United Nations war crimes investigators said on Wednesday that intensified coalition air strikes supporting an assault by US-backed forces on the Daesh stronghold of Raqqa in Syria were causing a "staggering loss of civilian life."
The Syrian Democratic Forces (SDF), supported by a US-led coalition, began to attack Raqqa a week ago with the aim of taking it from the terrorist group. The YPG-dominated SDF, supported by heavy coalition air strikes, have taken territory to the west, east and north of the city.
Paulo Pinheiro, chairman of the UN Commission of Inquiry also told the Human Rights Council that 10 agreements between the Syrian regime and armed groups to evacuate fighters and civilians from besieged areas, including eastern Aleppo, "in some cases amount to war crimes" as civilians had "no choice".
The battle for Raqqa is creating a humanitarian crisis
The battle to liberate Raqqa from Daesh is creating daunting challenges for aid groups responding to the latest humanitarian crisis in the Syrian conflict.
Tens of thousands of civilians have fled the city and its surrounds since the SDF began to advance on the Daesh stronghold last year.
But new waves of displacement are expected as the battle inside the city progresses.
"There is supply but it's very, very limited and the needs of the population are very high," said Puk Leenders, emergency coordinator for northern Syria for the group Doctors Without Borders (MSF).
The United Nations, which operates inside Syria with the permission of the Syrian regime, has been able to air lift supplies to the city of Qamishli, northeast of Raqqa, from regime-held Damascus.
But "this offered limited capacity and was insufficient to meet all needs," said David Swanson, regional spokesman for the UN's Office for the Coordination of Humanitarian Affairs (OCHA).
The UN estimates more than 169,000 people fled Raqqa city and its environs in April and May alone, and thousands of displaced civilians are now living in overcrowded and under-resourced camps.
"There are now more than 25,000 people in the Ain Issa camp, which was built with a capacity of 10,000," camp director Jalal Ayyaf said.
"International organisations are providing support, but it's not sufficient for the numbers who are arriving," he added.
Looting of aid
The UN's Regional Humanitarian Coordinator for the Syria Crisis, Kevin Kennedy, on Tuesday said the UN has only limited access to besieged areas of Syria, and humanitarian supplies which make it through are often looted by the regime army.
Kennedy said the UN was feeding at least a million people a month, with convoys reaching Syrian opposition areas through Turkey and Jordan.
"We do not get sufficient approval from the government of Syria to run these convoys," he said, describing how medical and surgical supplies were taken by Syrian regime forces.
"There are about 18 million people in Syria. Our estimate is over 13 million are in need of some form of humanitarian assistance – a large portion of the population, and often more than once," he added.
Donors lose interest
A group of Syrian doctors based in rebel-held provinces said on Tuesday that aid has dropped markedly over the last two months because donors are losing interest.
Tens of thousands of displaced Syrians have found refuge in the northern province of Idlib, which borders Turkey. It is a stronghold of opposition forces and other rebel groups.
"The situation in Idlib is very bad because many organisations have stopped their support," said Dr Farida, the last obstetrician-gynecologist to be evacuated from rebel-held eastern Aleppo to Idlib earlier this year. The doctors did not use their full names to protect their families from retaliation.
"Many hospitals are closing because their supporters from outside are bored now because it's the seventh year of the revolution. Many of them don't want to come in anymore," she said. She estimated some three million people now live in the area.
The three-doctor delegation from the Syrian American Medical Society Foundation (SAMS) was in Paris and will travel to the Netherlands and Luxembourg to get commitments for medical assistance in the region.
Russia and Iran, which back the Syrian regime, and opposition supporter Turkey agreed in May to arrange and monitor "de-escalation zones" in Syria to ease the fighting.
Regime bombing of rebel areas in the north has eased, but the Syrian army and Iran-backed militia forces have escalated air raids against a rebel-held part of the southern city of Deraa, a possible prelude to a large-scale campaign to take full control of the city.
The doctors said they feared that the northern respite would only be temporary and that the region was under-equipped medically to deal with a wave of air strikes.
"They gathered all the people in this area. We don't expect that they will leave us alone," said Dr Abdulkhalek, a former director at an eastern Aleppo hospital.