* Any views expressed in this article are those of the author and not of Thomson Reuters Foundation.
Ambulances and cars were arriving all the time with more casualties. Bodies lined the corridors. Frantic relatives searched for their loved ones.
I almost had to fight my way down the corridor with colleagues and staff to reach the generators and make sure they were still ticking over. The water, the lights, the medical equipment: all depended on it.
It was the summer of 2014 and the conflict in Gaza was in full swing. I was in Shifa hospital with an ICRC team trying to help the hospital keep the basic services going. The power plant had been put out of action so the electricity lines were down. There was no way to restore the electricity supply since the damage to the power plant was so extensive. Power lines from Israel were also affected and could not be reached because the roads were too dangerous.
With no electricity supply, there could be no water – which was difficult anyway because many groundwater wells and some desalination plants were no longer in operation, not to mention the pumping stations. In some places, raw sewage was overflowing in the streets, increasing the risk of illness and disease.
The whole infrastructure - all dependent on each other – was in ruins. After three wars in less than six years and with the ongoing restrictions on the entry of materials: the emergency response, never mind crisis recovery, was slow.
Tens of thousands of people were on the move, putting added pressure on the city's services. It was the perfect storm. And it was no more evident than at the hospital.
The war between Gaza and Israel in 2014 is just one example of the devastation modern wars can wreak on a city. One need just look to Mosul, Taiz or Aleppo for more recent ones. The growing sophistication of urban infrastructure and services like electricity, water, sewerage, waste disposal and health care means that everything is more dependent than ever on complex logistics and specialist personnel.
On top of this, chronic, water sustainability issues and climate change only make a bad situation worse.
The scale and interconnectedness is such that the disruption of one essential service during conflict, can have major reverberating effects on other services.
Attacks on health care facilities and personnel as well as essential civilian infrastructure, such as water treatment plants, are prohibited. Water supply must never be used as a weapon of war. Yet with cities the main battlefields of the Middle East’s ever more devastating conflicts, much more must be done to ensure better respect for international humanitarian law (IHL) and the services on which people depend for their survival. Today, no warring side, be they State armed forces or armed groups, are doing enough to ensure this respect. Neither are the States who support them.
More must also be done to support and enhance the development of resilient urban services during times of armed conflict. This means building services which can respond to and absorb the effects of shocks and stresses from conflict - and recover as rapidly as possible when circumstances permit.
For instance, working with the Syrian Arab Red Crescent and local water boards during the past few years, we helped develop an alternative water network in Aleppo. This was done by repairing or drilling more than 120 boreholes. This helps cover the water needs of more than half Aleppo’s two million people when the main water supply doesn’t function or is cut off, such as over the past two months. Yet during the violence last summer, ongoing and indiscriminate escalations meant half the boreholes were later damaged and impossible or difficult to reach.
The extensive destruction of populated areas, including essential civilian infrastructure, is also a contributor to massive civilian displacement.
It was 2014 once more and I was on the border between Syria and Jordan. Thousands of refugees, many from Syrian towns and cities, were arriving at transit sites which were the first point of contact in Jordan.
It was the first time for months, if not years, that they had felt safe and had access to basics such as health services, medicine, shelter, water, food, sanitation, and showers. For some of the very young, this was the first time they had ever accessed such services.
You should have seen the faces of the children as they quenched their thirst from the drinking water dispensers. They sprayed water at each other and turned rolled-up cardboard into toy swords, to play in the baking heat.
They had been forced to flee their homes because of insecurity and survived the use of explosive weapons of war in populated areas.
From Gaza to Aleppo, from Mogadishu to Taiz, the ICRC has become all too familiar with the severe humanitarian consequences of urban warfare. Civilians are injured and displaced in the short term but, there is also the long-term disruption to essential services and repeated urban displacement. Not to mention the social and emotional fractures which can take even longer to heal.
What must be done now? Firstly, those in authority - governments, mayors, local communities – must be given the support they need in order to deal with the consequences of this growing problem. Because, ultimately, it affects us all.
Secondly, beyond the obligations of States or armed groups at war with each other, States who support them must ensure they adhere to IHL, including by protecting critical infrastructure. They are in a unique and privileged position to do so. The cost of not doing so is too high, for those living in Taiz, Mosul or Damascus, and for the future of the entire region. It is one of the greatest challenges we face today.