A humanitarian crisis is erupting in northeastern Syria as tens of thousands of people who fled intense fighting in last month’s decisive battle against the Islamic State are flooding into a desperately overcrowded tent camp atop a rocky hill here.

More than 73,000 people, mostly women and children, are now packed into the sprawling al-Hol camp, under the control of U.S.-backed Kurdish forces. The camp, which opened in 1991 to host Iraqi refugees from the Persian Gulf War, was originally designed to hold barely half that number.

Amid a sea of white tents, thousands sleep in communal spaces, and children defecate outside. The war wounded are often left untreated. Thousands more are malnourished. There are just three mobile clinics at the camp, and local hospitals are swollen with patients critically wounded in the war. Those with non-life-threatening injuries often are given painkillers or antibiotics and sent on their way.

Last week, 31 people died on the way to the camp or shortly after arriving because of traumatic injuries and malnutrition, according to the International Rescue Committee, bringing the total number of such deaths to 217.


The al-Hol camp has dramatically increased in size in recent months to cope with new refugees as well as families of captured Islamic State fighters. (Bulent Kilic/AFP/Getty Images)

The al-Hol camp Sept. 25, 2017. (Maxar Technologies)

The camp on March 31, 2019. (Maxar Technologies)

Along the camp’s dirt roads, recently muddied by a downpour, amputees struggle without wheelchairs or crutches. Children, who make up 65 percent of the camp’s residents, haul injured or elderly relatives in makeshift carts fashioned from tarp.

The massive and rapid influx of civilians — including Syrians, Iraqis and thousands of other foreigners who flocked to the Islamic State’s so-called caliphate — caught aid agencies and local authorities off guard. Now, they say, they are scrambling to respond.

“It’s an emergency, an acute crisis. There are a lot of people arriving at the same time, lots of people we didn’t anticipate, and we’re needing to rapidly scale up,” said a senior aid official coordinating international assistance who spoke on the condition of anonymity to discuss the sensitive nature of operations at the camp.

Kurdish-led fighters — known as the Syrian Democratic Forces, or SDF — declared military victory over the Islamic State last month, following a brutal offensive to capture the militant group’s last foothold in the eastern Syrian village of Baghouz. While that village was just a small sliver of the once vast “caliphate,” there were an estimated 66,000 people still under the militants’ control there.

During the military operation in Baghouz, the SDF set up screening centers to separate the men, including suspected Islamic State militants, and sent them to detention centers in cities in northeast Syria. Women and children were transported to al-Hol.


Foreign women stand in line in a new annex of the al-Hol camp. They are under constant watch by the SDF forces. (Delil Souleiman/AFP/Getty Images)

Foreign women and children are housed in a separate annex at the camp, where they are watched over by armed guards and must be escorted when they visit other areas of the camp. The segregation was imposed because of tensions between the foreign women, who are seen as more radical, and the camp’s Syrian and Iraqi residents, many of whom fled the Islamic State.

“While hostilities in Baghouz appear to have ended, the crisis is far from over,” Corinne Fleischer, a U.N. official in Damascus, said in a statement. “We still don’t know whether more people will arrive.”

The United Nations this
week announced an additional $4.3 million in funds for “lifesaving assistance” for al-Hol, including tents, blankets, personal hygiene items and other supplies for medical care. There are also plans to build at least one field hospital.

But the enhanced medical facilities may not come soon enough.

“Please, look, my child is very sick. She needs to go to the hospital,” pleaded a veiled woman, Nazila Arkan, as she clutched her emaciated daughter. Arkan, 30, said that she was from Turkestan, a term used to describe parts of Central Asia and Muslim areas of western China, and that she was recently displaced from Baghouz.

Camp officials say they fear everything from the spread of infectious diseases to sexual violence against minors and hostility from camp residents still loyal to the Islamic State.

“We need to get the solid-waste management, sanitation [and] water situation under control to avoid any public health risks,” the senior aid official said.

“But the biggest challenge we have is just this very frustrated population. There’s no clarity about their movements or how to leave,” the official said, adding that the foreign women at the camp pose a particular challenge for aid workers and authorities.

“They are super angry because there’s no solution in sight,” the official said of the roughly 9,000 foreigners, who come from countries such as France, Germany, Russia and Ukraine. “It’s a big, ticking time bomb.”

Many of those who recently arrived at the camp are still die-hard followers of the militants’ ideology, and some have refused help or attacked security forces and staff. Western donors, too, are concerned about providing families linked to the Islamic State with cash and other assistance, aid officials and camp authorities say.

“Some NGOs have said, ‘We won’t help them,’ ” said Dilovan, a Kurdish security official at al-Hol, who declined to give her full name for security reasons.

“So there are constant shortages — of food, water, medicine,” she said. “These shortages have an impact, and people get angry. And they cause us security problems.”

Perhaps the biggest challenge is still ahead: figuring out where all of these people ultimately will go — and when.

But in the meantime, every day poses myriad emergencies.

A kerosene heater ignited a fire in one of the canvas tents on a recent day, and three Iraqi children were severely burned. They were transferred to a bare-bones hospital in the city of Hasakah about 20 miles away. As their mother wept, doctors said they might not survive.

“It’s a disaster,” said Aydin Khalil, the chain-smoking director of the People’s Hospital in Hasakah, describing the al-Hol camp.

The camp itself has been transformed into a midsize city. At its heart is a bustling market, where those residents who have cash or vouchers can buy diapers, fish, spices, plastic toys and more, all brought in from nearby towns and cities. But that variety is deceptive.

Amina Ahmed, who was shopping in the market, had choice words to describe her life since she arrived.

“Go look at the toilets,” said Ahmed, 24, from the Syrian city of Aleppo. “See for yourself how we live.”

With bright brown eyes and a chesty cough, Ahmed says she is caring for six children. Three of them are her brother’s. He was killed in an airstrike.

“His daughter, she has broken legs and needs a wheelchair,” Ahmed said. “But it seems no one cares.”


Iraqi refugees and displaced Syrian women queue to receive food at the al-Hol camp. (Delil Souleiman/AFP/Getty Images)