NEW YORK (AP) — Humanitarian groups working in southern Turkey and northwest Syria warn that Monday’s earthquake will have a “long tail” — a wide range of needs that will require donations for months, or even years, after the rescue and recovery missions end.

Among the worst in recent history, the 7.8 magnitude earthquake has killed at least 23,200 in the region and left tens of thousands more homeless, with thousands taking refuge in shopping malls, stadiums, mosques and community centers. Humanitarian access to northern Syria is complicated by the civil war, while sending funds can be blocked or slowed by U.S. sanctions, despite an exemption for relief efforts. The political environment in Turkey also poses challenges.

The first shipment of earthquake-related aid crossed from Turkey into Syria’s rebel-held enclave on Friday, a painful delay caused by damage and debris but also a U.N. policy that allows only for the use of a single crossing.

However, some aid groups were already in place because of the country’s 12-year civil war. Doctors Without Borders/Médecins Sans Frontières (MSF) had 500 staff, two of whom were among those killed, stationed in northern Syria, where they’ve helped meet medical needs amid the conflict.

“We were able to do a massive distribution of food and blankets to more than 500 families,” from one of their warehouses in the immediate aftermath of the quake, said Avril Benoît, executive director for MSF USA. Her organization keeps emergency supplies on hand in the case of major disasters.

“There’s a long tail to an emergency like this, both for the injured from the earthquake, but also for chronic disease management, making sure they have access to their medications,” Benoît said.

People will die without access to medications to control chronic illnesses such as hypertension and diabetes, she said, adding that the earthquake will also take a mental toll.

The International Federation of Red Cross and Red Crescent Societies said they had 5,200 volunteers mobilized on both sides of the border, with the Turkish operation being more robust and better-equipped because of its longstanding program to support Syrian refugees.

The IFRC’s Syrian chapter works in areas controlled by the government of Syrian President Bashar al-Assad, which has been sanctioned by the U.S. and European countries. In the past year, little humanitarian aid has arrived from Damascus to the opposition-held north, which has suffered an outbreak of cholera and COVID-19 amid desperate living conditions for many.

The Syrian government said Friday that it would allow aid to reach all parts of the country, including the northern enclave, portions of which are controlled by the Hayat Tahrir al-Sham, an insurgent group with ties to al-Qaida, as well as groups backed by Turkey and U.S.-backed Kurdish groups.

The Syrian American Medical Society, which also provides significant medical services in northern Syria, has called for the opening of additional border crossings and has commissioned a legal analysis that argues the United Nations has the authority to use other crossings.

“We think that the U.N. does not really need a Security Council resolution to proceed with this lifesaving medical relief,” said Dr. Basel Termanini, the medical society’s board chair.

Both MSF and SAMS said their supplies in the region are much depleted and need new shipments to continue to help.

However, delivering supplies is difficult. There are major obstacles to moving machinery to places in Syria where it’s needed to remove rubble. Fuel shortages also constrain the supply of electricity, said Xavier Castellanos, undersecretary general for operations coordination of the IFRC.

He called the situation in the region “the great storm,” with all the conditions reducing the amount of support to below the level that it should be.

Castellanos, speaking from Geneva on Thursday, said the IFRC has received “soft” pledges from governments and a very small number of pledges from companies so far. The group will look to individual giving to make up for the shortfall because those funds can be used wherever they are needed most.

The group has launched an appeal of 200 million Swiss Francs ($217 million) for responses in both countries and the national chapters of the IFRC are also collecting donations. He estimated the IFRC has received 7 million Swiss Francs ($7.6 million) so far in the early response to their appeals.

As of Thursday, MSF had $5.1 million come in from online donations along with a 10 million euros ($10.7 million) donation from the IKEA Foundation. SAMS had raised almost $2 million between a Facebook fundraiser and another on GiveSmart as of Friday.

The humanitarian organization Direct Relief immediately granted $100,000 to both SAMS and AKUT, a Turkish search and rescue team, and announced Friday that it was increasing its commitment to $3 million because of the strong support coming from donors from more than 70 countries. The Santa Barbara, California-based organization has shipped 42 pallets of supplies that it says will arrive by Sunday.

Thomas Tighe, who leads Direct Relief, said his team has opened discussions with health care companies to source the medications and supplies that are mostly likely to be needed based on the limited information available and in coordination with other groups.

“If you rush in too fast with the wrong quantities or the wrong material, you clog up the already compromised distribution channels, which then compounds the problem,” Tighe said.

Amazon has pledged $600,000 to humanitarian organizations, including AKUT and Red Crescent of Türkiye, in addition to supplying emergency supplies for cold weather, the company said in an online post. The founder of yogurt giant Chobani, Hamdi Ulukaya, a native of Turkey, pledged $1 million to the Turkish Philanthropy Funds and promised to match another $1 million in donations.

The IFRC already is planning its recovery efforts over 12 months, with reoccurring assessments to define the scope. Trauma response and sanitation issues are among the top priorities.

Some Syrians in the affected area have already been displaced many times by the war as well as separated from their families with little support. Many now have lost whatever shelter they had acquired.

“Over 12 years, you can imagine the loss of hope that one would have,” said Benoît, of MSF, which also provides psychological first aid and will train people to provide it if there are not enough counselors.

“It’s essentially to help the person in a culturally appropriate way, whatever is resonant for them,” she said. “To get through the day. To to be able to function, to be able to feed their children.”

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