In this northern Iraqi Kurdish governorate, refugees sit in huddled groups on the floors of local schools and mosques, families separated by a few blankets and possessions. Doctors weave their way through them to treat the sick and injured.
An influx of Syrian refugees into the semi-autonomous Kurdish region of Iraq in recent days left no time to prepare adequate health care for the new arrivals.
Sozdar Omar, a 20-year-old student from Derek in northeastern Syria, arrived in Sulaymaniyah Governorate two days ago with her cousins and aunt. They are all sleeping on the floor of a local mosque in the town of Arbat.
“I came to Kurdistan because [Jabhat] al-Nusra came to Derek to kill Kurdish people,” she said, referring to an Islamist rebel group fighting to oust the Syrian government. She spent one day waiting at the border to cross due to large crowds gathered there, and another day travelling the 400km from the Syrian border to Sulaymaniyah.
Whilst crossing the border, one of her cousins, Iman Omar, 25, fell and broke his foot but they had to continue travelling until they reached the makeshift camp.
“The journey here from the border is 10 hours and this has made some people very sick," said Kamaran Ali, head of the UN Refugee Agency’s (UNHCR) field unit in Sulaymaniyah Governorate.
Ambulances from three neighbouring towns have been put on alert to transfer those arriving with serious injuries or chronic health issues to nearby hospitals.
UNHCR says more than 37,000 Syrian refugees have arrived in Iraqi Kurdistan since 15 August, when the Peshkhabour bridge was opened across the River Tigris dividing Iraq and Syria. Many of them are fleeing a recent sharp rise in violence between Syrian Kurdish militias and al-Qaeda-affiliated extremist groups in northeastern Syria, though others cited aerial bombardment and a lack of basic services. Since last year, when the state withdrew from areas in northeastern Syria traditionally inhabited by Kurds, Kurdish militias have sporadically fought anti-government rebels for control of the territory.
Aid agencies and officials say the relief effort is overwhelmed by the influx. On 20 August, Kurdish officials imposed a daily quota of 3,000 Syrian refugees to try to deal with it, according to aid agencies.
Thousands of refugees are now stranded at the Iraqi-Syrian border, Save the Children said in a statement, and the charity has launched an appeal to help them. Over the next few days, Save the Children will provide 40,000 litres of bottled water at the border crossing to try and alleviate the situation. Over half of those who are stuck are children, the group said.
"The refugee response in Iraq is already thinly stretched," Alan Paul, Save the Children’s emergency team leader, said in the statement. "We urgently need to cover their basic needs: food, water and shelter."
Iraqi Kurdistan overwhelmed
Nichervan Ahmed Muhamed*, 19, travelled for 15 hours from his hometown of Hassake in northeastern Syria to seek refuge in Sulaymaniyah, where his family of six are sleeping on the floor of a mosque.
“There is not just a war in blood but also an economic war against the [Kurdish] people of Hassake," he told IRIN, adding: "There is not enough food in Syria.”
Before the influx, Iraq already hosted over 150,000 refugees, most of them in Kurdistan. Since the start of the conflict in Syria two years ago, nearly two million people have fled Syria to Iraq, Turkey, Lebanon, Jordan and Egypt.
“There is not enough international support for the refugees of Kurdistan," said Atta Mohamed, regional director of the Civil Development Organization (CDO), which works in partnership with UNHCR on the relief effort in Kurdistan. "The Kurdish Regional Government gave US$10 million but this is not enough.”
A UN-coordinated appeal for $311 million to fund assistance to Syrian refugees in Iraq in 2013 is currently 24 percent funded.
Scramble for accommodation
In Sulaymaniyah, and Iraqi Kurdistan's capital Erbil, temporary camps to house the new arrivals are still under construction. An emergency transfer camp in Sulaymaniyah is due to open on 22 August, according to CDO, the same day authorities have ordered schools and mosques used as temporary shelters to be vacated. Even if UNHCR and local NGO partners manage to finish the camp in time, it will have a capacity of 2,500 - not enough space to host more than 3,200 new refugees who have arrived in Sulaymaniyah alone in the last six days.
Housing vulnerable refugees in local schools is problematic, UNCHR's Ali told IRIN, because of a shortage of electricity and water, and an absence of facilities such as showers or air conditioning.
Water and food remain pressing concerns: NGOs such as CDO are working with local Iraqi Kurds to deliver three meals a day, as well as potable water and ice, to the refugees, who have no cooking facilities.
Aid agencies, refugees and analysts say all border crossings between Syria and Iraqi Kurdistan have been closed since mid-May.
According to one analyst, the closures followed tensions between the dominant Kurdish militias in Syria - the Kurdish People’s Defence Unit (PYD) and the People’s Protection Unit (YPG) - and the Kurdistan Democratic Party (KDP) led by Masoud Barzani, president of the Kurdish Regional Government (KRG) in Iraq, over the training of Syrian Kurdish fighters in Iraqi Kurdistan by Barzani's KDP.
After being sent back into Syria, the fighters were captured by PYD groups who did not welcome Iraqi Kurdistan's intervention. The KDP reportedly closed the Iraqi side of the border in retaliation for the arrests.
In contravention of international law, Turkey, Jordan, Lebanon and Iraq have each closed the border or limited the number of refugee entries at various points in the last two years as growing numbers of refugees have overwhelmed infrastructure and basic service delivery in many of these countries.
Dindar Zebari, deputy minister in KRG’s department of foreign relations, said the official border crossing at Sahela and the nearby unofficial crossing over the River Tigris were never officially closed, but Syrian refugees say security was very tight. Zebari said it was simply harder to cross before a new temporary bridge was constructed to “give humanitarian relief to those in need”. Since 18 August, authorities have directed all arriving refugees to the Saleha crossing.
Wladimir van Wilgenburg, a political analyst and writer for the Washington DC-based research institute Jamestown Foundation, said pressure from opposition parties inside Kurdistan, as well as media reports of fighting between al-Qaeda and Kurdish groups in Syria, could have led KRG to reopen the border in an effort to “help the Syrian Kurds”.
PYD in Syria is aligned with the Kurdish separatist group the PKK, which before a ceasefire agreed in March, had been engaged in a 35-year guerrilla war with Turkey and has a base in the north of Iraq.
Aid organizations working on the ground, however, say the decision to reopen the border crossing last week left them no time to prepare for the thousands of new arrivals.
Meanwhile, Barzani has called on Syrian Kurds to “stay and defend their land”. He also threatened to use “all capabilities” to intervene if reports of massacres of Syrian Kurds by Jabhat Al-Nusra are found to be true by a Kurdish delegation due to visit the region on a fact-finding mission.
*not a real name