Women and children sit at the waiting area in a clinic at al-Hol camp on May 28, 2019. About 49,000 of the refugees in al-Hol detention camp are children, and many are going hungry as conditions worsen. (Alice Martins for The Washington Post)

— At a makeshift clinic on the edge of this desolate camp, several dozen of the last and smallest inhabitants of the Islamic State’s self-proclaimed ­caliphate bawled and whimpered as they waited to see the only doctor on duty.

Shortages of food, clean water and medicine combined with the early arrival of the scorching summer heat have contributed to worsening conditions in the camp, which houses more than 73,000 family members of the Islamic State fighters who in March made their last stand in the Syrian village of Baghouz, the final sliver of the caliphate’s territory.

The vast majority of those family members — 49,000 — are children, and 95 percent of them are under the age of 12, according to Kurdish and U.N. officials.

It is the children who are suffering the most. They are falling ill by the hundreds, mostly with diarrhea, according to Ramadan Zaher, who manages the clinic for the Kurdish Red Crescent. Medical staff are also detecting a small but rising number of cases of severe malnutrition, he said, as the children pay the price for the choices their parents made.

They endured months or years of relentless U.S.-led airstrikes, were hustled from place to place under fire by their families as the Islamic State’s territory dwindled, and now face an uncertain future living indefinitely in what amounts to an internment camp, stuck in the desert, surrounded by barbed wire and armed guards.

Unwanted by their former communities and in many cases missing at least one parent, they are scarred by the terrors they have experienced. There are no schools in the camp, and the children remain vulnerable to the teachings of their surviving parents or guardians, who were among the staunchest holdouts of the Islamic State.  


Doctor Sino Antar examines Marwa, who is severely malnourished. (Alice Martins for The Washington Post)

Iman holds her little sister's foot while she waits to be seen by a pediatrician at al-Hol camp. (Alice Martins for The Washington Post)

Marwa's mother and sister wait for a stamp on a document she needs for her to be transferred to a hospital in Hasaka city. (Alice Martins for The Washington Post)

Many of the children arrived hungry, after months of living under siege. More than 300 died in the first weeks after the influx began in March, of hunger and injuries received in the fighting. Their bodies are buried on a bare hillside outside the camp, the tiny space they occupied in life marked by a only pair of cement bricks and little mounds of mud.  

Some were born hungry. Marwa, 2 months old, was lying immobile on an examination table, too weak to cry, her ribs jutting from her tiny frame. The clinic’s pediatrician, Antar Sino, gently raised her stick-thin arm to fit a color-coded tape measure around it. It slid to red, indicating, he said, that she was severely malnourished.

Sino said the clinic, a dingy concrete structure with few facilities, sees about four such children a day, mostly babies whose mothers don’t eat enough to produce milk. Marwa’s mother said she hadn’t produced milk since the baby was born, within days of her arrival from Baghouz, her five other children in tow. Their father was killed in the airstrikes.

The aid effort is beginning to ramp up. The International Committee of the Red Cross is in the process of opening a well-equipped field hospital. The World Health Organization is preparing to supply chlorine to improve the quality of the water.

Emergency cases such as Marwa are whisked by ambulance to a Syrian government-run hospital in the city of Hasakah. There, she recovered her strength, and is now back with her mother. But it is highly unusual for children to become so severely malnourished in a camp that is overseen by the international aid community, aid workers said.

That there isn’t enough aid is a function of the unexpectedly large number of civilians who had been hiding out with the Islamic State fighters in Baghouz. Aid workers had been told to prepare for an influx of about 10,000 civilians; instead, more than 60,000 came, joining about 9,000 mostly Iraqi citizens who were already living in Al-Hol after fleeing fighting just across the border in Iraq, said Amjad Yamin of the Save the Children Fund.


A woman cleans the clinic at al-Hol camp. (Alice Martins for The Washington Post)

Women and children sit at the waiting area in a clinic at al-Hol camp. (Alice Martins for The Washington Post)

Women stand at a registration office at al-Hol camp, looking for documents in their phones they need to print to apply for permission to leave the camp. (Alice Martins for The Washington Post)

About 8,000 of the children now living in the camp are foreigners — from dozens of countries around the world — who were either born in the caliphate or relocated there by their parents. Several hundred of those appear to have no surviving parents at all. But even camp officials aren’t sure who all the children are — orphans have been taken in by parents who lost their children, and some are either too young to know where they’re from or speak no languages understood by local staff, Yamin said. 

Foreign governments have begun, reluctantly, to repatriate some of the orphans — including Norway, Uzbekistan and Sweden. The United States flew six children and two women back to America this month. But for the most part, foreign governments are refusing to countenance the return of the vast majority of the children and their mothers, said Abdulkarim Omar, head of the foreign relations department in the self-proclaimed Kurdish administration that governs the area of northeast Syria where the camp is located. 

An additional 20,000 children are Iraqi, and the administration was hoping that the Iraqi government would take them back, Omar said. But only 5,000 Iraqis have volunteered to return to their home country, and the administration won’t force them to go back, he said.

Almost all of the adult residents are women who escaped with the children earlier this year. Their husbands are either dead or among more than 6,000 Islamic State fighters who are being detained in prisons by the Kurds.

The mothers of the sick children seem unrepentant, however. A German convert to Islam who had brought her 18-month-old daughter to the clinic because she had been suffering from diarrhea for weeks lamented the poor conditions, and especially the lack of medicines to help the children. Most are just given dehydration salts and sent on their way, she said. “There’s no family without sick children,” she said.

The woman, who declined to give her name, said she does not regret traveling to Syria to join the Islamic State. “In Germany you see drinking everywhere, drugs everywhere, television that destroys your mind, and I don’t want my children to grow up with this,” she said. 

Her 4-year-old daughter, who was born in Germany, sucked her thumb at her mother’s knee, her face and hair caked with dust. The sick baby fretted and fussed in the woman’s arms.


A blanket marks the grave of a small child who recently died in al-Hol camp. (Alice Martins for The Washington Post)

Kamiran Sadoun contributed to this report.