Thanassis Cambanis

[Originally published in The Boston Globe Ideas]

GAZIANTEP, Turkey — In a provincial town previously known for its nuts, Byzantine fortress, and Ottoman souk, shiny trailers now nestle among the pistachio groves. Smugglers, businessmen, Western aid workers, and Turkish police greet each other with warm familiarity. Hundreds of trucks loaded with food baskets, tents, and other essentials hurtle out of town every day, headed for the nearby Kilis crossing on the rebel-controlled border to Syria.

In 2012, as the Syrian civil war escalated into the deadliest conflict of our day, a pop-up humanitarian aid city sprang up here virtually overnight. There’s a sparkling refugee camp and a busy shuttle bus service for Syrians; an army of humanitarian workers operates hundreds of millions of dollars worth of programs out of offices kitted out with particleboard furniture. Syrian aid workers can attend their choice of international “capacity building” conferences, which teach them human-resources tricks while doubling as rest and relaxation from the war that is gutting their country.

The town has become a showcase for a generation’s worth of learning about wartime aid. After the wars in Darfur, Afghanistan, Somalia, Bosnia, and Rwanda, aid groups and the governments that fund them refined their approaches, drawing lessons and crafting new tactics. As a result, messy as the Syrian conflict is, aid here has been a considerable success. International groups have continued to deliver vital food to areas that have switched hands over and over. Building on past experience with the Taliban, they’ve figured out how to help people living under the rule of militant Al Qaeda offshoots. Though an estimated 160,000 have died, the famine and epidemics predicted early in the conflict have, so far, failed to materialize.

Even so, many Syrians are still deeply unhappy with the aid effort here. “What is happening here will be a black mark for the world. It has nothing to do with humanitarianism,” said Sheikh Towfik, a lifelong farmer in Aleppo Province who since the war began has commanded an antigovernment militia called the Noureddin Zinky Brigade.

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Syrian refugee children in a classroom at Kilis refugee camp near the Turkish border in June 2012.

At the source of the tension is the political decision by the most important aid power of them all, the gargantuan United Nations agencies, to work with only one side of the conflict: the government of Bashar Assad. To preserve access to the Syrian capital of Damascus and avoid the risk of retribution, the UN aid agencies abide by Assad’s rules inside Syria, funneling funds through his bureaucracy and delivering aid only to the areas he permits.

Aid groups always face criticism in conflicts and natural disasters, the most piercing often from within their own ranks. But in Syria, the relatively effective technical response has intensified the focus on the political calculations of the aid industry and its overarching impact on the conflict. Even aid that seems impartial, like the food and blankets distributed by Western groups over the Turkish border, arguably extends the war, by taking good enough care of civilians that militants and the government are free to pour their resources into fighting.

What’s happening in Syria raises the unsettling question of whether humanitarian aid, in the largest sense, could actually sometimes do harm. Critics who study the aid industry point out that for all the short-term relief it provides, the flow of aid money can also help prop up warlords and militia leaders. And the more professionalized and better-funded the aid industry becomes, the more it can help prolong the very conflicts it is supposed to alleviate.

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WARTIME AID as we understand it today has its roots in World War II. The UN High Commissioner for Refugees was established in response to the catastrophic displacement of millions of people across Europe, while Red Cross and Red Crescent societies expanded their reach and ambitions as well. By the 1970s, after the well-chronicled famine of the Biafran War in Nigeria, a host of smaller agencies and independent organizations sprang up to work with refugees, child soldiers, women, and others affected by conflict.

Under international law, humanitarian aid rests on the principle that people have a universal right to food, shelter, health care, and education even during a time of war. All the United Nations powers formally agree on this principle—even Russia, which this year used the threat of a Security Council veto to remove the enforcement provision from a resolution supporting equal access to civilians in all parts of Syria. This broad rights umbrella dictates that unarmed refugees should be free to leave conflict zones, and that neutral aid workers should be allowed unfettered access to provide medical care and deliver aid independently of combatant groups.

In real life, however, no one in a war zone can operate without regard for the people who carry the weapons. Aid workers, like everyone else, have to negotiate for access, and the more powerful the fighting groups, the more they may try to manipulate aid agencies and co-opt the flow of resources to their own ends.

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Syrian refugees at the Kilis refugee camp in Turkey.

In Syria, the Assad government declared from the beginning that it would deal only with groups that agreed to “respect Syria’s sovereignty” and avoid working in rebel areas. In the early years of the conflict, when the regime was on the verge of collapsing, it overlooked some aid groups that operated on both sides. But as Assad regained his footing he began to enforce the rules more aggressively, and today any aid group or individual who enters Syria through a rebel border crossing is blacklisted by the regime. In Syria, this has resulted in a stark split, in which aid groups must choose to serve only one side of the conflict: either the regime areas, reached from Damascus, or rebel areas, reached from Gaziantep and nearby towns along the Turkish border.

In May, the aid group Mercy Corps—one of the only groups still helping civilians on both sides of the conflict—was given an ultimatum by Assad: Stop working in rebel-held areas, or be evicted from Damascus. Reluctantly, Mercy Corps officials said, they closed their Damascus operation, which reached fewer people and had less freedom than the independent operation from Turkey. The message resonated with the rest of the aid community: Syria wouldn’t hesitate to kick out an aid agency even if it meant, in the case of Mercy Corps, depriving 350,000 people of help.

The major player in aid, however, has chosen Damascus: the United Nations, whose UNHCR and World Food Program account for the lion’s share of global humanitarian aid. When the war in Syria escalated in 2012 and the number of displaced reached 1 million, the UN expanded its small existing presence in Damascus to deliver aid to hungry or displaced people in areas under the regime’s control. (The UN had a Damascus operation in place to deal with refugees from the war in Iraq, and political staff handling negotiations between Assad and the West.)

International law ran squarely up against the demands of the Assad regime, which insisted it would expel the UN from the entire country if it worked in areas controlled by groups the regime considered “terrorists.” The stakes were high: Banned from Damascus, the UN would not only lose the ability to reach at least half the population, but it would be unable to conduct diplomacy between the regime, the opposition, and international powers. UN personnel feared harassment or violent retribution from the regime if they begin working on both sides of the conflict; some also saw the foothold in Damascus, and the relationship with the regime, as crucially important in the long run if Assad wins the civil war.

As a result, billions of dollars worth of supplies now go to areas designated by Assad; the president can essentially order the UN to send supplies to areas filled with his supporters or funnel it through Syrian nonprofits controlled by his allies. He can also cut off aid where he sees fit. The government routinely blocks food deliveries to the Palestinian refugees in Yarmouk camp, according to UN reports, creating a sustained emergency there.

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A drinking water tank in the refugee camp nicknamed Container City in Oncupinar, Turkey.

“It’s insane. The United Nations is supporting a regime which is committing war crimes,” says Osama Kadi, director of the Syrian rebels’ Assistance Coordination Unit, which secures Western grants for local governance groups around Syria.

By humanitarian estimates, about half all Syrians, and two-thirds of those in need, live outside of regime control—and thus have no access to UN help. This means that a patchwork of aid groups is responsible for millions of displaced Syrians in the country’s north. Independent groups like Mercy Corps, the Norwegian Refugee Council, and Doctors Without Borders have set up shop in Turkey and Northern Syria, navigating among dozens of armed groups, from Al Qaeda to the Syrian army, to help civilians in areas where rebels have pushed out the government.

They run food and emergency winterization programs to make sure those who were pushed out of their homes inside Syria were able to survive. (The UN estimates 6.5 million Syrians are displaced inside the country, and another 2.5 million have fled across the border.) In many ways, their effort has become a model for how to do wartime aid right: The Turkish government set up refugee camps near the border that are so clean and well organized that Syrians call them “five-star camps.” When polio broke out, international organizations collaborated with a Syrian opposition group and a network of Syrian medical volunteers to organize a vaccination campaign, still ongoing. Think tanks have sprung up in Gaziantep to assist the humanitarian response.

But to be effective, the groups also need to work with some unsavory local players, just as the UN has to work with Assad. Independent aid groups are delivering food and tents in areas controlled by local warlords, Al Qaeda, and even the ultra-extremist group the Islamic State in Iraq and the Levant, which has declared war on Al Qaeda for being too moderate. They have invested considerable resources and training in local civilian Syrian groups who are supposed to be able to operate in the war zone independently of the different militias. But there are no peacekeepers or neutral guards to protect them.

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FOR ALL ITS SUCCESSES, the Syrian conflict highlights a systemic problem that is becoming only more acute as aid becomes more professionalized and more effective. In principle, humanitarian aid represents an independent international effort based on universal norms. In practice, it’s an industry that has to work in the world’s most dangerous environments, in uneasy cooperation with precisely the regimes and militants causing the conflict.

On the UN side, it’s clear that the heavy flow of aid to areas selected for government largesse allows Bashar Assad to harness foreign aid as another patronage stream. On the other side, independent aid to civilians in areas under the control of warlords or Al Qaeda-style extremists effectively buttresses their local power. On balance, the flow of aid greatly favors Assad: For a sense of comparative scale, last year the Syrian political opposition’s humanitarian budget was $44 million, while the American and European international aid groups run several hundred million worth of programs; the UN’s humanitarian aid budget for the Syria crisis in 2014 is $4.2 billion.

As the aid industry grows, critics have become concerned that it is helping prolong the conflict it’s supposed to relieve. On a political level, the more effective the humanitarian aid, the easier it is for Western superpowers to contain the humanitarian spillover and ignore the conflict itself. In a recent study, a Harvard and a Yale economist found that an increase in food aid directly correlates with an increase in violence and the length of civil conflicts.

No one can quantify whether the huge flow of UN aid to Syria has conclusively tipped the balance in Assad’s favor, but many policy analysts believe it has bought him considerable breathing room. They also point out that it is profoundly inconsistent, at best, for the United States and other governments to fund aid programs that are effectively under the control of a dictator who they are also trying to indict for war crimes.

Aid organizations and the UN have struggled with this dilemma before: They had to negotiate access to southern Sudan with the dictator Omar al-Bashir, who was later indicted for war crimes. In Afghanistan, they’ve dealt for decades with health care, education, and food programs in areas where the Taliban sometimes tolerates and other times targets aid workers.

In Syria, however, the political conflict is perhaps starker than it has ever been. UN aid is going through a regime that has plenty of its own resources to provide food and health care to its citizens, and the aid is largely directed away from where it’s most needed.

Not even the fiercest critics of the aid establishment would say that wartime aid should cease. Even the rebel commanders most incensed about the imbalance said in interviews that everyone deserved an equal share. “The answer isn’t to stop aid,” one commander said in an interview. “The answer is to give the same amount to everyone.”

But when it comes to how that is supposed to happen, answers are scarce. Tellingly, a recent UN Security Council resolution upheld the principle that access to aid should be equal throughout Syria—but didn’t include any enforcement mechanism. Every decision about access carries such urgent life-or-death consequences for both the recipients and aid workers that it has been hard to have a serious debate about the implications.

After decades of practice, the aid community has shown that it’s made great strides in overcoming the technical challenges to helping people during wartime. But the debate over “how” has submerged other questions—including where the limits should be, and at what point an environment or a regime becomes so noxious that the aid community, or more importantly the UN, would decide to pull out. It’s easy to agree that the aid community must do anything it can to help a starving family or a sick child. It’s harder to confront the prospect that a clean, well-run aid village could be the very thing that allows the war over the border to continue.