S/PV.7870 Security Council

In accordance with rule 39 of the Council’s provisional rules of procedure, I invite the following briefers to participate in this meeting: Mr. Stephen O’Brien, Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator, Mr. Amir Mahmoud Abdulla, Deputy Executive Director of the World Food Programme; and Mr. Peter Salama, Executive Director of the World Health Organization Emergencies Programme. Mr. Salama is joining today’s meeting via video- teleconference from Geneva. I wish to draw the attention of Council members to document S/2017/58, which contains the report of the Secretary-General on the implementation of Security Council resolutions 2139 (2014), 2165 (2014), 2191 (2014), 2258 (2015) and 2332 (2016). The Security Council will now begin its consideration of the item on its agenda. We met to discuss the implementation of resolution 2336 (2016) and the Astana meeting last week. We look forward to taking stock, post-Astana, and discussing the important upcoming United Nations-led Geneva talks with Special Envoy de Mistura next week. Therefore, today we focus on the humanitarian situation in order to try to give it the due attention it deserves. I now give the floor to Mr. O’Brien. Mr. O’Brien: We witnessed devastation and suffering in Syria in 2016 at levels that defy comprehension. We witnessed people dying of starvation, with the pictures of emaciated, starving children from the besieged town of Madaya staining our conscience. There were the constant, harrowing images of bombs and mortars raining down on schools, medical facilities, internally displaced settlements, public markets and critical water networks. We saw a shocked, blank stare from five-year-old Omran Daqneesh, his silent face covered in blood and dust after being pulled from the rubble caused by an air strike in eastern Aleppo. We are still horrified by reports of rescue and medical workers teams, Syrian Arab Red Crescent volunteers and humanitarian personnel attacked while on duty. We witnessed the destruction in Darayya, dubbed “Syria’s capital of barrel bombs”, and the relentless demolition of eastern Aleppo. We saw towns besieged, bombed and then emptied. We saw buses, intended to evacuate civilians, burning outside of Fo’ah. We have seen the Islamic State in Iraq and the Levant (ISIL) recapture the ancient city of Palmyra. And we have watched as these actions brought with them an atrocious, incalculable human toll. The Secretary- General, myself and my colleagues have called the situation a slaughterhouse, a complete meltdown of humanity, the apex of horror. There is no pretending; that is what daily life was like for millions of civilians across Syria throughout 2016 — so much suffering in just 12 months, and all of it under our collective watch. And yet, as we start 2017, and as hard as it is to imagine, there are some emerging reasons to hope. Since 30 December, a nationwide ceasefire continues to hold, despite some breaches. That has provided a rare moment of respite for many, and we must all do everything in our power to see that it is consolidated and extended. I have also just returned from Helsinki, where the world came together to support Syrians and the region. Even with continuing dire humanitarian needs, I took away a sense of hope from my meetings in Finland, none more so than in the steady determination of Syrian non-governmental organizations, with whom I had the honour to sit alongside as we discussed the humanitarian priorities for the coming year. Together with the European Union, the United Nations will host a conference on Syria in the beginning of April. That will be an opportunity for the international community to reiterate and pledge their commitment to support the Syrian people. I also take hope in recent developments on the political track. This week we saw those who, despite years of fighting, were willing to set the past aside to sit alongside one another in Astana. The agreement by Russia, Turkey and Iran in Astana to establish a trilateral mechanism to observe and ensure full compliance with the ceasefire is a welcome development. Saving Syrian lives is the shared priority of all of us, and the United Nations stands ready to assist in the establishment of this mechanism. It is also our hope that further consolidation of the ceasefire will help to create a supportive environment for the resumption of intra-Syrian negotiations in Geneva, under the auspices and lead of the United Nations, as per relevant Security Council resolutions. Special Envoy de Mistura has just attended the Astana meeting and he will brief the Council, as the President mentioned, more fully on the political track, on 31 January. As we move towards United Nations talks, the collective hopes of the world are for a political solution based on resolution 2254 (2015) and the Geneva communiqué (S/2012/522, annex). There is no other solution, neither humanitarian nor, indeed, military — however emboldened some parties may feel following the full evacuation of eastern Aleppo. We all owe it to the people of Syria, who have suffered so much, to do everything in our power to see the political process succeed and to see their hope restored. Sadly, in recent months, we have too often been unable to translate hope into humanitarian action. From the formation of the Task Force on Humanitarian Access, as part of the International Syria Support Group in early 2016, up until September last year, we saw unprecedented access to those most in need in Syria. By September of last year, over one and a quarter million people were reached via inter-agency convoys to besieged and hard-to-reach areas, compared to just 487,000 in all of 2015. Such access was not easily achieved, but took the hard work of the United Nations team in Damascus and in Geneva, with the support of influential Member States  — especially the Russian Federation and the United States. Frustratingly, and with dire humanitarian consequences, significant challenges with cross-line access have re-emerged. Sadly, access has currently returned to the levels we saw before the humanitarian task force came into effect. That diminution in access is, in part, because the two-step approval process agreed by the Syrian authorities has become, in practice, a ten-step process. Despite high rates of in-principle approvals, only one or two approved convoys have reached their destinations in each of the last three months. In December, one — just one — inter-agency convoy delivered assistance to 6,000 people out of a total of 930,250 people requested under the December inter-agency convoy plan. This is less than 1 per cent of what we aimed to achieve, and even in this one instance when we could deliver, over 23,000 medical items were removed from the United Nations inter-agency convoy. So far, in January the situation is not much better, with only one inter-agency convoy deployed to Moadamiya, on 7 January, reaching 40,000 people; however, this was a location that we had requested under last November’s plan. In both December and January, the Syrian Government did respond within the agreed seven working days to our monthly inter-agency convoy plans, but subsequent administrative delays on the part of the Government — including in the approval of facilitation letters, approval by local governors and security committees, as well as broader restrictions on the part of all parties — continue to hamper our efforts and deprive the most vulnerable civilians of much- needed assistance. Let me be perfectly clear. We have a humanitarian task force whose sole purpose is to ensure access, and since 30 December we have had a ceasefire that has improved security in many areas. And yet, despite these two positive factors, we continue to be blocked at every turn by lack of approvals at the central and local levels, disagreements on access routes, and the violation of agreed procedures at checkpoints by parties to the conflict. Are these important? Yes. We cannot “just plough on” or “just get on with it”, as I have heard one member sitting around this say table to me, because if one brave aid worker drives through the check point without these facilitation letters and the command is then transmitted down the line, the checkpoint guard or their sniper takes the shot. On 11 January, the United Nations Resident Coordinator/Humanitarian Coordinator in Damascus sent a note verbale to the Syrian Ministry of Foreign Affairs with a list of practical suggestions to speed up access, simplify procedures and get convoys moving. No response has yet been received. We have the capacity to deliver to hundreds of thousands of people in besieged and hard-to-reach areas every month, and we are ready to move should access be allowed by the parties to the conflict. We call on all Council members with influence over the Syrian authorities and on members of the humanitarian task force to do more to ensure the support of the Syrian Government to deliver life-saving assistance through the existing structures and mechanisms. I say without, I hope, being seen as defensive, that the fault is not at the door of the United Nations or the non-governmental organizations (NGOs); it is the Syrian Government and the local governors who are responsible. I would ask Council members to direct their irritation and influence at them. We need to be allowed to pass — not as a favour but as a right — and safely. On the ground, despite enormous challenges, the United Nations and its humanitarian partners in Syria continue to deliver life-saving assistance and support to millions of people across the country every month. For example, the World Food Programme (WFP) — which the Council will hear more from in a few minutes — reached over 4 million people with food commodities in December alone. The World Health Organization, which the Council will also hear from this morning, along with UNICEF, implemented their accelerated routine immunization campaign in northern Syria, vaccinating some 104,000 children in Jarablus and other parts of Aleppo governorate. Over the course of 2016, over 4 million non-food items were distributed across Syria, nutrition items were provided to some 3 million, and shelter was provided to nearly 300,000 people. Moreover, the vital humanitarian cross-border activities continued to represent a crucial element of the United Nations response. Since cross-border operations began in July 2014, following the adoption of resolution 2165 (2014), the United Nations has conducted more than 467 cross-border convoys, or nearly four a week on average. This has allowed United Nations partners to deliver medical supplies sufficient for 9 million treatments, including for 2 million people to be vaccinated. Some 3 million have been fed, many on a monthly basis. Assistance has been delivered to various parts of Aleppo, Idlib, Lattakia and Hama governorates in Turkey, and Dar’a and Quneitra governorates in Jordan. These operations complement the critical role played by international and Syrian NGOs, which provide assistance and services to millions more from neighbouring countries. In addition, the United Nations has completed 294 airlifts to Qamishly, delivering 10,000 metric tons of food; water, sanitation and hygiene products; and nutrition, education, shelter and non-food assistance on behalf of humanitarian actors, including 120,000 full food rations. I will leave the WFP Deputy Executive Director to provide more context and reports on our United Nations airlift and air drops capacity, and activity, particularly at Hasaka and Deir ez-Zor. I pay a complete tribute to all the extraordinary steadfast and unflinchingly courageous aid workers — those from NGOs, Syrian, regional and international; those working cross-border from both Jordan and Turkey, as well as those within Syria; those across the United Nations agencies, funds and programmes, and my colleagues in the Office for the Coordination of Humanitarian Affairs (OCHA); those with the International Committee of the Red Cross, the Syrian Arab Red Crescent, the International Federation of Red Cross and Red Crescent Societies; and the local communities and families that have set aside so much to help others. They can rest assured that their actions have saved many lives of their fellow Syrian and global citizens, protecting them wherever possible and never desisting, despite relentless setbacks, threats and danger. And, if I may, let me pause to take a moment to honour all those humanitarian aid workers who have been killed in their duties. As was noted last month, with the evacuation of eastern Aleppo the number of those besieged in Syria was reduced. Following a comprehensive review by the United Nations, it is now estimated that as of January some 643,780 people are living in 13 areas under siege. Three locations were removed from the previous list of 16 locations, where some 974,080 people were unable to move freely. The eastern neighbourhoods of Aleppo were removed following their full take-over by the Government of Syria in December. Madimayet Elsham in rural Damascus was delisted due to the significant improvement in humanitarian access and freedom of movement over the past three months following the signing and subsequent implementation of a local agreement. Hajar al-Aswad, in rural Damascus, was also removed due to the access that has been available through Yarmouk, Yelda and Al-Qadam. Further, population figures have been adjusted for other locations based on the latest and most accurate information received from the ground. This includes a reduction of 1,200 people for Fo’ah and Kafraya, in Idlib, following their evacuation from the two towns in December. Adjustments were also made for areas in the eastern Ghoutah enclave due to movements within the enclave, as well as for Zabadani and Khan al-Shih. The reduction in numbers, however, should not be mistaken for progress in addressing the scourge of besiegement. Parties continue to use siege as a weapon of war, and in each of these cases we saw protracted periods of restricted aid, as well heavy fighting and bombing, as a precursor to the agreements that brought the areas back under Government of Syria control. I continue to call for an immediate end to all besiegement by all parties in this conflict. The act of besiegement does nothing other than to punish civilians, who already bear the brunt of this terrible conflict. Let me provide the Council with an update on four locations in Syria where humanitarian action remains greatly needed and, sadly, often contested: Aleppo, Deir ez-Zor, rural Damascus and Raqqa. I shall address each of these in turn. First, in Aleppo, humanitarian needs continue to be staggering. Since 24 November, nearly 160,000 people have been at least temporarily displaced from formerly besieged neighbourhoods of eastern Aleppo. This includes over 120,000 people displaced to Government- controlled areas in and around Aleppo city or having stayed in eastern Aleppo, and over 36,000 people evacuated to non-State armed group-controlled Idlib and rural western Aleppo. The humanitarian situation for many of those who have been displaced or have stayed has been difficult, and the cold winter has exacerbated the situation further. Following the cut-off of running water to the some 1.8 million in Aleppo due to a technical problem — as we understand it — whose solution lies in ISIL-controlled territory outside of the city, the humanitarian situation has become even more difficult. Last month, OCHA provided Council members with a detailed overview of our response to those 36,000 people who evacuated into rural western Aleppo and Idlib. Those 36,000 people were provided with immediate life-saving assistance that is now part of the regular cross-border humanitarian programming that assists some 900,000 internally displaced persons (IDPs) in Idlib, as well as elsewhere in the north. I will now brief the Council on the United Nations response in each of the main areas in which those affected by the Aleppo crisis have been displaced or returned to across the city itself. The United Nations has had an ongoing presence in Aleppo since 2014 and responded immediately to the additional humanitarian needs caused by the displacement of so many. The level of assistance was immediately increased and the United Nations has since continued to address the needs of those people displaced from or returning to eastern Aleppo, alongside the brave humanitarians working for the Syrian Arab Red Crescent and International Committee of the Red Cross, as well as other national and international non-governmental organizations. Nearly 90 per cent of the supplies distributed by all partners are provided by the United Nations, and just last week $19 million was released from the OCHA-managed Syria Humanitarian Fund to support immediate life-saving and early recovery assistance for thousands of people. Those funds will provide responses to immediate needs, assist with the rehabilitation of basic services and removal rubble and undertake other necessary steps to create the conditions where people can safely return to their homes. In eastern Aleppo, a total of over 65,000 people have been officially registered as having returned to or having stayed in the eastern districts of the city. Most now live in damaged houses or are scattered across various neighbourhoods, with Hanano hosting the largest number of returnees to date. Other neighbourhoods that registered high levels of returnees include Tariq Al-Bab, Al-Kalaseh and Bustan Al-Qaser. In those areas, the United Nations has been active in providing immediate relief. Food items, medical services, protection and education support have all been provided to those in need. I am deeply concerned about reports relating to the stockpiles of humanitarian supplies found in eastern Aleppo since the evacuation. I take that extremely seriously. We need to establish the facts and, as I speak, we are following up on those reports urgently. I emphasize to the Council that such matters draw into stark relief the need for unimpeded access of the United Nations and humanitarian partners to all areas in Syria, not only to allow us to deliver, but to monitor the needs and the appropriate distribution of assistance, even after materials have been pre-positioned. On the outskirts of eastern Aleppo city, there are 5,077 people who have been displaced to the Jibreen collective shelter. Parts of the shelter remain in need of rehabilitation, particularly winterization. The United Nations and its partners have provided hundreds of stoves and other essential winterization items. Furthermore, the United Nations is supporting communal kitchens that provide hot meals for thousands, and a static clinic and, in coordination with the relevant authorities, commenced with the distribution of personal identity documents. In western Aleppo, over 50,000 are being supported as part of increased regular programming activities already being delivered on a daily basis to support the over 400,000 IDPs inside western parts of the city. That includes regular distribution of food and non-food items. The United Nations has recently provided 250 metric tons of medical supplies — enough for 300,000 treatment courses — to Aleppo city, and in December provided enough medicine for 430,000 treatments. UNICEF continues emergency water trucking and the provision of fuel for operating wells, which together benefit nearly 1 million people  — 400,000 people from water trucking and 600,000 people from public wells  — across the city. And together with the Aleppo Department of Education, UNICEF and non-governmental organizations have provided education support to thousands of children and youth. We must make sure that the record and the positive balance are put in the public domain. The United Nations and others will remain committed and actively engaged in assisting all those in need in Aleppo who we can access, working tirelessly with our humanitarian partners to ease suffering and provide a basis for recovery. Secondly, I promised to provide an update on Deir ez-Zor. I am deeply concerned for the safety and protection of an estimated 93,500 people in the besieged western side of Deir ez-Zor in Syria following reports of ISIL attacks, resulting in the death and injury of scores of civilians. Since 15 January, ISIL reportedly took control of several areas including the main road and the Deir ez-Zor airport and is gaining ground in several more areas, splitting the besieged enclave in two. Beyond the temporary suspension of air drops by the World Food Programme, the Al-Assad National Hospital was temporarily closed. Water has reportedly also been cut for thousands of people living in ISIL- controlled areas around Deir ez-Zor due to fighting damaging power generators in the area. Mobile communication has reportedly stopped throughout the area. Thirdly, I turn now to rural Damascus, where the situation remains deeply troubling. Fighting in the Wadi Barada area, just outside of Damascus city, continues and has already displaced an estimated 17,500 people. Water remains cut off from the main source since the fighting began, affecting the primary water supply for some 5.5 million people in Damascus and surrounding areas, who now only have minimal access to water. In response, technical teams comprising the Syrian Arab Red Crescent and water authorities, entered the Wadi Barada area on 13 and 14 January for a preliminary assessment of damages. However, following the assassination of a member of the reconciliation committee, fighting was rekindled and the assessment mission suspended before the repair works could commence. Should such deprivation of water to civilians be determined to have been deliberate, those responsible may have committed a war crime. Accountability must be ensured for the perpetrators of such acts. Fourthly, I would draw the Council’s attention to the military operation in Raqqa district, where I have serious concerns for the safety and security of over 400,000 people in need, including over 150,000 internally displaced people. So far, some 35,000 people have been displaced as a result of the fighting, although many have returned to their homes since the fighting has subsided. Humanitarian partners are providing a response to those displaced to the north towards Tell Abyad. The majority of the population of Raqqa district is reportedly facing critical problems in meeting immediate needs. Fighting has had an adverse impact on infrastructure such as water and power stations, affecting people’s ability to access basic services. Food insecurity is also considered a major problem. Access to Raqqa by the United Nations has been highly constrained due to insecurity and ISIL’s restrictions on the delivery of humanitarian assistance, with the last United Nations inter-agency convoy to Raqqa taking place in October 2013. Access and security permitting, which they currently do not, the United Nations and humanitarian partners do stand ready nonetheless to respond to further large-scale temporary displacement as military efforts to push ISIL out of Raqqa continue. After nearly six years of senseless and brutal conflict, we have all been longing for a glimmer of hope that the suffering of the Syrian people might finally be coming to an end. The past few weeks have seen far fewer civilians killed and injured since the ceasefire came into effect on 30 December 2016. In some parts of the country at least, it has given a respite for people who have told us loud and clear that all they want is to be safe and for their families to be protected from violence. But the ceasefire alone is not enough. We must maintain our outrage at what is occurring in Syria and what is being perpetrated against the Syrian people. Now is the time for advocacy and now is the time for renewed determination. I call on the States members of the Council to do all in their power, collectively and individually, to see the following implemented. First, they must ensure the current ceasefire is sustained, and that it results in increased access after months of stagnation. We need full implementation of the monthly access plan to reach all those in need. Secondly, they must ensure that all parties protect civilians and civilian infrastructure and abide by their obligations under international humanitarian law. Thirdly, they must recommit to ensure that the barbaric act of besiegement is immediately lifted across the entire country. Fourthly, I ask that we all rally behind Staffan de Mistura’s tireless efforts on behalf of the Secretary-General to find a political solution that brings an end to the conflict and meets the aspirations of the Syrian people. After a chronicle of missed opportunities, this is the time for the various parties to come together and bring an end to this horrendous chapter in Syria’s history.

I thank Mr. O’Brien for his briefing. I now give the floor to Mr. Abdulla. Mr. Abdulla: Last year, the Executive Director of the World Food Programme, Ertharin Cousin, reported to the Council (see S/PV.7612), stating her grave concern about the deepening humanitarian crisis in Syria and the increasing hardship faced by people the in besieged areas. She warned then that they were falling into despair, malnutrition, starvation and death. Yet, today, despite some cause for optimism, the situation remains perhaps even more grave. Six years into the crisis, the humanitarian and food-security situation in Syria continues to deteriorate. Seven million people in Syria are already food insecure and an additional 2 million are at risk. That is 9 million people inside Syria — half the current population — who are in need of food, agriculture and livelihood assistance. Four out of five Syrians now live in poverty, with almost 80 per cent of the households across the country struggling to cope with food shortages. An alarming fact is that food production has hit a record low as widespread insecurity continues to hamper access to land, farming supplies and markets. Fuel is in short supply and infrastructure, such as irrigation systems, is often in a state of damage, all of which make it increasingly difficult for farmers to produce and maintain their livelihoods. The wheat harvest is at an all-time low, estimated at less than 50 per cent of the pre-conflict averages. As such, Syria is in danger of becoming a country of subsistence farmers with most of its commercial and large-scale agricultural base eroded. Food prices have steadily risen, reaching an increase of 43 per cent in besieged and hard-to-reach areas to which the World Food Programme (WFP) and other humanitarian organizations have no regular access. The highest cost for staple foods was reported in the besieged part of Deir ez-Zor city, in which more than 90,000 people are struggling to survive. The situation remains precarious in other besieged locations in which many people are struggling to get just one meal per day. To date, approximately 4.6 million people, including an estimated 2 million children, live in areas throughout Syria that are very hard to reach. They receive only sporadic humanitarian assistance, and as Under-Secretary-General O’Brien just said, more than 640,000 people are living in 13 besieged locations across of Syria, deprived of the most basic needs, especially food. During the first several few weeks of 2016, following the Munich agreement, access to besieged and hard-to-reach areas improved considerably. Despite those improvements, recent outbreaks of fighting, insecurity and delays in obtaining the necessary approvals have meant that millions of hungry Syrians were cut off from supplies and left without predictable food deliveries. As an example, in the third quarter of last year, WFP sent food to hard-to-reach and besieged areas through 23 inter-agency conveys; however, only 12 such conveys took place during the last quarter of 2016. Our persistent efforts to improve access continue to be challenged by numerous obstacles, and those were outlined earlier by Under-Secretary-General O’Brien. Access has been our challenge in Syria since the first days of the conflict. WFP continues to consider all options. We have consulted with many partners in world exports. We have considered airdrops, helicopters and delivering food by drones, but, in the end, it always comes down to access and ensuring safety. I would like to add a few words with regard to Deir ez-Zor and some of the airlifts to which Mr. O’Brien referred. Deir ez-Zor has been unaccessible to humanitarian workers since it fell under the control of Islamic State in Iraq and the Levant (ISIL) in March 2014. In April 2016, WFP, together with numerous partners and much assistance, began a complex, high-altitude parachute drop, which, as I will explain, delivered quite a lot. But the recent aspects of the security deterioration that Mr. O’Brien mentioned in Deir ez-Zor city, which was effectively cut in half, and fighting between Government forces and ISIL forced a suspension of that operation on 15 January. That operation had been providing a life line for that besieged population. Yet, before the operation was suspended, we had carried out 177 airdrops delivering food rations, as well as many other supplies, such as medical and hygiene supplies on behalf of all the other humanitarian agencies, to 93,000 people. That amounted to more 3,300 tons of relief items on 4,500 pallets using more than 10,000 parachutes in an unprecedented, highly technical and regrettably high-cost operation. In another operation in July 2016, we began an airlift operation to the Al-Hassakeh governorate, with planes taking off from Damascus airport and landing in Qamishly airport. Those airlifts were also costly with limited cargo capacity but, again, were the only option to provide emergency assistance to the most vulnerable and insecure people in the Governorate. To date, we have completed 294 airlifts to Qamishly, delivering 10,000 tons of many food items as well as numerous other humanitarian supplies. Those airlifts have enabled those supplies, food assistance and many other urgently needed items to reach approximately 64,000 people and are part of an inter-agency operation that, I have to advise, is running short of funds. As I conclude, I would like to say a few words and convey a key message in Arabic, the language of the region. (spoke in Arabic) Access to besieged areas cannot be arbitrary, improvised or accorded only after our repeated requests. Access to all areas that require assistance should be reasonably safe and consistent. Access should not be subject to an unreasonable approval process. (spoke in English) The Council may rest assured that the World Food Programme will continue to do its utmost to overcome setbacks and challenges to provide life-saving assistance. Together with partners, we continue to look towards new and innovative ways to reach people while hoping that a permanent ceasefire will be put in place to allow for increased, immediate and, above all, sustained access. But ultimately peace and security are the only solution to the Syrian crisis. As Under-Secretary- General O’Brien said, there is no humanitarian solution to the crisis. A new political commitment to peace is needed so that we can then focus all our energy and efforts on the future of Syrian families, thereby helping them rebuild their lives and livelihoods.

I thank Mr. Abdulla for his briefing. I now give the floor to Mr. Salama. Mr. Salama: I thank the Council for this opportunity to brief members on the impact of six years of war on the health of the Syrian people. The war in Syria has taken a devastating toll on the people of Syria and the health workers, hospitals and clinics intended to serve them. The war has obviously had a direct impact on the civilian population, with more than half a million people killed and 1.5 million injured. Indeed, until the recent security developments, we estimate that approximately 30,000 people were sustaining war-related injuries every month. Furthermore, in many parts of the country, the war has virtually gutted a once-strong health system. More than half of the country’s public hospitals and primary care centres have either closed or are only partially functioning. Approximately two-thirds of health workers have fled the country. Tragically, in 2016 there were reports of more than 100 attacks on hospitals and clinics across the country. Not surprisingly, the inability or unwillingness of the warring parties to safeguard basic health care has resulted in acute shortages and barriers to access, including for life-saving services, such as trauma care for the injured, medical treatment of common chronic diseases and basic prevention programmes, such as vaccination programmes for children. It is estimated that now one in two children is not protected against major infectious disease killers and that one in four children is at risk of developing serious mental health disorders, with their associated long-term impacts on the children themselves and on the society to which they contribute. More than 300,000 women are not able to get the urgent care they need for a safe pregnancy and delivery. Indeed, the indirect toll on civilian lives may eventually far outweigh the direct toll due to bombs and bullets. As with our other United Nations and non-governmental organization partners, in the health sector WHO has been challenged to find new and innovative ways to deliver services in that complex context, whether through mobile health clinics or through cross-line and cross-border programmes. In 2016, WHO and partners such as UNICEF and the Syrian Arab Red Crescent were able to vaccinate more than 2.5 million children against polio, measles and other diseases; deliver more than 10 million treatments and train more than 16,000 health workers; and assist in medical evacuations of the critically sick and injured. The credit for those results rests with the courageous Syrian health workers, who continue to deliver health care for their people under the most difficult circumstances imaginable. Unfortunately, in 2017 the ceasefire has not yet translated into sustained improvement in access to health care in the majority of hard-to-reach and besieged areas. As noted by Mr. O’Brien, we are particularly concerned by the situation in Deir ez-Zor, where people are struggling to survive in the besieged enclaves. The Al-Assad University Hospital has temporarily been out of service due to clashes in the area, necessitating the air evacuation of the wounded and the sick. WHO and its partners, such as the Syrian Arab Red Crescent, stand ready to deliver medical supplies sufficient to cover the needs of the population for three months in Deir ez-Ezor should there be access and a logistics system in place to deliver them. We also recognize the urgent un-met health care needs in and around Aleppo following the intense hostilities late last year and the resulting population displacement. WHO and its partners are already scaling up our existing primary health-care and other programmes. We are aware of the reports of medical supplies found in warehouses when the Government of Syria regained control over eastern Aleppo. We look forward to receving further details on the quantities and types of supplies in order to determine the appropriate action with the relevant authorities. Finally, we have four major requests of the Council today aimed at saving lives and underscoring the sanctity of health workers. First, we must ensure that all parties to the conflict permit the evacuation of critically ill and wounded patients and their families from all hard-to-reach and besieged areas of Syria. Secondly, we must ensure that medical teams are granted sustained and unconditional access to all parts of Syria in order to assess needs, monitor programmes — including the distribution of supplies and trained staff — as well as provide direct medical care. Thirdly, we must ensure that essential health supplies, including trauma and surgical supplies, which have been systematically removed from United Nations and Syrian Arab Red Crescent convoys, are consistently allowed into hard- to-reach and besieged areas. Finally, the pernicious attacks on health care workers and clinics must end. The perpetrators must be held accountable. These attacks undermine the very foundations of peace and security and have been the subject of previous Security Council deliberations. Equally unacceptable is any use of health-care facilities for military purposes. We should join together to condemn such egregious violations of international humanitarian law and find a practical mechanism to stop them once and for all. Ultimately, the Syrian health-care system will need to be rebuilt, with serious and sustained investment and the support of the entire international community. We will save that discussion for a more hopeful time, which we hope is not far off.

I thank Mr. Salama for his briefing. I shall now give the floor to those members of the Council who wish to make statements.

Allow me to thank our briefers — Under-Secretary-General Stephen O’Brien, Mr. Amir Abdulla and Mr. Peter Salama — for the valuable information they have given us today. The situation in Syria continues to be shameful. The country continues to be immersed in a bloody civil war that, after six years, has left it in ruins and destroyed the own roots of its society. However, for the first time in many months, there seems to be some improvement. The end of the military conflict in eastern Aleppo, the swift evacuation of its population and the cessation of hostilities at the end of December, reflected in resolution 2336 (2016), have made it possible to reduce substantially the levels of violence in some areas, giving its inhabitants necessary respite. In addition, the meeting in Astana that took place this week makes it possible to hope that next month in Geneva the Special Envoy of the Secretary-General for Syria, Mr. Staffan de Mistura, will manage, based on those exchanges, to give significant new momentum to the political process to put an end to conflict. All of us here trust in the ability of Mr. De Mistura to bring the parties together, reduce tensions and still-existing distrust and to work on the road map charted by resolution 2254 (2015) to achieve a process of political transition that would benefit the Syrian people. He has our full support. Nevertheless, we are still seriously concerned about the humanitarian situation in Syria which, as pointed out by the briefers today, presents quite a different picture than the political process. Although the end of the siege of eastern Aleppo was a necessary relief, which made it possible to reduce significantly the total number of people residing in besieged and hard-to-reach areas, almost 700,000 people remain there, subsisting with extreme needs, their situation aggravated by the hard winter conditions. It is neither acceptable nor tolerable that, in spite of the tremendous effort made by humanitarian workers of the United Nations and its partners in the field, in December barely 1 per cent of the total of the population could be reached. Neither is it acceptable or tolerable that none of the convoys included in the January plan were able to reach the recipients, with the exception of one that arrived in Muadamiyat Al-Sham on 7 January as part of a plan approved in November. It is also highly worrying that, despite the cessation of hostilities in force and the end of the seige of eastern Aleppo, humanitarian access seems to be worsening instead of improving. Also, with regard to deliveries by air in Deir ez-Ezzor, and after the excellent work undertaken by the World Food Programme, which has completed 177 deliveries to date, unfortunately, on 15 January operations were suspended due to the intense fighting in the area. We hope that they can restart shortly. I wish to briefly mention the situation in Wadi Barada. Let it be clear: the sabotage over the past month of the water supplies that serve the capital, Damascus, and surrounding areas — whoever may be responsible — should be considered a war crime, one of many suffered daily by the Syrian people. We hope that soon a cease fire will be achieved that will make it possible to quickly re-establish access to drinking water for more than 5 million people. In conclusion, allow me to reiterate the priorities of Uruguay with regard to substantially improving the Syrian humanitarian situation. It is necessary that the cessation of hostilities be consolidated throughout the territory; that all parties to the conflict continue to protect and improve the protection of citizens, infrastructure, hospitals and medical and health-care staff; that all sieges be lifted; that, in accordance with the monthly plans submitted by the United Nations, immediate and sustained humanitarian access be granted throughout the country; that the fight against terrorism in all its forms be continued; and that progress be made towards reaching a political solution to the conflict.

The delegation of Bolivia would like to thank the representatives of the Office for the Coordination of Humanitarian Affairs, the World Food Programme and the World Health Organization for their briefings today on the tragic situation facing the Syrian people. Bolivia would also like to emphasize the fact that the ceasefire instituted by Russia, Turkey and Iran has been effective and has had a direct impact not just on the possibility of improving the humanitarian situation but also, as the Secretary-General’s report (S/2017/58) states, on reducing the level of violence in the country. It represents a step in the right direction for reaching a political outcome that can end the violence, prevent further bloodshed among civilians and provide them with immediate humanitarian access. We welcome the efforts of all the humanitarian organizations on the ground, including the work of the Red Crescent, in conditions that have been described as extremely difficult. In that regard, we urge all parties to abide strictly by international humanitarian law in order to ensure the success of the ceasefire, the protection of civilians and civilian structures, the lifting of the sieges and, of course, a political solution to the conflict. We also welcome the fact that, according to the communiqué issued after the meeting in Astana, the parties are seeking a political outcome and a ceasefire that will contribute to “reducing violence, building confidence [and] ensuring unhindered humanitarian access swiftly and smoothly”. That is of course a step in the right direction for an intra-Syrian political process conducted under the auspices of the United Nations, aimed at ending this tragic conflict once and for all.

I now invite Council members to informal consultations to continue our discussion on this subject.