The chances of a person to receive life-saving health care inside Syria today are defined by the side of the front-line in which they happen to be. It is the consequence of deliberate choices made by those who hold the guns, and also of the operational compromises accepted by aid agencies themselves.

For the last three years, all sides in the Syrian conflict have convinced that the end they pursue justifies the means. The government of Syria has systematically withheld life-saving aid from crossing enemy lines. Agreements to deliver aid through front-lines or across the border from neighboring countries have never been reached. Everywhere, civilians are suffering appallingly.

As the war rages on, the United Nations' agencies multi-million dollar humanitarian aid effort is quietly being crippled and hijacked by the political agendas of the warring factions. The absence of public debate and scrutiny of the aid deadlock inside Syria is partially explained by the fragility of negotiated agreements with warring parties on the ground. The questionable nature of some of the compromises being made in Syria, however, threaten the credibility of humanitarian aid and do a terrible disservice to the Syrian people.

The chances of a person to receive life-saving health care inside Syria today are defined by the side of the front-line in which they happen to be. This is not just a matter of luck. It is the consequence of deliberate choices made by those who hold the guns, and also of the operational compromises accepted by aid agencies themselves.

The current outbreak of polio is a telling example of the problem. Polio paralysis is incurable once it has been contracted and a simple oral vaccine would be enough to prevent infection. But as the WHO and UNICEF finally announce a regional vaccination campaign to combat the disease in Syria and seven countries across the region, doctors on the ground know that the most pressing need is to contain the outbreak at its epicentre in Deir-ez-Zour, deep in the opposition-controlled areas of northeast Syria. Like in many other cities, Deir-ez-Zour is divided across a front-line, and in areas under the military control of the government the Syrian authorities are already vaccinating children with support of UNICEF. But in most opposition-controlled areas there is no outbreak response taking place. This critical detail is somehow conveniently omitted when describing the regional polio effort, which only refers to vague ‘security or capacity limitations in unspecified areas. The truth is that the Syrian government actively blocks efforts to vaccinate in opposition-controlled areas and, working in cooperation with Damascus, the UN is forced to abide.

Trying to break through this logic, MSF has tried to buy polio vaccines directly from the manufacturer. However, supply is controlled by UNICEF and importation requires authorisation from Damascus. The Syrian government continues to refuse authorisation for MSF to operate.

The consequence of this circular logic is clear; children in the wrong side of the front-line cannot be protected from polio. There are either no vaccines available or no agencies authorised to vaccinate. There are 62 registered cases of polio so far and this figure is likely to reach 160 by the end of the month. Moreover, since a minimum vaccination rate of 95% is necessary to prevent the spread of the disease, a ‘regional' vaccination effort which ignores the reality of Deir-ez-Zour and the other contested areas is fatally flawed. Unless things change, young children will continue to be punished by the cold logic of war and the deadlock of political agendas. We must challenge this and act before it is too late.

Providing aid in conflict always requires political negotiations with people in control of territory. However, pragmatic compromise can only be justified as a means to do the right thing. Authorisation to operate, granted by a warring party, cannot come at the cost of neglecting the other half. As a humanitarian agency, we have the duty to stand up for impartial delivery of aid and call on the warring factions to lift the scandalous blockade imposed on humanitarian efforts in Syria which continues to cost lives every day.