heaters) made available to people living in AlHol far outstrip what is available to ordinary Syrians in thesurrounding area.
People living in Hassakeh often perceive populationin Al-Hol as affiliated with IS, and therefore a threat tothem, and deeply resent the disproportionate distributionof resources. Meanwhile, people leaving Al-Hol often
experience social challenges as a result of the stigma
associated with the camp, finding themselves assumed
to have links to IS and therefore dangerous.

Challenges of providing
humanitarian aid in Al-Hol camp
Currently, decisions pertaining to the camp and to the management of thepeople within it are made first and foremost from a security perspective,
rather than from a humanitarian perspective, and ultimate authority rests
with those in charge of the camp’s security.
The evolution of Al-Hol from an open camp into a place ofdetention has happened gradually. Although NGOs havenoted and protested the increasing securitisation, there has
been no moment of collective recognition of the shift thathas taken place. As a result, operational modalities, security
analyses, and approaches to community engagement andprotection have not been adapted to reflect the change inthe environment.
One of the consequences of the changes taking placein Al-Hol is that the camp’s population often perceive
humanitarian organisations as extensions of the detention
apparatus, particularly as security incidents are often
followed by reductions in the presence and activities ofNGOs. For example the IS attack on Hassakeh prison in
January 202267 and the swathe of security operations that took
place in March 2022 were followed by a reduction in NGO
services to ‘essential lifesaving only’.

security forces, linked to subsequent arrests in the camp.
The conflation of NGO staff with security activities puts
humanitarian staff in the camp at direct risk and means that
community engagement activities need to be carried out withextreme sensitivity.

~ “Normally the population reacts aggressively

many are not running at full capacity due tosecurity incidents. The refugees are vulnerable andthey need NGO services but the security situation in
the camp doesn’t allow them to reach the services.”to these [security] measures. They link NGOs withthe security forces. Sometimes people even thinkthat NGOs are behind the security measures. For
example, one day when we had to go into the Annex
to close the valve on the water network, and someboys trapped us inside the water tower and told usthat they were holding us hostage. We talked withthem and eventually they let us go. The children in
the Annex think that some of the NGO staff havea connection with the security forces when they
use their phone during their work – like when they
are carrying their phone, making a call, taking aphoto to document their job – so they have a violent
reaction toward the staff.”

MSF staff member working in Al-Hol camp

MSF staff member working in Al-Hol camp

~ “Lots of NGOs have decreased their activities;

The reductions in humanitarian services contribute toworsening living conditions and frustrations amongst thecamp population. This is accompanied by a decrease incommunity acceptance of aid providers, which in turn affects
the protection and security of NGO workers, particularly in
the Annex. In the aftermath of security operations, camp
residents have responded with aggression towards NGO
staff, speculating that they are passing intelligence to the

40 | Between two fires

Between two fires | 41

“Mostly I worry about my nine-year-old
boy and that the security forces will takehim when he gets older. There are a lot[of mothers] whose boys were taken off
to prison by the security forces when theyturned 11 or 12, and they cry every day.”A view of Al-Hol camp, in northeastern Syria. Al-Hol was oncea humanitarian camp, designed to provide safe, temporary
accommodation and humanitarian services to civilians displacedby the conflict in Syria and Iraq. However, the nature and purpose of
the camp has long deviated from its humanitarian purpose and has
grown increasingly into an unsafe and unsanitary open-air prison
due to its residents’ perceived affiliation to IS.

42 | Between two fires

Between two fires | 43

© FLORENT VERGNES

Annex resident

Conclusion
MSF teams working in Al-Hol camp regularly witness acts of violenceand exploitation towards the camp’s population that are completely
unacceptable. The camp has become an environment characterised byhopelessness, fear and danger.

There are no formal legal policies and practices in place togovern the indefinite and arbitrary detention of women,children and men in Al-Hol. This leaves them vulnerable towidespread criminality and creates an environment that is
conducive to violent abuse by the security forces who are notheld accountable for their actions. Under the auspices of the
global fight against IS, policies of containment and extensive
securitisation have been put in place, many of which inhibit
the provision of, and access to, humanitarian assistanceand impartial care. This impacts community acceptance ofhumanitarian organisations, which are increasingly seen by
the camp population as part of the system of detention. Thisin turn affects the quality and accessibility of the aid on offer
and the safety and security of humanitarian staff.
Three years after the battle of Baghuz, no due legal process
has been applied to evaluate guilt and define the terms ofpunishment for the people living in Al-Hol, nor have any
reasonable efforts been made to find a long-term strategy todeal with them and ascertain their future.

44 | Between two fires

AANES has struggled to manage the extremely complicatedlegal and practical challenges that arise in Al-Hol in amanner in keeping with international standards and law.
Meanwhile, humanitarian needs in northeast Syria continue
to escalate, as a result of food insecurity, a water crisis,
economic decline, political instability, politicisation ofaid, and ongoing fighting and conflict. All of these factors
contribute to broader instability in the region. Countries
must assume responsibility for the repatriation of theirnationals living in Al-Hol; they must support local authorities
and ensure that they are taking immediate steps to guarantee
the wellbeing and protection of people in the camp andrespect for their fundamental human rights; and they must
invest in long-term strategies to address the situation in AlHol camp in a manner that is in keeping with international
standards and law.

Between two fires | 45

Recommendations:
Countries from the Global Coalition against IS should: Increase efforts to identify a long-term politicalsolution to put an end to the arbitrary detention ofpeople in Al-Hol camp.

 Invest in solutions and measures to ensure that arbitrarily
detained people in Al-Hol and other detention facilities
and camps in north east Syria have access to due process,including the right for a fair trial and the right to contest thelegality and necessity of their confinement before a judge.

 Provide the required support and guidance to local

authorities and security forces to ensure they havethe capacities to guarantee the safety and security forthe people detained in Al-Hol camp, in a manner thatis in keeping with international standards and law,
including protecting freedom of movement for all thecamp population and ensuring an adequate standard ofhumanitarian response.

 Strengthen capacity for the provision of humanitarianassistance to meet people’s basic needs, including throughincreasing funding for humanitarian aid and supportingnegotiations to allow unhindered and unconditional
humanitarian access to the camp.

The Autonomous Administration of North and East Syria andSecurity Forces should: Take immediate steps to guarantee and ensure thesafety and physical security of all people detained in AlHol by investing in measures that conform to international
standards and law to reduce violence and criminal activity;
by improving living conditions for the camp population;and by ensuring their fundamental rights, including therights to life, liberty and security.

return of the Syrian nationals to their areas of origin,and increase efforts around community reconciliation toprevent stigmatisation and marginalisation of returnees.

 Ensure that the returnees must be treated in line withinternational standards and law, including the prohibitionof torture and other cruel, inhumane or degrading
treatment or punishment

International donors, humanitarian agencies and protection
organisations should: Increase significantly the provision of independent“We are living in the desert here,
there is no education for our children,
we are losing a generation here.”
Main camp resident

humanitarian assistance in all Al-Hol and implement
mid-to-long-term interventions, particularly in respect tohealthcare and to water, sanitation and hygiene services.

 Enhance the scope of protection pathways out of
Al-Hol camp.

 Increase and strengthen response capacity forchild protection, including by establishing systematicfamily links mechanisms, increasing capacity for family
reunification, and providing education facilities and safe
spaces for children.

 Continue and increase efforts and advocacy toensure due process and long-term frameworks for all
people detained in Al-Hol, including – but not limited
to – advocacy around due process, alternative solutions
for Iraqis refugees, departure of Syrians who originate
from areas outside the control of AANES, and funding
and operationalisation of a coordinated multidisciplinary
response – looking at healthcare needs, protection andeducation.

The Government of Iraq and all States of foreign nationals in
Al Hol and other detention facilities and camps in north east
Syria should: Allow and facilitate unhindered, unconditional, timely  Take all possible measures to protect its nationals by Put an end to the practice of separating maleadolescents from their caregivers in the Annex, and workin collaboration with aid providers to ensure respect forpeople’s fundamental human rights and ensure family links
between children separated from their families as well as
between other separated family members.

The Government of Syria should: Take all possible measures to facilitate the voluntary

46 | Between two fires

accelerating efforts to allow people detained in Al-Hol
to access repatriation. All repatriated individuals mustbe treated in line with international standards and law,
including the prohibition of torture and other cruel,inhumane or degrading treatment or punishment.

 Ensure that transparent and extensive information
about the repatriation process is provided to enablepeople to make an informed decision.

 Refrain from confining returnees to restrictive

settings, such as closed camps, and increase
efforts around community reconciliation to prevent
stigmatisation and marginalisation of returnees.

© MSF

and dignified access to secondary healthcare facilities
outside the camp for health emergencies, including atnight, including ensuring that people requiring externalreferrals are allowed to be accompanied by caretakers.

Between two fires | 47

Endnotes
1 U.S. Committee for Refugees World Refugee Survey 2003 –Syria, 1 June 2003, https://www.refworld.org/docid/3eddc4869.html
2 ‘SDF spokesman Colonel Talal Selo in an interview with Al-Monitor’,Al-Monitor, https://www.al-monitor.com/ar/contents/articles/
originals/2015/12/syrian-democratic-forces-goal-liberation-isis.html
3 Humanitarian Response in Al Hol camp, Situation Report No. 3 – As of
1 May 2019, OCHA, https://reliefweb.int/report/syrian-arab-republic/syriahumanitarian-response-al-hol-camp-situation-report-no-3-1-may-2019
4 ‘When am I Going to Start to Live? The urgent need to repatriate foreign
children trapped in Al Hol and Roj Camps’, Save the Children, 2021, https://resourcecentre.savethechildren.net/document/when-am-i-going-startlive-urgent-need-repatriate-foreign-children-trapped-al-hol-and-roj
5 Camp Profile: Al Hol, September 2021, https://www.impact-repository.
org/document/reach/e0ca138e/REACH_SYR_Factsheet_NES_CampProfile_AlHol_September2021-2.pdf
6 As per latest figures from camp management – February 2022
7 ‘“Remember the Armed Men who Wanted to Kill Mum”: The hidden tollof violence in Al Hol on Syrian and Iraqi Children’, Save the Children, April
2022, https://resourcecentre.savethechildren.net/pdf/children_conflict_al_hol_camp_syria_2022.pdf/
8 ‘Transcript: Col. Myles Caggins, CJTF-OIR spokesperson, holds a press
conference with Syrian Democratic Forces’, Operation Inherent Resolve,
30 July 2020, https://www.inherentresolve.mil/Releases/Article/2295015/
transcript-col-myles-caggins-cjtf-oir-spokesperson-holds-a-pressconference-wit/
9 For analysis on this question, see, for example, Diakonia International
Humanitarian Law Centre, Legal Brief: The legal status of ISIS-affiliatedforeign nationals held in detention in North-East Syria, August 2019, pp
14-19.
10 Given the purpose of this section, further analysis on the classificationof the armed conflict is not included here. For more information on thissubject, see, for example,: the Rule of Law in Armed Conflicts project(RULAC) of the Geneva Academy of International Humanitarian Law
and Human Rights, Syria, at https://www.rulac.org/browse/countries/
syriahttps://www.rulac.org/browse/countries/syria (all links in thisdocument were accessed on 2 July 2022); Terry D. Gill, Classifying theconflict in Syria, International Law Studies, US Naval War College, Volume92, 2016; Diakonia International Humanitarian Law Centre, Legal Brief:
The legal status of ISIS-affiliated foreign nationals held in detention in
North-East Syria, August 2019, p. 10of the person, as well as his or her age, social, cultural religious or politicalbackground and past experiences. Military manuals, codes of conduct
and policy documents elaborated by states provide examples of humane
treatment, which include treatment with all due regard to the person’s sex,
provision of adequate food, drinking water and clothing, safeguards forhealth and hygiene, provision of suitable medical care, and appropriate
contacts with the outside world. (See International Committee of the
Red Cross (ICRC), Commentary of 2016 to the Convention (I) for the
Amelioration of the Condition of the Wounded and Sick in Armed Forces in
the Field, Geneva, 12 August 1949, paras 553, 558 at https://ihl-databases.
icrc.org/applic/ihl/ihl.nsf/Comment.xsp?action=openDocument&docume
ntId=59F6CDFA490736C1C1257F7D004BA0EC#_Toc465169892
13 Article 3 common to the 1949 Geneva Conventions, paras 1(a) and 2.
14 IHL Database, Customary IHL, Rules 118, 121, 122, 123, 126 and128, at https://ihl-databases.icrc.org/customary-ihl/eng/docs/v1_cha_chapter37https://ihl-databases.icrc.org/customary-ihl/eng/docs/v1_
cha_chapter37.
15 “Internment” means the deprivation of liberty of a person that has been
initiated/ordered by the executive branch – not the judiciary – without
criminal charges brought against the internee; it refers to detention
for security reasons in situations of armed conflict. “Internment is the
only concept which seems reserved for time of armed conflict.” (Seeparas 3063-3064 of the ICRC Commentary of 1987 to the 1977 Protocol
Additional to the Geneva Conventions of 12 August 1949, and relating to
the Protection of Victims of International Armed Conflicts (Protocol I);
ICRC Commentary of 2016 to the Convention (I) for the Amelioration of theCondition of the Wounded and Sick in Armed Forces in the Field, Geneva,
12 August 1949, para. 718, at https://ihl-databases.icrc.org/applic/ihl/ihl.
nsf/Comment.xsp?action=openDocument&documentId=59F6CDFA49073
6C1C1257F7D004BA0EC#_Toc465169892).
16 Jelena Pejic, Procedural principles and safeguards for internment/
administrative detention in armed conflict and other situations of violence,
International Review of the Red Cross, Volume 87 Number 858, 375-392,
June 2005, pp 380-383.
17 IHL Database, Customary IHL, Rule 119, at https://ihl-databases.icrc.
org/customary-ihl/eng/docs/v1_cha_chapter37_rule119.
18 Ibid., Rule 134, at https://ihl-databases.icrc.org/customary-ihl/eng/
docs/v1_rul_rule134.
19 Ibid., Rule 135, at https://ihl-databases.icrc.org/customary-ihl/eng/
docs/v1_rul_rule135.
20 Ibid., Rule 120, at https://ihl-databases.icrc.org/customary-ihl/eng/
docs/v1_cha_chapter37_rule120.
21 Ibid., Rule 105, at https://ihl-databases.icrc.org/customary-ihl/eng/
docs/v1_rul_rule105.

11 https://ihl-databases.icrc.org/applic/ihl/ihl.nsf/Article.xsp?action=openDocument&documentId=BAA341028EBFF1E8C12563CD00519E66

22 United Nations Security Council S/RES/2427 (2018), operative para. 20.

12 In particular, both objective and subjective elements have to be taken
into account, such as the environment, the physical and mental condition

23 IHRL imposes obligations on States to respect and ensure to allindividuals within their territories and subject to their jurisdiction human

48 | Between two fires

rights. This section will not analyse the question of whether non-State
armed groups are bound by IHRL, nor will it address the question ofwhether IHRL continues to apply during an armed conflict. This section
will only highlight the different rights and obligations that may be relevant
for this report. For discussion on these questions, see, for example, United
Nations Office of the High Commissioner for Human Rights, International
Legal Protection of Human Rights in Armed Conflict, United Nations, 2011,at https://www.ohchr.org/sites/default/files/Documents/Publications/
HR_in_armed_conflict.pdf; Katharine Fortin, The Accountability of Armed
Groups under Human Rights Law, Oxford Scholarship Online, 2017; Tilman
Rodenhäuser, The legal protection of persons living under the control of
non-State armed groups, International Review of the Red Cross, Volume
102 Number 915, 991-1020, 2020.
24 1966 ICCPR, Articles 4(2) and 7, at https://treaties.un.org/doc/
Treaties/1976/03/19760323%2006-17%20AM/Ch_IV_04.pdf. It is worth
noting that the United Nations Special Rapporteur on the promotion andprotection of human rights and fundamental freedoms while countering
terrorism “[…] has found the camp conditions to reach the legal thresholdof torture, cruel, inhuman, and degrading treatment or punishment underinternational law.” (See Position of the United Nations Special Rapporteuron the promotion and protection of human rights and fundamental
freedoms while countering terrorism on the human rights consequencesof citizenship stripping in the context of counter-terrorism with aparticular application to northeast Syria, February 2022, Section II, at
https://www.ohchr.org/en/special-procedures/sr-terrorism/return-andrepatriation-foreign-fighters-and-their-families).

29 Human Rights Committee, General Comment No. 29 “States ofEmergency (Article 4)”, CCPR/C/21/Rev.1/Add.11, 31 August 2001, para.
11.
30 Human Rights Committee, General Comment No. 21 “Article 10(Humane treatment of persons deprived of their liberty)”, Forty-Fourth
Session, 1992, para. 3
31 1966 International Covenant on Economic, Social and Cultural
Rights, Articles 11(2) and 12(1), at https://treaties.un.org/doc/
Treaties/1976/01/19760103%2009-57%20PM/Ch_IV_03.pdf.
32 1979 Convention on the Elimination of All Forms of Discrimination
against Women, Article 12, at https://treaties.un.org/doc/
Treaties/1981/09/19810903%2005-18%20AM/Ch_IV_8p.pdf.
33 1989 Convention on the Rights of the Child, Article 3(1), at https://www.ohchr.org/en/instruments-mechanisms/instruments/conventionrights-child
34 Ibid., Article 37(b); United Nations General Assembly A/RES/45/113(1990), United Nations Rules for the Protection of Juveniles Deprived of
their Liberty, Annex, Section I, para. 2.
35 Ibid., Convention on the Rights of the Child, Article 37(c).
36 Ibid., Article 37(a).

25 “Liberty of person concerns freedom from confinement of the body, nota general freedom of action. […] Deprivation of liberty involves more severe
restriction of motion within a narrower space than mere interference withliberty of movement under article 12.2 [of the ICCPR] […] Deprivation of
personal liberty is without free consent.” (see Human Rights Committee,
General Comment No. 35 “Article 9 (Liberty and security of person)”,
CCPR/C/GC/35, 16 December 2014, paras 3, 5-6).

37 Ibid., Article 37(c).

26 “Security of person concerns freedom from injury to the body and themind, or bodily and mental integrity […] The right to personal security also
obliges States parties to take appropriate measures in response to death
threats against persons in the public sphere, and more generally to protect
individuals from foreseeable threats to life or bodily integrity proceedingfrom any governmental or private actors. […] States parties must respond
appropriately to patterns of violence against categories of victims […].”(see ibid., paras 3, 9).

40 Ibid., Article 7(1).

27 1948 Universal Declaration of Human Rights, at https://www.un.org/
sites/un2.un.org/files/2021/03/udhr.pdf; ICCPR, Article 9(1); 2004 Arab
Charter on Human Rights, at https://digitallibrary.un.org/record/551368.
28 Ibid., Article 20(1); ICCPR, Article 10(1). The Human Rights Committee
has held that “[t]reating all persons deprived of their liberty with humanity
and with respect for their dignity is a fundamental and universally
applicable rule. Consequently, the application of this rule, as a minimum,
cannot be dependent on the material resources available in the State
party.” (emphasis added) (see Human Rights Committee, General
Comment No. 21 “Article 10 (Humane treatment of persons deprived of
their liberty)”, Forty-Fourth Session, 1992, para. 4).

38 Ibid., Article 9.
39 Ibid., Articles 24, 28, and 37(c). See also Committee on the Rights of
the Child, General Comment No. 24 on children’s rights in the child justicesystem, CRC/C/GC/24*, 18 September 2019, paras 95(c)-(e).

41 It is worth mentioning that the United Nations Special Rapporteur on
the promotion and protection of human rights and fundamental freedoms
while countering terrorism “[w]ith thirteen other Special Procedures
mandate holders and two Working Groups she has identified a credible
basis to hold that multiple human rights violations attach to [children][…] These conditions meet the threshold for torture, inhuman anddegrading treatment under international law, and no child should have toendure them. […] Instead, the Special Rapporteur observes practices ofsystematic human rights violations.” (See Position of the United Nations
Special Rapporteur on the promotion and protection of human rights andfundamental freedoms while countering terrorism on the human rights ofadolescents/juveniles being detained in North-East Syria, May 2021, pp 1,
3, 4 at https://www.ohchr.org/en/special-procedures/sr-terrorism/returnand-repatriation-foreign-fighters-and-their-families).
42 1951 Convention relating to the Status of Refugees, Article 1(A)(2), at
https://treaties.un.org/doc/Treaties/1954/04/19540422%2000-23%20
AM/Ch_V_2p.pdf, and 1967 Protocol relating to the Status of Refugees,
Article 1(2), at https://treaties.un.org/doc/Treaties/1967/10/19671004%20
07-06%20AM/Ch_V_5p.pdf.

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43 Ibid., 1951 Convention, Articles 20-23, 26.

January 2020, UN Doc A/HRC/43/CRP.6

44 OCHA Guiding Principles on Internal Displacement, Introduction, para.
2, at https://www.internal-displacement.org/publications/ocha-guidingprinciples-on-internal-displacement.

58 Mortality data for Al Hol Camp: 2021 Summary’, World HealthOrganization, 21 February 2022.

45 Ibid., Section I, Principle 1, para. 1.
46 ‘Displaced people and families of mercenaries arrive in Al-Hol
camp’, ANHA, 25 February 2019, https://www.hawarnews.com/ar/
haber/d986d8a7d8b2d8add988d986-d988d8b9d988d8a7d8a6d984d984d984d985d8b1d8aad8b2d982d8a9-d98ad8b5d984d988d986d985d8aed98ad985-d8a7d984d987d988d984-h15112.html
47 ‘Life inside Syria’s al-Hol camp’, Vera Mironova, Middle East Institute, 9
July 2020, https://www.mei.edu/publications/life-inside-syrias-al-hol-camp
48 ‘Syrian Arab Republic: North East Syria: Al Hol camp (as of 26 July2020)’, https://reliefweb.int/report/syrian-arab-republic/syrian-arabrepublic-north-east-syria-al-hol-camp-26-july-2020
49 ‘Mortality data for Al Hol Camp: 2021 Summary’, World HealthOrganization, 21 February 2022.
50 Health response and priorities in Northeast Syria’, Health Sector Syria,
14 March 2022, https://reliefweb.int/sites/reliefweb.int/files/resources/
health_response_and_priorities_in_northeast_syria.pdf
51 Based on camp management data - 69.7% of the cases were Iraqis,
29.6% were Syrian and 4.65% were foreign nationals.
52 OHCHR, 14 September 2022, https://www.ohchr.org/en/pressreleases/2022/09/dont-look-away-syrian-civilians-face-prospect-newescalation
53 ‘Unidentified gunmen killed two civilians in al Hawl IDP Camp in
Hasaka on November 12’, Syrian Network for Human Rights, 13 November
2021, https://news.snhr.org/2021/11/13/unidentified-gunmen-killed-twocivilians-in-al-hawl-idp-camp-in-hasaka-on-november-12/
54 Basic Principles on the Use of Force and Firearms by Law
Enforcement Officials, Eighth United Nations Congress on the Preventionof Crime and the Treatment of Offenders, 7 September 1990
55 Abandoned to torture: Dehumanising rights violations againstchildren and women in northeast Syria, Rights and Security International,
October 2021 https://www.rightsandsecurity.org/action/research/entry/
abandoned-to-torture-dehumanising-rights-violations-against-childrenand-women-in-northeast-syria

59 ‘Truck accident killing one child and injuring 2 shows dangers
of NE Syria camps for Children”, Save the Children, 1 December
2021, https://www.savethechildren.net/news/truck-accidentkilling-one-child-and-injuring-2-shows-dangers-ne-syria-campschildren#:~:text=December%202021%20%2D%20Syria-,TRUCK%20
ACCIDENT%20KILLING%20ONE%20CHILD%20AND%20INJURING%20
2%20SHOWS%20DANGERS,Save%20the%20Children%20said%20today.
60 “Speed up repatriations or foreign children could be stuck in North
East Syria camps for up to 30 years, warns Save the Children”, Save theChildren, 23 March 2022, https://www.savethechildren.net/news/speedrepatriations-or-foreign-children-could-be-stuck-north-east-syria-camps30-years-warns
61 ‘Review of 2021 referral statistics for Al Hol camp’, Health Cluster
Syria, 15 February 2022
62 In September 2019, MSF treated four women with gunshot wounds
after a shooting in the context of protests from the women and children
in the Annex which were met with force from the security authorities that
control the camp. “Women treated for gunshot wounds amidst violence
and unrest in Al-Hol camp”, MSF, 20 September 2019, https://www.msf.
org/women-treated-gunshot-wounds-amidst-violence-and-unrest-al-holcamp-syria
63 There is supposed to be a system of a caretaker being allocated at thereferral hospital by WHO for unaccompanied children, but MSF has notedthat this is not functioning.
64 ‘A new batch of displaced Syrians leaves Al-Hol camp towards Manbij
and its countryside’, North Press Agency, 13 December 2021, https://npasyria.com/89253/
65 https://www.rudawarabia.net/arabic/kurdistan/020620196 - The
scope of the tribal sponsorship procedures was limited to returns tonortheast Syria only (Deir Ez-Zor, Raqqa, Hassakeh, Tabqa and Manbij)
66 https://coar-global.org/2020/10/12/self-administration-vows-toempty-al-hol-camp/
67 ‘New measures for SDF in Al-Hol camp in Al-Hasakah countryside’,
Sadaa al Sharqieh, 14 February 2022, https://sadaalsharqieh.com/%D8%A5%D8%AC%D8%B1%D8%A7%D8%A1%D8%A7%D8%AA%D8%AC%D8%AF%D9%8A%D8%AF%D8%A9-56 ‘Syria: Fatal shooting of a child in al-Hol camp must be a call tointernational action’, Amnesty International, 8 February 2022, https://www.amnesty.org/en/latest/news/2022/02/syria-fatal-shooting-of-achild-in-al-hol-camp-must-be-a-call-to-international-action/
57 “They have erased the dreams of my children”: children’s rights in
the Syrian Arab Republic”, Conference Room Paper of the Independent
International Commission of Inquiry on the Syrian Arab Republic, 13

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www.msf.org