For two years the humanitarian drive in Syria has been hobbled by the same division, fatigue and confusion that has afflicted the political effort to stop the civil war. Aid appeals have been ignored; access for aid denied; aid workers targeted.
Now there are signs of new political cooperation over chemical weapons, and even talk of a revived negotiating process to end the war. They need to be matched by an urgent humanitarian surge - inside Syria and beyond.
Seven million Syrians have been driven from their homes. 60% of hospitals in this middle income country have been damaged or destroyed. Typhoid is on the loose. Food shortages are a daily reality. Without urgent action, there will be no Syria for the dominant power-brokers at the end of this war to inherit.
NGOs are working alongside the UN across Syria and in all four neighboring states, providing emergency health care, educating children, offering income support to host families. But so much more is needed, and so much more could be done. Whatever the ebbs and flows of the diplomatic tide over the next few weeks, there are now five priorities for the countries arriving in New York for the UN General Assembly this week.
First, our aid mindset needs to change from helping refugees in camps to helping urban refugees sleeping on floors, renting apartments or sleeping rough. There are 750,000 refugees in Lebanon - a flow of people equivalent to the whole of Britain coming to the US - but no camps. Overall at least 60% of Syrian refugees in neighbouring countries are in urban areas. For those displaced inside Syria this is the universal experience.
These largely undocumented people need a completely different configuration of services and support from those in refugee camps. Cash is important - and can be delivered electronically. So is support for host communities, already creaking under the pressure of previous generations of Palestinian and Iraqi refugees.
Second, the neighbors of Syria need support to shore up their own societies. Housing, schools, health clinics, never mind the local economies, are overwhelmed. The scale of the refugee flows means hundreds of thousands are stuck near the borders.
Because the scale of devastation is so great, many families will never go back to Syria. So more western countries will need to follow Germany, which says it will accept 5,000 Syrians this year. The US takes in 70,000 refugees a year, over half the global total, but so far only 60 have come from Syria.
Third, there is extensive technical experience of how to help displaced people survive the winter with special 'winterization' kits. But funding for this kind of intervention is so far lower than for last. With winter approaching, we are running out of time to ramp up these programs.
Fourth, civilians are paying a huge price as aid workers face enormous hazard in crossing battle lines and borders. I have met doctors who described losing colleagues to retribution for helping civilians in rebel-held areas. This is completely contrary to humanitarian law. The parties to the conflict need to be pressured by their backers to lift blockages on and threats to the safe passage of aid and aid workers.
Finally, public and private sectors need to dig into their pockets. The UN appeals - totalling some $4.5billion - are only about 40 percent funded. NGOs can scale up help, from cash assistance to trauma counseling, but only with more support.
$50 would cover the essentials of food and accommodation for a Syrian family of six in Lebanon. $12 per person delivers hygienic latrines for the people huddled in currently dire conditions against the Turkish and Jordanian borders - and there are hundreds of thousands of them.
This is not just a moral argument. The implosion of Syria is sending shock waves across the Middle East. The humanitarian grief is an additional source of destabilization in the regional geopolitics.
The Syria crisis is a complex political emergency. Humanitarian action cannot substitute for political and diplomatic action. But in humanitarian terms the needs are basic and simple. While diplomats work together to stop the killing, a dedicated humanitarian response could slow the dying.
David Miliband, formerly UK Secretary of State for Foreign Affairs, is President and CEO of the International Rescue Committee.
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