Humanitarian workers are scrambling to fill a void left by the collapse of governments in three of the world's hotspots amid an unprecedented demand for help in the past year.
In Syria, the Central African Republic and South Sudan, the World Health Organization is having to step in with other humanitarian groups to provide basic health services that would normally be delivered by a functioning government.
Amid the desperate need for help, officials have been hampered by a severe lack of access due to the bitter fighting and a shortage of funds, and in turn have increasingly become targets themselves.
"The idea of the sanctity of health care, the neutrality of health care, has been lost in a lot of these crises," WHO director of emergency risk management Richard Brennan said Wednesday.
"We've always seen this to some degree. We've never seen it to the degree we are seeing this right now."
He pointed to wanton destruction and looting of health facilities in all three countries, noting that even health care workers were "not off limits any more."
Stretched to the limit
Scant resources have been stretched to the limit with three Level 3 emergencies, as termed by the WHO, erupting from November to February. And that's apart from the need to deal with the ongoing devastation of the war in Syria.
The typhoon that hit the Philippines, as well as the outbreak of sectarian fighting in Central African Republic and hostilities in South Sudan were all such Level 3 "emergencies that completely overwhelm local capacities."
But they have also "stretched the capacities of the global system to support the affected communities," Brennan told a handful of reporters at a briefing held by the UN Foundation.
In the Philippines, the WHO coordinated closely with the government in Manila after November's Super Typhoon Haiyan, which killed or left missing about 8,000 people.
But in the CAR and South Sudan, "the entire state has collapsed, so now we're asking humanitarian actors to fill the space of an entire government," said his deputy, Michelle Gayer.
"Our role is to make sure that those gaps are filled, but when there isn't anyone we're the provider of last resort and we have to find means to address gaps," she added, admitting that it was not possible to reach everyone in need.
The figures are staggering. There are an estimated 9.5 million people in need in Syria, with 2.5 million refugees in neighboring countries and 6.2 displaced internally.
Around 140,000 people are thought to have been killed in Syria, which by conservative estimates probably means about 600,000 have been injured, said Brennan.
In both the CAR and South Sudan, there are about 700,000 displaced and 200,000 refugees.
Appeals for funds have also fallen on deaf ears, with a call for South Sudan raising only 23 percent of the required $8 million. while the CAR has largely been forgotten with a $16 million appeal bringing in only 11 percent of the money needed.
The WHO is now trying to get creative with solutions, such as paying directly the salaries of local health care workers to ensure they come to work, while also drawing up longer term strategies to fill the void.
"Food can be airlifted and dropped, and the average person knows what to do with food. You can't just drop medicine. You need to be diagnosed, you need to be treated, you need to be followed up," said Gayer.
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