As a former head of the United Nations office responsible for coordinating the response to humanitarian emergencies, I am acutely aware of the catastrophic effects of conflict on people across the world. Those affected are doubly failed when poor funding from the international community means inadequate aid to alleviate their suffering. The Syrian refugees I met last week during a visit to Jordan with the International Rescue Committee desperately need more and better targeted help.
Up to 230,000 Syrians are now estimated to be in Jordan and 500 more are crossing the border every day, stretching the scarce resources of a country that is already battling an economic crisis and cutting fuel subsidies for its own population.
Only a third of the $448 million requested for regional response by the UN refugee agency, UNHCR, has so far been received, though the UK, US and EU have stepped up to help. Jordan's own pleas for financial assistance have largely fallen on deaf ears. Aid agencies and NGOs are ready to do more but need more resources. Arab neighbours are helping in their own way but their efforts are uncoordinated with the rest, and duplication and gaps are inevitable unless that can be improved.
So far the humanitarian response has focused on helping those Syrians in refugee camps, particularly the 25,000 at Zaatari camp, near the border. Yet 80% are scattered through the towns and cities of northern Jordan, trying to survive somehow on dwindling funds brought with them, and sporadic assistance from agencies working in the country. Current funding enables support for less than 15% of the total refugee population. UNHCR, and the humanitarian community as a whole, need to shift their emphasis to help the vast majority of Syrians not in Zaatari.
This is also about alleviating Jordan's burden. Jordanian hospitality, official and private, has been exceptional, but inevitably the welcome is wearing thin. Tensions are beginning to rise in an already dire economic situation. The strains on local infrastructure and services, not least already scarce supplies of water, are growing rapidly.
There is also an urgent need to do more to protect the most vulnerable, particularly women and girls. Many endured terrible things in Syria before they left. We need to make sure they are safe now. In the refugee-inundated border city of Ramtha, where the IRC has set up a health centre for Syrians, patients described the challenges they face. Help is unpredictable. Psychological scars are deep and unaddressed. Most are living in poor and crowded conditions, paying rents they cannot afford. They are not remotely equipped for the approaching winter. Some are reluctant to register officially with the UNHCR for fear of repercussions on family members still in Syria if the lists find their way into the wrong hands.
Many children are missing school - despite the opening of local schools to them, places are hard to find in schools already running double shifts daily. Access to healthcare is difficult. Working is illegal, and badly paid at best if an informal job can be found. Families are panicky about the safety of their daughters, and even ready to agree to early marriage to protect them from perceived threats of dishonour or sexual violence.
The stories from refugees we met about what drove them out of Syria were harrowing - massive destruction from random shelling and bombing, arrests and torture, attacks on families, including rape, rapidly disappearing medical and education services, and dwindling supplies of increasingly expensive food. The picture was of a Syria much more badly destroyed than generally thought, and likely to emerge from war in desperate shape, whatever the outcome of the conflict.
The health situation seems particularly appalling: hospitals outside safe government-held areas have been bombed or closed, doctors have fled, and patients can no longer get to help even if any were available. Aid agencies are stepping up their efforts to get fresh medical equipment and supplies into the country, without the cooperation of the government if necessary, relying on the help of brave Syrian doctors and volunteers inside and outside the country. But it is so far only a drop in the ocean.
Contingency planning is under way to face the possibility of a much bigger exodus as the war continues, or when its end allows people to move as they feel they have to. But this planning needs to be speeded up. Specific risks need to be factored in, not least the danger of a sudden movement of the half million Palestinian refugees caught in the conflict in Syria - Jordan is particularly concerned about the potential destabilising effect on its own society and politics, as well as the cost, were they to seek refuge within its borders.
International attention is understandably riveted on the desperate military and political struggle going on inside Syria, and how outside powers should respond. The profound humanitarian fears and needs of the Syrians, those who have left as well as those who have stayed, should not be forgotten or neglected in the meantime.