This rapid literature review examines the lessons learned in terms of providing humanitarian access and protection for civilians in besieged areas. The focus is on the following besieged areas: Syria (e.g. Raqqa, Aleppo, Deir-Ez-Zor and Eastern Ghouta), Hudaydah in Yemen and Mosul in Iraq. The recent literature is dominated by the conflict in Syria while there is very little in-depth analysis of humanitarian access in Hudaydah or Mosul. This review utilised grey literature produced by research organisations, Non-Governmental Organisations (NGOs) and humanitarian organisations as well as academic literature on humanitarian access. The findings reported in the literature were based on case study analyses which encompassed in-depth interviews with humanitarian actors and victims of conflict.
The Syrian conflict is distinct because of the notable presence of diaspora organisations and local humanitarian actors who are able to use their local knowledge and personal connections to
gain access (Haddad & Svoboda, 2017). Consequently, the prominence of non-traditional, local humanitarian actors as providers of aid and access has grown in Syria. In contrast, the literature
on humanitarian access in Yemen is focused on high-level humanitarian diplomacy aimed at the Saudi coalition which is restricting access to Hudaydah port, the main conduit for food, fuel, aid
and medical supplies (Coppi, 2018; WHO, 2018). Apart from one study of trauma units in Mosul, this review did not find recent literature on humanitarian access in this area.
The following key findings with regard to humanitarian access in areas under siege emerged from the literature review:
- In besieged areas access has to be negotiated with a number of Non-State Armed Groups (NSAGs) (Haddad & Svoboda, 2017);
- There is a concern that humanitarian principles may be compromised during negotiations with NSAGs (Carter & Haver, 2016). For example, the perceived neutrality and independence of humanitarian actors may be undermined;
- Humanitarian organisations do not negotiate with armed groups which are classified as terrorist organisations and cannot gain access to areas under the control of such groups (Grace, 2017);
- Local humanitarian actors play a prominent role in delivering aid and negotiating access with NSAGs in Syria (Haddad & Svoboda, 2017). The World Health Organisation is working in partnership with local NGOs in Hudaydah (WHO, 2018);
- Remote programming is becoming the norm as international non-governmental organisations are based across the border and liaise with local partners on the ground. Diaspora organisations such as the Syrian American Medical Society Foundation provide training, patient monitoring and even guided surgery via webcams (Haddad & Svoboda, 2017). The World Food Programme has expanded its beneficiaries through remote programmes (Coppi, 2018);
- Private for-profit healthcare providers were utilised to provide trauma relief during the battle of Mosul (Spiegel, Garber, Kushner, & Wise, 2018); and
- The literature repeatedly emphasises the role of humanitarian diplomacy for securing humanitarian access and protection of civilians in besieged areas.
- Many women and girls are trapped in besieged areas and there is an urgent need for prenatal and antenatal medical services (Coppi, 2018). Conservative NSAGs were reluctant to provide access for humanitarian initiatives which targeted women and children or demanded that only female medics treat women. The community can occasionally pressure these NSAGs to make concessions so that services are available to women and girls (Haddad & Svoboda, 2017).