Syria: Overview of the Humanitarian Response
Released: 2014-06-24T00:00:00

Summary:
The ongoing conflict in Syria has created one of the most pressing humanitarian crises in the world. More than three years later, as of mid-June 2014, an estimated 9.3 million people inside Syria, nearly half the population, have been affected by the conflict, with nearly 6.5 million displaced. In addition, 2.8 million Syrians are displaced as refugees, with 97% fleeing to countries in the immediate surrounding region, including Turkey, Lebanon, Jordan, Iraq, Egypt, and other parts of North Africa. The situation is fluid and continues to worsen, while humanitarian needs are immense and increase daily.
While internationally supervised disarmament of chemical weapons in Syria is proceeding, albeit with some difficulty, U.S. and international diplomatic efforts to negotiate a political end to the fighting in Syria opened on January 22, 2014, in Montreux, Switzerland. The "Geneva II" talks included some members of the Syrian opposition, representatives of the Syrian government, and other government leaders. The first round of talks came to an end on January 31 and resumed February 10-15, but ended with little progress in efforts to end the civil war. The parties reportedly agreed to an agenda for a third round of talks. Many experts and observers hoped that a lasting agreement would have been reached on "humanitarian pauses" to allow access and relief to thousands of civilians blockaded in towns and cities in Syria. On February 22, the U.N. Security Council unanimously adopted Resolution 2139 (2014) to increase humanitarian access and aid delivery in Syria. On May 13, 2014, Secretary-General Ban Ki-moon announced that Lakhdar Brahimi, the Joint United Nations-League of Arab States Special Representative on the crisis, would resign his post, which became effective on May 31.
U.S. Assistance and Priorities
The United States is the largest donor of humanitarian assistance and is part of the massive, international humanitarian operation in parts of Syria and in neighboring countries. Beginning in FY2012, through June 4, 2014, the United States has allocated more than $2 billion to meet humanitarian needs using existing funding from global humanitarian accounts and some reprogrammed funding. U.S. humanitarian policy is guided by concerns about humanitarian access and protection within Syria; the large refugee flows out of the country that strain the resources of neighboring countries (and could negatively impact the overall stability of the region); and a protracted and escalating humanitarian emergency. The Administration's FY2015 budget request seeks $1.1 billion in humanitarian assistance for Syria and the region.
International Response
The international humanitarian response is massive and complex and struggles to keep pace with urgent developments that have escalated well beyond anticipated needs and continue to do so. Access within Syria is severely constrained by violence and restrictions imposed by the Syrian government on the operations of humanitarian organizations. In mid-December 2013, the United Nations launched two appeals—taken together its largest appeal in history—requesting $6.5 billion in contributions to meet the ongoing humanitarian needs in Syria and the region.
Ongoing Humanitarian Challenges of the Syria Crisis and U.S. Policy
As U.S. policy makers and the international community deliberate over what, if any, actions they can or should take on the Syria crisis, possible humanitarian policy issues for Congress include
the immediate need for access within Syria by humanitarian organizations, which has been severely constrained by violence and restrictions imposed by the Syrian government; examining U.S. assistance and priorities in an ongoing humanitarian response; balancing the Syria response with domestic priorities and other humanitarian concerns worldwide; ensuring the ongoing willingness and cooperation of Syria's neighbors, which are receiving the vast majority of refugees from Syria, to keep borders open and to host refugees fleeing Syria; finding ways to alleviate the strain on civilians and those responding to the crisis as the situation worsens and becomes more protracted, including the support of initiatives, such as emergency development assistance, for communities within neighboring countries that are hosting refugees; and encouraging the participation of other countries to provide support through humanitarian admission, resettlement, facilitated visa procedures, and protection for those seeking asylum.
The United States has a critical voice regarding humanitarian access in Syria, the pace of humanitarian developments and contingency planning, support to neighboring countries that are hosting refugees, and burdensharing among donors.
This report examines the ongoing humanitarian crisis in Syria and the U.S. and international response and will be updated as events warrant. For background and information on Syria, see CRS Report RL33487, Armed Conflict in Syria: Overview and U.S. Response, by [author name scrubbed] (coordinator), [author name scrubbed] and [author name scrubbed], and CRS Report R43201, Possible U.S. Intervention in Syria: Issues for Congress, coordinated by [author name scrubbed] and [author name scrubbed]. See also CRS Report R42848, Syria's Chemical Weapons: Issues for Congress, coordinated by [author name scrubbed]. This report does not address the humanitarian situation in Iraq as a result of the recent wave of violence that began on June 10, 2014. For more information, see CRS Report RS21968, Iraq: Politics, Governance, and Human Rights, by [author name scrubbed].

subsections: section_title: Overview and Recent Developments1
paragraphs: Congress has demonstrated an ongoing interest in many different aspects of the three-year civil war in Syria. The humanitarian situation, in particular, has garnered significant bipartisan attention. Members have proposed and enacted legislation addressing the issue and have held hearings on the U.S. and international humanitarian response to the conflict. Although not discussed in this report, the use of chemical weapons in Syria on August 21, 2013, triggered an intense debate over possible U.S. military intervention. This debate created temporary momentum focused on the dire humanitarian situation within Syrian where humanitarian organizations remain severely constrained by the conflict, fighting, and restrictions imposed by the Syrian government. 
Humanitarian assistance has traditionally been one of the least controversial types of foreign aid, and in the Syria context, it has so far been one avenue in which the United States has provided support to Syrian civilians absent a political solution. The United States remains the largest humanitarian donor. As of mid-June 2014, it is providing roughly 27% of the funding for the humanitarian response in calendar year (CY) 2014. In CY2012-CY2013, the United States provided an average of 22% of the funding for the crisis. U.S. humanitarian policy is guided by concerns about access and protection within Syria; the large refugee flows out of the country that strain the resources of neighboring countries (and could negatively impact the overall stability of the region); and an already escalating and protracted humanitarian emergency. 
Along with the international community, the United States provides humanitarian assistance to civilians affected by the conflict both inside and outside Syria. Such assistance includes medical care and medical supplies (including immunization programs), food, water, shelter, and other non-food items such as blankets and clothing. It also supports programs focused on psycho-social rehabilitation of refugees and the prevention of gender-based violence.
Since the conflict began in March 2011 in Syria, reportedly an unknown number of civilians have been wounded and tens of thousands of lives lost. Some observers estimate the death toll figures to be as many as 100,000 to 150,000, and others say it is likely much higher. In January 2014, according to press reports, the United Nations stopped updating the death toll figures from the Syria conflict, stating that it could no longer verify the sources of information that led to the last count of 100,000 (July 2013). It is estimated that more than 2% of the pre-conflict Syrian population of 21.4 million has been killed, maimed, or wounded over the course of the conflict.
In addition to the use of chemical weapons, there are repeated allegations of serious human rights and international humanitarian law violations on all sides of the conflict. Observers claim that hundreds of detainees and political prisoners have died under torture. The U.N. Independent International Commission of Inquiry on the Syrian Arab Republic pointed to the "reckless manner in which parties to the conflict conduct hostilities" as a main cause of the civilian casualties and displacement. The International Committee of the Red Cross (ICRC) has repeatedly urged all sides to fully comply with international humanitarian law. The ICRC currently has no access to detainees. 
The United States and many other countries have increasingly recognized the human rights crisis, which not only exacerbates the humanitarian situation, but raises the prospect that atrocities reaching the level of crimes against humanity and war crimes by armed groups may have been committed, including the use of chemical weapons that killed (by some reports) as many as 1,400 civilians on August 21, 2013. On January 17, 2014, U.N. High Commissioner for Human Rights Navi Pillay condemned the obstruction of food and medical deliveries to those living in the Yarmouk Palestinian refugee camp, emphasizing that starving civilians as a method of combat was prohibited under international law. Other reports of mass executions of detainees on the one hand and killing of civilians on the other have also generated condemnation. Outside Syria, humanitarian workers have observed a sharp rise in gender-based crimes, including rape and sexual violence, as well as exploitation and discrimination in refugee camps and informal settlements. 
The Independent International Commission of Inquiry on the Syrian Arab Republic was established on August 22, 2011, by the Human Rights Council. Its mandate is to investigate all alleged violations of international human rights law since March 2011 in the Syrian Arab Republic. The commission was also tasked with (1) establishing the facts and circumstances of such violations and (2) of the crimes perpetrated and, where possible, to identify those responsible with a view of ensuring that perpetrators of violations, including those that may constitute crimes against humanity, are held accountable. Recently, Pillay called for Syria to be referred to the International Criminal Court (ICC). On May 22, 2014, China and Russia blocked the French draft resolution referring Syria to the ICC. All other Council members voted in favor of the referral.
The short- to medium-term outlook for the resolution of the conflict in Syria and impact on its neighbors is not positive. The United States and other third parties face a number of difficult policy choices with limited potential to decisively shape the overall outcome. These issues are addressed in other CRS reports. As the international community deliberates over what action it can or should take on the crisis, a massive humanitarian operation continues in parts of Syria and in neighboring countries. 
subsections: section_title: Selected International Efforts
paragraphs: On October 2, 2013, the U.N. Security Council issued a Presidential Statement that urged Syrian authorities "to facilitate the expansion of humanitarian relief operations and lift bureaucratic impediments and other obstacles in Syria." Although non-binding, the statement indicated that the Council members recognized the deterioration of the humanitarian situation and the need to address particular elements, including access. As of mid-June 2014, over 3.5 million people were estimated to be living in hard-to-reach areas of Syria, including at least 242,000 people living in areas besieged by either the Government of Syria or opposition forces. Moreover, reports of intentional policies of starvation in areas under siege by the government, attacks against civilians and indiscriminant use of heavy weapons, and a weak health infrastructure that is often under deliberate attack illustrate the dire conditions under which civilians are trying to survive and aid agencies must operate. 
For many months, Valerie Amos, U.N. Under Secretary General for Humanitarian Affairs and Emergency Relief Coordinator, U.N. Office for the Coordination of Humanitarian Assistance (UNOCHA), has publicly called for all parties to end the violence, allow access for aid organizations, and "respect their obligations under international human rights and humanitarian law." For example, on December 31, 2013, Amos condemned the attacks against civilians in Aleppo and raised concerns about the government's indiscriminant use of heavy weapons. In a January 17, 2014, note to Council members, she acknowledged incremental progress in some situations, but emphasized the intense needs of civilians in besieged areas. On June 4, she issued a press release, focused on lack of access and violations of international humanitarian and human rights law. 
The "Geneva II" talks in Switzerland, which include some members of the Syrian opposition, representatives of the Syrian government, and other government leaders, were launched on January 22, 2014. The first round came to an end on January 31. Many experts and observers hoped that a lasting agreement would have been reached on "humanitarian pauses" to allow access and relief to thousands of civilians blockaded in towns and cities in Syria. On February 6, 2014, a representative of the U.N. Secretary-General "welcomed the reports that the Syrian parties have agreed to a humanitarian pause to allow civilians out of, and aid into, Old Homs City." The United Nations and its humanitarian partners prepositioned food and medical supplies on the outskirts of the besieged city with staff on standby to assist as a temporary ceasefire allowed some access, delivery of aid, and evacuations of civilians. A second round of the Geneva II talks took place in Switzerland between February 10-15, but ended with little progress in efforts to end the civil war. The parties reportedly agreed to an agenda for a third round of talks. After nearly two years, and amid continued lack of progress on a peaceful resolution to the conflict, on May 13, 2014, Secretary-General Ban Ki-moon announced that he "regretfully accepted" the resignation of Lakhdar Brahimi, the Joint United Nations-League of Arab States Special Representative on the crisis. He left his post effective May 31. 
Further recognizing the need for increased humanitarian access, on February 22, 2014, the U.N. Security Council unanimously adopted Resolution 2139 (2014), which demanded that "all parties, in particular the Syrian authorities, promptly allow rapid, safe and unhindered humanitarian access for U.N. humanitarian agencies and their implementing partners, including across conflict lines and across borders." The five-page resolution is comprehensive in its statement about the humanitarian situation, specifically addressing the impact on civilians in Syria and the region, and the efforts of host countries, the United Nations, and humanitarian actors to respond to the crisis. It also condemned the violations of human rights and international humanitarian law; demanded the end to all forms of violence, the cessation of attacks against civilians, and indiscriminate use of weapons; and called for the implementation of the aforementioned October 2, 2013 statement by the President of the Security Council. 
In addition, it called on parties to lift the sieges of populated areas and allow the delivery of food and medicine. Citing the Syrian authorities in particular, the Council urged all parties "to take all appropriate steps to facilitate the efforts of the United Nations, specialized agencies, and all humanitarian actors engaged in humanitarian relief activities, to provide immediate humanitarian assistance to the affected people in Syria." The resolution touched on medical neutrality, protection of civilians, detention and torture, and security of aid workers. It demanded an end to impunity for violations of international humanitarian law, and condemned the rise of Al-Qaeda- affiliated terrorist attacks. The Council requested that the Secretary-General submit a report to it every 30 days on the implementation of the resolution and expresses "its intent to take further steps in the case of non-compliance." On February 25, 2014, the U.N. General Assembly held an informal briefing on the humanitarian situation in Syria, at which the Secretary-General delivered remarks. Other senior officials also spoke at the meeting. 
On April 30, U.N. Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator Valerie Amos briefed the U.N. Security Council regarding the lack of progress in implementation of UNSC Resolution 2139. Amos is expected to brief Council members again on humanitarian access later in June. Reportedly, the Security Council is considering a resolution to authorize cross-border aid deliveries into Syria regardless of the approval of the Syrian Government.
section_title: Evolving Humanitarian Situation
paragraphs: The humanitarian situation in Syria and in neighboring countries is dire. As conditions inside Syria continue to deteriorate, UNOCHA estimates that of an overall population of just fewer than 21.4 million, nearly 50% (9.3 million people) are in need of humanitarian assistance, including between 6.5 million displaced inside Syria. The number of Syrians that have been displaced as refugees, primarily to countries in the immediate surrounding region, is estimated to be 2.8 million. 
subsections: section_title: Situation in Syria
paragraphs: Intense fighting and violence, population displacement, lack of basic public services, and economic collapse drive the humanitarian crisis. In recent months, cities and towns in Syria under siege by the government or opposition forces have added a layer of desperation for the more than 242,000 civilians that United Nations officials estimate are trapped and without access to humanitarian assistance. The conflict has brought out social, political, and sectarian tensions among Syrians in general amid concerns for minority groups in particular. The destruction of housing and infrastructure (hospitals, schools) combined with economic collapse has affected most Syrians. Food, water, sanitation, medical assistance, shelter, and essential non-food items are critically needed, particularly in areas that have seen intense fighting. In addition, other critical health concerns, such as the outbreak of polio, have highlighted the consequences of war and challenges faced by a vulnerable population.
The number of Internally Displaced Persons (IDPs)—estimated to be 6.5 million—is very fluid. Many Syrians, some of whom have been displaced multiple times, leave their homes to escape violence and then return when conflict in their area decreases. It is not clear how many IDPs are affected by repeat displacements, nor if, or how often, they are included in IDP counts. Many IDPs stay in unofficial shelters, unfinished buildings, makeshift accommodations, and unofficial camps. IDPs are predominantly women, children, and the elderly. While humanitarian needs are immense and continue to escalate, access and security in Syria present huge challenges in the humanitarian response, particularly for NGOs.
Syria also hosts refugees from elsewhere, and these populations have been vulnerable to the conflict. Of the estimated 530,000 Palestinian refugees living in Syria, approximately 420,000 require humanitarian assistance, of which 235,000—nearly half of the original number of Palestinian refugees hosted by Syria—have been internally displaced. In addition, Palestinian refugees have approached the U.N. Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) in Lebanon and a much smaller number have registered with UNRWA in Jordan. There have been reports of some Palestinian refugees finding their way to Gaza, Egypt, and Turkey, and in smaller numbers to Malaysia, Thailand, and Indonesia. 
Reportedly, Palestinian refugees in Syria are disproportionally and increasingly vulnerable. Many are living in areas that have seen intense fighting; they have nowhere to go within Syria and external flight options are limited. A case in point is the Yarmouk refugee camp near Damascus. From a pre-conflict population of about 160,000, there are approximately 18,000 Palestinians (and possibly non-Palestinian civilians) in the camp. Yarmouk has been under siege and little to no humanitarian access has been possible for months, despite UNRWA's calls for continuous, uninterrupted access. On January 30, 2014, a U.N. convoy entered Yarmouk and distributed food parcels, the first major distribution since July 2013. Distributions of aid have taken place since then.
Syria also hosts approximately 68,000 registered refugees who originate mainly from Iraq, Afghanistan, Somalia, and Sudan. Other vulnerable populations include third country nationals and vulnerable migrants. At this point it is not known how many of the refugee and vulnerable populations have been displaced. Moreover, these numbers do not account for populations who may have been living in Syria, but were not registered as refugees. For example, it is thought that 1 million or more Iraqis fled to Syria from Iraq between 2003 and 2006; current estimates suggest this number is now approximately 500,000, of which about 10% are registered with UNHCR. 
section_title: Situation in Neighboring Countries
paragraphs: The threat of a fragmented Syria and difficult challenges for neighboring countries hosting refugees have created a fragile security and political environment. As of mid-June 2014, an estimated 2.8 million Syrians have been forced to flee the violence and conflict with 97% seeking refuge in countries in the immediate surrounding region, primarily Lebanon, Jordan, Turkey, Iraq, Egypt, and in other parts of North Africa. The number of registered refugees (or those awaiting registration) continues to increase. In early April, UNHCR reported that the number of Syrian refugees in Lebanon had exceeded 1 million, making it the "highest per-capita concentration of refugees worldwide" as the number of Syrian refugees in the country rose to nearly a quarter of the overall population. Many observers are predicting a further spike in the number of displaced persons. Experts recognize that this number is likely much higher, as some Syrians have not registered, presumably from fear or other reasons, and have chosen instead to blend in with the local population, living in rented accommodations and makeshift shelters, particularly in towns and cities. 
The added economic, energy, and natural resource pressures of large Syrian refugee populations weigh heavily on neighboring countries, particularly in Lebanon, Jordan, and Turkey. Palestinian refugees from Syria also complicate the underlying political dynamics of Lebanon and Jordan, where large Palestinian refugee populations already reside. The governments of countries hosting refugees have concerns about the potential political implications of allowing displaced populations to remain, especially for a protracted period of time.
One of the biggest challenges is shelter. The types of assistance and shelter options available to refugees vary in the countries that are hosting them. In Turkey, Jordan, and Iraq, there are 24 refugee camps and new camps are under construction. In camps, assistance is provided by host governments and the international community, and there are concerns about overcrowding and the risk of disease. However, the U.N. Office for the Coordination of Humanitarian Assistance (UNOCHA) estimates that the majority of Syrian refugees (more than 80%) are living outside camps in mostly urban settings. The impact on many host communities has become overwhelming. Overcrowded schools, inadequate hospital services, impacts on resources such as water—all contribute to the burden for neighboring countries. 
Refugees living outside of camps face high rental rates, overcrowding, and competition for space in addition to other living expenses and limited, if any, work opportunities. Urgent priorities include protecting vulnerable refugees from violence and meeting their basic needs. Changes in season only compound the challenges these populations face. Moreover, urban refugees are often invisible and difficult to identify and assist. 
Jordan, Lebanon, and Turkey host the vast majority of the displaced populations outside Syria. (See Figure 3 .) The United States and the international community have recognized the contribution of those countries hosting refugees and supported their efforts, while encouraging them to keep their borders open to those fleeing conflict in Syria. At different times during the conflict, the number of refugees crossing into neighboring countries has decreased at some border points because refugee-hosting countries have taken steps to restrict the flow, causing those fleeing Syria to be stranded inside its border areas.
section_title: U.S. Policy
paragraphs: The Obama Administration has consistently supported providing humanitarian assistance to all civilians affected by the conflict in Syria. It is working closely with neighboring countries, other governments, the United Nations, and humanitarian partners in its response to the crisis. Congress has also demonstrated sustained interest and bipartisan support for a robust U.S. humanitarian response, although Members may be divided over other dimensions of U.S. policy.
U.S. humanitarian priorities in Syria include
providing as much humanitarian assistance as possible through partners and multilateral mechanisms; supporting protection activities for vulnerable populations; helping to develop a strong multilateral response to support countries hosting refugees; encouraging donor pledges and contributions; and building capacity within Syria and among its neighbors for immediate assistance and contingency planning for what has become a protracted crisis.
The key U.S. agencies and offices providing humanitarian assistance include the U.S. Agency for International Development (USAID), Bureau for Democracy, Conflict, and Humanitarian Assistance (DCHA) through the Office of Foreign Disaster Assistance (OFDA) and Food for Peace (FFP), and the State Department's Bureau of Population, Refugees, and Migration (PRM). 
There is functional or programmatic overlap between USAID's offices and PRM in the humanitarian response, and they coordinate with each other in supporting implementing partners. In general, PRM provides funds for multilateral actors, such as the U.N. High Commissioner for Refugees (UNHCR), while USAID focuses more on bilateral arrangements with NGOs. With regard to displaced populations, in many contexts including Syria, USAID takes the lead on IDPs, while PRM focuses on the needs of refugees and other persons of concern. Overall, 75% of U.S. government funding for Syria supports multilateral initiatives through the two U.N. appeals, and 25% supports NGOs directly. PRM is not providing funding to NGO partners working inside Syria. USAID funding for the humanitarian response, however, is split between multilateral and NGO programs. 
The breadth and scale of the crisis inside Syria, with 9.3 million people in need of humanitarian assistance, requires using multiple resources and aid delivery options. Through its OFDA and FFP offices, USAID currently has 28 partners, including NGOs and U.N. entities, although the names of the former have not been disclosed for security reasons. 
USAID's criteria for determining priority partners and sectors for humanitarian assistance inside Syria include 
analysis of on-the-ground assessments; assistance gaps (includes an analysis of what other donors are already contributing); and a determination of which humanitarian responders are best placed to respond to humanitarian needs in terms of capacity, technical expertise, and access to populations.
The safety and security of staff working for humanitarian organizations funded by the U.S. government is a primary concern. The names of NGO implementing partners are considered sensitive information, and obtaining many details is not possible. OFDA and its implementers have taken steps to manage the significant risks associated with working in Syria by putting into place a variety of internal controls based on best practices for operating in highly insecure environments.
subsections: section_title: U.S. Funding and Allocation
paragraphs: Beginning in FY2012, through June 4, 2014, the United States has allocated more than $2 billion for humanitarian activities both inside Syria and in neighboring countries. The U.S. contribution has been allocated in response to U.N. humanitarian appeals, as well as supporting other projects using existing funding from global humanitarian accounts and some reprogrammed funding.
See Table A-1 for a selected list of implementing partners receiving U.S. funding in FY2014.
U.S. assistance is distributed based on need throughout all 14 governorates of Syria. The United States is working through a number of channels to provide this assistance, including U.N. entities, non-governmental organizations (NGOs), community-based partners, and the Syrian Opposition Coalition's Assistance Coordination Unit. In addition, the United States works with host countries in the region that support the influx of Syrian refugees. The distribution of its humanitarian assistance is listed in the tables below.
section_title: Funding for Future Humanitarian Assistance in Syria
paragraphs: The Obama Administration has not elaborated on how it plans to meet future Syria-related needs for the remainder of FY2014. The Administration could continue to draw down global humanitarian accounts, such as MRA or IDA, and if necessary request a supplemental appropriation to replenish them, or use Emergency Refugee and Migration Assistance (ERMA) funds. Possible options could also include reprogramming funds from the Overseas Contingency Operations (OCO) account. The Administration's FY2015 budget request seeks $1.1 billion in humanitarian assistance for Syria and the region. Details of this request include (1) $635 million from the International Disaster Assistance (IDA) Overseas Contingency Operations (OCO) account, of which $335 million would be administered by USAID's Office of Foreign Disaster Assistance (OFDA) and $300 million would be administered by USAID's FFP for emergency assistance, and (2) $465 million from the Migration and Refugee Assistance (MRA) OCO account.
The sharp increase in needs of Syrians affected by the conflict may lead Congress to consider future funding requests from the Administration, including a potential supplemental request, if the situation worsens or persists. It remains to be seen how needs related to the Syria crisis are to be balanced with other humanitarian priorities worldwide, particularly if a major disaster or crisis occurs.
section_title: Branding
paragraphs: At points during the conflict, Members of Congress have demonstrated an interest in the labeling or "branding" of U.S. humanitarian aid delivered to Syria so that recipients are aware of its American origins. This issue is complicated in the Syria context. Very little U.S. assistance is currently being branded. The U.S. government is trying to balance the desire to maintain visibility as a contributor of humanitarian assistance with concerns for the security of aid recipients and implementing partners who could become possible targets of attacks. Finding appropriate ways for the United States to leverage its political objectives without politicizing humanitarian aid remains a significant challenge. There has been some debate about whether the United States is receiving adequate political benefit from its humanitarian assistance efforts. Anecdotal evidence from field reports and implementing partners suggests that many Syrians who may be receiving U.S. assistance remain unaware of its origins, or assume it is from a foreign government other than the United States. 
In response, some Members of Congress and observers have argued that the United States should begin to more aggressively brand U.S. aid to enhance local perceptions that the people of the United States stand in solidarity with Syrians. Humanitarian groups argue that objectives such as winning hearts and minds potentially compromise the neutrality of humanitarian assistance in general. In the context of Syria, experts contend that if a U.S.-funded clinic were to be targeted for its U.S. affiliation, it could jeopardize much broader humanitarian efforts there. Moreover, it is unclear whether raising awareness of U.S. humanitarian assistance would do much to change perceptions, as Syrians who support the opposition want weapons and other kinds of military help. The Administration is reportedly looking into ways of branding U.S aid that do not jeopardize the safety of those on the ground.
section_title: U.N. and International Humanitarian Efforts
paragraphs: International efforts to address the humanitarian situation in Syria range from global U.N. appeals to on-the-ground food aid to communities and assistance in camps and settlements. The following sections describe these and other activities in more detail. 
subsections: section_title: International Response Framework
paragraphs: International humanitarian agencies, including NGOs, and governments continue to work in Syria and in countries in the region to provide and coordinate assistance to the civilian populations. UNOCHA leads the humanitarian effort within Syria and has established relief sectors—or "clusters"—where possible. UNHCR leads efforts to provide assistance to Syrian refugees in neighboring countries, including non-food items such as shelter, clothing, fuel, cash assistance, and other essential items, as well as assistance to host communities that are supporting refugees. 
A key challenge facing international organizations and NGOs operating in Syria is access, which remains severely constrained by violence and insecurity and conflict, restrictions imposed by the Syrian government on the operations of humanitarian organizations, and obstruction by all sides to the conflict. Other contributing factors are lack of transportation and limited availability of fuel. The Syrian regime significantly restricts the ability of humanitarian organizations to operate by imposing bureaucratic and administrative obstacles, such as visa restrictions for U.N. staff, international organizations, and NGOs, and limiting the number of humanitarian partnerships. 
While the Syrian government has permitted some aid deliveries across conflict lines ("cross-line") from Damascus to opposition-held areas using interagency humanitarian convoys, numerous checkpoints are in place en route. Cross-border access to deliver humanitarian assistance from neighboring countries to opposition areas requires the agreement and cooperation of the Syrian authorities. A number of independent aid agencies are reportedly using one of these two systems for aid delivery into Syria, either through official channels in Damascus or through cross-border mechanisms, such as trucking aid through Jordan and Turkey. Experts recognize that providing humanitarian assistance within Syria may help to stem the tide of refugees seeking assistance across borders. In May 2014, the London 11 Core Group of the Friends of Syria announced plans to "step up efforts to deliver humanitarian aid across borders and across lines irrespective of the consent of the regime."
In Syria, the United Nations and its partners have identified activities in different sectors that reflect the key priorities. Relief sectors include food security; community services and protection; health; food; water and sanitation; and shelter and non-food items. (For examples of humanitarian activities, see Appendix B .) 
The landscape of access and aid delivery is complicated and constantly changing. The role of international NGOs is also difficult to grasp, in part because of the situation in which they are trying to operate and in part because of a reluctance to disclose information that might jeopardize the safety of the aid workers or recipients they are trying to help. Although little information is available about national organizations operating in country, the Syrian Arab Red Crescent (SARC) is a key Syrian implementing partner with more than 10,000 volunteers. The International Committee of the Red Cross (ICRC), while maintaining its independence as a separate international organization, works with the SARC throughout the country. A number of other organizations are also working on the humanitarian response, some also in partnership with SARC. These include 18 international NGOs that have been authorized by the government of Syria to work as well as 11 U.N. agencies and the International Organization for Migration (IOM). In addition, a handful of other international NGOs have agreements with relevant Syrian ministries. In addition, the government of Syria has authorized some national NGOs to provide humanitarian assistance in partnership with the United Nations. U.N. agencies have set up or are in the process of setting up hubs in several locations throughout the country. 
Levels of access differ among various aid organizations. Generally, U.N. entities have access to populations requiring assistance (especially the 3.5 million in besieged and hard-to-reach areas) that NGOs do not. In addition to access, U.N. entities have the capacity and technical expertise to conduct large-scale operations with consistent standards, such as vaccination campaigns and food delivery that individual NGOs, which operate on a much more limited scale, do not.
The U.N. Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) is also actively responding to the needs of Palestinian refugees affected by the conflict in Syria and those who have fled to other areas within UNRWA's mandate, particularly Jordan and Lebanon. For examples of humanitarian partners working in Syria and neighboring countries, see Appendix C .
section_title: U.N. Appeals and Other Donor Funding
paragraphs: Donor funding is usually provided in response to a crisis in the form of financial contributions or relief supplies. The Consolidated Appeal Process (CAP), now renamed the Strategic Response Plan (SRP), administered through UNOCHA, brings aid organizations together to coordinate a response to major humanitarian crises and disasters and appeal for funds through a collaborative plan. Funding provided for the Syria humanitarian crisis is in part through two separate U.N. appeals: the Syrian Humanitarian Assistance Response Plan (SHARP) and the Regional Refugee Response Plan (RRP). Contributions to the crisis have also been made outside of the U.N. appeals process. 
The SHARP and RRP appeals have been revised several times as the Syria crisis has evolved and humanitarian needs have increased. The December 18, 2012, version of the appeals was the fourth revision and covered the period January to June 2013. The fifth revision of the appeals, covering all of 2013, was launched on June 7, 2013. The sixth revision of the appeals, was launched on December 16, 2013.Together the latest SHARP and RRP appeals total $6.5 billion, making it the largest appeal for a single humanitarian emergency in the history of the United Nations. 
As of mid-June 2014, taken together the appeals are 29% funded. See Appendix D for a list of the top 25 country donors to the Syria crisis in 2012-2014. 
subsections: section_title: Syria Humanitarian Assistance Response Plan
paragraphs: The Syria Humanitarian Assistance Response Plan (SHARP), which includes U.N. entities and humanitarian partners, is a U.N. appeal seeking nearly $2.3 billion for projects inside Syria from January 1 to December 31, 2014. The plan addresses the needs of Syrians affected by conflict inside Syria. Its priorities include providing relief supplies such as food, healthcare, and water to the most vulnerable; assisting people who have fled their homes and the communities hosting them; and supporting reconstruction of critical infrastructure, including hospitals. The latest revision outlines strategic objectives and builds on findings from sectoral assessments conducted during 2013.
section_title: Regional Refugee Response Plan
paragraphs: A second U.N. appeal seeks more than $4.2 billion for a Regional Refugee Response Plan (RRP) to cover the protection and assistance needs of up to 3.4 million Syrian refugees in the region and covers the period from January 1 to December 31, 2014. The current plan brings together the coordinated efforts of international and national organizations with UNHCR continuing to lead the overall response. The main priorities for the RRP include protection, life-saving assistance, access to basic services, durable solutions (such as resettlement), and community outreach to refugees residing in urban areas and support to host communities.
section_title: Contributions Outside the U.N. Appeals
paragraphs: Additional bilateral and other contributions and pledges are also made outside of the U.N. appeals through direct bilateral assistance to governments, international organizations, and NGOs. Some analysts claim that a lack of transparency about these contributions makes it difficult to know what is being funded, where aid may be duplicated, and whether it is being distributed equitably among groups of different ethnic, religious, or political affiliations. 
In addition, UNOCHA draws on several smaller humanitarian funding sources as follows:
subsections: section_title: Syria Emergency Response Fund32
paragraphs: UNOCHA established the Emergency Response Fund (ERF) for Syria in mid-2012 to support the humanitarian response for the Syria crisis. In CY2012-2013, ERF provided support to local NGOs working in conflict areas in Syria that were difficult to reach. It also provided funding for projects in Jordan, Lebanon, and Iraq and continues to do so in CY2014. 
section_title: Central Emergency Response Fund (CERF)
paragraphs: As an international, multilateral funding mechanism, the Central Emergency Response Fund (CERF) aims to focus on early intervention, timely response, and increased capacity and support to underfunded crises. CERF was launched as part of the U.N. reform process in 2006 to strengthen the U.N.'s capacity to respond more efficiently, effectively, and consistently to natural disasters and humanitarian emergencies. It is managed by the Emergency Relief Coordinator and head of UNOCHA. In CY2012-2013, CERF provided funds to a number of appealing agencies in Jordan, Lebanon, and Syria and continues to do so in CY2014. 
section_title: Donor Conferences
paragraphs: On January 30, 2013, donors pledged $1.5 billion in humanitarian aid at the International Humanitarian Pledging Conference for Syria, hosted by Kuwait and chaired by U.N. Secretary-General Ban Ki-moon. A portion of the pledges made are helping to fund the SHARP and RRP (U.N. appeals) mentioned above for the humanitarian response in Syria and neighboring countries. Since then, donors have made other pledges. With the slow pace of funding of these appeals, concerns remain about whether many of the pledges will result in actual contributions. 
On September 16, 2013, Sweden hosted a donor conference, organized by UNOCHA, between donors and U.N. representatives to discuss coordination of the humanitarian operation in Syria and its neighboring countries. The forum offered the opportunity to share information and to discuss how to manage the challenges of supplying humanitarian assistance to those affected by the crisis.
On January 15, 2014, Kuwait hosted a second donors conference for Syria, which was chaired by U.N. Secretary General Ban Ki-moon. Donors pledged more than $2 billion in humanitarian aid. See Appendix E for a list of pledges not converted to commitments as of mid-June 2014.
section_title: Looking Ahead: Key Challenges
paragraphs: As Congress considers funding and legislation addressing the humanitarian situation in Syria, Members may want to take a number of challenges and policy issues into account: 
Impeded international humanitarian response . Despite the provision of substantial humanitarian assistance, insecurity within Syria and lack of cooperation by the Syrian government has severely hampered efforts by governments, U.N. entities, and humanitarian partners to access affected areas to provide humanitarian assistance to populations in need. Funding Shortfalls. Although the United Nations and governments, including the United States, have worked with both traditional and non-traditional donors to generate and increase contributions, the two U.N. appeals remain underfunded. Willingness and cooperation of neighboring countries . So far, Jordan, Lebanon, and Turkey have received the vast majority of refugees from Syria. The United States and the international community have recognized the contribution of neighboring countries and supported their efforts while simultaneously encouraging them to keep their borders open to those fleeing the conflict. Nevertheless, in the short term, the increasing numbers of refugees strain the infrastructure and capacity of these countries, and in the long term, they create concerns that the situation could become protracted with limited ongoing international support and attention. Ongoing capacity by the international community to keep pace with humanitarian developments . The urgent humanitarian needs coupled with the speed at which the situation is changing have many experts concerned that the international response capacity could be overwhelmed if the current pace and scope of conflict and displacement continues.
Amid these factors, Congress may also need to weigh the following:
Balancing priorities . Finding the resources to sustain U.S. aid pledges may be difficult in light of domestic budget constraints. When humanitarian emergencies like the Syria situation require immediate emergency relief, the Administration may fund pledges by depleting most global humanitarian accounts. In order to respond to future humanitarian crises, however, these resources would need to be replenished. If not replenished, U.S. capacity to respond to other emergencies could be diminished. Burdensharing . Both Congress and the Administration have encouraged other countries to provide humanitarian assistance for the Syria situation and to turn pledges into actual commitments. It is not always evident whether figures listing donor amounts represent pledges of support or more specific obligations. Pledges made by governments do not always result in actual contributions, as demonstrated by the donor conferences in Kuwait. It also cannot be assumed that the funds committed to relief actually represent new contributions, since the money may have been previously allocated elsewhere. Moreover, it is not readily apparent how the actual costs of a humanitarian emergency might be shared among international donors. Comparing U.S. assistance and international aid can also be difficult because of the often dramatically different forms the assistance takes (relief items versus cash, for instance). 
More broadly, political considerations play a role in the way humanitarian assistance is given and to whom. While the images of human suffering only reinforce the need to "do something," humanitarian assistance carries some weight as an instrument of "neutral" intervention and is the most flexible policy tool that can be quickly brought to bear in a crisis. Sometimes humanitarian assistance is expanded beyond its immediate function to avert a crisis, to provide support to allies, and to maintain a presence in the region. How it is used and whether it becomes more of a strategic, policy tool depends upon the situation, what other governments are doing, and the degree to which the United States has further interest in the region. 
Providing humanitarian assistance also raises questions about implications for future action. On the one hand, if the United States decides to reduce its humanitarian support to Syria, would this diminish U.S. standing among its allies or affect its interests in other ways? On the other hand, since the President has a great deal of flexibility over U.S. involvement, once commitment to a humanitarian effort is made, does this make the long-term U.S. participation in reconstruction and political solutions more likely? Regardless, the level and sources of U.S. humanitarian assistance will inevitably have an important impact not only on the Syrian relief operation itself, but on broader U.S. foreign policy goals.
Appendix A. Distribution of U.S. Funds, CY2012-2014
Appendix B. Selected Humanitarian Projects Funded by All Donors in Syria and the Region
Appendix C. Selected Humanitarian Partners Serving the Syria Arab Republic Civil Unrest, CY2014
Appendix D. U.S. and International Humanitarian Country Donors to the Syria Crisis, CY2012-2014
Appendix E. 2013 Pledges Not Converted to Commitments or Contributions as of June 18, 2014
Appendix F. Sources for Further Information
United States Agency for International Development (USAID)
Syria country page: http://www.usaid.gov/crisis/syria
No Lost Generation: http://www.usaid.gov/crisis/syria/children
U.S. Department of State
Syria country page: http://www.state.gov/p/nea/ci/sy/ 
Bureau of Population, Refugees, and Migration (PRM): http://www.state.gov/j/prm/ 
Central Intelligence Agency (CIA)
The World Factbook on Syria: https://www.cia.gov/library/publications/the-world-factbook/geos/sy.html
United Nations —Selected Sources
UN News Center: http://www.un.org/apps/news/infocusRel.asp?infocusID=146&Body=Syria&Body1= 
United Nations Inter-Agency Information Sharing Portal: http://data.unhcr.org/syrianrefugees/regional.php
Relief Web link: http://reliefweb.int/country/syr