A Syrian child walks barefoot at a refugee camp in Idlib, Syria on August 4, 2022. Photo: VCG

Drained by a decade of war, destitute families in northeastern Syria are now facing fresh misery - and a dilemma - over water.

It has become so expensive that communities are having to save scarce clean supplies for the elderly and young, leaving most people to choose between drinking dirty water and risking disease or going without and facing malnourishment, experts say.

Decrepit water systems damaged by the conflict have long forced people to rely on trucked water delivered by private firms or aid agencies, but the spike in commodity prices caused by the Russia-Ukraine conflict has exacerbated the situation.

Many residents of the region's cities and towns can no longer afford clean water, while humanitarian organizations have warned they may have to cut supplies for those living in refugee camps with logistical costs rising and Syria's economy reeling.

"It's a horrible choice [for people]," said Mohammad Mahmoud, director of the Water and Climate Project at the Middle East Institute, a think tank.

"[Either they] drink this water that is not treated, or that is not being treated to adequate standards, or don't drink it ... and possibly die."

In a June survey published by humanitarian initiative REACH, 45 percent of some 4,600 respondents mostly based in northeastern Syria said the cost of trucked water was a challenge and meant they were having to forgo other necessities and bathe and clean less.

In the city of Al-Hasakah - a focal point of the war - 99 percent of households said they did not have enough water, REACH found.

Huda, a 33-year-old English teacher, is among them, but she considers herself relatively lucky. She gets most of her water from a well facing her home. However, during summer, it runs dry and her family must rely on trucked water to meet their needs.

"It is mostly dirty, but it is the only solution we have at present," Huda told the Thomson Reuters Foundation by phone.

"We take risks getting water from the tankers, but we have to eat and cook."

A dearth of clean water sources, constant violence and the region's desert climate are leaving communities short of water while the collapse of Syria's pound has driven up the price of goods and aggravated hardship.

Tragic situation

The Euphrates river, the region's primary source of water, is drying up, while upstream damming by Turkey has reduced the incoming water supply, analysts and local activists said.

And infrastructure systems are failing, long ignored by the central government and worn down after years of war and drought.

The Alouk water station - located near the Syrian-Turkish border - provides around 1 million people in the region with water but was operating at half capacity 84 percent of the time between August 2021 and March 2022, according to REACH.

The water station has become caught up in conflict between Turkish-backed factions and the US-backed Syrian Democratic Forces (SDF), according to sources based in the region.

"When they fight, we get water cuts," an activist in the region said on condition of anonymity for fear of reprisals.

Spokespeople for the Turkish-backed factions and the SDF could not be reached for comment.

When the pipes run dry, residents resort to trucked water.

An aerial view of the refugee camp in Idlib, Syria on August 4, 2022 Photo: VCG

Every month, an average-sized family that depends on trucked water might spend as much as $150 on sanitation and cleaning, and almost $100 on drinking water, the activist said.

If a family were to rely on bottled water, they would have to spend around $320 a month.

"The situation is tragic, there is real thirst," the activist said.

While aid agencies provide water free of charge to refugees, the internally displaced and some neighborhoods, they too are being hit by rising prices of fuel, electricity and water treatment chemicals, said the UN children's fund UNICEF.

"In Syria we are paying twice as much as we used to pay," Chris Cormency, a water and climate change advisor for UNICEF.

"Costs have increased across the board and families must make decisions," he said. "People use less water so hygiene would not be as good and would propagate water-borne diseases."

A source from an aid organization that works in the refugee camps that dot northeastern Syria said rising fuel prices meant they may have to decrease the amount of water they provide per person in order to ensure more communities have access overall.

Yet there is nowhere near enough funding, capacity or will to address the problem with sustainable solutions, said the humanitarian worker, who was not authorised to speak to media.

Like medicine

The water crisis has also caused an increase in diseases such as diarrhea, malnutrition and skin conditions in the region, according to the World Health Organization (WHO).

More than 2,000 cases of leishmaniasis - a parasitic disease that causes skin lesions - were reported by Al-Hasakah officials in October 2021, up from 121 in October 2020, said the WHO.

Al-Hasakah authorities were not immediately available to respond to questions about the water situation in the city.

Meanwhile in Raqqa, a city which lies on the banks of the Euphrates, most people rely on the river for water for drinking and washing despite fully knowing that it is unfit for either purpose, said Ammar al-Ahmad, a researcher based in the city.

"Clean water is not so much a priority as rent, medicine and food," the independent researcher said.

Filtration systems to clean contaminated water before it reaches consumers are too expensive for many living in the city.

Their prices range from $30 to $200 and require around $7 in maintenance every season, a tall order for many in the war-stricken city, said Abdallah, the owner of a local plumbing store, who did not disclose his last name.

"People are pinching pennies and going hungry to save enough to buy a water filter," he said.

The liquid gushing from the city's faucets runs red, Al-Ahmad said. The price of filtered water has doubled in the last year. Families consume bottled water like it is medicine: Only drinking it when sick and on the advice of a doctor, he said.

"Only the velvet class uses healthy water," the researcher said, referring to the city's wealthiest residents.