But some 20,000 Palestinian refugees in the Yarmouk suburb of Damascus have faced an even worse fate, besieged by the Syrian army since the summer without access to food, medicine or other supplies.
In November, a tentative agreement to vacate armed groups from the camp collapsed, prolonging the grim situation.
Since September, 15 Palestinians in the area have died of starvation according to reports cited by Chris Gunness, spokesman for UNRWA, the UN agency for Palestine refugees.
“The continued presence of armed groups that entered the area at the end of 2012 and its closure by government forces have thwarted all our humanitarian efforts,” Gunness told Ma’an News Agency this week.
The BBC’s Lyse Doucet reported on 20 December that pictures from inside Yarmouk “showed street markets with only radishes for sale.”
Earlier this month, UNRWA Commissioner-General Filippo Grandi warned “that humanitarian conditions in the besieged refugee camp of Yarmouk are worsening dramatically and that we are currently unable to help those trapped inside.”
“If this situation is not addressed urgently, it may be too late to save the lives of thousands of people including children,” Grandi said.
Although not entirely spared from the fighting and shelling, the situation deteriorated sharply in December 2012 and the months since when, according to UNRWA, “armed conflict has caused at least 140,000 Palestine refugees to flee their homes in Yarmouk, as armed opposition groups established a presence in the area, with government forces controlling the periphery.”
Until July this year, UNRWA says those remaining behind could still access its “assistance at the Zahera entrance to Yarmouk. However, from mid-July 2013, Palestine refugees have been trapped in the area, with little or no access or freedom of movement.”
The turning point came on 16 December 2012 last year when, as the BBC reported, “government warplanes bombed Yarmouk for the first time,” after the opposition Free Syrian Army (FSA) “sought to seize control of the camp from the PFLP-GC. Some were reportedly killed when a rocket struck a mosque where people had taken shelter.”
The PFLP-GC – Popular Front for the Liberation of Palestine–General Command – is a Palestinian faction aligned with the Syrian government. It is distinct from the better-known Popular Front for the Liberation of Palestine (PFLP).
Various reports put the number of people killed in the attack at around two dozen.
In the days following the bombing, tens of thousands of Palestinians fled the camp leaving everything behind, with thousands heading to Lebanon, as warnings broadcast from mosques gave people just hours to leave.
In a February 2013 interview in Beirut, Yarmouk resident and activist Mutawalli Abou Nasser told The Electronic Intifada’s Moe Ali Nayel about the situation in the camp over the previous two years before the December 2012 bombing and the mass exodus.
According to Abou Nasser, while some youth in the camp organized in support of the Syrian opposition, “Yarmouk remained neutral the first year of the Syrian revolution,” amid “public awareness and consensus that the camp should be left out” of the conflict.
But according to Abou Nasser the situation began to shift when members of the PFLP-GC fired on camp residents holding funerals for family members killed by Israeli forces as theytook part in a march at the border in June 2011 commemorating the 1967 war.
Camp residents had accused people loyal to the government of encouraging youth from the camp to go to the border and face grave danger as part of a propaganda effort for the government.
In December 2012, FSA fighters entered the camp in order to fight the PFLP-GC.
“The residents of the camp were against the FSA stationing in it,” Abou Nasser said. “I personally rejected the FSA entering the camp. The camp had a humanitarian role; bringing the war to the middle of it was a mistake.”
Abou Nasser added:
The situation started deteriorating six days after the FSA entered the camp: there was no bread anymore, [and] a shortage of all the medical supplies needed by the four field hospitals in the camp.
Before the FSA involved the camp in its war the camp was a humanitarian phenomenon: rents stayed cheap, there was plenty of food, and the medical support the camp offered saved many lives. Only the Islamists in the camp were in favor of the FSA stationing in Yarmouk.
But that opposition softened after the December 2012 bombing by government warplanes.
“People must understand that the indiscriminate bombing of the camp by the regime – killing innocent people, children in their playground – made the FSA’s idea more acceptable to Palestinian residents of the camp,” Abou Nasser explained.
“The more the MiGs [warplanes] bombed the camp, the more people wanted the FSA to stay.”
For a year, the situation has been getting worse. This November a tentative agreement gave hope for some relief in the situation in Yarmouk.
Under the reported terms of the agreement, brokered by the Palestine Liberation Organization, armed men would have left the camp and displaced residents would have been given safe passage to return and rebuild.
When she took her son to a government-controlled hospital, she said, “they wanted me to sign a paper stating that my son was injured by the terrorists but I refused and told them the terrorists don’t have MiGs.”
The pressure can also come from the rebels. A Palestinian woman who survived an 11 October sinking of a refugee boat told Human Rights Watch, “We could not stay in Syria. I could not send the children to school, because [both sides] ask which side you support and, if you answer wrongly, they will kill you.”
In September, Peter Maurer, president of the Intenational Committee of the Red Cross,stressed his organization’s need for “rapid and unimpeded passage of humanitarian relief for people in sealed off areas, mainly Eastern Ghouta, the old city of Homs, Yarmouk and Moadamiyah.”
Maurer has also recently said both government and armed opposition block medical aid to the sick and wounded: “On both sides we are struggling with the argument that whatever medical aid is brought to one part or the other is interpreted as an indirect military support to the other side.”
But in the case of Yarmouk, no one disputes that government forces control the periphery and therefore have the power to grant the humanitarian access UN officials have been urging without success.
There can be no possible excuse or justification for the Syrian government to deny food and supplies to Yarmouk camp and other besieged areas.