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Cover story

Changing region, changing lives

Dania Amroosh wears a Hello Kitty shirt, tiny heart-shaped earrings and her hair in cute little pigtails. She looks like any other 7-year-old, except for the jagged scars on the bridge of her nose and across her chin.

There is much worse beneath her blanket on the third floor of the Kilis State Hospital in southern Turkey. A huge seeping wound on her stomach is closed with an angry grid of stitches. The casts are finally off her broken right leg and right hand, but her fingers are still black and blue and she can barely walk. Her lower body is covered with shrapnel scars.

Five months ago, Dania and her family were sitting in their home in Aleppo, Syria, about 60 miles south of here, when a bomb dropped from the sky. Her grandmother, aunt, uncle and two cousins were killed instantly. Another cousin lost his legs. Dania was mangled.

Mohammad Amroosh, her father, says that after what Syrian President Bashar al-Assad's military did to them, he can't go back. When Dania is ready to leave the hospital, the family will stay in Turkey, joining nearly 700,000 other Syrians who have taken shelter in the country.

"This is our home now," he says.

[Explore the Syrian refugee crisis in this high-resolution map.]

One of the world's largest forced migrations since World War II is transforming the Middle East.

The United Nations and governments in the countries where the refugees have taken shelter estimate that between 2.3 million and 2.8 million Syrians have fled their homeland. The United Nations says that number is rising by nearly 3,000 people a day, with no end in sight for a conflict that has lasted nearly three years.

The cost of the Syrian civil war continues to rise beyond the estimated 125,000 people killed and the tens of thousands maimed. The massive influx of refugees into neighboring countries - especially Lebanon, Jordan and Turkey - is crippling fragile economies and damaging delicate political and religious balances in the region.

"These places will never be the same," said Helen Clark, former prime minister of New Zealand, who now spends much or her time in the region as head of the U.N. Development Program. "Many of these people will never go home."

U.N. officials estimate that a third or more of the people living in Lebanon will soon be Syrian refugees - 1.6 million in a country with a prewar population of just 4.4 million people - or, as Clark said, "the equivalent of the entire population of Mexico taking refuge in the U.S."

Competition for homes, jobs and government services has created anger that regularly spills over into protests, even as most people welcome their neighbors in need.

Host countries are spending billions building schools, hospitals, water and sewage systems, power plants, roads and housing to cope with the population surge.

Refugee camps increasingly look like permanent cities, with local governments, schools, hospitals, mosques, supermarkets and Internet cafes.

A new generation is rising in the camps with the births of thousands of children. Arabic-speaking Syrian children are learning Turkish in school to prepare for a life in exile.

As of Nov. 25 There are 2,256,296 Syrian refugees.

1,000 refugees

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Jordan's Zaatari refugee camp, with 120,000 people, is suddenly the country's fourth-largest city. A new camp under construction deep in the desert is expected to be even bigger. Rather than tents and trailers, it has steel-framed buildings, an acknowledgment that the crisis will last many years.

More than three-quarters of the refugees live outside of camps, renting apartments or garage space, finding shelter in abandoned buildings or constructing homes on vacant land. The population of many towns has doubled or tripled virtually overnight.

While many of those fleeing are destitute, large numbers of Syrian professionals and business leaders have left, too. They are buying, renting or even building high-end real estate in Beirut, Amman and Istanbul.

Rising demand has driven up rents across the region, in many cases forcing local people out of their homes. Some Jordanian families are living in U.N. tents meant for Syrian refugees. The region’s worst winter storm in years has added to the misery in recent days. Refugees who have flimsy shelters, no source of heat and little warm clothing are now being forced to cope with freezing rain and snow.

Cross-border trade has been devastated. Farmers who used to ship goods to Syria, or across Syria to Saudi Arabia and other big markets, have suffered major losses. Tourism is down in Jordan and Lebanon, where large numbers of Syrians are now begging on the fashionable streets of Beirut.

A recent World Bank report said that between 2012 and 2014, the Syrian crisis is likely to cut the growth of Lebanon's gross domestic product by 2.9 percentage points annually, costing billions in lost economic activity. The report said increased competition for jobs is forcing down wages and could double the jobless rate among Lebanese workers to more than 20 percent. All those factors, the report concluded, are likely to push at least 170,000 more Lebanese into poverty, adding to the 1 million who are already there.

The Turkish government has spent more than $2.5 billion to care for refugees. Syrian patients are now the majority in many hospitals and clinics. Schools are running two or three shifts a day to keep a generation of Syrians from going uneducated.

Across the region, services such as electricity, sewage and garbage collection are stretched to the breaking point. Water is scarce; in Jordan, which has less renewable water than almost any other country, hundreds of thousands of new people are draining overburdened aquifers at an alarming rate.

Jordanian officials said it will cost $1.7 billion to continue housing the nearly 600,000 refugees in the country, including the construction of power plants, sewage treatment plants, hospitals and 120 schools in the coming months. That is equal to nearly 18 percent of last year's total national budget. Jordanian officials said refugee spending will jump to $3.2 billion next year.

Before the Syrian war, Kilis was a quiet outpost of about 80,000 people on the Syrian border. Now its population is at least 130,000.

At Kilis State Hospital, with pretty, salmon-colored walls, surgeons have operated on Syrians at least 11,000 times this year, in five operating rooms that run nonstop. Bomb and bullet wounds account for most of the injuries.

More than 530 refugees have died in the hospital this year, and more than 1,500 Syrian babies have been born. Doctors keep photos of the grotesque wounds they have treated, including one that shows a fetus with a bullet wound to its foot.

The hospital's surgeons saved Dania Amroosh's life.

Her father survived the blast that maimed her, and he immediately started digging in the rubble for his family. Neighbors and rescuers arrived. Mostly he was finding dead bodies.

The details of that night come to him now in disconnected bits: Dania at an Aleppo hospital. Her stomach flayed. His daughter's intestines.

Doctors telling him to go to Turkey immediately. Kilis State Hospital was an hour away, just over the border. Dania's best chance was there. He rode with her in an ambulance. A phone call to his wife. Dania was in surgery. He was still in his pajamas.

"I didn't expect her to live," says Amroosh, who worked as a tailor in Aleppo. "I still can't believe what happened. Sometimes I think it couldn't have happened."

For five months, he has been sleeping on the floor in the hall, or sometimes outside on the grass. His son Mahmoud, 8, sleeps where he can find space.

They have no money. The hospital gives them food. Their only possessions are a few clothes stuffed into a small plaid bag.

Dania's mother, Ghada Amroosh, has slept every night in the armchair beside her daughter's hospital bed. She doesn't mind.

"After what happened, nothing is really difficult anymore."

Before the war, Lebanon's population was about 60 percent Muslim, with almost equal numbers of Sunnis and Shiites. The flood of refugees threatens to upset that delicate equilibrium.

The vast majority of the million or so Syrian refugees in Lebanon are Sunnis. That nearly doubles the number of Sunnis in a country where sectarian tensions are always high.

Hezbollah, the powerful Shiite militia backed by Iran, is already fighting alongside Assad's military. Many Lebanese see introducing into Lebanon a huge new population of Sunnis, most of whom hate Assad, as a potential disaster. In a sign of deepening sectarian fallout from the Syria crisis, suicide bombers killed 25 people in a Nov. 19 attack on the Iranian embassy compound
in Beirut.

Lebanese officials have chosen not to create formal refugee camps, fearing what happened the last time they did.

WHEN THE PALESTINIANS CAME IN 1948, WE THOUGHT THEY WOULD STAY FOR A COUPLE OF WEEKS.

Lebanon set up camps for Palestinians displaced in 1948 by the creation of Israel and that year's Arab-Israeli War. To this day, nearly 300,000 Palestinians live in a dozen refugee camps, which have evolved from tent encampments into permanent towns.

"This scares us to death," said Antoine Chedid, Lebanese ambassador to the United States. "When the Palestinians came in 1948, we thought they would stay for a couple of weeks."

Growing resentment about the large numbers of refugees has led to protests and occasional violence across the region. In Lebanon early this month, refugees said local villagers in the Bekaa Valley attacked an informal encampment where at least 400 refugees were living, torching tents and tearing down other makeshift structures.

Perhaps weary of war, maybe bewildered by and suspicious of the complex web of factions warring inside Syria, the world has been slower to donate help to Syrian refugees than it has in other recent catastrophes.

The United Nations, in the biggest appeal of its history, has asked for nearly $5 billion - about $3 billion for refugees and $2 billion for humanitarian aid inside Syria. About 62 percent of that has been raised. The U.S. government has provided about $1.4 billion in humanitarian aid.

Private groups said fundraising has been difficult. Save the Children has raised $1.6 million in private donations for Syrian refugees over the past three years. In the first two weeks after the recent Philippines typhoon, the group raised $6 million. After the 2010 Haiti earthquake, it raised more than $26 million in six months.

"Unlike a sudden natural disaster, which elicits sympathy, this is a complicated and protracted crisis, so it's difficult to capture and sustain public attention," said Michael Klosson, a Save the Children executive. "There's no clear sense of who the 'good guys' are. It seems like yet another conflict in the Middle East and is easy to ignore."

Relief officials are worried because the crisis is getting worse.

The United Nations says 6.5 million Syrians have been forced out of their homes and have taken shelter inside Syria, often with relatives in rural villages. Nearly 3 million more are in need of food, medicine and other assistance. That's about 9.3 million people - closing in on half of Syria's 22 million pre-war population - who are already vulnerable or homeless.

Andrew Harper, who heads the U.N. refugee agency's office in Jordan, said 400,000 internally displaced Syrians are living within 36 miles of the Jordanian border - which could mean a new tsunami of refugees at any time.

"I pray that I will be proved wrong and that the conflict in Syria will be resolved and those who are now displaced will be able to return home," Harper said. "But do you honestly see that happening anytime soon?"

Five months after the bomb, Mohammad Amroosh still has a slightly dazed look in his eyes. He paces the hospital hallways to pass the time. Ever the tailor, he wears smart black pants and a stylish black-and-blue-striped dress shirt. The only time he smiles, faintly and briefly, is at a compliment about his style.

He said he left Syria only after three of Assad's bombs had decimated his life there. About 18 months ago, a bomb devastated his family's home, so he moved in with his parents. Last year, his tailor shop was destroyed. Then in May came the attack that maimed Dania.

He thought about leaving Aleppo after the earlier attacks.

"But my parents were old and they refused to get out," he says. "I couldn't leave them, and I stayed with them to the end."

As he speaks, Dania steps up out of bed and tries to walk, but it is obvious she can barely put weight on her crushed right leg. She will probably need at least one more surgery and months of physical therapy.

Asked what she misses most about home, she answers in her tiny voice: "My toys."

She smiles at the memory. She describes them as her "children."

"There were lots of them. They were living in my room, and I lined them up on a shelf," she explains. "They never slept or ate anything, but they were always hungry!"

Her father rubs his eyes and listens to his little girl talk about her lost home.

He walks out into the hallway.

"In one miserable night we found ourselves here," he says. "Maybe one day we will find ourselves back in our city."

He doesn't seem convinced. He looks out the window into the empty, brown fields beyond the hospital walls. It is not his land.

But it is now where he lives.

Every day, about 3,000 Syrians leave the country.

Since you started reading, roughly ## Syrians have left the country.