Nearly 2½ years after the fall of the Islamic State terror group's self-declared caliphate, there still appears to be no escape for tens of thousands of children left homeless in its wake.
Aid groups and observers say the children, some from families that flocked to join Islamic State and some from families who fled from its forces, are wasting away in displaced persons camps in northeast Syria, stalked by violence and even death.
"These children are experiencing traumatic events that no child should have to go through," said Sonia Khush, Syria response director for Save the Children, in a statement Thursday.
"It is incomprehensible that they are condemned to this life," Khush added. "Every day they are denied the opportunity to return to their home, denied the specialized services they so desperately need, and denied the right to live in safety and recover from their experiences is a day too many."
In a report Thursday, the aid group described the conditions in the two main camps — al-Hol and Roj — as dire for the 40,000 children who live there.
The camps are strewn with rubbish and waste, the report said, and there is little access to sanitation or health care. Some residents complained they sometimes go days without drinking water.
Malnutrition rates are rising, and diseases are taking a toll, all contributing to the deaths of two children a week on average through the first eight months of 2021, according to the report.
Despite a crackdown by the U.S.-backed Syrian Democratic Forces (SDF) in late March and early April, violence is also widespread.
The pro-Kurdish Rojava Information Center (RIC) has recorded 86 killings at al-Hol through the end of August, including more than 30 since the start of April.
In three cases this year, the victims were children, all shot to death.
"I fear living in the camp," one 10-year-old told Save the Children. "The people here keep fighting. I close my ears with my hands whenever I hear them fight. I don't even let my mother go outside."
Many of the children are already starting to lash out. Thirty-seven percent of caregivers at the al-Hol camp told Save the Children that their children "are always or usually angry."
And there are concerns it will only get worse.
"The longer they remain in the camps, the more acute a lack of belonging can become, growing frustration, a sense of uncertainty and a risk — particularly for boys — of prolonged detention can all reinforce trauma and isolation," the report said.
Others have also been sounding alarms.
"Fear, worry and stress is commonplace among children, adolescents and young people," an international aid worker with access to the camps told VOA last year. "Deprived from the traditional community support they enjoyed back home, it has led to significant long-term mental health and psychosocial consequences."
The worker further warned that "specialized targeted mental health interventions" had not been available.
VOA reached out to the SDF and the Autonomous Administration for North and East Syria, which oversee security for the camps and have yet to respond to the Save the Children report. But both have repeatedly called for more help to maintain the camps and for third countries to repatriate their citizens.
"The international community must help, and the citizens of every country must return to their homeland," Ali al-Hassan, a spokesman for the internal security forces, said earlier this year.
The process, though, has been slow.
According to Save the Children, since 2017, just under 1,200 children have been repatriated from Syria, with just 14 repatriation operations taking place so far this year.
The U.S. State Department has consistently pressured countries to take back citizens stuck in northeast Syria. The department itself repatriated 27 known Islamic State supporters from SDF custody.
Still, top U.S. military officials have repeatedly raised concerns that the combined efforts have not been enough.
"It is one of my very highest concerns," General Kenneth "Frank" McKenzie, the commander of U.S. Central Command, said in April.
"The long-term threat is ISIS radicalization," he said, using an acronym for the terror group. "Unless we find a way to pull these children out of these camps … find a way to reintegrate them into civil society and deradicalize them, we are giving ourselves a very significant military problem 10 years down the road."
Source: Voice of America