Losing Their Last Refuge: Inside Idlib’s Humanitarian Nightmare

As President Bashar al-Assad and his allies retook a large swath of Syrian territory over the last few years, rebel-held Idlib province and its surroundings in northwest Syria became the refuge of last resort for nearly 3 million people. Now the Syrian regime, backed by Russia, has launched a brutal offensive to recapture this last opposition stronghold in what could prove to be one of the bloodiest chapters of the Syrian war.

This attack had been forestalled in September 2018 by a deal reached in Sochi, Russia between Russia and Turkey. It stipulated the withdrawal of opposition armed groups, including Hay’at Tahrir as-Sham (HTS)—a former al-Qaeda affiliate—from a 12-mile demilitarized zone along the front lines, and the opening of two major HTS-controlled routes—the M4 and M5 highways that cross Idlib—to traffic and trade. In the event, HTS refused to withdraw and instead reasserted its dominance over much of the northwest. By late April 2019, the Sochi deal had collapsed in the face of the Syrian regime’s military escalation, supported by Russia. 

Idlib’s civilian population has largely borne the brunt of this escalation. Nearly half of that population have been displaced from other parts of the country retaken by Assad, and roughly two-thirds depend on humanitarian assistance. In the past three months, the Syrian regime and Russia’s indiscriminate bombardment has killed more than 500 civilians and injured thousands more. More worrisome, Russian and Syrian airstrikes have deliberately targeted vital civilian infrastructure, including hospitals and schools. Nongovernmental organizations (NGOs) shared the coordinates for these facilities with the United Nations, which in turn shared them with the warring parties in a bid to protect them and first responders. In August 2019, the UN announced an investigation into these airstrikes. However, it did not provide any details about its timeline and process.

Rebel groups have indiscriminately shelled government-controlled towns, killing scores of civilians. In addition, HTS has reportedly committed serious human rights violations against civilians in northwest Syria, including arbitrary arrests, kidnapping, torture, and murders.

Turkey is deeply concerned over the impact of the offensive. It already hosts more than 3.5 million Syrians, and the recent escalation could cause additional tens of thousands of refugees to seek refuge across the border. To prevent refugee flows into Turkey, Ankara has built a wall nearly 500 miles long on its southern border with Syria. However, Turkey also remains deeply engaged inside Idlib—where it supports armed groups fighting the regime—and in Syria more broadly, where it controls parts of the Aleppo province. Thanks in no small part to Turkey’s backing, these armed groups largely held the Syrian regime and Russia to a military stalemate on the ground for more than three months. However, Syrian forces recently made significant advances. Under heavy Russian air cover, they recaptured strategic areas in northern Hama and southern Idlib and regained control of the M5 highway. To halt these advances and stop the offensive, Ankara intensified diplomatic efforts with Russia. On August 31, following Turkish President Erdogan’s visit to Moscow, Russia committed to a unilateral ceasefire. However, that ceasefire, remains deeply fragile.

Humanitarian aid operations in Idlib and its surroundings are regulated by UN Security Council Resolution 2165, which is renewed annually and has been in place since 2014.[1] This resolution allows cross-border aid into nongovernment-controlled areas without previous approval from Damascus. Because the resolution expires in January 2020, humanitarian organizations worry that Russia—highly critical of cross-border assistance—might veto it.

Despite their best efforts, humanitarian organizations are reeling under the weight of Idlib’s overwhelming needs. The latest offensive has triggered the largest wave of displacement in the Syrian war thus far, displacing more than half a million people living in opposition-controlled areas. Because camps for internally displaced people (IDPs) are over capacity, most IDPs live in informal, overcrowded settlements. Life in these settlements is a daily struggle. Some lack even the most basic services, including access to toilets or water. Thousands of IDPs are reportedly living in open air under olive trees.

In addition, reports about early marriage, gender-based violence, and sexual exploitation, at times perpetuated by relief workers and camp managers, are on the rise. Further complicating the situation is a decline in funding driven by donor fatigue and concern among Western governments over the diversion of aid to HTS. Specifically, the United States ended its stabilization funding to northwest Syria in 2018 and significantly reduced its 2019 humanitarian contribution to the country.

Diplomatically, the U.S. administration has been largely disengaged from events in northwest Syria. The Trump administration has yet to make meaningful diplomatic efforts to reach a durable cessation of hostilities in northwest Syria.  It remains to be seen how long the current ceasefire will hold. In August, a previous ceasefire fell apart in a matter of days.  However, the fighting in Idlib has now reached a critical juncture and significant pressure on warring parties is urgently required to bring a lasting end to hostilities. Without it, the UN has warned that the situation in Idlib could turn into a “humanitarian nightmare unlike anything we have seen this century.”  


  • Turkey and Russia should seize the opportunity of the existing ceasefire and immediately enter into talks to negotiate a resumption of the Sochi agreement.
  • In support of these talks, Syrian government forces and armed opposition groups should stop the ongoing shelling and commit to refrain from further offensive operations in Idlib and its surroundings.
  • The Syrian government and Russia should commit to not resume aerial bombardments in northwest Syria.
  • The United States should undertake a concerted diplomatic effort to push for and support renewed talks between Turkey and Russia. President Trump should personally and forcefully condemn any violations of the current ceasefire.    
  • The United States and other members of the UN Security Council should pressure Russia to ensure the protection of humanitarian infrastructure and personnel, and relentlessly denounce attacks on humanitarian facilities as war crimes.
  • The UN should expedite the completion of its investigation into attacks on humanitarian facilities, attribute responsibility, and publicly share its findings. 
  • Members of the UN Security Council should engage with Russia to ensure that the cross-border aid resolution is renewed in January 2020.  
  • To bolster the ongoing relief effort inside Idlib, the following steps should be taken: 

    • The United States should immediately release emergency funds to support relief operations in Idlib and reverse its decision to cut stabilization funds to northwest Syria. 
    • European and Gulf donors should immediately scale up funding of lifesaving activities and restore funding for protection, education, and revenue-generating opportunities.
  • To prepare for an expansion of the regime’s offensive and a further deterioration of the humanitarian situation inside Idlib, the following steps should be taken:

    • Turkey should move quickly to establish IDP camps in areas it controls in northern Syria and increase the capacity of existing refugee camps inside southern Turkey to temporarily accommodate tens of thousands of civilians fleeing violence.
    • The international community should press Turkey to open its southern border to refugees fleeing the violence. 
    • Western donors and Gulf countries should pledge the necessary funding and assistance to allow Turkey to temporarily accommodate more refugees.
  • Humanitarian organizations operating in Idlib should strengthen their internal accountability and monitoring mechanisms to prevent aid diversion.  
  • Humanitarian organizations should enhance training for and monitoring of their staff with respect to sexual abuse and exploitation, and provide safe pathways for victims to report abuses. These organizations also should conduct community awareness sessions about early marriage, sexual exploitation, and gender-based violence. 
  • Turkey should facilitate the registration of NGOs and access to work permits to their staff. In return, humanitarian organizations should comply with Turkish laws and regulations.   


In February 2019, Syria and its ally Russia launched a campaign to reclaim Idlib province and its surroundings—the last opposition stronghold in northwest Syria. Turkey, whose military and humanitarian presence in the area is one of its main forms of strategic leverage in Syria, has successfully prevented previous Syrian military incursions. Now it stands to lose if the regime and Russia win. 

Idlib and its surroundings are important to Ankara’s domestic and external politics. Turkey already hosts more than 3.5 million Syrians displaced by the conflict and, given the ongoing war, more refugees will likely attempt to cross the border from Idlib. Warning that its national security could be threatened by the infiltration of jihadi fighters, in 2017-2018 the Turkish government built a wall nearly 500 miles long on its border with Syria. Moreover, Turkish forces maintain a presence in northwest Syria near the southern border, and Ankara supports some major Syrian armed factions in the area. Lastly, Turkey controls Syrian territory contiguous to Idlib in the Aleppo province.

In 2017, during talks in Kazakhstan, Turkey, Russia, and Iran reached a de-escalation agreement that covered four zones. Subsequently, the Syrian regime and its allies have retaken all but one—the so-called “Idlib de-escalation zone” in northwest Syria that includes Idlib province and contiguous areas in the northeastern Latakia, western Aleppo, and northern Hama provinces.(2) In September 2018, in an attempt to preserve this last “de-escalation zone,” Moscow and Ankara reached a memorandum of understanding (MoU) in Sochi, Russia. 

The Sochi deal was reached even as Syria’s Assad-led regime intensified its military presence in the area. Although flawed, the Sochi MoU forestalled what seemed to be an imminent humanitarian disaster. It called for removing armed groups and all heavy weaponry from a nearly 12-mile demilitarized zone (DMZ) along the front line in the northwest, and securing two major routes for traffic and trade controlled by Hay’at Tahrir as-Sham (HTS), a former al-Qaeda affiliate designated as a terrorist organization by most countries—the M4 and M5 highways linking Damascus to Aleppo and Latakia through Idlib. It also stipulated Russia’s commitment “to ensure that military operations and attacks on Idlib will be avoided and the existing status quo will be maintained,” and called on Turkey to reinforce the presence of its troops in observation posts inside the province, thus underlining Ankara’s crucial role in preserving the northwest region’s stability. 

In accordance with the agreement, Turkish-backed armed groups withdrew from the DMZ. However, HTS rejected the terms of the MoU. Instead, HTS launched a sweeping attack against Turkish-backed rebels in January 2019, reasserting its dominance over much of the area. Growing impatient with Turkey’s inability to implement the Sochi deal, Russia supported a military escalation led by the Syrian regime in February 2019. By late April 2019, this escalation had turned into a full-scale, bloody offensive. 

Armed factions affiliated with Turkey have been crucial in pushing back the regime’s advances for several months. However, the Syrian regime and Russia recently seized strategic areas in northern Hama and southern Idlib and retook control of the M5 highway. The aerial bombardment, though very brutal, is still largely confined to southern Idlib and contiguous pockets in the countryside of Hama, Aleppo, and Latakia provinces. With Russia’s support, the regime is likely to intensify bombing, thus increasing pressure on fighters and local communities, in a bid to continue its advance toward the M4 highway.  

Moreover, the regime offensive has exacted a grim humanitarian toll. Of the more than 3 million people living in northwest Syria, half have been displaced from other parts of the country. They had fled their homes as the regime moved through and captured large swaths of rebel-controlled territory. This area became the last safe haven for these internally displaced persons (IDPs), who now find themselves trapped. 

Indiscriminate regime and Russian bombings have killed more than 500 civilians since April 2019, injured many thousands, and displaced hundreds of thousands. Rebels also have indiscriminately shelled government-controlled towns, killing civilians.

On August 30, Russia declared a unilateral ceasefire that warring parties have largely respected, despite sporadic violations from both sides.(5) However, if this ceasefire collapses and violence escalates further, as seems likely, the crisis could become the “worst humanitarian disaster the world has seen so far this century.”


1 The number of the resolution changes every time it is renewed.  

2 In this report, this region is referred to as northwest Syria or Idlib and its surroundings, although some parts of this area subsequently have been retaken by the regime.