A previous version of the map accompanying this article incorrectly showed subdistricts in the northwest of Syria under control of the Syrian government. The graphic has been corrected.

CONTROL ZONES
Government
Hayat Tahrir al-Sham
SDF
Contested
Turkish forces
Very strong shaking
Light
Strong
Moderate
TURKEY
7.5-magnitude
earthquake
Batman
7.8-magnitude
earthquake
Mardin
Gaziantep
Adana
Al-Hasakah
Afrin
Aleppo
Raqqa
Idlib
Hama
Al-Quriyah
SYRIA
Tartus
Homs
Damascus
IRAQ
Amman
JORDAN
100 MILES
Areas of control as of July-September 2022
Source: USGS, ACLED
SAMUEL GRANADOS / THE WASHINGTON POST

CONTROL ZONES
Government
Hayat Tahrir al-Sham
Turkish forces
SDF
Contested
Very strong shaking
Strong
Moderate
Light
7.5-magnitude
earthquake
TURKEY
7.8-magnitude
earthquake
Batman
Mardin
Sanliurfa
Osmaniye
Gaziantep
Adana
Al-Hasakah
Afrin
Mosul
İskenderun
Aleppo
Raqqa
Idlib
Hama
SYRIA
Al-Quriyah
Tartus
Homs
LEB.
Beirut
Damascus
IRAQ
ISRAEL
Tel Aviv
JORDAN
Amman
Jerusalem
100 MILES
Areas of control as of July-September 2022
Source: USGS, ACLED
SAMUEL GRANADOS / THE WASHINGTON POST
The Syrian government has been sending the fighters and civilians from the areas it reconquered to the already impoverished Idlib province, up against the border with Turkey, and the region is now swollen with the displaced. In addition to regular shelling by government forces, disease was already ravaging the area.
Restricted access
This corner of land heavily relies on aid — even before the earthquake, 4.1 million required humanitarian assistance, according to the United Nations. This assistance is hampered by restrictions imposed by the Syrian government, which also disallows some international organizations from accessing the area. Aid must also be approved by the Turkish government, as it flows to the rebel-held pocket only through the Bab al-Hawa crossing on the Turkish border.
“But Turkey is now completely overwhelmed with dealing and helping their own people that we cannot realistically expect to prioritize focusing on facilitating aid to the Syrians,” said Mark Lowcock, former head of U.N. humanitarian affairs.
Delivery of aid to the enclave has been dependent on a vote every six months by the U.N. Security Council, but in 2020 Russia forced all the aid border crossings to close except for Bab al-Hawa, describing the aid as a violation of the sovereignty of its ally, the Syrian government.
Fears mount every six months that Russia will veto the final crossing, which the United Nations deems the only viable route to deliver lifesaving aid, including food, water, shelter and medical assistance.
Now with the earthquake, the roads to Bab al-Hawa are severely damaged and the cross-border response has been disrupted, according to the U.N. Office for the Coordination of Humanitarian Affairs, citing local sources. The road connecting the city of Gaziantep to the crossing is in one of the most damaged areas and is currently inaccessible.
Donor fatigue
International nongovernmental organizations have been providing assistance to Idlib and surrounding areas for years. But because of what United Nations officials have dubbed “Syria fatigue,” donations have dwindled and attention has turned elsewhere, especially following last year’s Russian invasion of Ukraine.
The past humanitarian efforts had been stopgap measures at best, leaving little to no room for emergency preparedness if a natural disaster took place.
“You are compounding an already extremely difficult situation where agencies were already up to their eyes trying to prevent famine, and child disease,” said Lowcock, adding that opposition-held areas appear to be the worst damaged in Syria. The government has a long “track record of resisting and trying to prevent people from going through,” he said.
Lowcock said solutions include donations to the White Helmets, a British- and American-supported civil defense outfit whose members have worked tirelessly since the earthquake, digging out dead on their own. The United Nations also must expand aid mechanisms from Turkey, and build international pressure on Syria so that the government removes restrictions, he added.
The White Helmets have since announced that Britain will release an additional $967,000 to support them and that the U.S. Agency for International Development has been in touch about how it can “fulfill the most urgent response needs.”
Lowcock was not optimistic that the Syrian government would facilitate access for international organizations, however, given its track record of “not wanting people to be in places they do not control.”
Syria’s northwest has long been suffering from regular bombardments — the latest raids were in January. Cholera has swept the area because of a lack of access to clean water. Now the earthquake has wiped out internet and electricity, and destroyed already rickety shelters.
“For sure you don’t have the international support [you have] with teams deployed in Turkey,” said Fabrizio Carboni, the regional director for the Near and Middle East at the International Committee of the Red Cross. “That means most people dying. It’s not a complicated equation to solve.”
Humanitarian access “is politicized” — especially in northwest Syria. “We don’t have access to the area of Idlib,” said Carboni.
The International Rescue Committee’s director of emergency preparedness and response said the border crossings available are “insufficient,” and the IRC had been demanding increased access — the difficulty of the task compounded by the widespread damage to infrastructure, buildings and roads from the earthquake.
Foreign sanctions
On the other side of the equation are areas held by the government of President Bashar al-Assad, facing U.S. and European sanctions. Foreign governments and many international aid groups avoid routing aid directly through the government, which they have sanctioned for war crimes against its own people. The belief that aid would be pocketed by war profiteers and Syrian officials is widespread.
The U.S. set of sanctions, known as the Caesar Act, aims to force the government to stop its bombardment and halt widely documented human rights abuses. “The Caesar Act and other U.S. Syria sanctions do not target humanitarian assistance for the Syrian people or hinder our stabilization activities in northeast Syria,” the act reads.
On Tuesday, the Syrian government challenged this claim. Its Foreign Ministry placed blame squarely on these restrictions, saying Syrians were resorting to “digging sometimes through the rubble by hand, because tools for removing rubble are prohibited for them, and they’re using the simplest, old tools … because they are punished by the Americans, who are blocking them from the needed supplies and equipment.”
The Syrian government often places the responsibility of much of its woes on international sanctions in an attempt to divert Syrians’ anger to outside forces.
On Tuesday, the director of Syria’s Red Crescent, Khaled Hboubati, called for the removal of sanctions “to deal with the effects of the devastating earthquake.” He said Syria needs heavy machinery and ambulances and firetrucks to continue its search and rescue operations and clear rubble, “which requires removing sanctions on Syria as quickly as possible.” He said there were between 30 and 40 ambulances responding to the disaster.
“We are ready to send … a caravan of aid to Idlib,” Hboubati said, and asked the European Union and USAID to help.
Charles Lister, the director of the Syria program at the D.C.-based Middle East Institute, dismissed Syria’s calls to lift sanctions as another “opportunistic regime talking point,” adding that the sanctions have “no effect in the delivering of assistance.”
Villegas reported from Washington. Louisa Loveluck in Baghdad contributed to this report.