As we drive through the countryside of Syria's north-west Idleb governorate, we pass many villages devoid of life. I see buildings riddled with bullet holes and holed by shells. Part of an apartment block has collapsed.
I am part of a UN mission that took place earlier this month to assess the humanitarian situation in Idleb, in particular the city of 1.5 million people, where it is estimated that up to 70% have been displaced from the surrounding countryside. With me are colleagues from WFP, UNHCR, IOM, UNDP, OCHA, and UNDSS.
Further on, a concrete overbridge lies broken and tangled, but we are able to nudge by.
Widespread conflict
One look at OCHA's "humanitarian snapshot" map of Syria for September tells the story very starkly. On this map, almost the entire governorate of Idleb is coloured light orange, signifying clash areas between January to July of this year. A few darker blobs indicate clashes in August. The map also shows that an estimated 430,000 people are in need in the governorate. Many families have been displaced by the fighting to neighbouring Lattakia governorate, have crossed the border with Turkey, or live in makeshift camps near the border.
Supplies get through
Although UN supply convoys had been able to get through the fighting and be distributed by local partner organisations, this was one of the few times in the past two years that it was considered safe enough for UN staff to travel to Idleb. The mission represented an opportunity to talk to partners directly and address the scale up of humanitarian assistance.
Local people were happy to see us, but surprised that we had made it through: "How did you manage to get here?" was a common question.
In contrast to the rural areas, the parts of the city I saw looked normal, with no damage to buildings. People moved around and there was a bustling market like in any city. The city's infrastructure is creaking, however, due to the huge influx of displaced families.
Shelters for displaced families
The mission team visited two shelters, one at a sports stadium and the other at a school. Each hosts up to about 40 families. The community organise cleaning and the local authorities provide support, but the shelters were not built for people to live in - they are far from comfortable and there is little privacy. The lack of toilets and bathing facilities sees up to six families sharing a single toilet.
Health needs
There is a lack of health care, with only one functioning hospital in the city. UNICEF's partner the Syrian Arab Red Crescent (SARC), runs two clinics providing essential medical services, including a mobile clinic servicing the shelters. Diarrhoea and upper respiratory tract infections were reported to be common in children, as was lice.
UNICEF supplies provided recently include more than 2,100 family hygiene kits, 6,200 baby hygiene kits, 369 First Aid Kits, and 200 boxes of Permethryn shampoo. A cold room has also been provided to support local vaccination services, which are able to continue near normally.
Water-related issues
The city water system is functioning, although UNICEF and ICRC provide tons of chlorine to the water authority. UNICEF has also provided five large water storage tanks, water pumps, and generators.
In rural areas, where water networks have broken down, people have little option but to dig traditional wells, relying on untreated water. A typhoid outbreak occurred last month in the north-west of the governorate, with 345 cases reported during the second half of September. Although information is patchy at best, any outbreak is treated extremely seriously. Preventative measures are essential to stopping the spread of potentially contagious disease. UNICEF has recently provided 200,000 aqua tabs for household water purification.
Although the garbage collection system is still operating and the streets look clean, there is a hidden menace. All five of the city's sewage treatment plants are out of order. Instead of being treated, the sewage is simply dumped, which causes environmental pollution and potential contamination of ground water.
Schools badly affected
I saw many children going to school carrying their UNICEF school bags, of which tens of thousands have been distributed in the governorate, but not all children are able to get to school. Of the 1,500 schools in Idleb governorate, education authority figures show that more than one in three schools are either completely out of service due to damage or used to shelter displaced families. A further 350 schools are partially operational, with some of the school space used as a shelter.
Apart from allowing the UN agencies to see the humanitarian situation first-hand, the mission also pointed to many urgent needs. For example, parents I spoke to, pointed to the need for winter clothing for their children as a top priority. UNICEF has provided 7,400 blankets, 3,000 children's winter sweaters, and 700 sets of children's clothing, but much more is needed as winter approaches.
For more information: www.childrenofsyria.info