In Syria, hundreds of thousands of civilians are being intentionally denied basic necessities such as food, water, and medicine as part of a cruel tactic of war. Long-term sieges of populated areas – some of which have been ongoing since 2012 – have had a devastating impact on the people trapped inside. Hundreds of deaths have been recorded from preventable causes such as starvation, dehydration, and a lack of basic medical care. Many of the victims are children. The international response to the long-term sieges of civilians in Syria has been entirely inadequate.

There have been no successful international efforts to end the sieges, and attempts to ameliorate their impact by sending in humanitarian aid have been woefully insufficient since they remain completely dependent on the besieging party for approval. Slow Death is a report by the Syrian American Medical Society (SAMS) that documents life and death in the besieged areas of Syria and examines the international response. New information presented in this report indicates that the scale of the crisis of civilians under siege in Syria is far greater than current UN OCHA estimates suggest. SAMS estimates that that there are more than 640,200 people living under long-term siege in Syria, more than three times the current UN OCHA estimate of 212,000.

This report utilizes SAMS’s networks on the ground to give a detailed overview of what life is like in the besieged areas. It describes the strategies that people use to survive under siege, and the ways that they die. Particular attention is paid to the way in which the sieges have caused the complete collapse of local health care systems and forced the remaining doctors to practice in primitive conditions. This qualitative picture of life under siege is reinforced with a dataset that contains information on 560 civilians who have died prematurely in besieged areas. Analysis of this data confirms that the physical impacts of siege disproportionally impact children and the elderly.

Graphing these deaths over time provides a visualization of the course of the sieges, which began to be implemented in a systematic manner in mid-2013. One hundred percent of the recorded deaths under siege were in areas besieged by the Syrian government. As of February 2015 the UN Secretary-General’s reporting officially recognized 11 besieged areas in Syria with a combined estimated population of 212,000. With no independent statics regularly available, these UN figures have come to play a critical role in framing the international community’s understanding of the siege crisis in Syria. The information presented in Slow Death indicates that the actual number of people living under siege is more than 640,200. The report also identifies 38 additional communities that meet the definition of Besieged but have not been designated as such by UN OCHA in the monthly Secretary-General’s reporting. Gathering this type of ground-level information in Syria is incredibly difficult due to access restrictions, and UN OCHA and other agencies deserve tremendous credit for taking on this task each month. Their important work has continued to highlight the plight of civilians trapped in horrendous conditions across the country. At the same time, SAMS believes that the current UN OCHA estimates are too low and their list of designated Besieged communities is incomplete, which means that the UN reporting may inadvertently downplay the magnitude of the crisis.

Slow Death describes how local ceasefire agreements do not always coincide with the end of a siege and presents examples where the UN has either failed to include or prematurely removed an area from its Besieged list based on the conclusion of local ceasefire negotiations. Among these examples is the current case of Moadamiya al-Sham in Rural Damascus, which was recently removed from UN OCHA’s Besieged list despite the fact that the remaining population continues to be deliberately deprived of humanitarian essentials and attacked by the Syrian government.

Read the Arabic version here.