Informing more effective Syria Community Profiles Update: May 2017 REACH humanitarian action

FOR HUMANITARIAN PURPOSES ONLY Introduction Executive Summary In order to inform a more evidence based response to addressing In May and early June 2017, REACH assessed the humanitarian situation in 42* communities in Syria currently facing the needs of vulnerable communities across Syria, REACH, in restrictions on movement and access, 18 of which are currently classified as besieged. The profiled communities were located support of members of the Syria INGO Regional Forum (SIRF), in Damascus, Deir ez Zor, Homs and Rural Damascus governorates, and information was gathered through a total of 163 has initiated regular monitoring of communities facing restrictions community representatives (CRs). Across assessed indicators, the humanitarian situation improved in the locations on civilian movement and humanitarian access. which had most recently implemented truce agreements, while it declined in communities experiencing ongoing conflict and the tightest restrictions on movement and access. The Syria Community Profiles intend to provide aid actors with • Ceasefires reached in early May in Burza and Jober, whilst leading to a de-escalation of conflict, resulted an understanding of the humanitarian situation within these in mixed outcomes, as access restrictions played a key role in humanitarian impact. In Jober, civilian mobility communities by assessing availability and access to food, increased, while in Burza, extreme access restrictions remained in place, negatively affecting food security and healthcare, water, education and humanitarian assistance, price health services. data, as well as the specific conditions associated with limited • Following a shift in control, the majority of residents in Qaboun (3,000-3,500 people) left the community in freedom of movement. May; for those remaining, the humanitarian situation remained critical. Methodology and limitations • Following the implementation of the Four Towns Agreement in Madaya, restrictions on movement and access to the community were partially lifted for the first time since assessments began in June 2016. This Based on data collected from 163 community representatives resulted in an overall improvement to the humanitarian situation in the community. inside Syria at the end of May and beginning of June 2017, these updates refer to the situation in May 2017. Information collected • Conflict escalated across all communities assessed in Deir ez Zor governorate (Abu Kamal, Joura, Qosour, provides an understanding of how limited freedom of movement and Sosa), with several casualties reported. restrictions on access affect humanitarian needs in communities • The humanitarian situation continued to improve in Al Waer and the Wadi Burda communities, which had in Syria. Participants provide information comparatively to the implemented local agreements in March and January 2017, respectively. previous month. Where possible during analysis, comparisons are also made to findings from previous months (if any). An List of Assessed Profiles May 2017 improvement or deterioration from the previous month may not PDF: Click on profile name to jump to factsheet indicate a trend but rather distinct circumstances specific to the month assessed. During analysis, data is triangulated through • Abu Kamal and Sosa • Deir ez Zor city (Joura, Qosour) • Madaya and Bqine secondary information, including humanitarian reports, news and social media monitoring, and partner verification, yet findings • Ar Rastan, Talbiseh and Taldu • Eastern Ghouta • Qaboun should be considered indicative rather than generalisable to the • At Tall • Hajar Aswad • Wadi Burda whole community as representative sampling, entailing larger scale data collection, remains challenging in areas with restricted • Bait Jan • Homs (Al Waer) • Yarmuk movement and access. Finally, the level of information on each • Damascus (Burza, Jober, Tadamon) • Khan Elshih community varies due to difficulties obtaining data from certain locations. * While data was collected for the communities of Hama, Qudsiya and Madamiyet Elsham, no profiles were created for these communities. Syria Community Profile Update:Abu Kamal and Sosa, Deir ez Zor Informing May 2017 more effective REACH humanitarian action

FOR HUMANITARIAN PURPOSES ONLY

Kisreh Abu Kamal Sosa Tabni ² Sur UN classification Hard-to-reach Hard-to-reach Syrian Arab DEIR EZ ZOR Estimated population1: 39000 26000 Republic Of which estimated IDPs1: 7900 380 Khasham Deir-ez-Zor % pre-conflict population remaining 51-75% 76-100% Basira (! Communities covered in % of population that are female 51-75% 51-75% this profile % of female-headed households 1-25% 1-25% Urban areas Subdistrict borders Muhasan SUMMARY Commercial access remained unchanged, with Main roads Thiban The communities of Abu Kamal and Sosa are restrictions still in place for vehicles, and no Main rivers located in south-eastern Deir ez Zor governorate, humanitarian deliveries were reported. Al Mayadin about 10km from the Iraqi border. Due to its location, Across other assessed indicators, the situation Abu Kamal district is an important commercial Hajin remained largely stable in both communities Ashara zone. Abu Kamal and Sosa communities have compared to April; assessed food and non-food faced access restrictions since mid-2014, and are items, and fuels entered through commercial currently classified as hard-to-reach by the UN. vehicles and most remained generally available in Jalaa REACH first assessed the locations in April 2017. markets, with no price changes reported. Following a significant intensification in SOSA Following repairs to damages in the water (! Susat hostilities in May, the humanitarian situation in network reported in April in Abu Kamal, access Sokhneh ABU KAMAL Abu Kamal and Sosa deteriorated. While access was restored in May - nonetheless, it remained Abu Kamal (! restrictions lessened as a consequence of insufficient to meet population needs for drinking developments in conflict dynamics, numerous water. There was no change in access to electricity or IRAQ civilian casualties were reported. education in either community as compared to April. Kms While in April residents in Abu Kamal and Sosa The health situation also remained unchanged 0 10 20 could only move between the two communities, in - while no medical facilities operated in Sosa, May, the group known as the Islamic State of Iraq residents could access three hospitals in Abu METHODOLOGY and the Levant (ISIL) also authorized movement to Kamal, subject to financial constraints. All assessed Based on data collected from community representatives inside Syria at the end of May and beginning the wider area under their control to avoid further medical items were reported as available. of June 2017, these updates refer to the situation in May 2017. Information collected provides an casualties following intensification of hostilities. understanding of how limited freedom of movement and restrictions on access affect humanitarian needs in communities in Syria. Participants provide information comparatively to the previous month. Where CHANGES SINCE APRIL possible during analysis, comparisons are also made to findings from previous periods the community Abu Kamal Sosa Abu Kamal Sosa has been assessed. An improvement or deterioration from the previous month may not indicate a trend but rather distinct circumstances specific to the month assessed. When possible, information presented Access Restrictions on Civilians Health Situation has been triangulated with other available sources prior to inclusion, yet findings should be considered indicative rather than generalisable to the whole community as representative sampling, entailing larger Commercial Vehicle Access Core Food Item Availability scale data collection, remains challenging in areas with restricted movement and access. Finally, the level of information on each community varies due to difficulties obtaining data from certain locations.In view Humanitarian Vehicle Access Core Food Item Prices of predicted developments in conflict dynamics in Deir ez Zor governorate, REACH will expand coverage Access to Basic Services Overall Humanitarian Situation2 to additional communities facing access restrictions in the area in the coming months, where possible. ACCESS TO SERVICES Goods entered Following repairs to the water network, access was restored in Abu Kamal in May and increased in comparison to April. However, populations continued to report coping strategies related to a lack of sufficient drinking water. In both communities, residents could intermittently access the electrical network, but continued Both communities: Food, fuel, NFIs and to rely on generators as the main source of electricity, with no change in access since April. All educational facilities in Abu Kamal and Sosa remained closed, as medical items continued to enter Abu Kamal has been the case since assessments began, as parents did not approve of the offered curriculum, while pre-conflict schools had been closed by ISIL. and Sosa via commercial vehicles in May. Some fuel was also locally produced. The Abu Kamal Sosa amount of goods entering reportedly did not WATER Main source of drinking water (Status) Water network (Water tasted bad, had a bad Water network (Water tasted bad, had a bad change between April and May. colour*) colour*) HEALTH SERVICES Available water to meet household needs Insufficient (Reduce consumption, modify Sufficient (Coping strategies) hygiene practices i.e. bathe less) Change since April in both communities: Access to water network per week 3-4 days 3-4 days Despite reported casualties related to increased Change since April hostilities, the overall health situation in Abu Kamal and Sosa did not change between April and May. ELECTRICITY Access to electricity network per day 1-2 hours 1-2 hours Three hospitals, focusing on primary healthcare, Access to electricity (Main source) per day 4-8 hours (Generator) 4-8 hours (Generator) obstetrics and surgeries respectively continued to operate in Abu Kamal. As all hospitals were Change since April private, some segments of the population could not access medical care due to financial limitations. EDUCATION Available education facilities None None No healthcare facilities were reported in Sosa, but Parents don’t approve of curriculum, pre- Parents don’t approve of curriculum, pre- residents remained able to seek services in Abu Barriers to education conflict schools closed by authorities conflict schools closed by authorities Kamal. Unavailable medical items3 Change since April * Data collected is based on perceptions of local actors and therefore reported water safety requires verification through water testing. Abu Kamal: Anti-anxiety medication, heart, diabetes and blood pressure medicines. Sosa: All assessed medical items were MOVEMENT OF CIVILIANS Risks faced when trying to enter or exit community representatives did not report a reported as unavailable in Sosa, as no medical (formally or informally) decline despite intensified hostilities. Most of facilities operated in the community. Change in # people able to leave commercial vehicles entering were reportedly both communities compared to April: Both communities: Verbal harassment, from Baghdad and Al Anbar governorate in Change in both since April People able to leave2 detention. Iraq. However, various restrictions on access remained, including required fees, searches and Following increased hostilities experienced MOVEMENT OF GOODS AND ASSISTANCE confiscation of goods, and the handing over of Most needed medical items4 by both communities in May, formal access Vehicles carrying commercial goods documents. Additionally, no goods were allowed points opened in both Abu Kamal and Sosa to leave Abu Kamal and Sosa via commercial Abu Kamal Sosa mid-month, allowing all residents to travel Change since April in both vehicles. to nearby communities. While according to 1. Heart medicine Heart medicine community representatives such movement communities: Humanitarian vehicles has intermittently been allowed in the past, this Both communities: Commercial vehicles Change since April in both 2. Diabetes medicine Diabetes medicine has not been the case since at least March continued to enter Abu Kamal and Sosa in 2017. While movement was unrestricted, communities: April, as has been the case since assessments 3. Artificial limbs Burn treatment residents had to continue to adhere to rules began in April 2016. At the time of assessment, regarding clothing and behaviour. Both communities: None reported.

Informing Available Positive increase Negative increase May 2017 2 more effective REACH humanitarian action Sometimes available No change Positive decrease Not available Negative decrease Permanent medical facilities available Unusual outbreaks of disease6 Strategies used to cope with a lack Due to limitations in coverage across Deir ez Zor governorate, a standard food basket price Both communities: None reported. of food AK S could not be calculated for nearby communities AK S not considered hard-to-reach for the purpose of Mobile clinics / field hospitals Strategies used to cope with a lack of medical services comparison. Reducing meal size Informal emergency care points Abu Kamal: None reported. Food item availability / prices Skipping meals Pre-conflict hospitals Sosa: Civilians without professional training Both communities: All assessed core food treating patients, carrying out operations Days without eating items, except bread from public bakeries, Pre-conflict clinics / surgeries without anaesthesia, using non-medical items were generally available in shops and markets for treatment (e.g. wooden sticks as casts). Eating non-food plants in both Abu Kamal and Sosa, as was the case Change since April in April. Additionally, no price changes were FOOD Eating food waste reported by community representatives. Due Medical services available Reportedly used as a coping strategy to limited coverage in Deir ez Zor governorate, Change in food situation it was not possible to collect price data from AK S compared to April in both: Not reportedly used as a coping strategy nearby communities not considered besieged or hard-to-reach for the purpose of comparison. Child immunization The food situation in both Abu Kamal and Sosa Notwithstanding an overall stable food remained stable in May, with populations able situation, residents in both communities WASH item availability / prices Diarrhoea management to access bread from (private) bakeries, and all continued to report reducing size of meals as 7 assessed core food items being generally available a coping strategy. According to community Both communities: All assessed hygiene and Emergency care in markets. No notable changes were reported in representatives, both men and women reduced sanitation products (soap, laundry powder, comparison to April. meal size equally. sanitary pads, toothpaste) also remained Skilled childbirth care Most common methods of obtaining Deaths attributable to a lack of food6 generally available in both communities in Surgery5 food at the household level May, similar to April. No price changes were Both communities: None reported. reported. Both communities: Purchasing from shops Diabetes care and markets, home production (backyard, CORE FOOD ITEM / NFI AVAILABILITY AND roof). Fuel availability / prices Change since April PRICES Most common methods of obtaining Both communities: Diesel and kerosene were Average cost of standard food basket8 bread at the household level generally available in Abu Kamal and Sosa, as Availability of medical personnel had also been reported in April, while butane Abu Kamal: Professionally trained surgeons, Both communities: Private bakeries. and propane were sometimes available.10 Abu Kamal Sosa 11 doctors, nurses and midwives, dentists, Challenges to obtaining bread: Yeast Firewood remained generally unavailable, due anesthesiologists, pharmacists. unavailable, expensive or hard to access; fuel to lower seasonal demand. Average cost Sosa: None. too expensive or hard to access. 51684 52597 The relatively low price of diesel and kerosene in May (SYP)9 Others providing medical services (in both): could be ascribed to the communities’ ability to Volunteers with informal medical training. Change in both since April Change since produce their own fuels. April Strategies used to cope with a lack of fuel: Change in both since April No data. The average cost of a standard food basket remained similar between the two communities, and did not change in comparison to April.

Informing Available Positive increase Negative increase May 2017 3 more effective REACH humanitarian action Sometimes available No change Positive decrease Not available Negative decrease CORE FOOD ITEM/NFI PRICE AND AVAILABILITY INDEX9 Endnotes 1 Figures based on HNO 2017 population data (December 2016). Item Abu Kamal Price changes Sosa Price changes Figures based on population estimates by local actors within the 12 12 communities assessed were reportedly 80,000-85,000 individu- since April since April als on Abu Kamal (including 17,000-17,500 IDPs), and 21,000- Food Items Bread private bakery (pack) 3207 3507 21,500 individuals in Sosa (including 500-600 IDPs). 2 While some indicators suggest an improved humanitarian sit- Bread public bakery (pack) Not available Not available uation in May, reports of extensive protection issues related to Rice (1kg) 6757 6507 ongoing hostilities indicate an overall deteriorating situation. 3 The fact that some informal points exist does not imply their 7 7 Bulgur (1kg) 550 550 safety, security, or the financial capacity of any notable portion of Lentils (1kg) 8007 8007 the population to pay the fees required to use them. 4 Some availability does not necessarily imply sufficiency. 7 7 Chicken (1kg) 1300 1300 Likewise, the list is not intended to be a comprehensive assess- 7 7 ment of all medical needs, but rather indicative of key medical Mutton (1kg) 3500 3500 items that speak to the trend in access to medical services in Tomato (1kg) 2257 2507 the area. 5 7 7 ‘Most needed’ does not necessarily imply unavailability. Cucumber (1kg) 200 200 Furthermore this list is not intended to be a comprehensive list of most Milk (litre) 2007 2007 needed medical items or medicines, but rather indicative of needs that speak to the trend in the priorities of medical items in the area. 7 7 Flour (1kg) 200 250 6 The availability of surgery does not necessarily imply treatment Eggs (1) 407 407 by a doctor formally trained in the relevant procedure, or the use of anaesthesia or appropriate clinical equipment. Community mem- Iodised salt (500g) 1507 1507 bers, without professional medical backgrounds, may have been 7 7 informally trained by medical personnel to carry out emergency Sugar (1 kg) 600 600 procedures. Cooking oil (litre) 9007 9007 7 Reported deaths are based on reported incidents within the WASH Items 7 7 community. There is better access to health reports in certain Soap (1 bar) 250 250 communities, therefore, validity of estimations varies. Without Laundry powder (1kg) 13507 13507 medical assessments, it was not possible to verify the exact causes of death cited, therefore the caseload is indicative of the Sanitary pads (9) 6507 6507 perceived health issues causing death in the communities. Toothpaste (125ml) 6007 6007 8 Generally available in markets (21+ days this month). 9 7 7 Calculation of average cost of food basket based on WFP’s stan- Disposable diapers (24 pack) 1650 1650 dard food basket of essential commodities. The basket includes Fuel Butane (cannister) 750010 750010 37 kg of bread, 19 kg rice, 19 kg lentils, 5 kg of sugar and 7 kg of vegetable oil, providing 1,930 kcal a day for a family of five during Diesel (litre) 1407 1407 a month. Available at: WFP, VAM Food Security Analysis, ‘Syria Market Price Watch Bulletin: April 2017’ (link here). Propane (cannister) 750010 750010 10 $1 = 515 SYP (UN operational rates of exchange as of 1 June Kerosene (litre) 1257 1257 2017). 11 Coal (kg) Not available Not available Sometimes available in markets (7-20 days this month). 12 Generally not available in markets (less than 7 days this month). 11 11 Firewood (tonne) 45000 45000 13 Price fluctuations of 5% or less were not reported.

Due to limited coverage, it was not possible to collect prices for comparison in May from nearby communities not considered For affected populations the functionality besieged or hard-to-reach. of, and access to, basic services such as medical facilities, water and electricity are highly dependent on the price and availability of fuel sources.

Informing Available Positive increase Negative increase May 2017 4 more effective REACH humanitarian action Sometimes available No change Positive decrease Not available Negative decrease Syria Community Profile Update:Ar Rastan, Talbiseh and Taldu, Homs Informing more effective May 2017 REACH humanitarian action

FOR HUMANITARIAN PURPOSES ONLY Ar Rastan Talbiseh Taldu ² Masyaf Hama UN classification: Hard-to-reach Hard-to-reach Hard-to-reach Syrian Arab Republic 1 Wadi Estimated population : 47000 41000 18000 El-oyoun Harbanifse Of which estimated IDPs1: 9000 11000 640 Dweir Raslan AR RASTAN % pre-conflict population remaining: 26-50% 26-50% 26-50% Ein Halaqim (! Sib(!beh Communities covered in this profile % of population that are female: 26-50% 26-50% 26-50% j ther assessed TALDU Ar Rastan % of female-headed households 1-25% 1-25% 26-50% neighbourhoods (! Talbiseh Mashta Urban area TALBISEH Elhiu Qabu Taldu (! SUMMARY noting discussions between representatives of Subdistricts Border Ein Elniser The communities of Ar Rastan, Talbiseh and the communities and the government. Access Main roads Nasra Taldu, situated between the cities of Homs and restrictions were loosened and humanitarian aid River/Lake Hama, have faced access restrictions since 2012. entered all three communities (some of which had Shin In early 2016, an escalation of the conflict led to not received aid since October 2016). Hawash HMS a deterioration in the humanitarian situation in The overall humanitarian situation worsened in (AL WAER the three communities, but conditions remained May in all three locations, due to the persisting herbet HOMS CITY relatively stable until another escalation of the lack of sufficient water that has been reported Tin Noor conflict in Ar Rastan occurred in October 2016. since March. Community representatives noted Tall alakh Hadideh Between October and February, the humanitarian that in May rising temperatures increased demand, situation did not significantly change. with populations reportedly borrowing money and In March, all three communities faced a sudden purchasing water on credit to meet needs as well tightening of access restrictions, leading to an as reducing water consumption. LEBANN Al Qusayr increase in food prices, increased pressure While humanitarian deliveries were reported in Kms on civilian populations and a worsening of the Taldu in April, no humanitarian aid reached the 0 5 10 humanitarian situation. The overall situation three communities in May. As has been the case subsequently improved in April, with media reports since at least June 2016, commercial vehicles were

CHANGES SINCE APRIL METHODOLOGY Ar Rastan Talb. Taldu Ar Rastan Talb. Taldu Based on data collected from community representatives inside Syria at the end of May and beginning of June 2017, these updates refer to the situation in May 2017. Information collected provides an Access Restrictions understanding of how limited freedom of movement and restrictions on access affect humanitarian Health Situation on Civilians needs in neighbourhoods in Syria. Participants provide information comparatively to the previous month. Where possible during analysis, comparisons are also made to findings from previous periods Commercial Vehicle Core Food Item the community has been assessed. An improvement or deterioration from the previous month may Access Availability not indicate a trend but rather distinct circumstances specific to the month assessed. When possible, Humanitarian Core Food Item information presented has been triangulated with other available sources prior to inclusion, yet findings Vehicle Access Prices should be considered indicative rather than generalisable to the whole community as representative sampling, entailing larger scale data collection, remains challenging in areas with restricted movement Access to Basic Overall Humanitarian and access. Finally, the level of information on each community varies due to difficulties obtaining data Services Situation from certain locations. not permitted into the region, and while movement MOVEMENT OF CIVILIANS began in June 2016, employees and students MOVEMENT OF GOODS AND ASSISTANCE between the three communities was possible, it continued to be able to exit the communities Change in # people able to leave Vehicles carrying commercial goods continued to involve the risk of shelling. compared to April in all three: through formal access points upon presenting identification. People with injuries were also Some positive developments were noted in May; Change since April in all three: the health situation improved across all three People able to leave2 reportedly able to exit the community, unless they perceived a risk of detainment. communities, due to the renewed availability of No change in access restrictions was No commercial vehicles entered any child immmunizations. This service had previously reported in May, with 11-25% of residents Since assessments began, residents have community in May, as has been the case since become unavailable in April. Additionally, more across all three communities able to use been able to move freely between the three assessments began in June 2016. doctors were reported in Taldu. Food prices also one formal access point. communities. However, risks associated with dropped by an average of 10% and the price of such movement, including shelling, have Humanitarian vehicles The last major changes occurred in March, butane continued to decline in all three communities. continued to be reported. with the temporary closure of the main access Change since April in Ar Rastan and No other significant changes to the humanitarian No informal routes have been reported in use point near Talbiseh, and the long-term closure Talbiseh: situation were reported in the communities. of informal routes and the only other formal in any community since access restrictions Electrical access remained similar to April, and no access point in the region, located near Taldu. tightened in March. Change since April in Taldu: change in educational services has been reported In March, only 1-10% of the populations in all Risks faced when trying to enter or exit since at least September 2016. three communities were able to use formal No humanitarian deliveries were reported points because of these changes. In April, this Formal: Detention. entering any of the three communities in April. number returned to 11-25%. Informal: Gunfire, shelling and landmines. The last humanitarian deliveries entered Taldu As has been the case since assessments in April, and Ar Rastan and Talbiseh in March. ACCESS TO SERVICES Water access in May continued to be reported as insufficient in all three communities, as had been the case since March. Rising temperatures also increased water needs when compared to previous months, and borrowing money, purchasing on credit and reducing water consumption were all reported as coping mechanisms in May. In Taldu, wells became the primary source of drinking water due to insufficient water on the network, although the network was still in use. No change in remaining services was reported in May. Electrical access had previously improved in April, when summer weather decreased demand and authorities lightened rationing on the power network. No changes to barriers to educational access (which are predominatly security-related) have been reported since at least September 2016, with reported challenges affecting boys and girls equally.

Ar Rastan Talbiseh Taldu

WATER Main source of drinking water (Status) Water network (Safe to drink)* Water network (Safe to drink)* Wells (Safe to drink)* Available water to meet household needs Insufficient Insufficient Insufficient (Coping strategies) Access to water network per week 1-2 days 1-2 days 1-2 days Change since April ELECTRICITY Access to electricity network per day 2-4 hours Network unavailable 1-2 hours Access to electricity (Main source) per day 8-12 hours (Network) 8-12 hours (Generator) 8-12 hours (Network) Change since April EDUCATION Pre-conflict primary, secondary, high schools; informal Pre-conflict primary, secondary, high schools; informal Pre-conflict primary, secondary, high schools; informal Available education facilities schools set up since conflict began schools set up since conflict began schools set up since conflict began Route to services unsafe, children required to work, Route to services unsafe, facilities destroyed, children Facilities destroyed, route to services unsafe, children Barriers to education facilities destroyed required to work required to work Change since April * Data collected is based on perceptions of local actors and water safety cannot be guaranteed in the absence of water testing.

Informing Available Positive increase Negative increase May 2017 2 more effective REACH humanitarian action Sometimes available No change Positive decrease Not available Negative decrease 6 Goods entered Permanent medical facilities available Unusual outbreaks of disease None reported in any of the communities since The amount of food, non-food items (NFIs) Ar Talb. Taldu at least October 2016. and medicine entering Ar Rastan and Talbiseh Ar Rastan Talb. Taldu did not change in April, after increasing in Rastan March following prior humanitarian deliveries. Child FOOD immunization Mobile clinics / The quantity of these items declined in Taldu field hospitals in May relative to April, due to the lack of Diarrhoea Change in food situation since humanitarian deliveries that month. No change management Informal April in all three: was reported in the amount of fuel entering all emergency care Emergency points three communities in May. care Strategies used to cope with a lack Food, NFIs, medicine and fuel continued to Skilled Pre-conflict of food enter all three communities via civilians from childbirth care hospitals 3 nearby communities, as has been the case Surgery Primary Ar Talb. Taldu since assessments began in June 2016. Local healthcare Rastan production also supplemented the amount of Diabetes care facilities food in Talbiseh and Taldu. Change since Change since Reducing HEALTH SERVICES April April meal size 4 Skipping Unavailable medical items 5 Change since April in all three: Most needed medical items meals Available (all communities): Antibiotics, Days without contraception, burn treatment, clean Ar Rastan Talbiseh Taldu eating The overall health situation improved in bandages, blood transfusion bags, anti- Assistive Surgical Assistive Eating non- all three communities in April, primarily anxiety medication, anaesthetics, medical 1. devices equipment devices food plants due to the renewed availability of child scissors; immunizations, after it became unavailable Surgical Assistive Surgical Eating food Sometimes available (all communities): 2. in March. In Taldu, the reported amount of equipment devices equipment waste medicine declined in May, compared to April, Heart, blood pressure and diabetes medicine. Reportedly used as a coping strategy due to the lack of humanitarian aid. However, Heart medicine: Sometimes available in Ar Artificial Heart Artificial 3. Not reportedly used as a coping strategy more doctors were reported in the community Rastan and Talbiseh, available in Taldu. limbs medicine limbs in May. Resorting to reducing meal sizes and skipping Change since April in Ar Rastan Availability of medical personnel meals have been reported in parts of the No changes to the type of medical services and Talbiseh or permanent medical facilities were reported Ar Rastan and Talbiseh: Professionally trained populations across all three communities since assessments began in June 2016, with across the three communities in May. The Change since April in Taldu surgeons, doctors, nurses and midwives. last significant change to the overall medical Taldu: Professionally trained doctors, nurses the exception of October 2016 when fewer situation occurred in December 2016, when and midwives. strategies were reported in Talbiseh and Taldu following humanitarian deliveries. These coping diabetes care became unavailable throughout Strategies used to cope with a lack of Others providing medical services: Dentists, all three communities. medical services strategies were reportedly still in place in May pharmacists, veterinarians, volunteers with in all three communities, as not all people were Medical services available No coping strategies have been reported in informal or no medical training. able to receive aid or pay the market price for any of the communities since October 2016, Child immunizations became available in May, Change since April in Ar Rastan food. In these cases, it was stated some men when residents in Ar Rastan reported using after being reported as unavailable in April (for and Talbiseh and women ate less so children could eat more. surgery without anaesthetics. the first time since assessments began in June 2016). Change since April in Taldu

Informing Available Positive increase Negative increase May 2017 3 more effective REACH humanitarian action Sometimes available No change Positive decrease Not available Negative decrease Most common methods of obtaining having remained largely stable in Ar Rastan of all available fuel item prices. The price of food at the household level and Talbiseh since January. The standard diesel continued to decline in Taldu but did food basket price in Taldu was more volatile, not significantly change in the remaining Since June 2016, purchasing from shops and with price changes also noted in March due to communities. Since April, both commodities farmers has been the most common method of changes in access restrictions that month. have continued to be reported as generally obtaining food in all three communities. available in markets. The prices of a standard food basket in Ar Most common methods of obtaining Rastan, Talbiseh and Taldu were comparable Strategies used to cope with a lack of fuel: bread at the household level to those of nearby communities not considered All three communities continued to report hard-to-reach. In April, the food basket cost in burning plastic to address fuel shortages, as Private bakeries were the most common source nearby communities had increased by 38%, has been the case since at least November of bread in all communities in May 2017, as has reportedly due to the rising prices of bread and 2016. generally been the case since August 2016. rise in those locations. No community reported any issues accessing Core food item availability bread every day in May. The most significant trend across the three communities in May was an average 58% drop Changes since April in all three in the price of cucumbers and an average 32% drop in the price of tomatoes, attributed to the Deaths attributable to a lack of food3 June harvest of those vegetables. Other notable None reported across all three communities trends were an average 10% increase in the since at least September 2016. price of a litre of milk and an average 15% decrease in the price of eggs. All assessed food CORE FOOD ITEM / NFI AVAILABILITY AND items were reported generally available10 in PRICES markets, as was also the case in April. Previously, overall food item prices dropped in 7 Average cost of standard food basket April due to the reduced access restrictions and fluctuated in prior months due to these changes. Ar Nearby Talb. Taldu Rastan areas8 WASH item availability / prices Average There was no significant change in availability cost 29834 31213 31333 34035 or prices of assessed hygiene and sanitation (SYP)9 items across the three communities in May. The largest change was a 10% increase in the Change price of soap and a 10% decrease in the price since April of toothpaste, both in Taldu. Similar to April, all assessed hygiene and sanitation items were The price of a standard food basket did not reported generally available in markets. significantly change in any community except Ar Rastan, where it dropped by 10% compared Fuel availability / prices to April. This was primarily due to the decline in the price of lentils and bread in the community. The price of butane dropped by an average of 13% across assessed communities in The cost of a standard food basket dropped by May, continuing a decline observed in April an average of 7% in all communities in April,

Informing Available Positive increase Negative increase May 2017 4 more effective REACH humanitarian action Sometimes available No change Positive decrease Not available Negative decrease CORE FOOD ITEM/NFI PRICE AND AVAILABILITY INDEX9 Endnotes 1 Figures based on HNO 2017 population data (December 2016). Figures based on estimates by local actors within communities Item Price change Price change Prince change Nearby Ar Rastan Talbiseh Taldu assessed were reportedly 77,000-80,000 including 7,000-8,000 since April11 since April11 since April11 areas8 IDPs (Ar Rastan), 50,000-52,000 including 3,000-4,000 IDPs (Talbiseh), and 13,000-14,000 including 500-700 IDPs (Taldu). Food Bread private bakery (pack) 20010 -11% 22510 +13% 20010 170 Items 2 The fact that some informal points exist does not imply their Bread public bakery (pack) Not available Not available Not available 150 safety, security, or the financial capacity of any notable portion of the population to pay the fees required to use them. Rice (1kg) 20010 25010 20010 500 3The availability of surgery does not necessarily imply treatment Bulgur (1kg) 20010 20010 20010 -11% 250 by a doctor formally trained in the relevant procedure, or the use 10 10 10 of anaesthesia or appropriate clinical equipment. Community Lentils (1kg) 500 -17% 500 -17% 600 517 members, without professional medical backgrounds, may Chicken (1kg) 105010 100010 75010 938 have been informally trained by medical personnel to carry out emergency procedures. Mutton (1kg) 290010 -7% 280010 -7% 300010 1950 4 Some availability does not necessarily imply sufficiency. Tomato (1kg) 25010 -29% 25010 -23% 22510 -44% 258 Likewise, the list is not intended to be a comprehensive 10 10 10 assessment of all medical needs, but rather indicative of key Cucumber (1kg) 150 -63% 150 -50% 150 -60% 355 medical items that speak to the trend in access to medical Milk (litre) 19510 +11% 19010 +9% 16510 +10% 173 services in the area. 5 10 10 10 ‘Most needed’ does not necessarily imply unavailability. Flour (1kg) 250 225 -10% 200 -33% 190 Furthermore this list is not intended to be a comprehensive list Eggs (1) 3510 -30% 4510 -10% 4510 -10% 57 of most needed medical items or medicines, but rather indicative of needs that speak to the trend in the priorities of medical items Iodised salt (500g) 3510 3510 3510 70 in the area. Sugar (1 kg) 37510 -6% 35010 -13% 35010 -13% 308 6 Reported deaths are based on reported incidents within the community. There is better access to health reports in certain 10 10 10 Cooking oil (litre) 850 700 -18% 750 -25% 958 neighbourhoods, therefore, validity of estimations varies. Without WASH Soap (1 bar) 10010 10010 10010 +11% 60 medical assessments, it was not possible to verify the exact Items causes of death cited, therefore the caseload is indicative of the Laundry powder (1kg) 67510 65010 60010 -14% 575 perceived health issues causing death in the neighbourhoods. 7 10 10 10 Calculation of average cost of food basket based on WFP’s Sanitary pads (9) 650 600 -8% 650 -13% 200 standard food basket of essential commodities. The basket Disposable diapers (24 pack) 120010 115010 120010 1350 includes 37 kg of bread, 19 kg rice, 19 kg lentils, 5 kg of sugar and 10 10 10 7 kg of vegetable oil, providing 1,930 kcal a day for a family of five Toothpaste (125ml) 250 200 225 -10% 500 during a month. Available at: WFP, VAM Food Security Analysis, Fuel Butane (cannister) 720010 -15% 750010 -12% 670010 -11% 14000 ‘Syria Market Price Watch Bulletin: April 2017’ (link here). 8 10 10 10 Nearby communities in Homs governorate which are not considered Diesel (litre) 365 -38% 360 340 -15% 388 besieged or hard-to-reach: Farqalas and Qazhal. Propane (cannister) Not available Not available Not available Not available 9 $1 = 515 SYP (UN operational rates of exchange as of 1 June Kerosene (litre) Not available Not available Not available 400 2017). 10 Generally available in markets (21+ days this month). 10 Coal (kg) Not available 500 Not available 375 11 Price fluctuations less than 5% were not reported. Firewood (tonne) Not available Not available Not available 30000 For affected populations the functionality of, and access to, basic services such as medical facilities, water and electricity are highly dependent on the price and availability of fuel sources.

Informing May 2017 5 more effective REACH humanitarian action Syria Community Profile Update: At Tall, Rural Damascus Informing May 2017 more effective REACH humanitarian action SUMMARY FOR HUMANITARIAN PURPOSES ONLY

At Tall is located in the Qalamoun mountains, Rankus 11km north of Damascus. It has faced military A ABDANI ² D encirclement, escalations in conflict due to several UN classification: Dimas Hard-to-reach Syrian Arab BQINE Madaya shifts in control, and severe access restrictions !( 1 Republic !( Sidnaya Estimated population : 238650 MADAYA since the end of 2013. Conflict escalated Ein Elfijeh dramatically in July 2016, which led to a substantial Of which IDPs1: 196260 Az abdani At Tall tightening of access restrictions before a truce was SQ WADI % pre-conflict BARHALIYA 1-25% BRDA !( reached on 2 December 2016. The truce resulted population remaining: (! Communities coered in !( DEIR MAQRAN !( !( D this rofile KAFR ELAWAMID !( !( EIN ELFIJEH AT TALL in the evacuation of 2,300 individuals and their !( D HSEINIYEH KAFIR BSEIMEH (! % population female: 26-50% !( ther assessed DEIR ELEIT families to Idleb governorate and comparative Harasta communities QANN Duma Qudsiya DMA improvements to the security and humanitarian % of female-headed HARASTA !( 1-25% D Formerly assessed !( HAMA BRA !( situation. However, despite the truce, movement households communities !( QDSIYA QABN ARBIN !( remained restricted, humanitarian access minimal rban area AMALKA HAMMRA !( Arbin !( (only one delivery, in January 2017, has been able to enter and exit the community via formal JBER !( Subdistrict borders DAMASCUS CITY !( !( SAQBA NASHABIYEH !( !( reported since the community was first assessed routes remained unchanged. Women affiliated EIN KAFR JISREIN Kafr Main roads Markaz TERMA BATNA Batna in June 2016) and access to basic services limited, with certain political groups reportedly continued to Darayya TADAMN Jaramana as of May 2017. face verbal harassment at checkpoints, whilst the Main riers !( Nashabiyeh Qatana !( D !( YARMK threat of conscription and detention continued to Maliha The humanitarian situation in At Tall, after MADAMIYET DARAYYA Hajar HAJAR ASWAD prevent men from obtaining medical care in nearby ELSHAM Aswad improving in January and February, stabilised Babella in March, and remained largely unchanged in communities. Sahnaya April and May. Although no humanitarian vehicles After improving in April with the opening of new KHAN ELSHIH hizlaniyyeh have entered At Tall since December, commercial health clinics and child immunization services !( KAFR HR BETIMA vehicles continued providing food, non-food items becoming available, the health situation remained !( !( unchanged in May. Bait Jan (NFIs), fuel and medical supplies to the community BEIT SABER Kisweh BAIT JAN MARAET !( in May. Around 26-50% of the population were Access to educational facilities has remained !( BEIT JIN !( able to enter and exit At Tall, thereby transporting stable since November 2016, although fewer Sasa Kms goods into the community. After declining slightly children were reported in school in May due to the 0 5 10 in April as parts of the electricity network summer break. Repairs to At Tall’s water network collapsed, access to basic services improved began in February, but no further improvement in METHODOLOGY again in May following repairs to the main access was reported in May. network. After fluctuating considerably in April due to a Based on data collected from community representatives inside Syria at the end of May and beginning Commercial vehicles meeting certain requirements, decrease in local vegetable production, food prices of June 2017, these updates refer to the situation in May 2017. Information collected provides an such as forfeiting portions of loads or paying fees, stabilised in May. No major increases or decreases understanding of how limited freedom of movement and restrictions on access affect humanitarian needs in communities in Syria. Participants provide information comparatively to the previous month. could access At Tall in May. The number of residents in food and NFI prices were reported. Where possible during analysis, comparisons are also made to findings from previous periods the CHANGES SINCE APRIL community has been assessed. An improvement or deterioration from the previous month may not indicate a trend but rather distinct circumstances specific to the month assessed. When possible, Access Restrictions on Civilians Health Situation information presented has been triangulated with other available sources prior to inclusion, yet findings should be considered indicative rather than generalisable to the whole community as representative Commercial Vehicle Access Core Food Item Availability sampling, entailing larger scale data collection, remains challenging in areas with restricted movement Humanitarian Vehicle Access Core Food Item Prices and access. Finally, the level of information on each community varies due to difficulties obtaining data from certain locations. Access to Basic Services Overall Humanitarian Situation MOVEMENT OF CIVILIANS Humanitarian vehicles ACCESS TO SERVICES* Despite ongoing repairs to the water network in At Tall, no increase in the availability of drinking water was Change in # people able to leave Change since April: reported in May. After access to electricity decreased in April, following damage sustained by generators compared to April: supplying the main network due to overuse, access to electricity increased again in May following the repair People able to leave2 No humanitarian vehicles entered At Tall in of the main network. Educational access has not changed since December 2016, when some students May, as has been the case since January. reportedly left school due to a lack of school supplies, or to work. Fewer children were reported attending Overall, access through formal routes school this month due to the summer break. improved following the truce agreement, Goods entered with around 26-50% of the population In May, similar amounts of food, NFIs, fuel WATER Main source of drinking water Water trucking (Safe to drink)** able to formally enter and exit At Tall since and medicine entered At Tall via commercial (Status) December 2016. After the number of people vehicles and individuals transporting items from Sufficiency of available water to Insufficient (Spend money usually accessing formal routes increased slightly nearby communities as in April. meet household needs (Coping spent on other things to buy water) in April due to a decrease in perceived risks HEALTH SERVICES strategies used) associated with their use, travel restrictions Access to water network per week 1 - 2 days per week remained unchanged in May. Students and Change in health situation ELECTRICITY Access to electricity network per 2 - 4 hours employees could use formal access points compared to April: day on workdays, while women and children were After the number of private clinics increased Access to electricity (Main source) 2 - 4 hours (Main network) unrestricted upon presentation of documents. in April, no new health facilities opened in per day Men not perceived as security threats by the May. Child immunization services remained EDUCATION Available education facilities Pre-conflict primary, secondary, high schools authorities could reportedly access some available after becoming available in April, routes with documentation. for the first time since November 2016. Barriers to education In December it was reported that some However, since the truce in December, The number of assessed medical supplies children had to drop out of school to work. detention and conscription have reportedly stabilised in May after stocks increased They have not returned to school since. persisted as potential risks when exiting and slightly in April as commercial vehicles *Arrows indicate change in access since April. entering the community throughout May. continued to enter the community following ** Data collected is based on perceptions of local actors and therefore reported water safety requires verification through water testing. Some women affiliated with certain political the truce agreement. groups were deterred from leaving At Tall due In May, low-income households continued to Medical services available Most needed medical items5 to perceived risks associated with accessing face barriers in accessing medical care due 1. Clean bandages formal entry and exit points. to prohibitive costs, while men with certain Child immunization Informal points used: None reported. political affiliations were reportedly deterred 2. Diabetes medicine from seeking treatment outside of their Diarrhoea management 3. Antibiotics Risks faced when trying to enter or exit community because they feared using formal Emergency care Availability of medical personnel (formally or informally) exit and entry points. Personnel available: Professionally trained Verbal harassment, detention, conscription Skilled childbirth care Permanent medical facilities available doctors, nurses and midwives. MOVEMENT OF GOODS AND ASSISTANCE 3 Mobile clinics / field hospitals Surgery Others providing medical services: Dentists, Vehicles carrying commercial goods pharmacists, medical or pharmacy students. Diabetes care Informal emergency care points Change since April: Change since April Change since April Pre-conflict hospitals About the same number of commercial vehicles 4 Strategies used to cope with a lack of entered At Tall in May as in April. Vehicles Unavailable medical items Primary healthcare facilities medical services entering At Tall remained subject to searches All assessed medical items were available in and fees. It was also reported that a portion Private Clinics At Tall in May. None reported. of goods was usually taken by authorities, Unusual outbreaks of disease: and drivers had to present documentation. Change since April Change since April None reported.

Informing Available Positive increase Negative increase May 2017 2 more effective REACH humanitarian action Sometimes available No change Positive decrease Not available Negative decrease FOOD Deaths attributable to a lack of food6 CORE FOOD ITEM/NFI PRICE AND AVAILABILITY INDEX9 Change in food situation None reported. compared to April: CORE FOOD ITEM / NFI AVAILABILITY For affected populations the functionality of, and access to, basic services such as medical facilities, water and electricity are highly dependent on the price and availability of fuel sources. AND PRICES Food availability remained similar in May, compared to April. Increased commercial Average cost of standard food basket7 vehicle access and humanitarian aid deliveries Item At Tall Price change since Nearby non- in January led to an improvement in the food At Tall Nearby areas8 April10 hard-to-reach situation following the truce. As the flour areas9 stocks in the community have increased since Average cost 31984 32962 Food Items Bread private bakery (pack) 10011 100 May (SYP)9 January, there were no issues in accessing Bread public bakery (pack) Not available 58 bread in At Tall in May. Change since Rice (1kg) 50011 -9% 535 10 Most common methods of obtaining April Bulgur (1kg) 50011 320 food at the household level The average cost of a standard food basket in Lentils (1kg) 50011 525 Purchasing from shops and markets. At Tall was comparable to that in nearby areas Chicken (1kg) 135011 1120 not considered hard-to-reach in May, as was Mutton (1kg) 500011 3925 Most common methods of obtaining the case in April. bread at the household level Tomato (1kg) 35011 410 Food item availability / prices Cucumber (1kg) 25011 -17% 318 Most common source: Private bakeries Average prices of all assessed food items were Milk (litre) 25011 215 Other sources: In April, the availability of generally similar to those recorded in April, Flour (1kg) 15011 233 bread increased due to a rise in flour stocks with slight decreases in the price of rice and Eggs (1) 6011 50 and bread was reported available at the market cucumbers. on at least 21 days. In May, bread remained Iodised salt (500g) 10011 65 generally available and could be accessed WASH item availability / prices Sugar (1 kg) 50011 438 everyday. 11 All assessed hygiene and sanitation items were Cooking oil (litre) 900 1225 11 WASH Items 11 Change since April reported generally available in May, as had Soap (1 bar) 150 113 also been the case in April. Prices remained the Laundry powder (1kg) 250011 875 Strategies used to cope with a same in these two months, but were significantly Sanitary pads (9) 75011 444 higher than those in nearby communities not lack of food 11 considered hard-to-reach. Toothpaste (125ml) 350 382 Disposable diapers (24 pack) 250011 1575 Reducing meal size Fuel availability / prices Fuel Butane (cannister) 300012 2925 Skipping meals After decreasing in April due to a seasonal lack Diesel (litre) 40012 280 of demand, fuel prices stabilised in May. Propane Days without eating Propane (cannister) Not available 2560 and firewood were reported unavailable in At Tall Kerosene (litre) 40012 400 Eating non-food plants in May, as had been the case in April. Coal (kg) 40012 450 Eating food waste Strategies used to cope with a lack of fuel: Firewood (tonne) Not available Not available Reportedly used as a coping strategy Since April, no strategies to cope with a lack of fuel, such as burning plastics or waste, have Not reportedly used as a coping strategy been reported in the community. No negative coping strategies were reported in At Tall in May, as has been the case since February 2017.

Informing Available Positive increase Negative increase May 2017 3 more effective REACH humanitarian action Sometimes available No change Positive decrease Not available Negative decrease Endnotes 1 Figures based on HNO 2017 population data (December 2016). Figures based on estimate by local actors withing communities assessed were reportedly 900,000-915,000 individuals, including 600,000-650,000 IDPs. 2The fact that some informal points exist does not imply their safety, security, or the financial capacity of any notable portion of the population to pay the fees required to use them. 3The availability of surgery does not necessarily imply treatment by a doctor formally trained in the relevant procedure, or the use of anaesthesia or appropriate clinical equipment. Community members without professional medical backgrounds may have been informally trained by medical personnel to carry out emergency procedures. 4Some availability does not necessarily imply sufficiency. Likewise, the list is not intended to be comprehensive assessment of all medical needs, but rather indicative of key medical items that speak to the trend in access to medical services in the area. 5 ‘Most needed’ does not necessarily imply unavailability. Furthermore this list is not intended to be a comprehensive list of most needed medical items or medicines, but rather indicative of needs that speak to the trend in the priorities of medical items in the area. 6 Reported deaths are based on reported incidents within the community. There is better access to health reports in certain communities, therefore, validity of estimations varies. Without medical assessments, it was not possible to verify the exact causes of death cited, therefore the caseload is indicative of the perceived health issues causing death in the communities. 7 Calculation of average cost of food basket based on WFP’s standard food basket of essential commodities. The basket includes 37 kg of bread, 19 kg rice, 19 kg lentils, 5 kg of sugar and 7 kg of vegetable oil, providing 1,930 kcal a day for a family of five during a month. Available at: WFP, VAM Food Security Analysis, ‘Syria Market Price Watch Bulletin: April 2017’ (link here). 8 Nearby communities in Rural Damascus governorate which are not considered besieged/hard-to-reach: Deir Ali and Kisweh. 9 $1 = 515 SYP (UN operational rates of exchange as of 1 June 2017). 10 Price fluctuations of 5% or less were not reported. 11 Generally available in markets (21+ days this month). 12 Sometimes available in markets (7 – 20 days this month).

Informing May 2017 4 more effective REACH humanitarian action Syria Community Profile Update: Bait Jan, Rural Damascus Informing more effective May 2017 REACH humanitarian action

FOR HUMANITARIAN PURPOSES ONLY Communities with a truce agreement: Beit Saber, Betima and Kafr Hoor Communities without a truce agreement: Bait Jan and Mazraet Beit Jin Rankus A ABDANI ² D Dimas Syrian Arab BINE Madaya Beit Mazraet !( Bait Jan Betima Kafr Hoor Republic !( Sidnaya Saber Beit Jin MADAYA Ein Elfieh Hard-to- Hard-to- Hard-to- Hard-to- Hard-to- Az abdani UN classification At Tall reach reach reach reach reach SU WADI BURDA BARHALIYA !( !( 1 (! Communities covered in DEIR MARAN Estimated population (individuals) 1400 7200 7000 6500 2000 !( !( D this profile KAFR ELAWAMID !( !( EIN ELFIJEH AT TALL !( D !( HSEINIYEH KAFIR BSEIMEH !( Other assessed DEIR ELEIT 2 Harasta Of which estimated IDPs 180 - 200 150 - 200 50 - 55 25 - 30 100 - 150 communities ANUN Duma udsiya DUMA HARASTA !( D Formerly assessed !( HAMA BURA !( % pre-conflict population remaining 26 - 50% 76 - 100% 76 - 100% 76 - 100% 51 - 75% communities !( UDSIYA ABOUN ARBIN !( Urban area AMALKA HAMMURA !( Arbin !( % of population that are female 26 - 50% 51 - 75% 51 - 75% 51 - 75% 26 - 50% JOBER !( Subdistrict borders DAMASCUS CITY !( !( SABA NASHABIYEH !( !( EIN KAFR JISREIN Kafr % of female-headed households 1 - 25% 1 - 25% 1 - 25% 1 - 25% 1 - 25% Main roads Markaz TERMA BATNA Batna Darayya TADAMON Jaramana Main rivers !( Nashabiyeh SUMMARY notable improvements to the humanitarian situation atana !( D !( YARMUK Maliha MADAMIYET DARAYYA Haar HAJAR ASWAD The Bait Jan area is located in the southwest of Rural in all Bait Jan communities in January and February ELSHAM Aswad 2017. In April, truce negotiations faltered in Babella Damascus governorate, close to the Lebanese Sahnaya border, and has faced access restrictions since the two remaining communities, Bait Jan and Mazreat Beit Jin, precipitating increased access early 2013. This profile covers five communities KHAN ELSHIH Ghizlaniyyeh restrictions and a return of shelling in the two BETIMA !( in this area: Bait Jan, Beit Saber, Betima, Kafr KAFR HOOR (! communities. This profile presents the situation (! Hoor and Mazraet Beit Jin. These communities, all Bait Jan classified as hard-to-reach, were profiled for the first in the Bait Jan communities during May 2017, with BEIT SABER Kisweh comparisons made to April. BAIT JAN (! time in November 2016. A truce agreement with (! (! MAZRAET BEIT JIN Sasa Beit Saber, Betima and Kafr Hoor was signed in The humanitarian situation in the Bait Jan Kms January 2017, which resulted in the lifting of access communities did not significantly change in 0 5 10 restrictions on people and vehicles, leading to May. The humanitarian situation last changed in CHANGES SINCE APRIL METHODOLOGY

Truce No Truce Truce No Truce Based on data collected from community representatives inside Syria at the end of May and beginning of communities communities June 2017, these updates refer to the situation in May 2017. Information collected provides an understanding of how limited freedom of movement and restrictions on access affect humanitarian needs in communities Access Restrictions Health Situation in Syria. Participants provide information comparatively to the previous month. Where possible during on Civilians analysis, comparisons are also made to findings from previous periods the community has been assessed. Commercial Vehicle Core Food Item An improvement or deterioration from the previous month may not indicate a trend but rather distinct Access Availability circumstances specific to the month assessed. When possible, information presented has been triangulated with other available sources prior to inclusion, yet findings should be considered indicative rather than Humanitarian Core Food Item generalisable for the whole community as representative sampling, entailing larger scale data collection, Vehicle Access Prices remains challenging in areas with restricted movement and access. Finally, the level of information on each community varies due to difficulties obtaining data from certain locations. Access to Basic Overall Humanitarian Services Situation April, but only in the communities without a truce Risks faced when trying to enter or exit restrictions did not affect commercial traffic Others providing medical services agreement (Bait Jan and Mazraet Beit Jin), due to between the five communities, but prevented (all communities except Mazraet Beit Jin): increased access restrictions negatively impacting All communities: None reported. any vehicle from outside from entering the Dentists, veterinarians, pharmacists, medical food and fuel prices, as well as access to medicine two communities without truce agreements. MOVEMENT OF GOODS AND ASSISTANCE or pharmacy students, volunteers with informal in those communities. Prior to that, no change had been reported in or no medical training. The most significant change was a decrease Vehicles carrying commercial goods any community since January, when access in the price of vegetables across all five restrictions were lifted in all communities Change since April communities (a change reported widely across following the truce agreement. Change since April: Unavailable medical items4 Syria) and a drop in the price of butane in Bait Jan HEALTH SERVICES and Mazraet Beit Jin. No other significant change in No medical items available: No change to the amount of, or restrictions access restrictions for civilians, commercial traffic, Mazraet Beit Jin on, commercial traffic entering the five Change in health situation since humanitarian deliveries, health and other services communities was reported in May. From April: Unavailable (in Bait Jan): provision or food access was reported in May. January through March, it was reported that Burn treatment. No change to the health situation in the five commercial vehicles freely accessed all five Unavailable (in all communities): MOVEMENT OF CIVILIANS communities was reported in May. Access to communities after a truce agreement was Anaesthetics and medical scissors. 3 medical items previously declined in Bait Jan in People able to leave reached with Beit Saber, Betima and Kafr Hoor. April, due to the increased access restrictions The amount of medical items in the five After truce negotiations with the remaining two Change in # people able to leave imposed on the communities without truce communities did not change in May, after a communities (Bait Jan and Mazraet Beit Jin) compared to April: agreements. As Mazreat Beit Jin community decrease was reported in Bait Jan in April broke down in early April, official authorities representatives have not reported any medical due to the imposition of access restrictions No change in restrictions on movement for no longer permitted access to commercial staff, facilities or goods in the community since on the community. No medical items have civilians was reported in any of the five assessed vehicles from outside to enter Bait Jan and assessments began, the situation did not been reported available in Mazraet Beit Jin communities in May. Mazraet Beit Jin, with with no change reported change there due to these increased access since assessments began, but community in regard to the other communities. As has been the case since truce negotiations restrictions. representatives reported no issues in accessing broke down in Bait Jan and Mazraet Beit Jin medical supplies from other communities in As has been the case since these communities As has been the case since the communities in early April, only a small number of civilians were first assessed in November 2016, no the Bait Jan area. The overall availability of from these communities were able to use formal were first assessed in November 2016, while medical items in the remaining communities formal restrictions on commercial vehicle traffic community representatives in Mazraet Beit access points to enter or exit the wider area. between the five communities was reported. has not changed since access increased with Jin stated no medical items or facilities were the onset of the truce. Elsewhere, between 76-100% of all residents However, it was reported that shelling was available in the community, no issues in from Beit Saber, Betima and Kafr Hoor have been renewed around Bait Jan and Mazraet Beit Jin accessing medical care in nearby communities Change since April: able use formal access points after identification after truce negotiations broke down in April. were reported. Several community respondents checks since January, with the onset of the truce in multiple communities have stated residents in Most needed medical items5 agreement in these communities. Humanitarian vehicles all five communities have access to healthcare Prior to April, the same access restrictions were across all five communities when necessary. Across communities assessed in the Bait Jan Change since April: area, the most needed medical items in May applied to all five communities, and between 76- The last change to the health situation in 100% of residents in Bait Jan and Mazraet Beit have not changed since November: No humanitarian vehicles have entered the all communities occurred in January and Jin were able to use formal access points. This February, when increasing amounts of medical 1. Diabetes medicine ended with the breakdown in truce negotiations. Bait Jan communities since at least November 2. Heart medicine 2016 when assessments began. items entered the area through commercial No restrictions on access between the traffic following the truce agreement. 3. Antibiotics five communities has been reported since Goods entered Unusual outbreaks of disease6 Strategies used to cope with a lack of assessments began in November 2016, but No change in the amount of goods entering medical items / medicines shelling was once again reported in Bait Jan No known cases across all communities, the communities was reported in May. The None reported across all communities; and Mazraet Beit Jin following the failure of the amount entering Bait Jan and Mazraet Beit which has not changed since November 2016. truce negotiations in April. residents in Mazraet Beit Jin continued to Jin previously decreased in April due to the Availability of medical personnel seek medical services in other communities Informal entry points: None reported. increased access restrictions. These access All communities: Professionally trained when necessary, as has been the case since doctors, nurses and midwives; November 2016.

Informing Available Positive increase Negative increase May 2017 2 more effective REACH humanitarian action Sometimes available No change Positive decrease Not available Negative decrease Medical services available Permanent medical facilities available Bait Jan Beit Saber Betima Kafr Hoor Mazraet Beit Jin Bait Jan Beit Saber Betima Kafr Hoor Mazraet Beit Jin

Child immunization Mobile clinics / field hospitals Diarrhea management Informal emergency care points Emergency care

Skilled childbirth care Pre-conflict hospitals Surgery7 Primary healthcare facilities Diabetes care Change since April Change since April

ACCESS TO SERVICES* No changes to service provision were reported in any community in May. Electrical access previously improved for communities connected to the electrical network in April, due to official authorities easing rationing restrictions on the network. No other changes to service provision have been reported in any community since assessments began in November 2016.

WATER ELECTRICITY EDUCATION Main source of drinking water Available water to Access to Access to electricity Access to Available education Barriers to (Status**) meet household needs water network network per day electricity (Main facilities education (Coping strategies) per week source) per day Bait Jan Closed wells and water network Sufficient 1 - 2 days Network unavailable 1 - 2 hours Pre-conflict primary, None reported (Safe to drink) (Generators; Solar secondary, and high panels) schools Beit Saber Water network (Safe to drink) Sufficient 1 - 2 days 1 - 2 hours 2 - 4 hours Pre-conflict primary, None reported (Network) secondary, and high schools Betima Water network (Safe to drink) Sufficient 1 - 2 days 1 - 2 hours 2 - 4 hours Pre-conflict primary, None reported (Network) secondary, and high schools Kafr Hoor Water network (Safe to drink) Sufficient 1 - 2 days 1 - 2 hours 2 - 4 hours Pre-conflict primary, None reported (Network) secondary, and high schools Mazraet Closed wells and water network Sufficient 1 - 2 days Network unavailable 1 - 2 hours Pre-conflict primary and None reported Beit Jin (Safe to drink) (Generators; Solar secondary schools panels) *Arrows indicate change in access since April. ** Data collected is based on perceptions of local actors and and water safety cannot be guaranteed in the absence of water testing.

Informing Available Positive increase Negative increase May 2017 3 more effective REACH humanitarian action Sometimes available No change Positive decrease Not available Negative decrease FOOD Strategies used to cope with a lack of food Food item availability / prices with firewood reportedly no longer available due to a lack of seasonal demand. Change in food situation Bait Jan and The price of assessed fresh vegetables decreased across all five communities in May, Due to the access restrictions, the price of compared to April: Mazraet Beit Jin as has been reported in many communities fuels remained higher and availability of fuels In Bait Jan and Mazraet Beit Jin, assessed Reducing meal size across Syria and may be related to the expected remained lower in Bait Jan and Mazraet food prices were between 25-125 SYP more start of harvest season for many vegetables in Beit Jin than in the remaining communities. Skipping meals 11 expensive than prices in communities with a June. Additionally, the reported price of sugar All fuel items were generally available in communities with a truce agreement, and only truce agreement, likely due to the increased Days without eating decreased in the three communities with a access restrictions imposed in April. truce agreement. The prices of all remaining sometimes available in Bait Jan and Mazraet 12 Most common methods of obtaining Eating non-food plants food items changed by 5% or less from April. Beit Jin. The prices of butane and diesel were reported 28% and 11% higher from April food at the household level The price of flour, lentils, bulgur, rice and bread Eating food waste were reported between 5-20% higher in Bait in the communities with and without access 1. Purchasing from shops or markets Jan and Mazraet Beit Jin than in the remaining restrictions, respectively. Reportedly used as a coping strategy 2. Purchasing from local farmers communities with a truce agreement, with all Beyond a slight drop in fuel prices in Bait Jan 3. Home production Not reportedly used as a coping strategy remaining food items showing no significant and Mazraet Beit Jin, prices remained similar to change between regions. Men and women have been reported using April. Butane prices had previously increased As has been the case since assessments 10 coping strategies in Bait Jan and Mazraet Beit No food item was reported generally available by over 60% in March, which was attributed to began in November 2016, all five communities Jin since the faltering of truce talks in April, in Bait Jan and Mazraet Beit Jin in May for the a general fuel shortage that was affecting many reported that populations could purchase food with no change reported in May. No coping first time since assessments began. All food communities in Rural Damascus. from shops, markets or local farmers, as well 11 strategies have been reported in use in the items were reported as sometimes available Strategies used to cope with a lack of fuel: as rely on home production. in May. However, this was only a slight decline remainig communities since assessments No coping strategies were reported in any Most common methods of obtaining began in November 2016. in availability from April, and attributed to the continuing access restrictions that limit community in May. While prior to March this was bread at the household level CORE FOOD ITEM / NFI AVAILABILITY AND commercial traffic to the two communities. the case in all five communities, the imposition PRICES of access restriction led to the burning of Bait Jan and Mazraet Beit Jin: Shops. WASH item availability / prices plastics and waste in Bait Jan Mazraet Beit Jin Beit Saber, Betima and Kafr Hoor: Private Average cost of standard food basket8 As had been the case since April, soap and in March and April. Reportedly, the decrease bakeries. laundry powder were reported sometimes in fuel prices and warm weather led to the Challenges to obtaining bread: No Bait Jan Nearby available11 in Bait Jan and Mazraet Beit reduction in reported coping strategies in these challenges were reported in any community in Average areas9 Jin. All other hygiene and sanitation items communities in May. May 2017. were reported generally available12 in all Average cost May 10 36319 32962 communities. Change since April (SYP) On average, prices of assessed items Change since Deaths attributable to a lack of food6 remained similar to previous months, with no April systematic price differences between the Bait All communities: None reported since The average price of a standard food basket Jan communities and nearby communities not assessments began in November 2016. from the Bait Jan communities and nearby non- considered hard-to-reach. hard-to-reach communities has not notably Fuel availability / prices changed since January 2017. In May, the price of a standard food basked in the Bait Jan Since April, butane and diesel were the only fuel communities was 10% higher than in nearby sources available across Bait Jan communities, communities not considered hard-to-reach.

Informing Available Positive increase Negative increase May 2017 4 more effective REACH humanitarian action Sometimes available No change Positive decrease Not available Negative decrease CORE FOOD ITEM / NFI AVAILABILITY AND PRICES10 Endnotes 1 Figures based on HNO 2017 population data (January 2017). Figures based on estimates by local actors within communities For affected populations the functionality of, and access to, basic services such as medical assessed were reportedly 2,000-2,300 (Bait Jan), 5,000-5,200 facilities, water and electricity are highly dependent on the price and availability of fuel sources. (Beit Saber), 5,000-5,300 (Betima), 4,000-4,100 (Kafr Hoor) and 5,000-5,150 (Mazraet Beit Jin) individuals. 2 Figures based on estimates by local actors within communities Item Bait Jan Price change since Nearby non-hard-to- assessed. Figures based on HNO 2017 population data (December 2016) were reportedly 50-65 (Beit Saber), 25-35 average 13 reach communities9 April (Betima), 25-35 (Kafr Hoor), 180-200 (Bait Jan) and 5,000-5,150 Food Items Bread private bakery (pack) 7212 100 (Mazreat Beit Jin) IDPs. 3 The fact that some informal points exist does not imply their Bread public bakery (pack) Not available 58 safety, security, or the financial capacity of any notable portion of Rice (1kg) 52012 535 the population to pay the fees required to use them. 4 12 Some availability does not necessarily imply sufficiency. Likewise, Bulgur (1kg) 260 320 the list is not intended to be a comprehensive assessment of all Lentils (1kg) 52012 525 medical needs, but rather indicative of key medical items that speak to the trend in access to medical services in the area. 12 Chicken (1kg) 1035 1120 5 ‘Most needed’ does not necessarily imply unavailability. Further Mutton (1kg) 350012 3925 this list is not intended to be a comprehensive list of most needed medical items or medicines, but rather indicative of needs that Tomato (1kg) 35012 -29% 410 speak to the trend in the priorities of medical items in the area. Cucumber (1kg) 25512 -47% 318 6 Reported deaths are based on reported incidents within the community. There is better access to health reports in 12 Milk (litre) 200 215 certain communities, therefore, validity of estimations varies. 12 Without medical assessments, it was not possible to verify the Flour (1kg) 260 233 exact causes of death cited, therefore the caseload is indicative Eggs (1) 5012 50 of the perceived health issues causing death in the communities. 7 Iodised salt (500g) 5012 65 The availability of surgery does not necessarily imply treatment by a doctor formally trained in the relevant procedure, or the use Sugar (1 kg) 39512 -14% 438 of anaesthesia or appropriate clinical equipment. Community 12 members, without professional medical backgrounds, may Cooking oil (litre) 1750 1225 have been informally trained by medical personnel to carry out WASH Items Soap (1 bar) 10012 113 emergency procedures. 8 12 Calculation of average cost of food basket based on WFP’s Laundry powder (1kg) 437 875 standard food basket of essential commodities. The basket Sanitary pads (9) 44512 444 includes 37 kg of bread, 19 kg rice, 19 kg lentils, 5 kg of sugar and 7 kg of vegetable oil, providing 1,930 kcal a day for a family of five 12 Toothpaste (125ml) 440 382 during a month. Available at: WFP, VAM Food Security Analysis, Disposable diapers (24 pack) 112012 1575 ‘Syria Market Price Watch Bulletin: April 2017’ (link here). 9 Nearby communities in Rural Damascus governorate which are Fuel 12 Butane (cannister) 3340 -9% 2925 not considered besieged/hard to reach: Deir Ali and Kisweh. Diesel (litre) 23512 280 10 $1 = 515 SYP (UN operational rates of exchange as of 1 June 2017). Propane (cannister) Not available 2560 11 Sometimes available in markets (7-21 days this month) Kerosene (litre) Not available 400 12 Generally available in markets (21+ days this month) Coal (kg) Not available 450 13 Price fluctuations of 5% or less were not reported. Firewood (tonne) Not available 70000

Informing Available Positive increase Negative increase May 2017 5 more effective REACH humanitarian action Sometimes available No change Positive decrease Not available Negative decrease Syria Community Profile Update:Burza, Jober and Tadamon, Damascus Informing more effective May 2017 REACH humanitarian action

FOR HUMANITARIAN PURPOSES ONLY

Rankus Burza Jober Tadamon AZ ZABDANI ² D Dimas UN classification: Besieged Besieged Hard-to-reach Syrian Arab BINE Madaya !( 1 Republic !( Sidnaya Estimated population : 30000-32000 250-350 1800-2000 MADAYA Ein Elfieh Of which estimated IDPs1: 6000-8000 None 250-300 Az Zabdani At Tall SU WADI % pre-conflict population remaining: 51-75% 1-25% 1-25% BURDA BARHALIYA Neighbourhoods covered !( !( DEIR MARAN !( !( D in this profile KAFR ELAWAMID !( !( EIN ELFIJEH AT TALL % of population that are female: 26-50% 1-25% 1-25% !( D !( HSEINIYEH KAFIR BSEIMEH Other assessed DEIR ELZEIT Harasta neighbourhoods ANUN Duma % of female-headed households 1-25% 1-25% 1-25% udsiya DUMA HARASTA !( !( Other assessed !( HAMA BURZA !( communities !(!( !( UDSIYA ABOUN ARBIN SUMMARY escalation of conflict have affected Burza and Jober !( D Formerly assessed ZAMALKA HAMMURA Located in eastern Damascus governorate, the in the first half of 2017. In early May, a ceasefire communities !( !( DAMASCUS CITY !( JOBER !( !( SABA NASHABIYEH neighbourhoods of Burza, Jober and Tadamon was reached between parties to the conflict and the !( !( Urban area EIN KAFR JISREIN Kafr have faced access restrictions since mid-2013. security situation stabilised again in Damascus city. Markaz TERMA BATNA Batna Subdistrict borders Darayya TADAMON Jaramana Nashabiyeh Burza, previously considered as ‘hard-to-reach’, In May, access to basic services improved in all Main roads !( atana !( D !( YARMUK was reclassified as ‘besieged’ in April 2017. While Maliha three communities. Cessation of hostilities in Main rivers MADAMIYET DARAYYA Haar HAJAR ASWAD the profile refers to the situation in May 2017, ELSHAM Aswad Burza and the return of some families to Jober Babella comparisons were made to changes observed resulted in the reopening of some school facilities Sahnaya since April, when the neighbourhoods were last in the two neighbourhoods, while better access to KHAN ELSHIH Ghizlaniyyeh assessed. water trucking services was reported in Tadamon. !( KAFR HOOR BETIMA Overall, in May the humanitarian situation Further, access to electricity improved in Burza !( !( improved in Burza, where it nonetheless following the ceasefire. Bait Jan BEIT SABER Kisweh remained critical, and Jober, compared to BAIT JAN MAZRAET !( In Burza, a humanitarian distribution of bread !( BEIT JIN April. Conversely, no change was reported in !( bags took place on 14 May. However, no other Sasa Kms Tadamon. goods were allowed into the neighbourhood this 0 5 10 While the humanitarian situation remained month. Further, Burza remained entirely isolated relatively stable from June 2016 to December from other areas and civilian movement was not 2016, progressively tighter access restrictions and allowed except within the framework of planned METHODOLOGY CHANGES SINCE APRIL Based on data collected from community representatives inside Syria at the end of May and beginning of June 2017, these updates refer to the situation in May 2017. Information collected provides an Burza Jober Tadamon Burza Jober Tadamon understanding of how limited freedom of movement and restrictions on access affect humanitarian Access Restrictions needs in neighbourhoods in Syria. Participants provide information comparatively to the previous Health Situation on Civilians month. Where possible during analysis, comparisons are also made to findings from previous periods the community has been assessed. An improvement or deterioration from the previous month may Commercial Vehicle Core Food Item not indicate a trend but rather distinct circumstances specific to the month assessed. When possible, Access Availability information presented has been triangulated with other available sources prior to inclusion, yet findings Humanitarian Core Food Item should be considered indicative rather than generalisable to the whole community as representative Vehicle Access Prices sampling, entailing larger scale data collection, remains challenging in areas with restricted movement Access to Basic Overall Humanitarian and access. Finally, the level of information on each community varies due to difficulties obtaining data Services Situation from certain locations. evacuations. Persisting access restrictions resulted MOVEMENT OF INDIVIDUALS risks associated with using informal routes MOVEMENT OF GOODS AND ASSISTANCE in a worse food situation, compared to April, as Change in # people able to leave decreased in May, compared to April. De- Vehicles carrying commercial goods well as in poorer access to medicine, hygiene and compared to April in Burza and escalation of conflict in the neighbourhood sanitation items, and fuel. In particular, among prompted several families to return to Jober, Change since April in all three: Jober: assessed items, only sugar and sanitary pads were with marked a change from April when no available on markets this month. Change in # people able to leave women or children were left in the community. All neighbourhoods: None reported. This compared to April in Tadamon: was the case since assessments began. Conversely, civilian mobility improved in Jober, due Tadamon: As had been the case since to lower risks associated with using informal access People able to leave2 assessments began in June 2016, women, Humanitarian vehicles points. As a result, several families returned from children and the elderly were allowed to move Eastern Ghouta this month. Populations reported Burza: Following the ceasefire in early through formal entry points twice per week, Change since April in Burza: having better access to food, NFIs, fuel and medical May, four evacuations occurred during this upon presenting documents. The number of Change since April in Jober and month, with around 6,000 people leaving the services in May, compared to April, due to more people allowed to leave through both formal Tadamon: civilians being able to leave the community and neighbourhood. Access restrictions remained and informal routes has remained the same bring items back. otherwise unchanged, as no one was allowed (26-50%) since September 2016. Burza: On 14 May, humanitarian aid vehicles to enter or exit the community, except as part of entered the neighbourhood and distributed As conflict de-escalated, caseloads reduced in planned evacuations. As had been the case in Risks faced when trying to enter or exit bread bags to residents. This was the first both Burza and Jober in May. However, the health April, the neighbourhood remained completely (formally or informally) distribution reported since October 2016. situation remained critical in Burza, due to the isolated from nearby areas. Burza: None; depletion of medical item stocks and the evacuation Jober and Tadamon: None reported. This had of some medical personnel. No change was Jober: While no formal entry points were Jober: Gunfire, shelling; been the case since assessments began. reported in Tadamon. available, as had been the case since the Tadamon: Gunfire, verbal harassment, detention. community was first assessed in June 2016, ACCESS TO SERVICES De-escalation of conflict in Burza and Jober resulted in the reopening of schools in both neighbourhoods this month. Schools had ceased to operate in March due to security risks in Burza and to the departure of all school-aged children from Jober. Children in Tadamon, where no facilities were available, could access schools in nearby communities, as had been the case since assessments began. Access to water improved in Tadamon in May as access to water trucking, the main source of drinking water, increased. Residents reportedly resorted to closed wells for other household needs. No change in access to water was reported in Burza and Jober since February. Further, restrictions on the supply of electricity through the main network were lifted in Burza as a result of the ceasefire in early May and access significantly improved. Burza Jober Tadamon WATER Main source of drinking water (Status) Water network (Water was safe to drink)* Water network (Water was safe to drink)* Water trucking (Water was safe to drink)* Available water to meet household needs Sufficient Sufficient Sufficient (Coping strategies) Access to water network per week 3-4 days 5-6 days Network unavailable Change since April ELECTRICITY Access to electricity network per day >12 hours Network unavailable Network unavailable Access to electricity (Main source) per day >12 hours (Network) 2-4 hours (Generator) 2-4 hours (Generator) Change since April EDUCATION Available education facilities Pre-conflict primary schools Pre-conflict primary schools None Barriers to education All school aged children accessed education All school aged children accessed education Parents do not approve of curriculum, services are too far, routes to services unsafe Change since April * Data collected is based on perceptions of local actors and therefore reported water safety requires verification through water testing.

Informing Available Positive increase Negative increase May 2017 2 more effective REACH humanitarian action Sometimes available No change Positive decrease Not available Negative decrease Goods entered in March and April, although medical facilities Strategies used to cope with a lack of Jober: Anti-anxiety, heart and diabetes were available in the neighbourhood, these medicine, contraception, blood transfustion Burza: With the exception of a humanitarian medical services were reportedly unable to provide most health bags, clean bandages, burn treatment; distribution of bread in mid-May, no food, services. Burza: None; non-food, fuel or medical items entered Burza Jober: Using expired medicine; Tadamon: Clean bandages, blood transfusion this month. This had been the case since the Jober: The health situation in Jober improved bags, burn treatment, anaesthetics, medical closure of all formal access points in February compared to April, when a decrease in Tadamon: Using expired medicine, civilians scissors, diabetes, blood pressure and anti- for food and non-food items, while fuel and available personnel and medical items, as well without professional training treating patients. anxiety medicine. as ongoing clashes had negatively affected medical items had not entered since January Medical services available 2017 and December 2016, respectively. As a residents. The improvement of the security Change since April in Burza: situation in May resulted in lower caseloads result, nearly all of the items assessed were Burza Jober Tadamon Change since April in Jober and as well as improved access to some services, unavailable on markets this month. Populations Tadamon: reportedly resorted to coping strategies such as such as child immunization. Child reducing the size of meals and using electricity Tadamon: Residents could cope with a lack immunization Permanent medical facilities available instead of fuel. of services by accessing medical care in Diarrhoea Jober: Reduction in hostilities in May resulted in nearby communities, as had been the case management Burza Jober Tad. fewer risks associated with entering or leaving since assessments began in June 2016. Emergency Mobile clinics / field the community informally. Consequently, a Barriers to accessing medical services care hospitals higher number of residents were able to leave persisted for people living in some parts of Skilled Informal emergency the neighbourhood and bring goods back, the neighbourhood and people with certain childbirth care political affiliations. care points compared to April. Higher availabilities and Surgery4 lower prices on markets were thus reported Availability of medical personnel Pre-conflict hospitals this month. Diabetes care Tadamon: No significant changes were Burza: Professionally trained surgeons and Primary healthcare nurses; Change since facilities reported in Tadamon, where residents would April access markets in the nearby neighbourhoods Jober: Professionally trained nurses; Change since April of Yalda and Babella. This had been the case No change in available services was reported since assessments began. Tadamon: None; civilians relied on traveling in Burza and Tadamon in May. In Jober, after to nearby neighbourhoods to access medical a reduction of available services was reported Most needed medical items6 HEALTH SERVICES services. in April, child immunization services became Change in health situation in Burza and Others providing medical services: available in May. This was reportedly due Burza Jober Tadamon Tadamon: Volunteers with informal medical training. to SARC’s distribution of vaccines in April in Eastern Ghouta, where residents of Jober were Diabetes Clean Clean Change in health situation in Jober: 1. Change since April in Burza: able to obtain it. medicine bandages bandages Women in need of childbirth care reportedly Burza: Cessation of hostilities in the aftermath Change since April in Jober and Blood Heart of the ceasefire resulted in lower caseloads Tadamon: had to travel to nearby communities to cope 2. transfusion Antibiotics medicine in May, compared to April. However, due to with the lack of services in Jober and Tadamon. bags persisting bans on the entry of medical items, 3 5 Unusual outbreaks of disease Unavailable medical items Blood as well as to a futher decrease in available Diabetes None reported in all three communites; this 3. Antibiotics transfusion medical personnel, the health situation Burza: Contraception, anti-anxiety medication, medicine had been the case since December 2016. bags remained critical in Burza. As was the case blood transfusion bags, clean bandages, antibiotics, heart, diabetes and blood pressure medicine;

Informing Available Positive increase Negative increase May 2017 3 more effective REACH humanitarian action Sometimes available No change Positive decrease Not available Negative decrease FOOD Deaths attributable to a lack of food3 Jober: In May, the reported cost of a standard toothpaste, sanitary pads, disposable diapers) food basket was 34% lower than in April, and was critically low in Burza, and only sanitary Change in food situation in Burza: No known cases in all three neighbourhoods, 10 as had been the case since the communities was 166% higher than in nearby communities pads remained sometimes available in Change in food situation in Jober: were first assessed. not considered besieged or hard-to-reach. markets. In April’s profile, the price of a standard food In Jober, similarly to food items, better access Change in food situation in Tadamon: Strategies used to cope with a lack of basket was misreported (62,162 SYP) and has to hygiene and sanitation items was reported food since been corrected (123,565 SYP). The food situation worsened in Burza for the fifth in May, compared to April, as availability and Tadamon: The average price of a standard prices improved this month. Prices decreased consecutive month, despite SARC’s distribution of Burza Jober Tadamon bread bags in mid-May. Ongoing access restrictions food basket remaind unchanged compared to by an average 27%, yet remained 57% resulted in lower food availabilities, with nearly all Reducing April, and was 9% lower than in nearby non- higher than those reported in non-besieged core items assessed being unavailable on markets meal size hard-to-reach communities. communities. this month. Conversely, the food situation improved Skipping Food item availability / prices In Tadamon, no significant change in in Jober, where the improvement in the security meals availabilities or prices was reported in May, Burza: Availability of assessed core food items situation in May allowed civilians to travel more Days without compared to April. easily to nearby areas in order to obtain food. No further decreased in May, with only sugar eating Fuel availability / prices change was reported in Tadamon, as had been the available on markets this month. As such, no Eating non- price comparisons could be made to April or to No fuel was reportedly available in Burza this case since assessments began. food plants prices reported in nearby communities. month. With the exception of diesel, which Most common methods of obtaining Eating food Jober: In May, availability of food items became temporarily available in April with food at the household level waste improved in Jober. Chicken, tomato, mutton prohibitively high prices, all other fuel items had Burza: Home production in backyards and Reportedly used as a coping strategy and cucumber became available after been unavailable since March. roofs; Not reportedly used as a coping strategy becoming unavailable in either March or April. Compared to April, no significant changes in Jober and Tadamon: Purchasing from shops As a result of higher availabilities, prices of access to fuel were reported in Jober, where and markets in nearby areas. Reported strategies used to cope with a lack most assessed items decreased, compared prices remained 453% higher than those of food remained unchanged since December Most common methods of obtaining to April. This was due to an improved security reported in nearby communities not considered 2016. situation and greater freedom of movement bread at the household level besieged. in the neighbourhood, whose residents could CORE FOOD ITEM / NFI AVAILABILITY AND In Tadamon, fuel prices were 128% higher more easily obtain food from nearby areas. Burza: Humanitarian distribution; than in nearby communities, while the price of PRICES Nonetheless, prices remained on average Challenges to obtaining bread (Burza): diesel marginally increased after decreasing in Average cost of standard food basket7 76% higher than in nearby communities not Bread unavailable in bakeries, flour unavailable. April, due to changing availabilities in close by considered besieged. Access to bread temporarily improved in Nearby neighbourhoods. Burza Jober Tad. areas8 Tadamon: On average, prices of food items mid-May due to SARC’s distribution of bread Strategies used to cope with a lack of fuel: bags among resident populations. Barriers to remained unchanged compared to April, Average cost and fluctuations observed in May depended Burza: Using electricity; accessing bread remained otherwise similar to May (SYP)9 No info 82032 28070 30878 those reported in April. on the availability and prices of items in Jober and Tadamon: Burning furniture in use nearby communities, where residents most Challenges to obtaining bread (Jober and or without use, burning clothes or plastics. Change since No info commonly obtained their food. On average, Tadamon): Bread unavailable in bakeries, April reported prices were similar to those in nearby flour too expensive/hard to access, electricity/ communities not considered hard-to-reach. fuel too expensive/hard to access. Burza: It was not possible to calculate the price for a standard food basket in May, due to WASH item availability / prices Change in availability in Burza unavailability of most core food items; this had since April The availability of assessed hygiene and been the case since February; sanitation items (soap, laundry powder, Change in availability in Jober and Tadamon since April

Informing Available Positive increase Negative increase May 2017 4 more effective REACH humanitarian action Sometimes available No change Positive decrease Not available Negative decrease CORE FOOD ITEM/NFI PRICE AND AVAILABILITY INDEX9 Endnotes 1 Figures based on estimates by local actors within neighbourhoods assessed. The last HNO 2017 population data (December 2016) For affected populations the functionality of, and access to, basic services such as medical facilities, water and electricity are highly dependent on provides the following population estimates: Burza (88,387), Jober the price and availability of fuel sources. (2,000), Tadamon (691). 2 The fact that some informal points exist does not imply their Item Nearby safety, security, or the financial capacity of any notable portion of Price change Price change Price change the population to pay the fees required to use them. non-hard-to- Burza 12 Jober 12 Tadamon 12 3 since April since April since April reach areas8 Reported deaths are based on reported incidents within the community. There is better access to health reports in certain Food Bread private bakery (pack) Not available Not available Not available 181 neighbourhoods, therefore, validity of estimations varies. Without Items medical assessments, it was not possible to verify the exact Bread public bakery (pack) Not available Not available Not available 53 causes of death cited, therefore the caseload is indicative of the Rice (1kg) Not available Available 110011 -41% 25011 500 perceived health issues causing death in the neighbourhoods. 4 11 11 The availability of surgery does not necessarily imply treatment Bulgur (1kg) Not available Available 900 -18% 300 +9% 1042 by a doctor formally trained in the relevant procedure, or the use of Lentils (1kg) Not available Available 80011 50011 +11% 588 anaesthesia or appropriate clinical equipment. Community members, without professional medical backgrounds, may have been informally Chicken (1kg) Not available 240011 Not available Not available 1256 trained by medical personnel to carry out emergency procedures. Mutton (1kg) Not available 400011 Not available Not available 4256 5 Some availability does not necessarily imply sufficiency. Likewise, the list is not intended to be a comprehensive assessment of all Tomato (1kg) Not available 170011 Not available 40011 247 medical needs, but rather indicative of key medical items that Cucumber (1kg) Not available 110011 Not available 30011 -40% 275 speak to the trend in access to medical services in the area. 6‘Most needed’ does not necessarily imply unavailability. 11 10 Milk (litre) Not available 325 -7% 250 256 Furthermore this list is not intended to be a comprehensive list Flour (1kg) Not available 100011 30011 301 of most needed medical items or medicines, but rather indicative of needs that speak to the trend in the priorities of medical items Eggs (1) Not available 10011 -31% 5510 58 in the area. Iodised salt (500g) Not available 30011 15011 140 7 Calculation of average cost of food basket based on WFP’s standard food basket of essential commodities. The basket includes 37 kg of Sugar (1 kg) 100010 Not available 125011 -61% 40011 444 bread, 19 kg rice, 19 kg lentils, 5 kg of sugar and 7 kg of vegetable 11 11 oil, providing 1,930 kcal a day for a family of five during a month. Cooking oil (litre) Not available 1300 -53% 750 850 Available at: WFP, VAM Food Security Analysis, ‘Syria Market Price WASH Soap (1 bar) Not available Available 15011 -40% 12511 146 Watch Bulletin: April 2017’ (link here). As bread was unavailable in Items private and public bakeries in all three neighbourhoods, no prices Laundry powder (1kg) Not available Available 185011 65011 +8% 888 were available for bread sold in bakeries. However, food basket 10 11 11 prices were calculated using the reported price of bread sold in Sanitary pads (9) 850 +125% 550 -35% 300 438 shops (Jober: 500 SYP. Tadamon: 200 SYP). 11 11 Toothpaste (125ml) Not available 500 -9% 450 245 8 Nearby communities in Damascus which are not considered Disposable diapers (24 pack) Not available 320011 -47% 165011 2188 besieged/hard to reach: Ayoubiya, Jalaa, Zahreh, Midan Wastani. 9 Fuel 11 $1 = 515 SYP (UN operational rates of exchange as of 1 June Butane (cannister) Not available Not available 3800 2960 2017). Diesel (litre) Not available Available 190011 -24% 60011 +9% 290 10 Sometimes available in markets (7-20 days this month). Propane (cannister) Not available Not available Not available 4500 11 Generally available in markets (21+ days this month). 12 Price fluctuations of 5% or less were not reported. Kerosene (litre) Not available Not available Not available 350 Coal (kg) Not available Not available Not available 350 Firewood (tonne) Not available 22500011 +18% 12500011 50000

Informing May 2017 5 more effective REACH humanitarian action Syria Community Profile Update: Deir ez Zor City (Joura, Qosour), Deir ez Zor Informing May 2017 more effective REACH humanitarian action

FOR HUMANITARIAN PURPOSES ONLY SUMMARY The city of Deir ez Zor, located in eastern Syria, ² has experienced heavy conflict since June 2012. Syrian Arab Kisreh The neighbourhoods of Joura and Qosour were UN classification: Besieged Republic Tabni recognized as besieged in January 2015. Since 1 Estimated population : 100000-120000 assessments began in June 2016, the communities have experienced a deteriorating humanitarian Of which IDPs1: None situation due to extreme access restrictions and % pre-conflict Neighborhoods ongoing hostilities between the various parties population remaining: 26-50% covered in this profile to the conflict present in the area. This profile Other neighborhoods % population female: reflects the humanitarian situation in Deir ez Zor 26-50% Sbdistricts Border city in May, with community representatives making % female-headed ain roads households: 26-50% DEIR EZ ZOR comparisons to April; the communities were last Riverae CITY assessed in March 2017. JOU!(RA months, it was reported that such deliveries did !( The humanitarian situation in Joura and Qosour not reach large portions of the civilian population. QOSOUR continued to deteriorate in May, with on- Indeed, food security deteriorated further in going access restrictions and violent clashes May in Joura and Qosour, with a higher number leading to a reported 25 civilian casualties. of deaths related to a lack of food reported. Khasham Deir ez Zor Furthermore, stocks of food and medical items, While some diesel and kerosene continued to be and access to electricity decreased throughout produced locally in the communities, it was resold the period. at prohibitive prices and a majority of residents No formal or informal entry routes to Joura and did not have access to functioning generators Qosour were available in May, as has been the (and electricity) in May due to the lack of fuel. hasan case since assessments of the communities Similarly, drinking water remained insufficient and began. Further, conflict dynamics continued to of poor quality, and no schools operated in the limit movement inside the neighbourhoods, neighbourhoods. Kms 0 3 6 with women reportedly subject to harassment No medical items entered Joura and Qosour in May, and rape, while men reported risks of detention for the fifth consecutive month, further negatively METHODOLOGY and conscription. affecting the health situation. Access to formal Limited amounts of food and non-food items medical services remained extremely limited, due Based on data collected from community representatives inside Syria at the end of May and beginning continued to enter Joura and Qosour via airdrops to security concerns related to seeking assistance of June 2017, these updates refer to the situation in May 2017. Information collected provides an in May; however, as has been the case in previous at the only available medical facility. understanding of how limited freedom of movement and restrictions on access affect humanitarian needs in communities in Syria. Participants provide information comparatively to the previous month. CHANGES SINCE APRIL Where possible during analysis, comparisons are also made to findings from previous periods the Access Restrictions on Civilians Health Situation community has been assessed. An improvement or deterioration from the previous month may not indicate a trend but rather distinct circumstances specific to the month assessed. When possible, Commercial Vehicle Access Core Food Item Availability information presented has been triangulated with other available sources prior to inclusion, yet findings should be considered indicative rather than generalisable to the whole community as representative Humanitarian Vehicle Access Core Food Item Prices sampling, entailing larger scale data collection, remains challenging in areas with restricted movement and access. Finally, the level of information on each community varies due to difficulties obtaining data Access to Basic Services Overall Humanitarian Situation from certain locations. MOVEMENT OF CIVILIANS NFIs (soap, detergent). However the exact ACCESS TO SERVICES* contents and quantities of such deliveries Due to continuously depleting fuel stocks, the number of functioning generators available in the Change in # people able to leave remained contested as aid was distributed communities decreased further, with less than 20% of the populations reporting access to electricity. compared to April: unevenly and only reached small portions of Access to drinking water also remained insufficient, and water continued to be reported as of poor quality. As the civilian population. has been the case since assessments began, no educational facilities operated in Joura or Qosour in May.

2 People able to leave Goods entered WATER Main source of drinking water Surface water / unprotected spring No access routes to or from Joura While limited amounts of food and NFIs (Status**) (People got sick after drinking water) and Qosour have been reported since reached the communities via airdrops in May, Sufficiency of available water to meet Insufficient (Modify hygiene practices, assessments of the communities began in no medical items have been delivered since household needs (Coping strategies bathe less, reduce drinking water June 2016; this remained the case in May. January 2017. used) consumption, drink water used for Although residents could move between the A local petroleum source, first discovered in cleaning or other purposes than drinking) two neighbourhoods, they faced checkpoints February 2017, continued to produce limited while doing so. Risks associated with their quantities of diesel and kerosene. No fuel Access to water network per week 1-2 days use (detention, conscription) prevented many has entered Joura and Qosour through formal ELECTRICITY Access to electricity network per day Network unavailable men from internal travel. Women in Joura and routes since assessments began in June 2016. Access to electricity (Main source) per No electricity available Qosour have consistently reported feeling day unsafe around checkpoints and other areas HEALTH SERVICES with armed actors present, due to risks of EDUCATION Available education facilities None rape, detention and harassment. Change in health situation Barriers to education Facilities destroyed, routes to schools compared to April: Risks faced when trying to enter or exit unsafe, lack of teaching staff (formally or informally) As stocks of medicine continued to deplete *Arrows indicate change in access since April ** Data collected is based on perceptions of local actors and water No risks were reported as no one attempted due to the lack of medical deliveries, the safety cannot be guaranteed in the absence of water testing. to enter or leave the communities. health situation in Joura and Qosour deteriorated further in May. Additionally, Permanent medical facilities available Most needed medical items4 MOVEMENT OF GOODS AND ASSISTANCE men in particular remained largely unable to seek medical services at the only available, 1. Antibiotics Vehicles carrying commercial goods military, hospital due to risks of detention or Mobile clinics / field hospitals 2. Artificial limbs disappearances. Overall, only residents with 3. Contraception Change since April: sufficient financial means or good relations Informal emergency care points with local authorities could access formal Medical services available Able to enter: None reported. medical services. Pre-conflict hospitals Child immunization Humanitarian vehicles Contraception continued to be reported Pre-conflict clinics / surgeries among the most needed medical items due Diarrhoea management to the high reported prevalence of rape. Change since April: Change since April Emergency care Availability of medical personnel Unavailable medical items3 Able to enter: None reported. Personnel available: Professionally trained Skilled childbirth care surgeons, nurses and midwives; Anti-anxiety medication, clean bandages, burn Humanitarian airdrops 5 treatment, anaesthetics, heart, diabetes and Surgery Others providing medical services: blood pressure medicine. Change since April: Anaesthesiologists; volunteers with informal Diabetes care or no medical training. Sometimes available: blood transfusion bags. Change since April In May, airdrops reportedly continued to Change since April deliver some food items (bread, eggs) and Change since April

Informing Available Positive increase Negative increase May 2017 2 more effective REACH humanitarian action Sometimes available No change Positive decrease Not available Negative decrease Strategies used to cope with a lack of Deaths attributable to a lack of food6 Fuel availability / prices medical services Deaths related to a lack of food have been Following the discovery of a petroleum spot which Strategies used to cope with a lack of As a result of the poor availability of formal reported in the two neighbourhoods since allowed for some local production, diesel and fuel: Burning plastics, clothes and waste; medical services, populations had to undergo September 2016. According to community kerosene appeared in markets in February; however, burning furniture with and without use; burning operations without anaesthesia and to representatives, the number reported in May availability remained extremely limited in May. agriculture apparels and other productive assets. use non-medical items for treatment. The was higher than in April, as well as in March, CORE FOOD ITEM/NFI PRICE AND AVAILABILITY INDEX9 communities have reported various coping when the communities were last assessed. strategies since October 2016. For affected populations the functionality of, and access to, basic services such as medical Strategies used to cope with a facilities, water and electricity are highly dependent on the price and availability of fuel sources. Unusual outbreaks of disease6 lack of food Item Joura/Qosour Price change since Due to the informal nature of medical services March9 Reducing meal size in the communities, availability of detailed Food Items Bread private bakery (pack) Not available and verifiable medical information remained 11 difficult to obtain. However, community Skipping meals Bread public bakery (pack) 600 representatives continued to report cholera, Rice (1kg) Not available hepatitis and HPV in Joura and Qosour.7 Days without eating Bulgur (1kg) 350011 Lentils (1kg) Not available FOOD Eating non-food plants Chicken (1kg) Not available Change in food situation Eating food waste Mutton (1kg) Not available compared to April: Reportedly used as a coping strategy Tomato (1kg) Not available Due to the continued extreme access restrictions Cucumber (1kg) Not available facing the communities and the uneven Not reportedly used as a coping strategy Milk (litre) Not available distribution of food rations delivered via airdrops, food insecurity deteriorated in Joura and Qosour CORE FOOD ITEM / NFI AVAILABILITY AND Flour (1kg) Not available in May. Further, the amount of bread distributed PRICES Eggs (1) 50011 in the neighbourhoods reportedly decreased Iodised salt (500g) 50011 further in May. As has been the case since Average cost of standard food basket8 Sugar (1 kg) Not available February, all assessed strategies to cope with a It has not been possible to calculate a standard Cooking oil (litre) 900011 lack of food were reported in the communities. food basket price for Deir ez Zor since WASH Items Soap (1 bar) 190012 Most common methods of obtaining December 2016, due to the unavailability of Laundry powder (1kg) 1200011 food at the household level most core food items. Sanitary pads (9) Not available Receiving from food distributions (airdrops), Food item availability / prices Toothpaste (125ml) Not available bartering. As has been the case since February, the only Disposable diapers (24 pack) Not available Most common methods of obtaining remaining core food items in Joura and Qosour Fuel Butane (cannister) Not available bread at the household level were bread from public bakeries, bulgur, eggs, salt and cooking oil. All items were reported to Diesel (litre) 70011 Most common source: Public bakeries. be prohibitively priced. Propane (cannister) Not available Challenges to obtaining bread: Flour, wheat 11 WASH item availability / prices Kerosene (litre) 1900 and yeast unavailable or too expensive/hard to access; electricity/fuel insufficient or too Soap and laundry powder entered the Coal (kg) Not available expensive/hard to access. communities via airdrops, and were resold in Firewood (tonne) Not available markets at prohibitive prices. In the absence Change since April of sanitary pads, women continued to resort to Due to limited coverage, it was not possible to collect prices for comparison the use of cloth. in May from nearby communities not considered besieged or hard-to-reach.

Available Positive increase Negative increase May 2017 3 aaa a Sometimes available No change Positive decrease Not available Negative decrease Endnotes 1 Figures based on estimates by local actors within communities assessed. The last HNO 2017 population data (December 2016) estimates that population figures within Deir ez Zor City are 110,000 individuals, inclulding 52,200 IDPs. 2 The fact that some informal points exist does not imply their safety, security, or the financial capacity of any notable portion of the population to pay the fees required to use them. 3 Some availability does not necessarily imply sufficiency. Likewise, the list is not intended to be a comprehensive assessment of all medical needs, but rather indicative of key medical items that speak to the trend in access to medical services in the area. 4 ‘Most needed’ does not necessarily imply unavailability. Furthermore this list is not intended to be a comprehensive list of most needed medical items or medicines, but rather indicative of needs that speak to the trend in the priorities of medical items in the area. 5 The availability of surgery does not necessarily imply treatment by a doctor formally trained in the relevant procedure, or the use of anaesthesia or appropriate clinical equipment. Community members without professional medical backgrounds may have been informally trained by medical personnel to carry out emergency procedures. 6 Reported deaths are based on reported incidents within the community. There is better access to health reports in certain communities, therefore, validity of estimations varies. Without medical assessments, it was not possible to verify the exact causes of death cited, therefore the caseload is indicative of the perceived health issues causing death in the communities 7 Information collected rom community representatives has not been verified by medical professionals. 8 Calculation of average cost of food basket based on WFP’s standard food basket of essential commodities. The basket includes 37 kg of bread, 19 kg rice, 19 kg lentils, 5 kg of sugar and 7 kg of vegetable oil, providing 1,930 kcal a day for a family of five during a month. Available at: WFP, VAM Food Security Analysis, ‘Syria Market Price Watch Bulletin: April 2017’ (link here). 9 $1 = 515 SYP (UN operational rates of exchange as of 1 June 2017). Due to limited coverage in May, core food item and NFI prices were unable to be collected from nearby communities not considered besieged or hard-to-reach. As such, no comparisons were able to be calculated for this assessment. 10 Prices were compared to when the community was last assessed. Price fluctuations of 5% or less were not reported. 11 Generally not available in markets (less than 7 days this month). 12 Sometimes available in markets (7 – 20 days this month).

Informing May 2017 4 more effective REACH humanitarian action Syria Community Profile Update:Eastern Ghouta, Rural Damascus Informing more effective May 2017 REACH humanitarian action

FOR HUMANITARIAN PURPOSES ONLY Arbin Duma Ein Terma Hammura Harasta Jisrein Kafr Batna Nashabiyeh Saqba Zamalka UN classification Besieged Besieged Besieged Besieged Besieged Besieged Besieged Besieged Besieged Besieged Estimated population (individuals)1 39000 153900 23300 18000 20000 14000 19500 4000 24000 12000 Of which estimated IDPs1 1930 29900 14300 5850 5270 6300 5770 1300 8500 2640 % pre-conflict population remaining 51-75% 1-25% 1-25% 1-25% 1-25% 51-75% 51-75% 1-25% 26-50% 1-25% % of population that are female 1-25% 1-25% 1-25% 26-50% 1-25% 51-75% 26-50% 1-25% 26-50% 1-25% % of female-headed households 1-25% 1-25% 1-25% 1-25% 1-25% 1-25% 1-25% None 1-25% 1-25%

SUMMARY In May, the overall humanitarian situation in Information in this profile was gathered from 10 Eastern Ghouta improved, compared to April. Ranus A ABDANI ² D communities: Arbin, Duma, Ein Terma, Hammura, An escalation of internal clashes in the first Dimas Syrian Arab BINE Madaya Harasta, Jisrein, Kafr Batna, Nashabiyeh, Saqba week of the month negatively affected access !( Republic !( Sidnaya MADAA and Zamalka. While the profile refers to the situation to healthcare and services during this period, Ein Efieh in May 2017, comparisons were made to changes as well as mobility inside the area; however, A abdani observed since April, when the communities were the reopening of the only formal access point At Ta S ADI last assessed. to Eastern Ghouta and the improvement in BRDA BARHAIA (! Communities covered in !( !( DEIR MARAN !( !( D commercial vehicle access resulted in an overall this profie KAR EAAMID !( !( EIN EIJEH AT TA Military control of Eastern Ghouta, an agricultural !( D !( HSEINIEH KAIR BSEIMEH region east of Damascus, has been contested improvement of the food and health situation. !( Other assessed DEIR EEIT ANN Harasta communities DUMA Duma since 2012, with restrictions on access tightening in Infighting within Eastern Ghouta escalated on 28 udsiya HARASTA (! D ormery assessed !( HAMA BRA (! mid-2013. In November 2016, Nashabiyeh was re- April and negatively affected the humanitarian communities !( DSIA ABON ARBIN classified by the United Nations from hard-to-reach situation in particular during the first week of May. As rban area (! ZAMALK(!A (!HAMMURA to besieged, following an escalation of clashes. All checkpoints were created between different areas JOBER Arbin Subdistrict borders DAMASCUS CITY (! ! (! SAQBA NASHABIYEH ( (! (! other assessed communities have been classified in Eastern Ghouta and security risks increased, EIN JISREIN Kafr Main roads Mara TERMA KAFR Batna Darayya BATNA as besieged since 2014. movement of residents was restricted during this TADAMON Jaramana Main rivers !( Nashabiyeh atana !( D !( ARMK METHODOLOGY Maiha MADAMIET DARAA Haar HAJAR ASAD Based on data collected from community representatives inside Syria at the end of May and beginning of ESHAM Asad Babea June 2017, these updates refer to the situation in May 2017. Information collected provides an understanding Sahnaya of how limited freedom of movement and restrictions on access affect humanitarian needs in communities in Syria. Participants provide information comparatively to the previous month. Where possible during KHAN ESHIH hianiyyeh !( analysis, comparisons are also made to findings from previous periods the community has been assessed. KAR HOOR BETIMA !( !( An improvement or deterioration from the previous month may not indicate a trend but rather distinct Bait Jan circumstances specific to the month assessed. When possible, information presented has been triangulated BEIT SABER Kiseh BAIT JAN MARAET !( with other available sources prior to inclusion, yet findings should be considered indicative rather than !( BEIT JIN !( generalisable to the whole community as representative sampling, entailing larger scale data collection, Sasa Kms remains challenging in areas with restricted movement and access. Finally, the level of information on each 0 5 10 community varies due to difficulties obtaining data from certain locations. period. The communities of Arbin and Zamalka were Further, in May some commercial vehicles most heavily affected, as people could rarely leave CHANGES SINCE APRIL started circulating again within the wider their residence due to high security risks. Access contiguous area; this is in contrast to Access Restrictions on Health Situation to education services worsened across most of the Civilians April, when, in order to cope with low fuel communities assessed, at this time, as schools were availabilities, vehicles had stopped circulating temporarily shut down due to security concerns. Commercial Vehicle Access Core Food Item Availability between Eastern Ghouta communities. Although checkpoints remained in place for the remainder of the month, security risks subsided after Humanitarian vehicles the first week of May because of the de-escalation Humanitarian Vehicle Access Core Food Item Prices of clashes. Change since April: In contrast, access restrictions into the Eastern Access to Basic Services Overall Humanitarian Situation Ghouta area decreased, as the Al Wafideen route On 2 May, an inter-agency aid convoy was reopened on 2 May. A humanitarian delivery was MOVEMENT OF CIVILIANS compared to April. However, the percentage reached the town of Duma for the first time of the population who were allowed to move since October 2016. The convoy consisted of allowed into Duma on the same day, including food, 2 non-food items and medicine, while commercial People able to leave through the checkpoint remained low; only 56 trucks carrying food, non-food items and vehicle access was permitted for the first time since Change in # people able to leave 1-10% were allowed to leave upon presenting medical supplies sufficient for 35,000 people. March. compared to April: document and after being searched, as had Reportedly, none of the aid reached other been the case since assessments began. towns in Eastern Ghouta, with the exception While goods delivered through the humanitarian When clashes erupted between different of vaccine, which was distributed across all convoy, with the exception of vaccine, were distributed These included some public sector employees, groups in Eastern Ghouta in late April, mobility students and some retired individuals. communities. exclusively in Duma, the entry of commercial was significantly reduced in the area. In No informal routes were available, after having vehicles resulted in higher availabilities of food, particular, while people had been able to move Goods entered been rendered unserviceable in March. non-food and medical items across all communities. without restrictions between communities in Significantly, no challenges to accessing bread were In May, food, non-food and medical items April, in May new checkpoints were created and Risks faced when trying to enter or exit entered Eastern Ghouta for the first time reported this month, in contrast to April. Further, populations were required to show identification. (formally or informally) prices of most assessed items decreased, after since March, through commercial vehicles Further, a significant increase in the risk of Duma: Violence towards women, verbal and crossing Al Wafideen checkpoint. In Duma, a having progressively increased between February shelling and gunfire in relation to travel was physical harassment, detention, confiscation of and April. Prices remained however significantly significant amount of goods was also delivered reported. While risks decreased after the first documents, conscription; through a humanitarian distribution on 2 May. higher than those reported in nearby communities week of May, when clashes de-escalated, the not considered besieged or hard-to-reach. Other communities: Shelling, gunfire, The reopening of the only formal route into new restrictions remained in place during the detention. Eastern Ghouta had thus positive effects of Restrictions on the entry of fuel remained unchanged, entire reporting period. availabilities and prices of goods on markets with no fuel entering for the fifth consecutive month. MOVEMENT OF GOODS AND ASSISTANCE this month. However, fuel was not allowed into Fuel shortages remained critical, as only locally In Arbin and Zamalka, escalation of conflict negatively affected movement of residents at the Vehicles carrying commercial goods the wider contiguous area since February, and produced diesel and firewood were available on could only be produced locally. markets. beginning of May, when populations reportedly could not move inside the two communities Change since April: As a result of vaccine being distributed across all due to security concerns. Further, as had been assessed communities, child immunization services reported in March and April, women felt unsafe With the reopening of Al Wafideen checkpoint became available this month. Availability of medicine moving through certain areas in Arbin, Jisrein, in early May, commercial vehicles were also increased due to more medical items entering, Kafr Batna and Zamalka due to harassment. allowed into Eastern Ghouta for the first time compared to April. An outbreak of measles, first since March. Vehicles were allowed through reported in February, was no longer reported in May. Due to the reopening of Al Wafideen access the checkpoint only on certain days, upon point in early May, movement outside of the presenting documents, and were subject to the wider contiguous area marginally improved payment of fees as well as the searching and confiscation of loads.

Informing Available Positive increase Negative increase May 2017 2 more effective REACH humanitarian action Sometimes available No change Positive decrease Not available Negative decrease ACCESS TO SERVICES* After closing in March and reopening in April, schools in Eastern Ghouta were again shut down for about one week in early May, due to security concerns. As a result, access to education worsened in May, compared to April. Schools in Harasta were an exception to this, as they were reportedly unaffected by escalation of clashes. Access to electricity remained poor, after worsening in March and April due to fuel shortages. Local councils had already reduced the number of hours of electricity provided with subscriptions in March and raised prices per kilowatt in April. Further, hours of access significantly fluctuated on a daily basis, depending on the amount of fuel available to run generators. No change in access to water was reported in May, as had been the case in April, and all communities reported that available water was sufficient to meet household needs. Water was considered safe to drink in all those communities that relied mainly on water trucking, while it reportedly smelled or tasted bad in Arbin, Kafr Batna and Zamalka, where populations mostly relied on closed wells. As had been the case since January, access to services was worse in Nashabiyeh compared to other communities, as the generator-run electrical system was out of use and only few households could rely on solar alternatives.

WATER ELECTRICITY EDUCATION Main source of Available water to Access to Access to electricity Access to Available education Barriers to education drinking water meet household needs water network network per day electricity (Main facilities (Status**) (Coping strategies) per week source) per day Arbin Closed wells Sufficient Network Network unavailable 4 - 8 hours Informal schools set up Facilities destroyed; route to (Smells/tastes unavailable (Generator) since conflict began services is unsafe bad) Duma Water trucking Sufficient Network Network unavailable 4 - 8 hours Informal schools set up Facilities destroyed; route to (Safe to drink) unavailable (Generator) since conflict began services is unsafe

Ein Terma Water trucking Sufficient 1-2 days Network unavailable 4 - 8 hours Informal schools set up Facilities destroyed; route to (Safe to drink) (Generator) since conflict began services is unsafe Hammura Water trucking Sufficient Network Network unavailable 4 - 8 hours Informal schools set up Facilities destroyed; route to (Safe to drink) unavailable (Generator) since conflict began services is unsafe Harasta Water trucking Sufficient Network Network unavailable 4 - 8 hours Informal schools set up Facilities destroyed; route to (Safe to drink) unavailable (Generator) since conflict began services is unsafe Jisrein Water trucking Sufficient 1-2 days Network unavailable 2 - 4 hours Informal schools set up Route to services is unsafe; (Safe to drink) (Generator) since conflict began children need to work

Kafr Batna Closed wells Sufficient Network Network unavailable 4 - 8 hours Informal schools set up Facilities destroyed; route to (Smells/tastes unavailable (Generator) since conflict began services is unsafe bad) Nashabiyeh Closed wells Sufficient Network Network unavailable No usable Informal schools set up Facilities destroyed; route (Smells/tastes unavailable electricity since conflict began to services is unsafe; lack of bad) source teaching staff Saqba Water trucking Sufficient Network Network unavailable 4 - 8 hours Informal schools set up Route to services is unsafe; (Safe to drink) unavailable (Generator) since conflict began children need to work Zamalka Closed wells Sufficient Network Network unavailable 4 - 8 hours Informal schools set up Facilities destroyed; route to (Smells/tastes unavailable (Generator) since conflict began services is unsafe bad) *Arrows indicate change in access since April **Data collected is based on perceptions of local actors and water safety cannot be guaranteed in the absence of water testing.

Informing Available Positive increase Negative increase May 2017 3 more effective REACH humanitarian action Sometimes available No change Positive decrease Not available Negative decrease Permanent medical facilities available Arbin Duma Ein Terma Hammura Harasta Jisrein Kafr Batna Nashabiyeh Saqba Zamalka

Mobile clinics / field hospitals Informal emergency care points Pre-conflict hospitals Primary healthcare facilities

HEALTH SERVICES Medical facilities and services Availability of medical personnel 1. Heart medicine 2. Blood transfusion bags Change in health situation compared As had been the case since assessments At least one professionally trained doctor, to April: began in June 2016, some medical facilities nurse, midwife, dentist and pharmacist were 3. Antibiotics were functioning across all Eastern Ghouta present in most communities. 4. Assistive devices Overall, the health situation in Eastern Ghouta communities in May (see table above), with no The number of available trained medical improved in May, despite a temporary worsening change reported compared to April. personnel, as well as the number of volunteers Strategies used to cope with a lack of in the first week of the month. Infighting between The availability of medical services increased medical items / medicines armed groups in the area had negative effects with informal or no medical training remained this month, as child immunization became unchanged since January across most After coping strategies were reported across on the medical situation in early May. In Arbin, available in all communities assessed. Vaccine surgery became temporarily unavailable due communities. all assessed communities in April for the first entered the area through a humanitarian time since assessments began, no change was to shelling that damaged the surgical section Change since April convoy on 2 May and was later redistributed reported in May. Adopted strategies included of its field hospital. Further, residents of Arbin in the wider contiguous area. No other and Zamalka were unable to access medical sharing resources between medical facilities, services became available this month, after Unavailable medical items3 recycling medical items (e.g. bandages, care in this period, due to security concerns diarrhoea management became unavailable Availabilities of medical items increased in syringes, needles) or using expired medicine. over leaving their houses. In addition to this, in Nashabiyeh, and diabetes care became all communities assessed in May, compared worse mobility conditions affected parts of the unavailable in Arbin, Kafr Batna and Zamalka, Unusual outbreaks of disease5 to April. This was the case for vaccine, in population who had been previously able to in April. travel to other communities to access needed particular, after the humanitarian distribution of Most cases of measles, first reported in services. This was particularly the case for As had been the case in April, only simple 2 May. February in Ein Terma, as well as in March and women in need of skilled childbirth care or surgery could be carried out in Harasta, Ein April across all assessed communities, had Terma and Jisrein, and patients were sent to Unavailable across a majority of reportedly been treated in May. Further, the services treating female-specific conditions in communities: Anti-anxiety, heart, diabetes Ein Terma, Harasta, Jisrein and Nashabiyeh. other towns when in need of more advanced number of new cases significantly reduced this surgical interventions. and blood pressure medicine; month. This was due both to greater amounts However, the situation improved later in the Barriers to accessing healthcare persisted Sometimes available across a majoriy of of medicine entering Eastern Ghouta as well as month, as security conditions also improved. communities: Blood transfusion bags. to seasonal factors. The entry of medical items through commercial in Nashabiyeh, where people with physical constraints (e.g. with disabilities, injured) vehicles in May as well as the distribution of Change since April vaccine across all Eastern Ghouta communities and people who lived in certain locations resulted in a higher number of available in the community (e.g. people who lived far Most needed medical items4 services and greater availability of medicine, from facilities, people who lived in certain compared to April. Further, the outbreak of neighbourhoods) could not travel to the nearest Across communities assessed in Eastern measles that had been reported in February, available services in other communities. Ghouta, the most needed medical items were reported to be: March and April was contained in May and no Change since April new cases were reported.

Informing Available Positive increase Negative increase May 2017 4 more effective REACH humanitarian action Sometimes available No change Positive decrease Not available Negative decrease Medical services available

Arbin Duma Ein Terma Hammura Harasta Jisrein Kafr Batna Nashabiyeh Saqba Zamalka

Child immunization Diarrhoea management Emergency care Skilled childbirth care Surgery5 Diabetes care

FOOD Access to bread, which had worsened in Strategies to cope with a lack of food remained Food item availability / prices March and April, significantly improved in reportedly unchanged in Eastern Ghouta since Change in food situation compared May. In contrast to April, when all communities assessments began. While some food items had become unavailable to April: had reported barriers to accessing bread, in April, all assessed food items were generally 11 no barriers existed in May and bread was Deaths attributable to a lack of food6 available in markets during the month of May. Most common methods of obtaining This was due to the reopening of Al Wafideen generally available in markets. No known cases in all communities assessed. food at the household level route and the entering of commercial vehicles This had been the case since June 2016, when Similarly, due to higher flour availabilities after for the first time since March. 1. Purchasing from shops or markets the communities were first assesed. the reopening of Al Wafideen checkpoint, Further, prices of most food items decreased 2. Purchasing from local farmers bakeries that had been shut down in April were CORE FOOD ITEM / NFI AVAILABILITY AND compared to April, although they remained on 3. Home production reopened in May. average 205% higher than those reported in PRICES In May, as had been the case since the Strategies used to cope with a lack of food nearby communities. communities were first assessed, all Average cost of standard food basket7 communities reported that residents were able All WASH item availability / prices to purchase food from shops, markets and communities Eastern Nearby Similar to food, the availability and prices of 8 local farmers, or produce it at home. In Duma, Reducing meal size Ghouta areas assessed sanitation and hygiene items (soap, residents were also able to obtain food through laundry powder, sanitary pads, toothpaste and Average cost May the humanitarian distribution of 2 May. 9 82151 32962 disposable diapers) were positively affected by Skipping meals (SYP) the improved mobility of commercial vehicles. Most common methods of obtaining bread at the household level Days without eating Change since Prices decreased by 30%, on average, April10 compared to April, although they were 53% All: Shops. higher than those in nearby non-besieged Eating non-food plants On average, the cost of a standard food communities. Most commonly reported challenges to basket decreased by 31% in May compared obtaining bread: Flour too expensive or Eating food waste to April, but was 149% higher than in nearby hard to access, wheat too expensive or communities not considered besieged or hard- hard to access, yeast too expensive or hard Reportedly used as a coping strategy to-reach. to access. Not reportedly used as a coping strategy

Informing Available Positive increase Negative increase May 2017 5 more effective REACH humanitarian action Sometimes available No change Positive decrease Not available Negative decrease 9 Endnotes Fuel availability / prices CORE FOOD ITEM / NFI PRICE AND AVAILABILITY INDEX 1 Figures based on HNO 2017 population and IDP data Fuel availability in the Eastern Ghouta area Item Eastern Ghouta Price change since Nearby non-hard-to- (December 2016). Figures based on population estimates by remained unchanged in May after decreasing average April10 reach communities8 local actors within the community assessed were Arbin: 42,500- for five consecutive months. Despite the entry 43,500; Duma: 122,000-128,000; Ein Terma: 31,000-33,000; Food Items Bread private bakery (pack) 650 -17% 100 Hammura: 30,000-33,000; Harasta: 18,000-19,000; Jisrein: of commercial vehicles into Eastern Ghouta, 18,000-20,000; Kafr Batna: 18,000-20,000; Nashabiyeh: 500- restrictions on fuel persisted in May and the Bread public bakery (pack) Not available 58 700; Saqba: 50,000-53,000; and Zamalka: 11,500-12,500. only remaining fuel sources were diesel and Rice (1kg) 1140 -37% 535 2 The fact that some informal points exist does not imply their firewood. safety, security, or the financial capacity of any notable portion Bulgur (1kg) 850 -15% 320 Diesel continued to be produced locally through of the population to pay the fees required to use them. the altering of plastics as had been the case Lentils (1kg) 830 -6% 525 3 Some availability does not necessarily imply sufficiency. Likewise, the list is not intended to be a comprehensive since February. Chicken (1kg) 2400 Not available 1120 assessment of all medical needs, but rather indicative of key Prices of available fuel items remained Mutton (1kg) 3933 3925 medical items that speak to the trend in access to medical unchanged compared to April and were services in the area. Tomato (1kg) 1533 Not available 410 4 ‘ 579% higher than in nearby communities not Most needed’ does not necessarily imply unavailability. considered besieged or hard-to-reach. Cucumber (1kg) 1100 +32% 318 Further this list is not intended to be a comprehensive list of most needed medical items or medicines, but rather indicative Strategies used to cope with a lack of fuel: Milk (litre) 315 215 of needs that speak to the trend in the priorities of medical Flour (1kg) 990 233 items in the area. All communities: Burning furniture not in use, 5 The availability of surgery does not necessarily imply treatment burning productive assets, burning plastics and Eggs (1) 100 -35% 50 by a doctor formally trained in the relevant procedure, or the use waste. Iodised salt (500g) 500 +50% 65 of anaesthesia or appropriate clinical equipment. Community members, without professional medical backgrounds, may Sugar (1 kg) 1200 -59% 438 have been informally trained by medical personnel to carry out emergency procedures. Cooking oil (litre) 1330 -50% 1225 6 Reported deaths are based on reported incidents within WASH Items Soap (1 bar) 150 -42% 113 the community. There is better access to health reports in certain communities, therefore, validity of estimations varies. Laundry powder (1kg) 1700 -23% 875 Without medical assessments, it was not possible to verify Sanitary pads (9) 500 -38% 444 the exact causes of death cited, therefore the caseload is indicative of the perceived health issues causing death in the Toothpaste (125ml) 500 382 communities. Disposable diapers (24 pack) 3060 -46% 1575 7 Calculation of average cost of food basket based on WFP’s Fuel standard food basket of essential commodities.The basket Butane (cannister) Not available 2925 includes 37 kg of bread, 19 kg rice, 19 kg lentils, 5 kg of sugar and Diesel (litre) 1900 280 7 kg of vegetable oil, providing 1,930 kcal a day for a family of five during a month. Available at: WFP, VAM Food Security Analysis, Propane (cannister) Not available 2560 ‘Syria Market Price Watch Bulletin: May 2017’ (link here). 8 Kerosene (litre) Not available 400 Nearby communities in Rural Damascus governorate which are not considered besieged/hard to reach: Deir Ali and Kisweh. Coal (kg) Not available 450 9 $1 = 515 SYP (UN operational rates of exchange as of 1 June Firewood (tonne) 209500 Not available 2017) 10 Prices were compared to when the community was last assessed. Price fluctuations of 5% or less were not reported. For affected populations, the functionality of, and access to, basic services such as medical 11 Generally available in markets (21+ days this month) facilities, water and electricity are highly dependent on the price and availability of fuel sources.

Informing Available Positive increase Negative increase May 2017 6 more effective REACH humanitarian action Sometimes available No change Positive decrease Not available Negative decrease Syria Community Profile Update: Hajar Aswad, Rural Damascus Informing May 2017 more effective REACH humanitarian action

FOR HUMANITARIAN PURPOSES ONLY SUMMARY

The community of Hajar Aswad, situated just south Rankus of Damascus City, has faced access restrictions A ABDANI ² D Dimas since early 2013. In 2014, the community witnessed Syrian Arab BINE Madaya UN classification: Hard-to-reach !( critical levels of food insecurity before local actors in Republic !( Sidnaya 1 MADAYA the area reached a truce agreement. Hajar Aswad Estimated population : 4500 Ein Elfijeh Az abdani was first assessed in June 2016, and since then, 1 Of which IDPs : 320 At Tall the security situation in the community has been SU WADI BURDA BARHALIYA stable. The community was reclassified as hard-to- % pre-conflict (! Communities covered in !( !( DEIR MARAN 1-25% !( !( D population remaining: this profile KAFR ELAWAMID !( !( EIN ELFIEH AT TALL !( D !( reach from besieged in January 2017. HSEINIYEH KAFIR BSEIMEH !( Other assessed DEIR ELEIT Harasta The overall situation in Hajar Aswad remained % population female: 1-25% communities ANUN Duma udsiya DUMA HARASTA !( the same in May, with movement of people % of female-headed D Formerly assessed !( HAMA BURA !( 1-25% communities and goods severely restricted. Access to !( UDSIYA ABOUN ARBIN households !( Urban area AMALKA HAMMURA medical services and supplies was also !( Arbin !( since assessments began. Residents of the OBER !( Subdistrict borders DAMASCUS CITY !( !( SABA NASHABIYEH limited. Meanwhile, the price for the majority !( !( community could purchase items in the nearby EIN KAFR ISREIN Kafr of assessed core food items stayed constant, Main roads Markaz TERMA BATNA Batna towns of Yalda and Babella, but, unlike in April, Darayya while fuel prices decreased. TADAMON aramana could not obtain items from aid distributions in the Main rivers !( Nashabiyeh atana !( D (! YARMUK Women, children and the elderly presenting two towns. However, the number of items able to Maliha MADAMIYET DARAYYA Hajar HAJAR ASWAD identification remained able to enter and exit the enter was reportedly unaffected. ELSHAM Aswad Babella community twice a week via formal routes. Verbal Residents continued to rely on wells and generators Sahnaya harassement of men and women, including sexual for water and electricity in May, as the water and harassement for the latter group, were reported at KHAN ELSHIH Ghizlaniyyeh !( electricity networks remained unavailable. Water BETIMA checkpoints, as was the case in April. However, KAFR HOOR !( supplies reportedly stayed insufficent, and !( physical violence towards women has not been electricity extremely limited. Meanwhile, children Bait an reported since February. For the third consecutive BEIT SABER Kisweh faced several barriers to education, including BAIT AN MARAET !( !( BEIT IN month, threat of detention was reported as a damaged facilities, a shortage of teaching staff, and !( Sasa barrier to men seeking healthcare outside of Kms some children - especially boys - being required to 0 5 10 Hajar Aswad and, more broadly, to accessing work for economic reasons. formal routes. In contrast, women have been able to seek medical care in nearby areas for childbirth Fuel prices decreased overall in May due to lower METHODOLOGY seasonal demand. Although prices increased for since at least February 2017. Based on data collected from community representatives inside Syria at the end of May and the some core food items, they overall stayed similar beginning of June 2017, these updates refer to the situation in May 2017. Information collected provides Humanitarian and commercial vehicles have to previous months. Meanwhile, the price of some been prevented from entering Hajar Aswad an understanding of how limited freedom of movement and restrictions on access affect humanitarian hygiene items rose. needs in communities in Syria. Participants provide information comparatively to the previous month. CHANGES SINCE APRIL Where possible during analysis, comparisons are also made to findings from previous periods the community has been assessed. An improvement or deterioration from the previous month may not Access Restrictions on Civilians Health Situation indicate a trend but rather distinct circumstances specific to the month assessed. When possible, Commercial Vehicle Access Core Food Item Availability information presented has been triangulated with other available sources prior to inclusion, yet findings should be considered indicative rather than generalisable to the whole community as representative Humanitarian Vehicle Access Core Food Item Prices sampling, entailing larger scale data collection, remains challenging in areas with restricted movement and access. Finally, the level of information on each community varies due to difficulties obtaining data Access to Basic Services Overall Humanitarian Situation from certain locations. MOVEMENT OF CIVILIANS since assessments began. In contrast to April, ACCESS TO SERVICES* goods entered did not include those from aid Change in # people able to leave In May, access to water, electricity and education remained unchanged in Hajar Aswad. However, as water distributions in Yalda and Babella, as there was compared to April: supplies remained insufficient, the coping strategy of using money intended for other purposes to purchase no distribution in those communities in May. drinking water was reported, while the former coping strategy of bathing less was not reported, due to an People able to leave2 increased need for bathing in warm weather. Generators and closed wells were the main sources of electricity HEALTH SERVICES and water, respectively. Additionally, the number of children attending school remained the same. Approximately 11-25% of the population utilised formal routes in May, a rate which Change in health situation WATER Main source of drinking water (Status) Closed wells (Safe to drink)** has remained consistent since the community compared to April: was first assessed in June 2016. Women, Sufficiency of available water to meet Insufficient (spend money usually spent on household needs (Coping strategies other things to buy water) children and the elderly with identification The health situation in Hajar Aswad with regards were permitted to leave on average twice a used) to access to medical facilities and services has Access to water network per week Network unavailable week, and reportedly used these routes to remained relatively stable since June 2016. All buy goods and collect remittances (hawala assessed medical items remained sometimes ELECTRICITY Access to electricity network per day Network unavailable transfers3) from nearby areas. Meanwhile, available in May, after a reported decrease in the Access to electricity (Main source) per 2-4 hours per day (Generators) men avoided formal routes due to the availability of several assessed medical items in April. reported risk of detention at checkpoints. day Informal points used: Yes. Men have continued to face barriers to healthcare EDUCATION Available education facilities Pre-conflict primary, secondary, high schools due to the reported risk of detention at checkpoints, Barriers to education Facilities destroyed, children need to work Risks faced when trying to enter or exit as has been the case since March 2017. In contrast, (primarily boys), lack of teaching staff (formally or informally) some women were able to access improved *Arrows indicate change in access since April. Shelling, gunfire, detention, verbal generalised care during childbirth from nearby harrassment of men and women, sexual communities in May and since at least February 2017. ** Data collected is based on perceptions of local actors and therefore reported water safety requires verification through testing. harassment of women. Permanent medical facilities available Medical services available Reusing medical items and sharing resources between medical facilities have been reported MOVEMENT OF GOODS AND ASSISTANCE Child immunization since December and January, respectively. Mobile clinics / field hospitals Vehicles carrying commercial goods 5 Diarrhea management Unavailable medical items Informal emergency care points Emergency care Sometimes available: Clean bandages, anti- Change since April: anxiety, heart, diabetes and blood pressure Pre-conflict hospitals Skilled childbirth care medicine, antibiotics, blood transfusion bags, Able to enter: none reported burn treatment, anaesthetics, medical scissors. Primary healthcare facilities Surgery4 Humanitarian vehicles Change since April Change since April Able to enter: none reported Diabetes care Most needed medical items6 Availability of medical personnel Change since April Change since April: Personnel available: Professionally trained 1. Blood transfusion bags nurses and midwives. 2. Clean bandages Strategies used to cope with a lack of 3. Antibiotics Goods entered Others providing medical services: medical services Pharmacists, volunteers with informal medical In May, goods entered via individuals Unusual outbreaks of disease training. Recycling medical items (e.g. bandages, obtaining items from the nearby communities syringes, needles, etc.), sharing resources None reported since December 2016. of Yalda and Babella, as has been the case Change since April between medical facilities.

Available Positive increase Negative increase Informing May 2017 2 more effective REACH humanitarian action Sometimes available No change Positive decrease Not available Negative decrease Reducing meals has been reported since Hajar FOOD Fuel availability / prices Aswad was first assessed. Meanwhile, skipping The prices for several assessed fuels decreased in May, due to lower seasonal demand. Prices of Change in food situation meals altogether has not been reported since diesel and kerosene dropped by 20% in May, with price decreases reported for two consecutive months. compared to April: August 2016, though in May, some men ate less However, diesel remained 45% more expensive in Hajar Aswad than in nearby non-hard-to-reach areas. to ensure enough food for women and children. Most common methods of obtaining Also, the price of coal decreased by 10%, and firewood was unavailable for the third consecutive month. food at the household level 7 Deaths attributable to a lack of food Strategies used to cope with a lack of fuel: Purchasing from shops and markets in None reported. None reported, for the first time since at least November 2016. neighbouring communities. CORE FOOD ITEM/NFI PRICE AND AVAILABILITY INDEX10 In May, food could be purchased from the towns CORE FOOD ITEM / NFI AVAILABILITY AND For affected populations the functionality of, and access to, basic services such as medical of Yalda and Babella. However, residents of PRICE facilities, water and electricity are highly dependent on the price and availability of fuel sources. Hajar Aswad could not procure food items Average cost of standard food basket8 from aid distributions in the communities Item Hajar Aswad Price change Nearby non-hard-to- in May, as none occurred, in contrast to all Hajar Nearby areas9 10 reach areas9 other assessed months except March 2017. Aswad since April Food Items Bread private bakery (pack) Not available 100 Most common methods of obtaining Average cost May 10 32782 32962 Bread public bakery (pack) Not available 58 bread at the household level (SYP) 12 Change since Rice (1kg) 400 +14% 535 Most common source: purchasing from 12 shops in nearby communities April11 Bulgur (1kg) 250 320 Lentils (1kg) 25012 525 Challenges to obtaining bread: There There was no notable increase in the average 12 have been no functioning bakeries in Hajar Chicken (1kg) 1400 1120 cost of a standard food basket in Hajar Aswad in Mutton (1kg) 500012 3925 Aswad since it was first assessed. Reported May. The price of a basket remained comparable barriers to obtaining bread have included to that of nearby areas not considered hard- Tomato (1kg) 35012 410 prohibitive prices for flour and yeast and to-reach for the third consecutive month. Cucumber (1kg) 30012 +20% 318 lack of availability of wheat. People have 12 reportedly been able to buy bread in Food item availability / prices Milk (litre) 250 215 Yalda and Babella since September 2016. Flour (1kg) 30012 +20% 233 In May, all assessed items, except bread from Eggs (1) 6012 50 Change since April bakeries, reportedly remained sometimes 12 available11 in markets. A 20% increase in the Iodised salt (500g) 200 65 Strategies used to cope with a price of cucumbers and flour was reported, Sugar (1 kg) 40012 -11% 438 lack of food as was a 14% increase in the price of rice. Cooking oil (litre) 70012 1225 While sugar decreased by 11%, after having WASH Items Soap (1 bar) 15012 +50% 113 Reducing meal size risen 13% in April, the reported price of iodised Laundry powder (1kg) 100012 875 salt was 167% higher in Hajar Aswad than in Sanitary pads (9) 30012 +20% 444 Skipping meals communities not considered hard-to-reach. Toothpaste (125ml) 40012 382 Days without eating WASH item availability / prices Disposable diapers (24 pack) 150012 1575 In May, the price of soap increased by 50%, Fuel Butane (cannister) 320012 2925 Eating non-food plants after having decreased by 33% in April, while Diesel (litre) 40012 -20% 280 Eating food waste sanitary pads were 20% more expensive after Propane (cannister) Not available 2560 having decreased in April by 31%. Despite Kerosene (litre) 40012 -20% 400 Reportedly used as a coping strategy these fluctuations, the price and availability of Coal (kg) 45012 -10% 450 Not reportedly used as a coping strategy hygiene items has stayed relatively constant since November 2016. Firewood (tonne) Not available Not available

Available Positive increase Negative increase May 2017 3 aaa a Sometimes available No change Positive decrease Not available Negative decrease Endnotes 1 Figures based on population estimates by local actors within communities assessed. The last HNO population data (December 2016) estimates that the population in Hajar Aswad is 4,900-5,000 individuals, including 700-1,000 IDPs. 2 The fact that some informal points exist does not imply their safety, security, or the financial capacity of any notable portion of the population to pay the fees required to use them. 3 Hawala systems refer to a semi-formal method of transferring money within Syria (similar to that of Western Union). Notably, it can allow people within besieged or hard-to-reach areas to receive money from other areas of Syria, or from relatives and friends living abroad. 4 The availability of surgery does not necessarily imply treatment by a doctor formally trained in the relevant procedure, or the use of anaesthesia or appropriate clinical equipment. Community members without professional medical backgrounds may have been informally trained by medical personnel to carry out emergency procedures. 5 Some availability does not necessarily imply sufficiency. Likewise, the list is not intended to be a comprehensive assessment of all medical needs, but rather indicative of key medical items that speak to the trend in access to medical services in the area. 6Most needed’ does not necessarily imply unavailability. Furthermore this list is not intended to be a comprehensive list of most needed medical items or medicines, but rather indicative of needs that speak to the trend in the priorities of medical items in the area. 7 Reported deaths are based on reported incidents within the community. There is better access to health reports in certain communities, therefore, validity of estimations varies. Without medical assessments, it was not possible to verify the exact causes of death cited, therefore the caseload is indicative of the perceived health issues causing death in the communities. 8 Calculation of average cost of food basket based on WFP’s standard food basket of essential commodities. The basket includes 37 kg of bread, 19 kg rice, 19 kg lentils, 5 kg of sugar and 7 kg of vegetable oil, providing 1,930 kcal a day for a family of five during a month. Available at: WFP, VAM Food Security Analysis, ‘Syria Market Price Watch Bulletin: April 2017’ (link here). As bread was unavailable in private and public bakeries in Hajar Aswad, no prices were available for bread sold in bakeries in the community. The food basket price for Hajar Aswad for May was therefore calculated using the reported price of bread sold in shops (300 SYP). 9 Nearby communities in Rural Damascus governorate which are not considered besieged/hard to reach: Deir Ali and Kisweh. 10 $1 = 515 SYP (UN operational rates of exchange as of 1 June 2017). 11 Price fluctuations of 5% or less were not reported. 12 Sometimes available in markets (7-20 days this month).

Informing May 2017 4 more effective REACH humanitarian action Syria Community Profile Update: Al Waer, Homs Governorate Informing May 2017 more effective REACH humanitarian action

FOR HUMANITARIAN PURPOSES ONLY SUMMARY ² Al Waer, located to the west of the city of Homs, asyaf Hama has faced access restrictions since 2013, which UN classification: Besieged Syrian Arab tightened in mid-2014. Classified by the United Wadi Republic Nations as besieged since May 2016, the Estimated population1: 4000-6000 El-oyoun Haranifse humanitarian situation in Al Waer worsened in Of which IDPs1: 2500-3500 Dweir subsequent months, before improving due to a Raslan AR RASAN Ein Halaim truce agreement in September 2016. However in % pre-conflict Neighourhoods !( population remaining: 1-25% Sieh November, clashes intensified once again, and all coered in this rofile access in and out of the community was closed. % population female: ther neighourhoods AD Ar-Rastan 1-25% !( aliseh As a result, the humanitarian situation continued to !( ther assessed % of female-headed ashta deteriorate in the following months. 1-25% communities ABISEH households Elhiu au aldu !( Sudistricts Border Ein Elniser On 14 March 2017, a second truce agreement Bariiyeh was signed ending the fighting in Al ,Waer There was also an improvement in the overall ain roads health situation in the community, as residents Nasra relaxing access restrictions on civilians and Rierae commercial vehicles. The deal involved the were able to access medical treatment outside the community. This was notwithstanding a Shin evacuation of fighters and residents willing to leave HOMS to Idleb, Jarablus or rural Homs, with transport decrease in the number of medical facilities and (AL WAER) staff in Al Waer following the evacuations. Hawash provided weekly since the truce agreement. The last heret HOMS CITY evacuation occurred on 18 May, and community Other notable changes included additional hours in Noor representatives estimated that between 4,000 of power from the electrical network, and a all alah Hadideh and 6,000 residents remained in Al Waer (out a decrease in price of assessed non-food items and population of 30,000-35,000 in March, before the fuels. All foods were reported generally available implementation of the agreement). in the community, but on average prices did not The overall humanitarian situation in Al Waer decrease in May. However, significant price continued to improve in May. Following the volatility compared to April was reported, EBANN Al usayr which could partly be attributed to the changes final evacuation, access restrictions on civilian Kms in population numbers and access restrictions movement and commercial traffic were lifted, 0 5 10 and all food and non-food items, fuel and in the community. medical items were allowed into the community. No other significant changes were reported in METHODOLOGY For the first time since assessments of the the community, with water networks functioning Based on data collected from community representatives inside Syria at the end of May 2017 and community began in June 2016, no coping since repairs were completed in April. All students beginning of June 2017, these updates refer to the situation in May 2017. Information collected provides strategies related to a lack of food were reported. remaining in Al Waer were able to attend schools. an understanding of how limited freedom of movement and restrictions on access affect humanitarian CHANGES SINCE APRIL needs in communities in Syria. Participants provide information comparatively to the previous month. Where possible during analysis, comparisons are also made to findings from previous periods the Access Restrictions on Civilians Health Situation community has been assessed. An improvement or deterioration from the previous month may not indicate a trend but rather distinct circumstances specific to the month assessed. When possible, Commercial Vehicle Access Core Food Item Availability information presented has been triangulated with other available sources prior to inclusion, yet findings should be considered indicative rather than generalisable to the whole community as representative Humanitarian Vehicle Access Core Food Item Prices sampling, entailing larger scale data collection, remains challenging in areas with restricted movement and access. Finally, the level of information on each community varies due to difficulties obtaining data Access to Basic Services Overall Humanitarian Situation from certain locations. MOVEMENT OF CIVILIANS Humanitarian vehicles ACCESS TO SERVICES Electrical access continued to improve in May, with a further increase in the operating hours of the electrical Change in # people able to leave Change since April: network reported. The network was reactivated after the truce agreement in March. Water access did not compared to April: change from April, when authorities repaired damaged water pipes. All children in Al Waer were reported as As has been the case since October 2016, accessing schools in May, but it was noted that fewer children were reported in the community than in April due People able to leave2 no humanitarian vehicles delivered aid to Al to the evacuations. Waer in April. One humanitarian NGO began Access restrictions were significantly lessened operations in Al Waer after the truce, but WATER* Main source of drinking water (Status) Water network (Safe to drink)** following the final evacuation on 18 May, with focused on medical evacuations for residents Sufficiency of available water to meet community representatives reporting that all with special medical concerns. household needs (Coping strategies Sufficient remaining residents were able to enter and used) leave the community whenever they wanted Goods entered without any checks. An increase in all food, non-food, fuel and Access to water network per week 7 days Prior to this evacuation, access restrictions medical items was reported in May, due to Access to electricity network per day 8 - 12 hours had remained the same since the signing the relaxed access restriction for civilians and ELECTRICITY* of the truce agreement on 14 March, when commercial traffic. Since the implementation of Access to electricity (Main source) 8 - 12 hours (Main network) students, public sector employees, retirees, the truce agreement on 14 March, commercial per day women, children and men who did not vehicles were permitted to bring in some food EDUCATION* Available education facilities Pre-conflict primary, secondary, high perceive a risk of detainment were able to use and non-food items. However, for the first schools the formal access point. Between 76-100% time since assessments began, fuel and *Arrows indicate change in access since April. ** Data collected is based on perceptions of local actors and of civilians had been able to use the formal medical items were permitted to enter the therefore reported water safety requires verification through testing. point since April, after registering with the community via commercial vehicles after the final evacuation on 18 May. authorities. Permanent medical facilities available Strategies used to cope with a lack of No informal points have been reportedly used HEALTH SERVICES medical services Mobile clinics / field hospitals since November 2016. None reported. Change in health situation Risks faced when trying to enter or exit Informal emergency care points (formally or informally) compared to April: Change since April No risks reported. Following the reduced access restrictions Pre-conflict hospitals after the final evacuation on 18 May, residents Unavailable medical items4 MOVEMENT OF GOODS AND ASSISTANCE were reportedly able to seek medical Primary healthcare facilities treatment outside Al Waer and commercial All assessed medical items reported available. Vehicles carrying commercial goods Change since April vehicles were allowed to bring medical items Most needed medical items5 Change since April: into the community. This mitigated the effects of the closure of all but one healthcare facility Following the final evacuation on 18 May 1. Heart medicine Following the final evacuation on 18 May, (a public hospital) and the departure of many and the departure of many medical workers, 2. Diabetes medicine several medical facilities closed in May. there was a notable increase in the number of medical workers from Al Waer due to the 3. Antibiotics vehicles allowed to enter Al Waer, with fuel and evacuations. However, one public hospital was operating in medicine permitted into the community, but May, with residents additionally able to access Availability of medical personnel Due to these changes, all assessed medical healthcare facilities outside Al Waer. searches and documentation requirements services and items were reported available, Personnel available: Professionally trained 3 remained in place. and no coping strategies were reported for the Unusual outbreaks of disease surgeons, doctors, nurses, and midwives. first time since assessments began. None reported; this has been the case since assessments began in June 2016. Change since April

Informing Available Positive increase Negative increase May 2017 2 more effective REACH humanitarian action Sometimes available No change Positive decrease Not available Negative decrease Medical services available Strategies used to cope with a lack of Significant price fluctuations were observed Strategies used to cope with a lack of fuel: food across assessed food items, with a 43% No coping strategies were reported in May for Child immunization No data volatility rate compared to April. Price increases the first time since assessments began. were reported in several goods including Reducing meal size Diarrhoea management No data rice, lentils and bulgur. Price decreased were reported in dairy, egg and bread prices. Emergency care No data Skipping meals While notable, these changes were minor in Skilled childbirth care No data Days without eating comparison to the decrease reported in these goods since the truce agreement. Surgery6 No data Eating non-food plants While the prices of goods included in the food basket were much cheaper in Al Waer than in Eating food waste Diabetes care No data nearby communities not considered besieged Change since April No data Reportedly used as a coping strategy or hard-to-reach, many meat, vegetables and Not reportedly used as a coping strategy other assessed foods were more expensive It was not possible to collect data as to the in Al Waer, and overall food prices were on specific services offered by the remaining For the first time since assessments began, no average 1% cheaper than in those nearby hospital in Al Waer in May. However, all coping strategies related to a lack of food were communities. residents were able to leave the community to reported in Al Waer. WASH item availability / prices seek medical treatment in nearby areas, where All assessed hygiene and sanitation items all medical services were reportedly available. CORE FOOD ITEM / NFI AVAILABILITY AND PRICES were generally available10 in Al Waer in May. FOOD 7 While the price of toothpase increased in Al Average cost of standard food basket Waer and decreased in nearby communities Change in food situation Al Waer Nearby areas9 not considered besieged or hard-to-reach, the compared to April: average price of all remaining WASH items Average cost May 14526 31375 decreased by approximately 40% in both Al (SYP)8 Deaths attributable to a lack of food5 Waer and nearby communities. Change since Fuel availability / prices None reported since January. April Prices of available fuel items decreased on Most common methods of obtaining The average cost of a standard food basket average by 75% in May, continuing a decline that began with the end of the siege in March. food at the household level in Al Waer increased by 2,179 SYP in May, after decreasing by 33,819 SYP since the Notably, while the cost of diesel in Al Waer Purchasing from markets. truce agreement was signed in March. In was within 100 SYP of the cost in nearby nearby assessed communities not considered communities not considered besieged or hard- Most common methods of obtaining besieged or hard-to-reach, the average cost to-reach, the price of butane and coal was bread at the household level of a standard food basket did not significantly approximately 50% cheaper in Al Waer than in Most common source: Public bakeries change, and was 116% higher than in Al Waer. those communities. Propane, kerosene and firewood continued Challenges to obtaining bread: No issues, Food item availability / prices bread accessed every day. to be reported unavailable in Al Waer, with All food items were reported generally all other fuel items generally available10 in the Change since April available10 in Al Waer for the first time since the community. community was first assessed.

Informing Available Positive increase Negative increase May 2017 3 more effective REACH humanitarian action Sometimes available No change Positive decrease Not available Negative decrease CORE FOOD ITEM/NFI PRICE AND AVAILABILITY INDEX8 Endnotes 1 Item Al Waer Price change Nearby non-hard- Figures based on population estimates by local actors within the community. Their assessments in March estimated 30,000- 12 9 since April to-reach areas 35,000 individuals, including 20,000-25,000 IDPs. Figures based Food Items Bread private bakery (pack) 20010 -60% 125 on HNO 2017 population data estimate 50,000 residents, and approxiamtely 25,000 IDPs (December 2016). Bread public bakery (pack) 7510 -6% 90 2 The fact that some informal points exist does not imply their Rice (1kg) 10010 +100% 463 safety, security, or the financial capacity of any notable portion of Bulgur (1kg) 7510 +50% Not available the population to pay the fees required to use them. 3 Lentils (1kg) 15010 +150% 550 Reported deaths are based on reported incidents within the community. There is better access to health reports in certain Chicken (1kg) 200010 +100% 975 communities, therefore, validity of estimations varies. Without Mutton (1kg) 350010 +17% 2775 medical assessments, it was not possible to verify the exact 10 causes of death cited, therefore the caseload is indicative of the Tomato (1kg) 250 -44% 550 perceived health issues causing death in the communities. 10 Cucumber (1kg) 350 +17% 225 4 Some availability does not necessarily imply sufficiency. Likewise, Milk (litre) 35010 -29% 200 the list is not intended to be a comprehensive assessment of all 10 medical needs, but rather indicative of key medical items that Flour (1kg) 200 -33% 200 speak to the trend in access to medical services in the area. 10 Eggs (1) 30 -25% 50 5 ‘Most needed’ does not necessarily imply unavailability. Iodised salt (500g) 5010 60 Furthermore this list is not intended to be a comprehensive list of most needed medical items or medicines, but rather indicative of Sugar (1 kg) 10 350 -13% 425 needs that speak to the trend in the priorities of medical items in Cooking oil (litre) 70010 650 the area. WASH Items Soap (1 bar) 10010 -50% 55 6 The availability of surgery does not necessarily imply treatment Laundry powder (1kg) 50010 -29% 925 by a doctor formally trained in the relevant procedure, or the use of anaesthesia or appropriate clinical equipment. Community Sanitary pads (9) 20010 Not available members without professional medical backgrounds may have been Toothpaste (125ml) 20010 +100% 250 informally trained by medical personnel to carry out emergency procedures. Disposable diapers (24 pack) 100010 -50% 2000 7 Calculation of average cost of food basket based on WFP’s Fuel 13 10 Butane (cannister) 2815 -78% 6750 standard food basket of essential commodities. The basket Diesel (litre) 30010 -80% 400 includes 37 kg of bread, 19 kg rice, 19 kg lentils, 5 kg of sugar and Propane (cannister) 7 kg of vegetable oil, providing 1,930 kcal a day for a family of five Not available Not available during a month. Available at: WFP, VAM Food Security Analysis, Kerosene (litre) Not available Not available ‘Syria Market Price Watch Bulletin: April 2017’ (link here). Coal (kg) 35010 -65% 700 8 $1 = 515 SYP (UN operational rates of exchange as of 1 June Firewood (tonne) Not available 60000 2017). 9 Nearby communities in Homs governorate which are not For affected populations the functionality of, and access to, basic services such as medical considered besieged/hard-to-reach: Farqalas and Qazhal. 10 facilities, water and electricity are highly dependent on the price and availability of fuel sources. Generally available in markets (21+ days this month). 11 Sometimes available in markets (7 – 20 days this month). 12 Price fluctuations of 5% or less were generally not reported.

Informing May 2017 4 more effective REACH humanitarian action Syria Community Profile Update: Khan Elshih, Rural Damascus Informing May 2017 more effective REACH humanitarian action

SUMMARY FOR HUMANITARIAN PURPOSES ONLY

Khan Elshih is a largely Palestinian-populated Rankus community located southwest of Damascus, that A ABDANI ² D has been affected by access restrictions since Dimas Syrian Arab BINE Madaya March 2013. Conflict escalated dramatically in UN classification: Hard-to-Reach !( Republic !( Sidnaya MADAYA October 2016, which led to a substantial tightening 1 Estimated population : 9000-9500 Ein Elfijeh of access restrictions before a truce was reached Az abdani Of which IDPs1: 100-200 At Tall in late November 2016. Over 3,000 individuals and SU WADI BURDA BARHALIYA their families were evacuated to Idleb governorate % pre-conflict (! Communities covered in !( !( DEIR MARAN 26-50% !( !( D and a general improvement in the humanitarian this profile KAFR ELAWAMID !( !( EIN ELFIJEH AT TALL population remaining: !( D !( HSEINIYEH KAFIR BSEIMEH !( Other assessed DEIR ELEIT situation has been witnessed since the onset of Harasta % population female: 51-75% communities ANUN Duma udsiya DUMA the truce, causing the UN to reclassify Khan Elshih HARASTA !( % of female-headed D Formerly assessed !( HAMA BURA !( from besieged to hard-to-reach in April 2017. communities 1-25% !( UDSIYA ABOUN ARBIN households !( In May, the humanitarian situation remained Urban area AMALKA HAMMURA !( Arbin !( JOBER !( unchanged compared to the situation in April. Subdistrict borders DAMASCUS CITY !( !( SABA NASHABIYEH The health situation in Khan Elshih also remained !( !( Although no humanitarian vehicles entered Khan EIN KAFR JISREIN Kafr unchanged after improving slightly in April, Main roads Markaz TERMA BATNA Batna Elshih in May, commercial vehicles continued Darayya TADAMON Jaramana when medical stocks increased due to improved Main rivers Nashabiyeh providing food, NFIs, medical supplies and fuel !( commercial vehicle access. Nonetheless, the atana !( D !( YARMUK Maliha to the community. Medical stocks remained MADAMIYET DARAYYA Hajar HAJAR ASWAD threat of conscription and detention reportedly ELSHAM Aswad unchanged in May (after a slight increase in April), Babella continued to hinder men from seeking medical care Sahnaya as did access to water, electricity and education. in nearby communities. No barriers to accessing education were reported, Food prices stabilised in May, after considerable KHAN ELSHIH Ghizlaniyyeh although no children attended school due to the (! fluctuations in April due to a decrease in local KAFR HOOR BETIMA summer break. Water trucking was the main !( !( vegetable production. No major increases in food Bait Jan source of water in At Tall, and generators continued prices were reported, with the exception of a 30% BEIT SABER Kisweh to provide electricity to the community. BAIT JAN MARAET !( !( BEIT JIN increase in the price of salt. As was the case in !( The number of residents accessing formal access Sasa April, no negative food-based strategies to cope Kms points in Khan Elshih remained unchanged in May, with a lack of food were reported in May. 0 5 10 after increasing slightly in April, when groups with For the first time since assessments began, fuel certain political affiliations could move more freely. was reported sufficient to meet community needs Women reportedly continued to face verbal and and no coping strategies to deal with a lack of fuel sexual harassment at checkpoints. Restrictions on METHODOLOGY were reported. This occurred due to a seasonal the quantities of goods brought into the community lack of demand coupled with a gradual increase in Based on data collected from community representatives inside Syria at the end of May 2017 and via commercial vehicles remained. beginning of June 2017, these updates refer to the situation in May 2017. Information collected provides NFI availability following the truce. an understanding of how limited freedom of movement and restrictions on access affect humanitarian CHANGES SINCE APRIL needs in communities in Syria. Participants provide information comparatively to the previous month. Where possible during analysis, comparisons are also made to findings from previous periods the Access Restrictions on Civilians Health Situation community has been assessed. An improvement or deterioration from the previous month may not indicate a trend but rather distinct circumstances specific to the month assessed. When possible, Commercial Vehicle Access Core Food Item Availability information presented has been triangulated with other available sources prior to inclusion, yet findings should be considered indicative rather than generalisable to the whole community as representative Humanitarian Vehicle Access Core Food items Price sampling, entailing larger scale data collection, remains challenging in areas with restricted movement and access. Finally, the level of information on each community varies due to difficulties obtaining data Access to Basic Services Overall Humanitarian Situation from certain locations. MOVEMENT OF CIVILIANS Humanitarian vehicles ACCESS TO SERVICES* 3 Change in # people able to leave Access to water services in Khan Elshih has reportedly been insufficient since April 2017 , with the main water network still unavailable. Trucking remained the primary method of water delivery. Though repairs to compared to April: Change since April: the electrical network began in February, generators remained the main source of power in May. All school- People able to leave2 No humanitarian vehicles entered Khan Elshih aged children continued to have access to schools, but no children were reported in school this month due to the Ramadan holiday. The ability of civilians to leave and enter the in May. However, local NGOs operated on the ground, as was the case in previous months. community improved following the truce on WATER Main source of drinking water (Status) Closed wells (Safe to drink)** 30 January, with approximately 11-25% of Goods entered the population using formal routes to enter Food, fuel, NFIs, medicine and medical Sufficiency of available water to meet Insufficient to meet household needs and exit Khan Elshih under certain conditions equipment entered Khan Elshih through household needs (Coping strategies (Spend money usually spent on other since then. The number of people accessing commercial vehicles and civilians bringing used) things to buy water) formal routes in May remained the same after items from nearby communities. Access to water network per week Network unavailable a slight increase in April, when groups with ELECTRICITY Access to electricity network per day Less than 1 hour certain political affiliations were permitted to HEALTH SERVICES Access to electricity (Main source) 2-4 hours (Generators) move more freely than in March. per day Change in health situation Access for women, children and individuals Available education facilities Pre-conflict primary, secondary, high schools compared to April: EDUCATION with certain political affiliations remained UNRWA schools unrestricted, upon presentation of identification No skilled childbirth services or surgeries were documents. Employees and students could Barriers to education None reported available in May, as had been the case since use formal routes on workdays. However, * Arrows indicate change in access since April. conflict escalated in October 2016. Patients perceived risks of harassment associated ** Data collected is based on the perceptions of local actors. Water safety cannot be guaranteed in the absence of formal water testing. were transferred to hospitals in Damascus with accessing checkpoints reportedly when these services were required. Child deterred some women from exiting Khan 6 immunization services continued to be Medical services available Most needed medical items Elshih via formal routes. As was the case in available in May, as had been the case in April. 1. Clean bandages April, individuals using formal entry and exit points also reported risks of conscription. All assessed medical items continued to be Child immunization 2. Antibiotics available in May after stocks increased thanks 3. Blood transfusion bags Informal points used: None reported. Diarrhoea management to improved commercial vehicle access, Risks faced when trying to enter or exit following the truce. However, low-income Emergency care Availability of medical personnel (formally or informally) families continued to have limited access to Personnel available: Professionally trained Verbal harassment of women, conscription. healthcare, and some men still reported fears Skilled childbirth care doctors, nurses and midwives; of detention and conscription at checkpoints, MOVEMENT OF GOODS AND ASSISTANCE 4 preventing them from seeking medical care Surgery Others providing medical services: Dentists Vehicles carrying commercial goods outside of Khan Elshih in May. and pharmacists. Diabetes care Change since April : Permanent medical facilities available Change since April Change since April The number of commercial vehicles entering Mobile clinics / field hospitals Khan Elshih in May remained largely the same Strategies used to cope with a lack of as in April. Limitations on the amount of goods Informal emergency care points Unavailable medical items5 medical services permitted to enter Khan Elshih per vehicle None reported, since the onset of the truce in Pre-conflict hospitals All assessed medical items were reported stayed in place. Vehicles also remained available in May. December 2016. subject to searches while drivers were Primary healthcare facilities required to present identification documents. 7 Change since April Unusual outbreaks of disease As was the case in April, fees were usually Change since April required for vehicles to enter Khan Elshih. None reported. Informing Available Positive increase Negative increase May 2017 2 more effective REACH humanitarian action Sometimes available No change Positive decrease Not available Negative decrease FOOD CORE FOOD ITEM / NFI AVAILABILITY AND has not been sold in the community since April due to a seasonal lack of demand. PRICES Change in food situation Strategies used to cope with a lack of fuel: For the first time since the assessment began, no strategies 8 compared to April: Average cost of standard food basket to cope with a lack of fuel were reported. The increasing availability of fuel since the signing of the truce, Khan Nearby coupled with low seasonal demands, resulted in the community having a sufficient amount of fuel. Most common methods of obtaining Elshih areas9 food at the household level CORE FOOD ITEM / NFI AVAILABILITY AND PRICE INDEX9 Average cost 24897 32962 The most common methods of obtaining May (SYP)10 food in May were purchasing from shops For affected populations the functionality of, and access to, basic services such as medical Change since and markets, as well as receiving food from April11 facilities, water and electricity are highly dependent on the price and availability of fuel sources. humanitarian distributions run by local NGOs operating inside Khan Elshih. The cost of a standard food basket in Khan Item Khan Elshih Price change since Nearby non- Elshih remained largely unchanged in May, and March11 hard- to-reach Most common methods of obtaining was 24% cheaper than in nearby communities areas9 bread at the household level not considered hard-to-reach. The prices of Food Items Bread private bakery (pack) 10013 100 rice, lentils and cooking oil were 25%, 43% 12 Purchasing from shops and markets. Bread public bakery (pack) 70 -13% 58 and 27% cheaper respectively than in nearby Rice (1kg) 40012 535 Since March 2017, bread has been available in communities in May, leading to this difference 12 public bakeries, in addition to private bakeries. in the food basket price. Bulgur (1kg) 300 320 Lentils (1kg) 30012 525 Food item availability / prices Challenges to obtaining bread: None Chicken (1kg) 135012 1120 reported. All assessed food items were reportedly 12 sometimes available,12 except for bread Mutton (1kg) 5000 3925 12 Change since April from private bakeries, which was generally Tomato (1kg) 350 410 available.13 After considerable price fluctuations Cucumber (1kg) 30012 318 Strategies used to cope with a lack of in April, the prices of the majority of assessed Milk (Litre) 6012 215 food food items stabilised in May. There was Flour (1kg) 15012 233 however a slight decrease in the price of bread Eggs (1) 6012 50 Reducing meal size from public bakeries and a 30% increase 12 in iodised salt compared to April 2017, as Iodised salt (500g) 130 +30% 65 Skipping meals commercial vehicles continue to enter the Sugar (1 kg) 50012 438 community following the truce. Cooking oil (litre) 90012 1225 Days without eating 13 WASH item availability / prices WASH Items Soap (1 bar) 100 113 13 Eating non-food plants All assessed hygiene and sanitation items Laundry powder (1kg) 2000 875 were reported as generally available13 in May, Sanitary pads (9) 50013 444 Eating food waste with no price changes since December 2016. Toothpaste (125ml) 35013 382 13 Reportedly used as a coping strategy However, WASH items were still on average Disposable diapers (24 pack) 2500 1575 83% more expensive than those in nearby non- Fuel Butane (cannister) 300012 2925 Not reportedly used as a coping strategy hard-to-reach communities. Diesel (litre) 40012 280 Fuel availability / prices Since April 2017, no strategies related to a Propane (cannister) Not available 2560 lack of food have been reported. Coal became available in February, and prices Kerosene (litre) 40012 400 7 stabilised in May after dropping by 58% in April 12 Deaths attributable to a lack of food due to lower seasonal demand. The availability Coal (kg) 500 450 None reported, as has been reported since of other assessed fuels has remained the same Firewood (tonne) Not available Not available assessments of the community began. since December, apart from firewood which

Informing Available Positive increase Negative increase May 2017 3 more effective REACH humanitarian action Sometimes available No change Positive decrease Not available Negative decrease Endnotes 1 Figures based on estimates by local actors within communities assessed. The last HNO population data (December 2016) estimates that figures within Khan Elshih community are up to 12,000, including 3,000 IDPs. 2 The fact that some informal points exist does not imply their safety, security, or the financial capacity of any notable portion of the population to pay the fees required to use them. 3 An error in April’s profile stated that water was sufficient in Khan Elshih in April. 4 The availability of surgery does not necessarily imply treatment by a doctor formally trained in the relevant procedure, or the use of anaesthesia or appropriate clinical equipment. Community members without professional medical backgrounds may have been informally trained by medical personnel to carry out emergency procedures. 5 Some availability does not necessarily imply sufficiency. Likewise, the list is not intended to be a comprehensive assessment of all medical needs, but rather indicative of key medical items that speak to the trend in access to medical services in the area. 6 ‘Most needed’ does not necessarily imply unavailability. Furthermore, this list is not intended to be a comprehensive list of most needed medical items or medicines, but rather indicative of needs that speak to the trend in the priorities of medical items in the area. 7 Reported deaths are based on reported incidents within the community. There is better access to health reports in certain communities, therefore, validity of estimations varies. Without medical assessments, it was not possible to verify the exact causes of death cited, therefore the caseload is indicative of the perceived health issues causing death in the communities. 8 Calculation of average cost of food basket based on WFP’s standard food basket of essential commodities. The basket includes 37 kg of bread, 19 kg rice, 19 kg lentils, 5 kg of sugar and 7 kg of vegetable oil, providing 1,930 kcal a day for a family of five during a month. Available at: WFP, VAM Food Security Analysis, ‘Syria Market Price Watch Bulletin: April 2017’ (link here). 9 Nearby communities in Rural Damascus governorate which are not considered besieged/hard-to-reach: Deir Ali and Kisweh. 10 $1 = 515 SYP (UN operational rates of exchange as of 1 June 2017). 11 Price fluctuations of 5% or less were not reported. 12 Sometimes available in markets (7 – 20 days this month). 13 Generally available in markets (more than 20 days this month).

Informing May 2017 4 more effective REACH humanitarian action Syria Community Profile Update: Madaya and Bqine*, Rural Damascus Informing May 2017 more effective REACH humanitarian action

FOR HUMANITARIAN PURPOSES ONLY

SUMMARY ankus A ABDA ² Madaya and Bqine*, which sit within a contiguous D Dimas UN classification: Besieged BQINE Madaya area, are located 40km northwest of Damascus Syrian Arab (! 1 Republic city. The mountainous communities have faced Estimated population : 40500-42500 (! MADAYA Sidnaya restrictions on movement since July 2015, and in lfieh Of which IDPs1: 8700-9400 Az adani were classified as besieged by the UN in January At Tall S AD 2016. Az Zabdani, which was assessed by REACH % pre-conflict BAAA 51-75% BDA !( population remaining: (! ommunities covered in !( D MAA between June 2016 and March 2017, had been !( !( D this profile AF AAMD !( !( FJ AT TA !( D !( classified as besieged since November 2015. S AF BSM % population female: 26-50% !( Other assessed D T arasta The civilian population was evacuated from Az communities A Duma udsiya DMA 2 % of female-headed AASTA !( Zabdani in early 2016; all remaining population left 26-50% D Formerly assessed !( AMA BA !( households communities the community in April 2017. !( DSA ABO AB !( ran area AMAA AMMA The humanitarian situation in Madaya !( Arin !( Madaya via commercial vehicles and civilians JOB !( Sudistrict orders DAMASCUS CITY !( !( SABA ASAB improved in May, as restrictions on movement !( !( bringing such items from nearby communities. AF JS afr and access to and from the community were Main roads Markaz TMA BATA Batna Shops and markets, which had been closed since Darayya TADAMO Jaramana finally relaxed as a consequence of the December 2016, reopened in May. Fuel, which had Main rivers !( ashaiyeh 3 atana !( D !( AM implementation of the Four Towns Agreement. Maliha been in critically low supply in the community since MADAMT DAAA aar AJA ASAD All types of goods, most of which had been assessments began, entered in May via residents SAM Aswad Baella prevented from formally entering Madaya since bringing it back from nearby communities. Sahnaya assessments began in 2016, became available Following a shift in local control, repairs were made in May; the medical situation improved, A S hizlaniyyeh to the electrical and water networks, increasing !( and access to all basic services increased. AF OO BTMA populations’ access to both. However, access !( !( On 30 April, two formal access points became to drinking water remained insufficient to meet Bait Jan BT SAB isweh operational in Madaya, a development reported for household needs, with negative coping strategies BAT JA MAAT !( !( BT J the first time since assessments of the community !( reported. Further, repairs were made to some Sasa began. Additionally, some commercial vehicles Kms educational facilities, and security risks were no 0 5 10 were able to enter the community. While these longer a perceived barrier to education (however faced restrictions, it was the first time commercial all schoolchildren were on holidays during May). access was reported since assessments began. METHODOLOGY The overall health situation also improved, as two Humanitarian aid, which last reached Madaya in public clinics (and several private ones) were able Based on data collected from community representatives inside Syria at the end of May and beginning March, did not enter in May. to resume operations, following the entry of medical of June 2017, these updates refer to the situation in May 2017. Information collected provides an Following the opening of formal access points, aid and the return of some medical personnel to the understanding of how limited freedom of movement and restrictions on access affect humanitarian food, NFIs and medical items were able to enter community in May. needs in communities in Syria. Participants provide information comparatively to the previous month. Where possible during analysis, comparisons are also made to findings from previous periods the CHANGES SINCE APRIL community has been assessed. An improvement or deterioration from the previous month may not indicate a trend but rather distinct circumstances specific to the month assessed. When possible, Access Restrictions on Civilians Health Situation information presented has been triangulated with other available sources prior to inclusion, yet findings should be considered indicative rather than generalisable for the whole community as representative Commercial Vehicle Access Core Food Item Availability sampling, entailing larger scale data collection, remains challenging in areas with restricted movement Humanitarian Vehicle Access Core Food Item Prices No data and access. Finally, the level of information on each community varies due to difficulties obtaining data from certain locations. Access to Basic Services Overall Humanitarian Situation *For the purpose of this profile, the contiguous area of Madaya and Bqine will further be referred to as Madaya. MOVEMENT OF CIVILIANS vehicles entered Bqine and Madaya in ACCESS TO SERVICES* May following the opening of the two access Access to all basic services significantly improved in May. Following repairs to the network, access to Change in # people able to leave points. Commercial access was however electricity, which had previously been minimal, was restored in the community. Similarly, the water network compared to April: subject to the payment of fees, documentation became available in Madaya in May, for the first time since assessments began in June 2016. However, access requirements, searches, confiscation of parts remained insufficient, and residents continued to report related negative coping strategies. Additionally, in People able to leave4 of shipments and restrictions on time and days May, schools became operational following repairs and an improved security situation, for the first of entry. time since December 2016. However, all children were on summer vacation. Following the implementation of the Four Towns Agreement, two formal Humanitarian vehicles access points opened on 30 April, one WATER Main source of drinking water (Status) Water network (Safe to drink)** in Madaya and one in Bqine. For the first Change since April: Sufficiency of available water to meet Insufficient (Spend money usually spent time since assessments began in June household needs (Coping strategies elsewhere to buy water) 2016, residents were able to leave and No humanitarian vehicles entered Madaya in used) enter the communities, with an estimated May. The last time the community received aid Access to water network per week 1-2 days 26-50% using the access points during was in March 2016. ELECTRICITY Access to electricity (Main source), 2-4 hours (Main network) May. However, such movement reportedly per day involved various risks, inlcuding harassment, Goods entered Access to electricity network, per day 2-4 hours detention and conscription. For the first time since assessments began, food, NFIs and medical items could enter In addition to the relocations which took place EDUCATION Available education facilities Pre-conflict primary, secondary and high in mid-April, whereby 2,500 residents from Madaya in May, via commercial vehicles and schools Madaya and 700 from Bqine were evacuated, with civilians bringing goods from nearby Barriers to education None reported a further 500 individuals left Madaya during communities (Sidnayah and Damascus city). *Arrows indicate change in access since April. May. Following these developments in While no fuel entered via commercial vehicles, **Data collected is based on perceptions of local actors and therefore reported water safety requires verification through water testing. April and May, the number of female- it was brought into the community by civilians. headed households increased in both HEALTH SERVICES Madaya and Bqine. Most needed medical items6 Permanent medical facilities available For the second consecutive month, no Change in health situation 1. Antibiotics security risks associated to movement within compared to April: Mobile clinics / field hospitals the communities were reported in May. 2. Heart medicine There was a marked improvement in the health 3. Clean bandages Informal emergency care points Informal points used: None reported. situation in Madaya in May, relative to April. Following the lifting of access restrictions, Availability of medical personnel Pre-conflict hospitals Risks faced when trying to enter or exit medical items entered the community, (formally or informally) Personnel available: Professionally trained Primary healthcare facilities enabling the re-opening of medical facilities doctors, nurses and midwives. and resumption of medical services. Verbal and physical harassment, detention, Others providing medical services: Change since April Additionally, some medical personnel returned to conscription. Dentists, pharmacists, and medical or the community as the security situation improved. Two public primary healthcare clinics opened MOVEMENT OF GOODS AND ASSISTANCE pharmacy students. 5 in May, one in Madaya and one in Bqine. This Unavailable medical items was a marked improvement compared to April, Vehicles carrying commercial goods Change since April All assessed medical items became when the only exisiting facility had to cease sometimes available in May. operations due to lack of staff and supplies. Change since April: Prior to April, residents in Madaya had limited Change since April For the first time since assessments of the communities began, commercial

Informing Available Positive increase Negative increase May 2017 2 more effective REACH humanitarian action Sometimes available No change Positive decrease Not available Negative decrease access to medical assistance at one mobile FOOD Following the improvement in food security, however on average 39% more expensive clinic. Further, in May, an estimated 5-7 private no coping strategies related to a lack of food than in nearby communities. clinics opened in the community, however Change in food situation were reported in May, for the first time since Fuel availability / prices access was limited to those with sufficient compared to April: assessments of Madaya began in June 2016. financial resources. Fuel, which has been formally prevented Food security improved significantly in Madaya CORE FOOD ITEM / NFI AVAILABILITY from entering Madaya since assessments Medical services available in May, as food items entered the community AND PRICES began in June 2016, was brought into and markets and shops reopened for the first the community in May from nearby Child immunization time since December 2016. All assessed core Average cost of standard food basket9 communities. Butane, propane, diesel and food items, with the exception of bread from Nearby coal all became sometimes available in markets Diarrhea management Madaya bakeries, became available, and no negative areas10 following the lifting of access restrictions. Fuels Emergency care coping strategies were reported in the community. prices were on average 20% higher than in Average cost May 30133 32962 nearby communities not considered besieged (SYP)11 Skilled childbirth care Most common methods of obtaining or hard to reach. food at the household level Strategies used to cope with a lack of fuel: 7 Change since April No info Surgery None reported. Purchasing from shops and markets. Diabetes care For the first time since assessments of the Most common methods of obtaining community began, a complete food basket Change since April bread at the household level price could be calculated for Madaya in May. A standard food basket was 8% more Following the re-opening of medical facilities Most common source: Shops. expensive than in nearby communities not in Madaya, some medical services resumed, Challenges to obtaining bread: None considered besieged or hard-to-reach. representing an improvement from April reported; bread accessed every day. when no medical assistance was available Food item availability / prices in the community. However, childbirth care Change since April remained unavailable, and women had to All assessed core food items became seek assistance in nearby communities. While Deaths attributable to a lack of food8 sometimes available12 in May, following residents could seek medical assistance in the cessation in hostilities and partial nearby communities, men were hesitant to use None reported. lifting of access restrictions. Shops and the formal access points for this purpose, due to Strategies used to cope with a markets reopened in May, for the first time perceived risks of detention and conscription. lack of food since December 2016 when they were closed due to conflict-related security concerns. Unusual outbreaks of disease8 Reducing meal size While bread from bakeries (public and private) Following the lifting of access restrictions, remained unavailable, other assessed food those suffering from meningitis and kidney Skipping meals items were similarly priced to those in nearby failure (outbreaks first reported in October and Days without eating communities. November 2016, respectively) could either be evacuated or seek treatment in nearby Eating non-food plants WASH item availability / prices communities. Eating food waste All assessed hygiene and sanitation products Strategies used to cope with a lack of Reportedly used as a coping strategy (soap, laundry powder, sanitary pads, medical services toothpaste, disposable diapers) became Not reportedly used as a coping strategy None reported. generally available13 in May. They were

Informing Available Positive increase Negative increase May 2017 3 more effective REACH humanitarian action Sometimes available No change Positive decrease Not available Negative decrease CORE FOOD ITEM/NFI PRICE AND AVAILABILITY INDEX9 Endnotes 1 Figures based on estimate by local actors withing communities 11 $1 = 515 SYP (UN operational rates of exchange as of 1 June Item Madaya Price change since Nearby non- assessed. The last HNO population data (December 2016) 2017). April hard-to-reach estmates that figures within Madaya are up to 51,100, including 12 Sometimes available in markets (7 – 20 days this month). 1,800 IDPs. areas8 13 Generally available in markets (21+ days this month). 2 Food Items Prior to the departure of all remaining population, REACH Bread private bakery (pack) Not available Not available 100 assessed Az Zabdani together with Madaya and Bqine between Bread public bakery (pack) Not available Not available 58 June 2016 and March 2017. Rice (1kg) 55012 Not available 535 3 The Four Towns Agreement was a deal between parties to 12 the conflict, affecting, among others, humanitarian access to Bulgur (1kg) 450 Not available 320 the communities of Az Zabdani and Madaya (Rural Damascus Lentils (1kg) 40012 Not available 525 governorate) and Foah and Kafraya (Idleb governorate). Chicken (1kg) 140012 Not available 1120 4 The fact that some informal points exist does not imply their 12 safety, security, or the financial capacity of any notable portion of Mutton (1kg) 5000 Not available 3925 the population to pay the fees required to use them. Tomato (1kg) 30012 Not available 410 5 Some availability does not necessarily imply sufficiency. 12 Likewise, the list is not intended to be comprehensive Cucumber (1kg) 250 Not available 318 assessment of all medical needs, but rather indicative of key Milk (litre) 25012 Not available 215 medical items that speak to the trend in access to medical services in the area. Flour (1kg) 15012 Not available 233 6 ‘Most needed’ does not necessarily imply unavailability. 12 Eggs (1) 60 Not available 50 Furthermore this list is not intended to be a comprehensive list Iodised salt (500g) 10012 Not available 65 of most needed medical items or medicines, but rather indicative 12 of needs that speak to the trend in the priorities of medical items Sugar (1 kg) 450 Not available 438 in the area. 12 Cooking oil (litre) 800 Not available 1225 7 The availability of surgery does not necessarily imply treatment WASH Items Soap (1 bar) 10013 Not available 113 by a doctor formally trained in the relevant procedure, or the use 13 of anaesthesia or appropriate clinical equipment. Community Laundry powder (1kg) 2000 Not available 875 members without professional medical backgrounds may Sanitary pads (9) 50013 Not available 444 have been informally trained by medical personnel to carry out 13 emergency procedures. Toothpaste (125ml) 400 Not available 382 8 13 Reported deaths are based on reported incidents within the Disposable diapers (24 pack) 2500 Not available 1575 community. There is better access to health reports in certain Fuel Butane (cannister) 320012 Not available 2925 communities, therefore, validity of estimations varies. Without 12 medical assessments, it was not possible to verify the exact Diesel (litre) 400 Not available 280 causes of death cited, therefore the caseload is indicative of the Propane (cannister) 300012 Not available 2560 perceived health issues causing death in the communities. Kerosene (litre) Not available Not available 400 9 Calculation of average cost of food basket based on WFP’s 12 standard food basket of essential commodities. The basket Coal (kg) 500 Not available 450 includes 37 kg of bread, 19 kg rice, 19 kg lentils, 5 kg of sugar Firewood (tonne) Not available Not available Not available and 7 kg of vegetable oil, providing 1,930 kcal a day for a family of five during a month. Available at: WFP, VAM Food Security Analysis, ‘Syria Market Price Watch Bulletin: April 2017’ (link For affected populations the functionality of, and access to, basic services such as medical here). As bread was unavailable in private and public bakeries in Madaya, no prices were available for bread sold in bakeries in facilities, water and electricity are highly dependent on the price and availability of fuel sources. the community. However, the food basket price for Hajar Aswad for May was calculated using the reported price of bread sold in shops (100 SYP). 10 Nearby communities in Rural Damascus governorate which are not considered besieged/hard-to-reach: Deir Ali and Kisweh.

Informing May 2017 4 more effective REACH humanitarian action Syria Community Profile Update: Qaboun, Damascus Governorate Informing May 2017 more effective REACH humanitarian action

FOR HUMANITARIAN PURPOSES ONLY

SUMMARY Rankus Qaboun is a neighbourhood in eastern Damascus city AZ ZABDANI ² D Dimas which has, along with the adjacent neighbourhoods Syrian Arab BQINE Madaya UN classification: Besieged !( of Burza and Tishreen, faced access restrictions Republic !( Sidnaya 1 MADAYA since 2013. In early 2014, semi-official truces were Estimated population : 25-50 Ein Elfijeh Az Zabdani reported in all three neighbourhoods. Due to the 1 Of which IDPs : None At Tall proximity of these communities to Eastern Ghouta, SUQ WADI BURDA BARHALIYA tunnels were constructed linking these two areas to % pre-conflict Neighbourhoods covered !( !( DEIR MAQRAN 1-25% !( !( D facilitate the transport of goods between them. The population remaining: in this profile KAFR ELAWAMID !( !( EIN ELFIJEH AT TALL !( D !( HSEINIYEH KAFIR BSEIMEH unofficial ceasefires in the neighbourhoods ended Other assessed DEIR ELZEIT % population female: Harasta 1-25% neighbourhoods QANUN Duma in February 2017 when the only formal access point Qudsiya DUMA Other assessed HARASTA !( into Qaboun, Burza and Tishreen was shut down, % of female-headed None !( !( HAMA BURZA !( households communities effectively putting the three neighbourhoods under !( QUDSIYA QABOUN ARBIN Formerly assessed !( D ZAMALKA HAMMURA siege. However, this profile focuses only to the do so. Entering the community was not possible for communities !( Arbin !( !( DAMASCUS CITY JOBER !( !( SAQBA NASHABIYEH situation in Qaboun, and not the Burza or Tishreen civilians or commercial vehicles in May, but three !( !( Urban area EIN KAFR JISREIN Kafr neighbourhoods as Burza is assessed in another humanitarian food deliveries were permitted to Markaz TERMA BATNA Batna Subdistrict borders Darayya TADAMON Jaramana profile. enter the community during the evacuation. Nashabiyeh Main roads !( Qatana !( D !( YARMUK This renewed escalation of conflict not only cut The humanitarian situation was reportedly Maliha Main rivers MADAMIYET DARAYYA Hajar HAJAR ASWAD off Eastern Ghouta’s main supply route but also critical in March and April, and continued to ELSHAM Aswad Babella caused the humanitarian situation in Qaboun to rapidly deteriorate in May due to the effects of Sahnaya deteriorate rapidly as neither civilians nor food, NFIs the siege. The prices of available food items were on or medical items were able to enter the community average triple the price in nearby non-hard-to-reach KHAN ELSHIH Ghizlaniyyeh !( BETIMA in March and April. Qaboun was officially classified communities in April, before all assessed food KAFR HOOR !( by the UN as besieged in May. By mid-May, official !( items became unavailable in May. Additionally, Bait Jan authorities were reportedly in control of the entire all assessed fuel items as well as all hygiene BEIT SABER Kisweh BAIT JAN MAZRAET !( neighbourhood and negotiations for evacuation and sanitation products, apart from sanitary !( BEIT JIN !( began. pads, were reportedly unavailable on markets. Sasa Kms The shift in control led to a mass evacuation Indeed, no items have been permitted into the 0 5 10 of Qaboun’s population to Idleb Governorate, community since the closure of formal and with less than 50 individuals reamaining in informal routes in February with the exception METHODOLOGY Qaboun at the time of data collection in late of three food aid deliveries in May. May as they did not wish to evacuate. Anyone The shift in power resulted in the closure of Based on data collected from community representatives inside Syria at the end of May and beginning wishing to leave the community was permitted to Qaboun’s last remaining medical facility and all of June 2017, these updates refer to the situation in May 2017. Information collected provides an understanding of how limited freedom of movement and restrictions on access affect humanitarian CHANGES SINCE APRIL needs in communities in Syria. Participants provide information comparatively to the previous month. Where possible during analysis, comparisons are also made to findings from previous periods the Access Restrictions on Civilians Health Situation community has been assessed. An improvement or deterioration from the previous month may not indicate a trend but rather distinct circumstances specific to the month assessed. When possible, Commercial Vehicle Access Core Food Item Availability information presented has been triangulated with other available sources prior to inclusion, yet findings should be considered indicative rather than generalizable to the whole community as representative Humanitarian Vehicle Access Core Food Item Prices No Data sampling, entailing larger scale data collection, remains challenging in areas with restricted movement and access. Finally, the level of information on each community varies due to difficulties obtaining data Access to Basic Services Overall Humanitarian Situation from certain locations. medical stocks were looted by the authorities, ACCESS TO SERVICES* enter Qaboun since the closure of the formal leaving them completely depleted. All medical access point in Burza on 17 February. In contrast to April where water was reported sufficient in Qaboun, access to the water network decreased to staff was evacuated in May. one to two days per week in May as the authorities removed water tanks from buildings and destroyed pipes Access to basic services continued to decline as the Humanitarian vehicles connecting houses to the main water network. The electricity network remained unavailable in April, as it shut electrical network remained shut down in May, as has down in March. As was the case in April, no children were able to attend school in May due to the destruction been the case since March. Schools continued to be Change since April and shut down of facilities following the deterioration in the security situation. closed in May due to the security situation, and water was reportedly insufficient in the neighbourhood In contrast to previous months since February WATER Main source of drinking water (Status) Water network (Safe to drink)** as the authorities damaged water tanks and pipes 2017, humanitarian aid entered the community Sufficiency of available water to meet connecting tanks to the main network from residential three times in May during the evacuations. household needs (Coping strategies Insufficient (no coping strategies buildings. Although this overview covers the reported) Goods entered used) humanitarian situation in May, at the time of writing it was reported that further pre-conflict residents had Following the gradual depletion of all goods in Access to water network per week 1 - 2 days left Qaboun as the dire humanitarian condition has Qaboun after the last formal access point was made the neighbourhood unsuitable for habitation. closed in February, the Syrian Red Crescent ELECTRICITY Access to electricity network per day Network unavailable was able to enter Qaboun three times in May to Access to electricity (Main source) 1 - 2 hours (Generator) provide food for residents. No NFIs or medicine per day MOVEMENT OF CIVILIANS reportedly entered Qaboun in May. Available education facilities None Change in # people able to leave EDUCATION HEALTH SERVICES compared to April: Barriers to education Facilities destroyed, routes unsafe, lack of school supplies Change in health situation People able to leave2 compared to April: Arrows indicate change in access since April. ** Data collected is based on perceptions of local actors and therefore reported water safety requires verification through testing. In contrast to April where no one reportedly attempted to enter or leave Qaboun, as has After the health situation declined in April due to the progressive depletion of medical 5 4 been the case since the last remaining formal Most needed medical items Unavailable medical items supplies in the neighbourhood since the access point was closed on 17 February 1. Antibiotics All assessed medical items were unavailable in in Burza, everyone who wanted to leave closure of the formal access point in February, it worsened in May as the last medical facility 2. Diabetes medicine Qaboun in May as all remaining stocks were Qaboun was evacuated to Idleb in May with 3. Heart medicine a maximum of 50 individuals remaining in was shut down by the authorities. Following looted and the last hospital was closed down, Qaboun at the time of data collection. This the shift in control, the last remaining medical Strategies used to cope with a lack of while no additional medical supplies were able marks a major decrease in population size items were seized by the authorities and the medical services to enter the neighbourhood. hospital was closed. The families remaining compared to April when it was estimated In contrast to April, no strategies to cope that 3,000 - 3,500 individuals were living in Qaboun were unable to seek medical help Change since April in neighbouring communities as all re-entry with a lack of medical services were reported in Qaboun. Entry to the community has as the community has been almost entirely points were closed off. The last remaining Medical services available remained restricted by official authorities evacuated. since the shift in control in February. medical personnel were evacuated from the 6 Child immunization Risks faced when trying to enter or exit neighbourhood in May. Unusual outbreaks of disease (formally or informally) Permanent medical facilities available None reported in May, with no change from Diarrhoea management No risks associated with exiting the community April indicated. Mobile clinics / field hospitals Emergency care were reported. Availability of medical personnel MOVEMENT OF GOODS AND ASSISTANCE Informal emergency care points Personnel available: No medical personnel Skilled childbirth care was reportedly left in Qaboun in May. Vehicles carrying commercial goods Pre-conflict hospitals 3 Others providing medical services: No one Surgery Change since April: Primary healthcare facilities provided medical services in May. Diabetes care No commercial vehicles have been allowed to Change since April Change since April Change since April

Informing Available Positive increase Negative increase May 2017 2 more effective REACH humanitarian action Sometimes available No change Positive decrease Not available Negative decrease FOOD Challenges to obtaining bread: Bread was lack of demand as a vast majority of community Strategies used to cope with a lack of fuel: unavailable in May due to the further depletion members was evacuated by the end of May. No strategies to cope with a lack of fuel were Change in food situation of food stocks since the closure of formal reported, due to less demand following the compared to April: and informal access points to the region in departure of a majority of the population in May. February. Food decreased in Qaboun in April and CORE FOOD ITEM/NFI PRICE AND AVAILABILITY INDEX8 continued to decrease in May due to the further Change since April depletion of food stocks since the closure of Item Qaboun Price change since Nearby non- both formal and informal access points to the CORE FOOD ITEM / NFI AVAILABILITY AND April10 hard-to-reach 9 neighbourhood in February. PRICES areas Food Items Bread private bakery (pack) Not available 181 Strategies used to cope with a lack of 7 Average cost of standard food basket Bread public bakery (pack) Not available 53 food In contrast to April where the cost of a standard Rice (1kg) Not available Available 500 food basket in Qaboun was 275% higher than Bulgur (1kg) Not available Available 322 Reducing meal size in nearby neighbourhoods not considered hard- Lentils (1kg) Not available Available 588 to-reach, all core food items were reported Skipping meals unavailable in Qaboun in May. It has therefore Chicken (1kg) Not available 1256 Mutton (1kg) Not available Available 4256 Days without eating not been possible to calculate a standard food basket price for Qaboun this month. Tomato (1kg) Not available 247 Cucumber (1kg) Eating non-food plants Food item availability / prices Not available 275 Milk (litre) Not available 256 Eating food waste While most core food basket items were reported available in markets in Qaboun in April Flour (1kg) Not available 301 Reportedly used as a coping strategy - although average prices nearly tripled those in Eggs (1) Not available 58 Not reportedly used as a coping strategy nearby communities not considered besieged Iodised salt (500g) Not available 140 Both men and women reportedly reduced the or hard-to-reach - no assessed food items Sugar (1 kg) Not available Available 444 size of their meals to cope with food shortages were reported available in May. The dramatic Cooking oil (litre) Not available Available 850 in May. decrease in food item availability occurred due WASH Items Soap (1 bar) Not available Available 146 to the depletion of stocks within the community 6 Laundry powder (1kg) Not available Available 888 Deaths attributable to a lack of food as well as the departure of a vast majority of 11 None reported in May, with no change from the community’s population. Sanitary pads (9) 500 -33% 438 Toothpaste (125ml) Not available 245 April indicated. WASH item availability / prices Disposable diapers (24 pack) Not available 2188 Most common methods of obtaining As opposed to April when soap, laundry powder Fuel Butane (cannister) Not available 2960 food at the household level and sanitary pads were reportedly available in Diesel (litre) Not available Available 290 Meal distributions were the most common Qaboun, only sanitary pads remained available Propane (cannister) means of obtaining food in May as markets and in May. The price of sanitary pads dropped by Not available 4500 shops have shut down in Qaboun. 33% due to a lack of demand as the fighting Kerosene (litre) Not available 350 in Qaboun led to most, if not all, women Coal (kg) Not available 350 Most common methods of obtaining evacuating the neighbourhood. Firewood (tonne) Not available 50000 bread at the household level Fuel availability / prices Most common source: Bread was unavailable No fuel items were available in Qaboun in May For affected populations the functionality of, and access to, basic services such as medical in May. due to the depletion of stocks in the community facilities, water and electricity are highly dependent on the price and availability of fuel sources. as well as the closing down of markets and the

Available Positive increase Negative increase Informing May 2017 3 more effective Sometimes available No change Positive decrease REACH humanitarian action Not available Negative decrease Endnotes 1 Figures based on population estimates by local actors within the community. 2 The fact that some informal points exist does not imply their safety, security, or the financial capacity of any notable portion of the population to pay the fees required to use them. 3 The availability of surgery does not necessarily imply treatment by a doctor formally trained in the relevant procedure, or the use of anaesthesia or appropriate clinical equipment. Community members without professional medical backgrounds may have been informally trained by medical personnel to carry out emergency procedures. 4 Some availability does not necessarily imply sufficiency. Likewise, the list is not intended to be a comprehensive assessment of all medical needs, but rather indicative of key medical items that speak to the trend in access to medical services in the area. 5 ‘Most needed’ does not necessarily imply unavailability. Furthermore this list is not intended to be a comprehensive list of most needed medical items or medicines, but rather indicative of needs that speak to the trend in the priorities of medical items in the area. 6 Reported deaths are based on reported incidents within the community. There is better access to health reports in certain communities, therefore, validity of estimations varies. Without medical assessments, it was not possible to verify the exact causes of death cited, therefore the caseload is indicative of the perceived health issues causing death in the communities. 7 Calculation of average cost of food basket based on WFP’s standard food basket of essential commodities. The basket includes 37 kg of bread, 19 kg rice, 19 kg lentils, 5 kg of sugar and 7 kg of vegetable oil, providing 1,930 kcal a day for a family of five during a month. Available at: WFP, VAM Food Security Analysis, ‘Syria Market Price Watch Bulletin: April 2017’ (link here). 8 $1 = 515 SYP (UN operational rates of exchange as of 1 June 2017). 9 Nearby communities in Homs governorate which are not considered besieged/hard-to-reach: Jalaa, Midan Wastani, Ayoubiyah, Zahreh. 10 Price fluctuations of 5% or less were not reported. 11 Generally unavailable in markets (<6 days this month).

Informing May 2017 4 more effective REACH humanitarian action Syria Community Profile Update: Wadi Burda, Rural Damascus Informing more effective May 2017 REACH humanitarian action

FOR HUMANITARIAN PURPOSES ONLY

Barhaliya Hseiniyeh Kafir Elzeit Deir Maqran Suq Wadi Burda Deir Qanun Kafr Elawamid UN classification Hard-to-reach Hard-to-reach Hard-to-reach Hard-to-reach Hard-to-reach Hard-to-reach Hard-to-reach Estimated population (individuals)1 5000-5500 4800 8000 9000 6900 7300 3100 Of which estimated IDPs1 2800-3000 820 760 3100 810 840 560 % pre-conflict population remaining 76-100% 76-100% 76-100% 51-75% 51-75% 51-75% 76-100% % of population that are female 26-50% 51-75% 26-50% 26-50% 51-75% 51-75% 51-75% % of female-headed households 1-25% 1-25% 1-25% 1-25% 1-25% 1-25% 1-25%

SUMMARY January. This followed a period of intense hostilities ² and tight access restrictions which commenced D Information in this profile was gathered from in December 2016, and negatively impacted the Syrian Arab seven communities within the Wadi Burda region, !( security and humanitarian situations across the Republic !( northwest of Damascus city: Barhaliya, Hseiniyeh, whole Wadi Burda area. Kafir Elzeit, Deir Maqran, Suq Wadi Burda, In May, the overall humanitarian situation in Deir Qanun and Kafr Elawamid. These seven Wadi Burda improved further, for the fourth communities, all classified by the UN as hard-to- SUQ WADI BARHALIYA consecutive month since the implementation BURDA (!(! DEIR MAQRAN reach, were profiled for the first time in August (! (! (! KAFR ELAWAMID (! D 2016. Assessements of Bseimeh and Ein Elfijeh of the truce agreement. This was largely due to (! D !( (! KAFIR the entry of a second humanitarian delivery, as !( HSEINIYEH ceased in January, as no populations reportedly DEIR ELZEIT well as additional repairs to the water network QANUN remained following a shift in control across the !( which increased access to drinking water. D !( !( Wadi Burda area. While this profile presents the !( situation in May, comparisons were made to April. !( Restrictions on civilian movement have remained !( !( A significant improvement across all indicators was unchanged since March, with an estimated 26- !( DAMASCUS CITY !( !( !( !( first observed in Wadi Burda in February, following 50% of Wadi Burda residents using formal access the signing of a local truce agreement on 30 points to leave and enter the area. These included !( METHODOLOGY !( D !( Based on data collected from community representatives inside Syria at the end of May and beginning of June 2017, these updates refer to the situation in May 2017. Information collected provides an understanding of how limited freedom of movement and restrictions on access affect humanitarian needs in communities in Syria. Participants provide information comparatively to the previous month. Where possible during analysis, comparisons are also made to findings from previous periods in which !( the community has been assessed. An improvement or deterioration from the previous month may !( not indicate a trend but rather distinct circumstances specific to the month assessed. When possible, !( information presented has been triangulated with other available sources prior to inclusion, yet findings should be considered indicative rather than generalisable for the whole community as representative !( !( sampling, entailing larger scale data collection, remains challenging in areas with restricted movement !( and access. Finally, the level of information on each community varies due to difficulties obtaining data Kms from certain locations. 0 5 10 an estimated 26-50% of Wadi Burda residents Humanitarian vehicles CHANGES SINCE APRIL could use the formal access points. Change since April: Access Restrictions on Civilians Health Situation While populations could move between all assessed Wadi Burda communities unrestrictedly, some security concerns related A humanitarian convoy consisting of 20 Commercial Vehicle Access Core Food Item Availability to perceived risks of detention were reported trucks entered Wadi Burda on 6 May, in May. delivering food, NFIs and medical items. This was an improvement since April, when no Humanitarian Vehicle Access Core Food Item Prices In contrast to previous months following the humanitarian deliveries occured. However, the truce agreement, no additional relocations or aid quantities were limited, and were solely Access to Basic Services Overall Humanitarian Situation population movement was reported in May. directed towards poorer families, excluding Informal points used: None reported. other sections of the population. Overcrowding students, employees, women and children. Although The overall health situation, which improved at distribution points was also reported. Risks faced when trying to enter or exit populations could move freely across assessed progressively between February and April, (formally or informally) Prior to the entry of aid on 6 May, the last communities, perceived heightened risks of detention remained largely unchanged in May. While humanitarian delivery occured in March (which were reported in May. While commercial access was permanent medical facilities were available in All communities: Conscription and verbal was also the first time aid entered Wadi Burda not altered in May, with several restrictions still in all of the assessed communities, segments of harassment; in particular, women continued since assesments of the community began in place, humanitarian vehicles were allowed to the populations continued to report that financial to feel unsafe when using the access points August 2016). enter Wadi Burda on 6 May, for the first time since constraints limited their access to health services. due to the risk of harassment. Further, in May, March, delivering food, NFIs and medical items. Additionally, childbirth care remained unavailable detention was also reported as a perceived Goods entered in Wadi Burda, while men were hesitant to travel risk related to travelling into and out of Wadi In addition to goods that were delivered via As has been the case since the opening of outside the community to seek medical assistance Burda. the humanitarian convoy, food, fuels, NFIs and access points in February, food, fuels, NFIs due to perceived security risks associated with such medicine also continued to enter Wadi Burda and medicine continued to enter Wadi Burda movement. MOVEMENT OF GOODS AND ASSISTANCE through commercial vehicles and civilians, who were in May via commercial vehicles and civilians procuring such items from nearby communities. Vehicles carrying commercial goods travelling and bringing back goods from nearby Following the progressively increasing MOVEMENT OF CIVILIANS communities. movement of goods, no negative coping People able to leave2 Change since April: The delivery of food, NFIs and medical items strategies related to lack of food or fuel were Change in # people able to leave The number of commercial vehicles entering via the humanitarian convoy additionally reported in the communities in May, for the third increased the amount of such goods entering and second consecutive month, respectively. compared to April: the Wadi Burda area remained unchanged in May, compared to March and April. Traders the communities compared to April, while the As a result of additional repairs to the water All communities: Three formal access points, continued to be restricted in the size of amount of fuel remained unchanged. network, access to drinking water further allowing movement to and from Wadi Burda, loads they were allowed to bring each week. increased in all Wadi Burda communities in continued to be reported in May. As has been Implemented restrictions also remained, and May. Access to electricity remained unchanged, the case since the communities implemented included documentation requirements, the with populations mainly relying on generators, with the truce agreement, employees and students payment of fees, limitations on day and times intermittent access to the electrical network. While were able to use these during weekdays upon of entry, searches and partial confiscation of no barriers to education were reported in any of the presenting identification, while women and loads. communities, notably all children were on summer children could leave at the discretion of local break in May. authorities. For the fourth consecutive month,

Informing Available Positive increase Negative increase May 2017 2 more effective REACH humanitarian action Sometimes available No change Positive decrease Not available Negative decrease ACCESS TO SERVICES* Access to drinking water increased further in May, following additional repairs to the main water network. Access to water has progressively been increasing across all assessed communities since the implementation of the truce agreement, and community representatives predicted that repairs would finalize shortly, with a view to restoring full access. While residents in all communities were able to connect to the electrical network, such access remained intermittent, and generators continued to be reported as the main source of electricity in Wadi Burda in May. Repairs to the network were reportedly planned. Pre-conflict primary, secondary and high-schools were available in all Wadi Burda communities (except in Hseiniyeh, where no high-schools were reported), with no barriers to education reported; however, following the end of the school year, children did not attend classes in May.

WATER ELECTRICITY EDUCATION Main source of Available water to Access to Access to Access to Available Barriers to Change in # of drinking water meet household needs water network electricity network electricity (Main education education children attending (Status**) (Coping strategies) per week per day source) per day facilities school (since April) Barhaliya Water network Sufficient 5-6 days 1-2 hours 2-4 hours Pre-conflict primary, None reported All school-aged children (Safe to drink) (Generator) secondary and high on summer vacation schools

Hseiniyeh Water network Sufficient 5-6 days 1-2 hours 2-4 hours Pre-conflict primary None reported All school-aged children (Safe to drink) (Generator) and secondary on summer vacation schools

Kafir Elzeit Water network Sufficient 5-6 days 1-2 hours 2-4 hours Pre-conflict primary, None reported All school-aged children (Safe to drink) (Generator) secondary and high on summer vacation schools

Deir Water network Sufficient 5-6 days 1-2 hours 2-4 hours Pre-conflict primary, None reported All school-aged children Maqran (Safe to drink) (Generator) secondary and high on summer vacation schools

Suq Wadi Water network Sufficient 5-6 days 1-2 hours 2-4 hours Pre-conflict primary, None reported All school-aged children Burda (Safe to drink) (Generator) secondary and high on summer vacation schools

Deir Qanun Water network Sufficient 5-6 days 1-2 hours 2-4 hours Pre-conflict primary, None reported All school-aged children (Safe to drink) (Generator) secondary and high on summer vacation schools

Kafr Water network Sufficient 5-6 days 1-2 hours 2-4 hours Pre-conflict primary, None reported All school-aged children Elawamid (Safe to drink) (Generator) secondary and high on summer vacation schools

*Arrows indicate change in access since April. ** Data collected is based on the perceptions of local actors. Water safety cannot be guaranteed in the absence of formal water testing.

Informing Available Positive increase Negative increase May 2017 3 more effective REACH humanitarian action Sometimes available No change Positive decrease Not available Negative decrease Permanent medical facilities available Most needed medical items4 Across communities assessed in Wadi Burda, Barhaliya Hseiniyeh Kafir Elzeit Deir Maqran Suq Wadi Burda Deir Qanun Kafr Elawamid the most needed medical items in May were Mobile clinics / field hospitals reportedly: 1. Antibiotics Informal emergency care points 2. Clean bandages Pre-conflict hospitals 3. Blood transfusion bags Primary healthcare facilities Unusual outbreaks of disease5

None reported. HEALTH SERVICES Since February, when the health situation in Wadi Strategies used to cope with a lack of Change in health situation Availability of medical personnel Burda started to improve, private clinics have medical items / medicines compared to April: opened in all of the assessed communities in No change was reported in the overall number All communities: None reported, as has been The overall medical situation across the addition to public healthcare facilities; however, of available medical personnel in Wadi Burda the case since January. assessed Wadi Burda communities remained due to prohibitive costs, only certain parts of the in May. Trained doctors and nurses continued largely unchanged in May, having progressively populations have been able to access these. to be present across all of the assessed improved since February following the communities. Additionally, pharmacists were implementation of the truce agreement. Medical facilities and services reported in most of the communities, while dentists were also present in Hseiniyeh and Since March, all assessed medical items have been The type and number of medical facilities Deir Qanun, and midwives as well as medical available in all of the Wadi Burda communities. remained unchanged in May, with private and pharmacy students in Deir Qanun. Although quantities of medical items increased clinics reported in all communities, in addition Due to the availability of sufficient skilled slightly in May, with the entry of the humanitarian to primary healthcare facilities. The availability personnel, volunteers providing medical convoy, the overall access to health services of medical facilities in Wadi Burda has not assistance have not been reported in the remained largely unchanged. changed since the implementation of the truce communities since March. agreement in February. While there were plans to restore childbirth services in the communities, according to community Child immunizations, which became available Change since April representatives, such services remained unavailable in April, remained as such in May. Skilled childbirth care remained unavailable in all in May, and women had to travel to Damascus to for Unavailable medical items3 seek skilled assistance. Some severe medical cases assessed communities, as has been the case which were not able to receive appropriate services since December 2016. For the third consecutive month since March, inside the communities had to travel to Damascus all assessed medical items were available Change since April for this purpose as well.. However, men in the across the Wadi Burda communities in May. communities continued to avoid such movement due Additionally, following the entry of medical items to the perceived risks of detention and conscription. via the humanitarian delivery, the overall amount available in the communities increased.

Change since April

Informing Available Positive increase Negative increase May 2017 4 more effective REACH humanitarian action Sometimes available No change Positive decrease Not available Negative decrease Medical services available were not yet operating). The price of fresh vegetables (tomatoes and cucumber), which Barhaliya Hseiniyeh Kafir Elzeit Deir Maqran Suq Wadi Burda Deir Qanun Kafr Elawamid had previously increased due to nationwide shortages, decreased in May by 25% and 29%, Child immunization respectively. Although marginal increases in the price of mutton and salt were reported, Diarrhea management overall price levels remained stable in Wadi Burda. Emergency care Core food items in the assessed communities Skilled childbirth care remained on average 12% more expensive than in nearby areas not considered hard-to- 6 Surgery reach. Diabetes care WASH item availability / prices Price and availability of assessed hygiene and FOOD Strategies used to cope with a lack of CORE FOOD ITEM / NFI AVAILABILITY sanitation products (soap, laundry powder, AND PRICES sanitary pads, toothpaste, disposable diapers) Change in food situation food remained unchanged between April and May, Average cost of standard food basket8 compared to April: All communities with all items generally available. While these items were on average 77% more expensive The food situation in Wadi Burda remained largely Reducing meal size unchanged in May, after having progressively Wadi Nearby than in nearby communities, this price gap improved since February. All core food items (except Skipping meals Burda areas9 decreased in May (from 135% in April). bread from public bakeries) were generally available,7 Average cost in Fuel availability / prices and no coping strategies related to the lack of food Days without eating 32150 32962 May (SYP)10 Butane remained generally available, while were reported for the third consecutive month. Eating non-food plants diesel, kerosene and coal remained sometimes Change since available11 in Wadi Burda in May. Firewood, Most common methods of obtaining April food at the household level Eating food waste which became unavailable in April, due to lower seasonal demand, remained as such The price of a standard food basket in Wadi Reportedly used as a coping strategy in May. Prices decreased by an average 7% All communities: Receiving from food Burda remained unchanged in May, for Not reportedly used as a coping strategy compared to April, but remained 15% higher distributions, purchasing from shops and the fourth consecutive month since access than in nearby commmunities not considered markets. restrictions were relaxed at the end of January. No strategies related to a lack of food were hard-to-reach. Most common methods of obtaining reported in any of the Wadi Burda communities, It also remained similar to the price of a bread at the household level as has been the case since March. standard food basket in nearby communities Strategies used to cope with a lack of fuel: not considered hard-to-reach. For the second consecutive month, no negative All communities: Private bakeries. 5 Deaths attributable to a lack of food coping strategies related to a lack of fuel were Private bakeries started operating across all Food item availability / prices No cases reported across Wadi Burda. reported across the assessed communities. assessed communities in April, and access Availability of assessed core food items remained unchanged in May. No barriers to in markets remained largely unchanged obtaining bread every day were reported. between April and May. All items were Change since April generally available, with the exception of bread from public bakeries (such bakeries

Informing Available Positive increase Negative increase May 2017 5 more effective REACH humanitarian action Sometimes available No change Positive decrease Not available Negative decrease CORE FOOD ITEM / NFI PRICE AND AVAILABILITY INDEX10 Endnotes 1 Figures based on HNO 2017 population data (December 2016); For affected populations the functionality of, and access to, basic services such as medical when unavailable, figures based on data collected from local facilities, water and electricity is highly dependent on the price and availability of fuel sources. councils in the Wadi Burda region. 2 The fact that some informal points exist does not imply their safety, security, or the financial capacity of any notable portion of Item Wadi Burda Price change since Nearby non-hard-to- the population to pay the fees required to use them. average April12 reach communities9 3 Some availability does not necessarily imply sufficiency. Food Items Bread, private bakery (pack) 1007 100 Likewise, the list is not intended to be a comprehensive assessment of all medical needs, but rather indicative of key Bread, public bakery (pack) Not available 58 medical items that speak to the trend in access to medical services in the area. Rice (1kg) 5507 535 4 ‘Most needed’ does not necessarily imply unavailability. 7 Bulgur (1kg) 493 320 Furthermore, this list is not intended to be a comprehensive list 7 of most needed medical items or medicines, but rather to indicate Lentils (1kg) 493 525 needs that speak to the trend in the priorities of medical items Chicken (1kg) 14507 1120 in the area. 5 Mutton (1kg) 50007 +11% 3925 Reported deaths are based on reported incidents within the community. There is better access to health reports in Tomato (1kg) 2647 -25% 410 certain communities, and as such, validity of estimates varies. 7 Without medical assessments, it was not possible to verify the Cucumber (1kg) 214 -29% 318 exact causes of death cited; therefore, the caseload is indicative Milk (litre) 2507 215 of the perceived health issues causing death in the communities. 6 7 The availability of surgery does not necessarily imply treatment Flour (1kg) 150 233 by a doctor formally trained in the relevant procedure, or the use Eggs (1) 607 50 of anaesthesia or appropriate clinical equipment. Community members, without professional medical backgrounds, may 7 Iodised salt (500g) 150 +16% 65 have been informally trained by medical personnel to carry out Sugar (1 kg) 5007 438 emergency procedures. 7 Generally available in markets (more than 20 days this month) Cooking oil (litre) 8007 1225 8 Calculation of average cost of food basket based on WFP’s WASH Items Soap (1 bar) 1507 113 standard food basket of essential commodities. The basket 7 includes 37 kg of bread, 19 kg rice, 19 kg lentils, 5 kg of sugar and Laundry powder (1kg) 2500 875 7 kg of vegetable oil, providing 1,930 kcal a day for a family of five Sanitary pads (9) 7507 444 during a month. Available at: WFP, VAM Food Security Analysis, ‘Syria Market Price Watch Bulletin: April 2017’ (link here). 7 Toothpaste (125ml) 400 382 9 Nearby communities in Rural Damascus governorate which are Disposable diapers (24 pack) 30007 1575 not considered besieged/hard to reach: Deir Ali and Kisweh. 10 Fuel 7 $1 = 515 SYP (UN operational rate of exchange as of 1 June Butane (cannister) 3000 -6% 2925 2017) Diesel (litre) 40011 -11% 280 11 Sometimes available in markets (7-20 days this month) Propane (cannister) Not available 2560 12 Price fluctuations of 5% or less were not reported. Kerosene (litre) 40011 -11% 400 Coal (kg) 45011 450 Firewood (tonne) Not available Not available

Informing Available Positive increase Negative increase May 2017 6 more effective REACH humanitarian action Sometimes available No change Positive decrease Not available Negative decrease Syria Community Profile Update: Yarmuk, Damascus Informing May 2017 more effective REACH humanitarian action

FOR HUMANITARIAN PURPOSES ONLY

SUMMARY Rankus The Palestinian community of Yarmuk, located in A ABDA ² D Dimas the southern suburbs of Damascus, has faced a Syrian Arab BE Madaya UN classification: Besieged !( deteriorating humanitarian situation since early Republic !( Sidnaya 1 MADAYA 2013, and was classified as besieged in 2014. In Estimated population : 7500-8500 Ein Elfijeh Az abdani April 2016, direct fighting between multiple parties 1 Of which IDPs : 600-700 At all present in the community intensified significantly, SU WAD % pre-conflict BURDA BARHAYA leading to increased access restrictions in June and (! Communities covered in !( !( DER MARA 1-25% !( !( D population remaining: this profile KAFR EAWAMD !( !( E EFJEH A A August. The conflict further intensified in October !( D !( HSEYEH KAFR BSEMEH !( ther assessed DER EE and December, leading to an additional worsening % population female: 1-25% Harasta communities AU Duma udsiya DUMA of the overall situation, including damage to the HARASA !( % of female-headed D Formerly assessed !( HAMA BURA !( main water source, later repaired in March 2017. households 1-25% communities !( UDSYA ABU ARB !( Urban area AMAKA HAMMURA In May, as part of a local truce agreement, to cover their faces and wear black cloaks, !( Arbin !( JBER !( negotiations for the evacuation of some fighters Subdistrict borders DAMASCUS CITY !( !( SABA ASHABYEH and did not feel safe in certain areas of the !( !( E KAFR JSRE Kafr began on the 8th and were reportedly ongoing at community. Meanwhile, risks of verbal and sexual Main roads Markaz ERMA BAA Batna Darayya ADAM Jaramana the time of writing. Meanwhile, a separate truce harrassment and confiscation of documents, while Main rivers (! ashabiyeh agreement reached in early June resulted in the attempting to enter and exit Yarmuk, persisted. atana !( D !( YARMUK Maliha MADAMYE DARAYYA Hajar HAJAR ASWAD planned evacuation of more fighters. No further The closure of primary healthcare facilities in ESHAM Aswad details were available at the time of writing. Babella May due to lack of necessary staff, as well as Sahnaya Overall, the humanitarian situation in Yarmuk anaesthetics becoming unavailable, placed further declined in May. No humanitarian or commercial strain on the health situation in Yarmuk. Access to KHA ESHH hizlaniyyeh !( vehicles were allowed entry, and the medical KAFR HR BEMA basic services remained unchanged, with water !( !( situation deteriorated in comparison to the supplies reportedly sufficient, but limited access to Bait Jan previous month. Meanwhile, access to basic electricity and barriers to education. BE SABER Kisweh BA JA MARAE !( !( BE J services remained limited, though availability Meanwhile, availability of assessed fuel and core !( Sasa of commodities improved. food items increased, although some fuel items Kms 0 5 10 Women reportedly continued to face the remained unavailable, and prices for several food threat of sexual harrassment when moving in items increased. METHODOLOGY public spaces. In addition, they were obliged Based on data collected from community representatives inside Syria at the end of May and beginning CHANGES SINCE APRIL of June 2017, these updates refer to the situation in May 2017. Information collected provides an understanding of how limited freedom of movement and restrictions on access affect humanitarian Access Restrictions on Civilians Health Situation needs in communities in Syria. Participants provide information comparatively to the previous month. Where possible during analysis, comparisons are also made to findings from previous periods the community has been assessed. An improvement or deterioration from the previous month may not Commercial Vehicle Access Core Food Item Availability indicate a trend but rather distinct circumstances specific to the month assessed. When possible, information presented has been triangulated with other available sources prior to inclusion, yet findings Humanitarian Vehicle Access Core Food Item Prices should be considered indicative rather than generalisable to the whole community as representative sampling, entailing larger scale data collection, remains challenging in areas with restricted movement Access to Basic Services Overall Humanitarian Situation and access. Finally, the level of information on each community varies due to difficulties obtaining data from certain locations. MOVEMENT OF CIVILIANS Humanitarian vehicles ACCESS TO SERVICES* There were no reported changes in access to services in May. Previously, access to and quality of water Change in # people able to leave No humanitarian vehicles were permitted entry improved in March, following repairs to the Ein Al-Fijeh water spring and procurement of additional water trucks compared to April: into Yarmuk in May, as has been the case in in Yarmuk. Residents continued to rely on generators for electricity, and access to schools has remained the all assessed months except for April 2017. In same for the past eight months, with many children reportedly attending informal schools, due to parents’ People able to leave2 April, while a humanitarian delivery took place disapproval of the curriculum available in pre-conflict schools in certain areas of the community. on the 23rd, supplies only reached areas of the In May, around 11-25% of the population were community under certain administration and WATER Main source of drinking water (Safe Private water trucking** able to enter and exit the community, as was the to drink) military control, and the vast majority of the case in most assessed months since August population did not receive any aid. Sufficiency of available water to meet Sufficient 2016. Previously, in January and February household needs (Coping strategies 2017, access reportedly tightened temporarily Change since April: used) due to a shift in authorities at formal checkpoints. Access to water network, per week Network unavailable In general, women, children and elderly people Goods entered who provided identification have been able ELECTRICITY Access to electricity network, per day Network unavailable to use formal routes a few times per month In May, the amount of goods entering Yarmuk remained similar to that of the past four months. Access to electricity (Main source) per 2 - 4 hours (Generators) since assessments began, including in May. day Meanwhile, residents have been accessing Previously, a decrease in goods allowed into informal routes since at least July 2016. the community occurred in February, due to the EDUCATION Available education facilities Pre-conflict primary, secondary schools, tightening of access restrictions. Goods entered informal schools Verbal harassment persisted as reported via residents leaving Yarmuk and purchasing risks for men and women using formal Barriers to education Parents don’t approve of curriculum, items from nearby areas. services too far, lack of teaching staff and informal access points. Women also reportedly faced sexual harassment and felt HEALTH SERVICES *Arrows indicate change in access since April. unsafe in certain areas of the community. **Data collection is based on the perception of local actors and water safety cannot be guaranteed in the absence of water testing. They also continued to be required to wear Change in health situation comparison to April, the range of reported deaths Change since April black cloaks and cover their faces in public. compared to April: stayed the same.3 Informal points used: Yes. Medical services available For the first time since October 2016, the health Permanent medical facilities available Risks faced when trying to enter or exit situation in May deteriorated notably with the closure Child immunization of primary healthcare facilities. These facilities were Mobile clinics / field hospitals Formal: Confiscation of documents, verbal previously operational for a few days per week, with Informal emergency care points Diarrhoea management harrassment of men and women, sexual medical staff traveling to the community from nearby harassment of women Emergency care areas. However, medical staff reportedly did not Pre-conflict hospitals Informal: Gunfire, verbal and sexual come to Yarmuk in May. Skilled childbirth care harassment. Primary healthcare facilities Residents’ access to medical care continued to MOVEMENT OF GOODS AND ASSISTANCE Surgery6 vary between locations within Yarmuk in May, while Change since April Vehicles carrying commercial goods access to care in neighbouring areas was reportedly Diabetes care influenced by political and religious affiliation. Availability of medical personnel Able to enter: None reported Anaesthetics were reported as sometimes available Change since April to a small part of the community in April due to the Personnel available: Professionally trained Change since April: aid delivery that month, but were unavailable in May. doctors, nurses and midwives. Strategies used to cope with a lack of Other medical items continued to enter Yarmuk Others providing medical services: medical services via civilians bringing them from nearby areas. In Dentists, pharmacists, anaesthesiologists, Recycling medical items (e.g. bandages, volunteers with informal or no medical training. syringes, needles) has been reported since

Informing Available Positive increase Negative increase May 2017 2 more effective REACH humanitarian action Sometimes available No change Positive decrease Not available Negative decrease assessments began in June 2016, while aid distributions in the two communities, as considered hard-to-reach. using expired medicine was first reported in there were no humanitarian deliveries in Yalda Change since April November 2016. and Babella in May. Fuel availability / prices Unavailable medical items4 Most common methods of obtaining CORE FOOD ITEM / NFI AVAILABILITY AND The overall availability of assessed fuel Unavailable: Burn treatment, clean bandages, bread at the household level PRICES items in Yarmuk increased in May due blood transfusion bags, anaesthetics, anti- 7 to lower seasonal demands. However, anxiety and diabetes medicine. Average cost of standard food basket Most common source: Shops in the propane, kerosene and coal having remained Nearby unavailable since assessments began in June Change since April community. Yarmuk 8 areas 2016. Both butane and diesel were generally Challenges to obtaining bread: Bread 11 Average cost May 28070 29627 available , in contrast to April when they were Most needed medical items5 unavailable in bakeries, flour too expensive (SYP)9 reported only sometimes available12. However, or hard to access, not enough electricity/fuel 1. Clean bandages after declining by 27% in April, there was a rise available, electricity/fuel too expensive or hard 2. Anaesthetics Change since April of 9% in the price of diesel, most likely due to to access. 3. Antibiotics persisting access restritions in the community. Unlike in previous assessed months, residents In April, there was no notable change in the Meanwhile, firewood was 150% more Unusual outbreaks of disease of Yarmuk were unable to obtain bread from aid price of a standard food basket in Yarmuk, and expensive in Yarmuk than in nearby areas not None reported, as has been the case since at distributions in Yalda and Babella in May. no significant price difference was reported considered besieged. least June 2016. between Yarmuk and neighbouring areas of Damascus City not considered besieged. FOOD Change since April Strategies used to cope with a lack of fuel: Bulgur and rice were notably less expensive Burning plastics and furniture not in use. Change in food situation than in nearby, non-besieged areas, with prices Strategies used to cope with a lack of Despite the increase in availability of fuel, compared to April: lower by 71% and 50%, respectively. negative coping strategies were still reported in food May, and have been since at least October 2016. Food item availability / prices In contrast to the previous three months, there Most common methods of obtaining Reducing meal size was a slight increase in availabilty reported food at the household level for assessed food items in May. The price of Skipping meals Purchasing from shops and markets. cucumbers dropped by 50%, but the price of lentils, chicken and mutton increased by 11%, Days without eating As has been the case in previous months, 9% and 9%, respectively. After rising 60% in April, the price of tomatoes remained the same availability of food depended on the ability of Eating non-food plants residents to enter and exit the community to in May, but was 62% higher than prices in non- hard-to-reach areas of Damascus. bring items from nearby, non-besieged areas. Eating food waste Civilians from Yarmuk were reportedly able WASH item availability / prices to purchase food in the nearby communities Reportedly used as a coping strategy The availability of assessed hygiene and of Yalda and Babella in May, as was the Not reportedly used as a coping strategy sanitation items remained largely unchanged case previously. However, in contrast to past in Yarmuk in May, as was the case in April months, food items could not be obtained from In some families, men and women reportedly and since September 2016. The price of all ate less, so that children could eat more. assessed items remained the same except for toothpaste, which experienced an 11% Deaths attributable to a lack of food3 decrease. On average, hygiene items were None reported, as has been the case since at 7% cheaper than those in nearby areas not least June 2016.

Available Positive increase Negative increase May 2017 3 aaa a Sometimes available No change Positive decrease Not available Negative decrease CORE FOOD ITEM/NFI PRICE AND AVAILABILITY INDEX9 Endnotes 1 Figures based on population estimates by local actors within For affected populations the functionality of, and access to, basic services such as medical communities assessed. The last HNO population data (December 2016) estimates that the population in Yarmuk is facilities, water and electricity are highly dependent on the price and availability of fuel sources. about 9,800, including 6,000 IDPs. Item Yarmuk Price change Nearby non-hard- 2 The fact that some informal points exist does not imply their since April10 to-reach areas8 safety, security, or the financial capacity of any notable portion of the population to pay the fees required to use them. Food Items Bread private bakery (pack) Not available 181 3 Reported deaths are based on reported incidents within the Bread public bakery (pack) Not available 53 community. There is better access to health reports in certain Rice (1kg) 25011 500 communities; therefore, validity of estimations varies. Without medical assessments, it was not possible to verify the exact 11 Bulgur (1kg) 300 1042 causes of death cited, therefore the caseload is indicative of the Lentils (1kg) 50011 +11% 588 perceived health issues causing death in the communities. Chicken (1kg) 120012 +9% 1256 4 Some availability does not necessarily imply sufficiency. Likewise, 12 the list is not intended to be a comprehensive assessment of all Mutton (1kg) 3800 +9% 4256 medical needs, but rather indicative of key medical items that Tomato (1kg) 40011 247 speak to the trend in access to medical services in the area. Cucumber (1kg) 25011 -50% 275 5 ‘Most needed’ does not necessarily imply unavailability. 12 Furthermore, this list is not intended to be a comprehensive list of Milk (litre) 250 256 most needed medical items or medicines, but rather indicative of Flour (1kg) 30011 301 needs that speak to the trend in the priorities of medical items in Eggs (1) 5511 58 the area. 6 11 The availability of surgery does not necessarily imply treatment Iodised salt (500g) 150 140 by a doctor formally trained in the relevant procedure, or the use Sugar (1 kg) 40011 444 of anaesthesia or appropriate clinical equipment. Community Cooking oil (litre) 75011 850 members without professional medical backgrounds may have been informally trained by medical personnel to carry out emergency 11 WASH Items Soap (1 bar) 125 146 procedures. Laundry powder (1kg) 65011 888 7 Calculation of average cost of food basket based on WFP’s Sanitary pads (9) 30011 438 standard food basket of essential commodities. The basket 11 includes 37 kg of bread, 19 kg rice, 19 kg lentils, 5 kg of sugar and Toothpaste (125ml) 450 -11% 245 7 kg of vegetable oil, providing 1,930 kcal a day for a family of five Disposable diapers (24 pack) 165011 2188 during a month. Available at: WFP, VAM Food Security Analysis, Fuel Butane (cannister) 11 ‘Syria Market Price Watch Bulletin: April 2017’(link here). As bread 3800 2960 was unavailable in private and public bakeries in Yarmuk, the food Diesel (litre) 60011 +9% 290 basket price for Yarmuk was calculated using the reported price of Propane (cannister) Not available 4500 bread sold in shops (150 SYP). 8 Kerosene (litre) Not available 350 Nearby communities in Damascus governorate which are not considered besieged/hard to reach: Jalaa, Midan Wastani, Coal (kg) Not available 350 Ayoubiyah and Zahreh. 11 Firewood (tonne) 125000 50000 9 $1 = 515 SYP (UN operational rates of exchange as of 1 June 2017). 10 Price fluctuations of 5% or less were not reported. 11 Generally available in markets (21+ days this month). 12 Sometimes available in markets (7 – 20 days this month).

Informing May 2017 4 more effective REACH humanitarian action