Since 2011, Syria’s Idlib governorate has suffered heavy bombardments and fierce clashes between rebel forces and soldiers loyal to Bashar Al Assad.
But the overcrowded governorate, home to at least three million displaced people, is facing another crisis: there is not enough drinking water.
Recent years have seen the bombing of hospitals in rebel-held parts of the country, part of a concerted strategy to make towns and villages unbearable places to live, displacing millions of civilians so that government forces can retake them more easily.
But water infrastructure has also been destroyed – in June 2019, eight water facilities in southern Idlib were bombed in the space of two months, affecting 250,000 people.
The ongoing war, and a stand-off between militant group Hayat Tahrir Al Sham that controls the governorate and Al Assad's forces, mean that repairing damaged facilities has been slow.
Climate crisis and war combine
Climate change is worsening the problem: northern Syria is experiencing one of its worst droughts in recent memory: in early November, Duwaisat Dam reservoir, a key source of water for Idlib, was all but dry.
Millions of people in the province have been reduced to drinking contaminated or disease-ridden water.
“Since we were displaced from our village to the camp, the pain in my flank has become unbearable. The doctor told me that lime water has the worst effect on me, I have to purchase pure drinking water every day”.
Khalda Sultan, 67, lives in the station camp in north-west Idlib. She has developed a disease in her kidneys since being displaced from her village due to her use of water stored in containers.
The NGO Doctors Without Borders said last month that many charities were cutting back operations to truck in fresh water, due to funding problems.
“We were affected significantly. The water in the containers could be used for washing but it is not proper for drinking”.
She said they used sterile water for drinking only and not for cooking, to limit their dependence on it.
“I have to buy it despite my miserable financial status as my health requires it. I need six litres per day at least,” she says.
She adds that the majority of the camp’s inhabitants use the lime water stored in containers for drinking because of the increasing price of sterile water.
“One package of pure water costs $1.25 that could only last two days,” she says, a financial burden that is too great for many displaced civilians with no income.
In a horrible irony, a recent downpour has barely helped because there is no camp has the infrastructure to clean the runoff, which gathers in filthy pools across the nearly 2,000 refugee camps in the governorate.
According to Abdulsalam Yusuf, the manager of Alteh camp, some inhabitants gather rain water by setting pieces of canvas between the tents.
"We use rain water for drinking and cooking and it's better than tanks of water because it contains less percentage of lime," he says.
"Not all camps could gather this water," according to Fateh Sbieh one of the inhabitants of Aqrabat camp on the Turkish-Syrian border. Tent roofs are "often full of holes and water may not be gathered", he says.
"Some camps are built as concrete structures with a roof, like a house so it's possible to install water pipes and lead them to barrels."
Drinking water in camps
A growing problem is that dwindling water supplies from the Euphrates, due to upriver Turkish dam construction and climate change, is that pollution has become more concentrated in smaller volumes of freshwater, according to nutrition specialist Shokran Al Qadhi, who works at a clinic in Idlib.
“Pollution has resulted in strange materials getting mixed with water such as rubbish, corroding metal, chemical substances, fertilisers, bacteria and viruses”.
Mr Al Qadhi said chemical pollution from oil and petrol is also a risk. In hot weather, bacteria and viruses also thrive in rainwater that has been crudely harvested in the camps.
The specialist adds that polluted water has direct effects – through drinking, and indirect effects through eating contaminated food prepared with polluted water.
“Symptoms could be mild such as diarrhoea, intestinal infection, vomiting or they could be serious such as cholera, typhoid, schistosomiasis, salmonella, or dysentery”.
For elderly or vulnerable people, or children, these conditions can be fatal.
Dr Khaled Al Swied works in Sams hospital in Idlib. He says that water pollution could result in disorders in the immune system and the formation of agonising kidney stones and conditions related to rust contamination.
“I think the polluted water in camps must be sterilised by chlorination,” he says, describing a wave of cases of “intestinal and urinary infections and hepatitis”, that have become endemic in the camps.
Idlib city besieged
Drinking water is provided daily in Idlib city, according to Adel Mara’e, the co-ordinator of water, sanitation and shelter sector at IYD, a Turkish NGO, but capacity to provide the vital resource could soon be overwhelmed.
Mr Mara’e says that a person's share of water in general must not be less than 75 litres per day and 15 litres in emergency situations.
“In Idlib, we provide 40 litres of chlorinated water per individual,” she says.
IYD runs six groundwater substations that pump water to the city. Mr Mara’e confirms that IYD, along with other organisations, are working on covering 100 per cent of Idlib’s drinking water after sterilising it with a safe level of chlorine.
But local NGO’s fear that Idlib city’s inhabitants could swell to 500,000, from a current population of 130,000, especially as violence increases in the countryside around the city.
This is a highly precarious situation because IYD, as well as other NGOs working in water and sanitation do not have secure funding.
“Each Syrian is thinking of going abroad due to the miserable financial and service conditions,” according to Ghassan Dno, who lives in Idlib.
“Water, electricity and roads – if there would be better services many people would change their mind in going abroad”.
Mr Dno says that current water supplies are barely enough for him to fill the 1,900-litre tank in his house, although he has cut down on his consumption.
“I consume water carefully because I don’t want to pay extra expenses, plus I struggle to fill it and it could easily be polluted,” he says.
“We can’t offer to buy drinking water because it is so expensive and I would prefer to buy other things that are more important”.
Mr Dno says he is afraid of kidney stones and the agonising pain they could cause, not to mention the high medical bill for removing them.
But as NGOs like MSF and IYD question the sustainability of funds for providing fresh water, Mr Dno may soon have little choice but to drink the water which could make him, and millions of others, seriously ill.