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Homeless, sleep deprived and shell shocked – this is what it's like to work as an aid worker in Idlib, Syria

The last few days have brought about an exodus in Idlib, the likes of which we have not seen since the Syria crisis began in 2011. Some 700,000 people have been uprooted in 10 weeks alone – the biggest wave of displacement since the crisis started, according to the United Nations. And 90 per cent of staff at Islamic Relief, where I am Syria country director, have been forced to flee their homes, many of whom have been displaced five, six or more times already.

A few nights ago Hussein*, a 33-year old member of our team, left the house at 1am, fearing an airstrike. He was proved right: just hours later, his home was destroyed. Luckily his family had fled earlier.

Dozens of our staff have likewise been forced to flee under the cover of darkness and find temporary shelter during the night – although there is virtually nowhere left to go. People are living in bombed out buildings and even in a prison that briefly doubled up as a refugee camp before it was attacked. They’re squeezing into tiny rooms with relatives, sleeping at the edge of squalid overcrowded camps. Those who can afford it are paying extortionate amounts for a small room in villages far from work – where the commute can often be deadly.

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Then in the day – now homeless, sleep deprived and shell shocked – staff come to work as we battle to provide food and shelter to thousands of people fleeing for their lives.

Where are these people going, you might ask?

There is a line of vehicles – sometimes 40km long – venturing north, searching for safe havens near the borders. Not everybody has a car: most are loaded onto crowded trucks, while others hurry with motorbikes, or even use animal-pulled carts to carry their belongings. Many are completely on foot, carrying elderly or disabled relatives and children on their shoulders.

Some are fleeing to hills along the border, despite the weather often being harsher. Reports show that it snowed in northern Idlib last night, but desperate people will go wherever they hope the attacks will be fewer.

For those of our staff remaining in Idlib, operating in a humanitarian crisis is difficult enough already. But recent attacks have only made it even harder. Since the beginning of December, 15 health facilities supported by Islamic Relief have been hit. At least 55 places where we distribute food have been rocked by nearby airstrikes, of which our teams identified more than 400 in the past four weeks.

We are having to constantly move our operations as the places we should be delivering healthcare and food, morph into the frontlines.

Fuel prices have increased by more than 20 per cent in just one month, forcing health facilities to make unimaginable decisions in order to keep ventilators running, to keep blood refrigerated and operation rooms functioning. And those living in camps are using cheaper, unsafe forms of fuel, causing several fires in recent weeks. People have already had almost nine years of this and some are at breaking point.

Many of our staff and the people we work with, chose to stay inside the country rather than become refugees and try to make a difference – a choice that ultimately may well cost them their lives.

Dr Zakwan Tamaa, who managed the al-Shami hospital in the town of Ariha in North West Idlib, was killed when the healthcare facility was bombed two weeks ago. The hospital was supported by Islamic Relief, which provided important medical supplies, and it provided care to around 3,000 people every month. At least 10 people were killed including four children and six women while more than 35 injured, including four nurses, according to local news reports.

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For the almost three million people – half of whom are children – now stuck in the ever shrinking enclave of Idlib, leaving is not an option. They are being thrust into the last front lines of this brutal crisis that in the last nine years has produced 5.6 million refugees and displaced 6.6 million within the country, ripping families apart.

Hundreds of thousands have died, although the true figure will likely never be known. Unless we see an urgent ceasefire in Idlib and a renewed international push for a lasting peace, I fear this number will only climb further. Aid workers will be powerless to stop it.

Ahmed Mahmoud is Syria Country Director for Islamic Relief. For security reasons, he is writing under a pseudonym

*name has been changed