Last week the world’s attention focused on the Oscar-winning documentary film For Sama, about the plight of civilians caught up in Syrian war. Now the world looks away as one of the conflict’s biggest humanitarian crises unfolds in Idlib. Foreign Editor David Pratt examines what’s at stake.

A FEW days ago a Syrian doctor gave his personal account of life on the frontline.

At one point he described to an Al Jazeera journalist how, following a Syrian regime air strike, many civilian casualties – along with the bodies of the dead – were brought into the hospital where he worked.

With precious few resources, he and the other doctors were overwhelmed. The doctor was then confronted with the terrible choice of deciding which of the two badly wounded patients lying before him he should respond to first and which should be referred to another hospital.

One was a man in his thirties, the other a three-year-old boy. Whoever the doctor decided would be transferred would most likely die during the 30-minute journey.

In the event the doctor chose to work on the child, who died from the shrapnel wounds in his chest shortly afterwards.

Finding that the man was still waiting on an ambulance to transfer him, the doctor began to work on his wounds, only again to lose his patient on the operating table.

Frustrated and exhausted, the doctor went outside where he was asked by another local man about the two patients he had just tried to save before informing the man that both had died. “You know, doctor, the two were a man and his son,” the local man told him.

Later, the doctor would describe how losing both patients was one of the most traumatising moments of his life. In facing such a painful choice, that doctor is far from alone in Syria.

Nowhere is that more evident than in Idlib province where one of the worst humanitarian catastrophes of this near decade-long conflict is shamefully playing out.

I say shamefully, because many of those innocents caught up in the worst of what is happening, find themselves in such a position through no fault of their own.

Instead they are caught up as human pawns and collateral in a vast game of cynical geopolitics, over which they have no control.

But more of that shortly, for the moment just consider this. At time of writing, some three-quarters of a million ordinary people are fleeing fighting and bombardment. That and the fact that an estimated 60% of these are said to be children faced with the choice of staying and dying or fleeing to camps on a closed border with Turkey, beggars belief in a war already beyond the pale in terms of civilian suffering.

Idlib province is currently home to more than three million people, more than one million of whom only arrived there in the first place because they had already been uprooted from their homes in towns and cities across Syria.

Now, once again, they find themselves forced to flee as fighting surrounds them, and have run out of “de-escalation zones” to flee to and have little chance of escape.

Calling for international action on the growing crisis, Mark Cutts, the UN deputy regional humanitarian coordinator for Syria, described the new displacement in Idlib as an “exodus”.

He said: “We’ve been calling repeatedly on the Security Council for the protection of the civilian population.

“What’s this world coming to if we’re not able to protect three million civilians, mostly women and children, who are trapped in a war zone?”.

Some have called Idlib the endgame in Syria’s war – they could not be more wrong.

Indeed, if anything, what is unfolding there has the capacity to spark another conflict, this time directly between Turkey and the regime of Syrian president Bashar al-Assad, and even potentially between Turkey and Russia. So how did it come to this?

To understand how the current situation arose we have to go back a few years to when Syrian government forces and their allies gradually took over opposition-held territory.

In the wake of that advance, hundreds of thousands of civilians and opposition fighters from those areas moved to Idlib province.

Then, back in 2018, that government advance was paused when Turkey and Russia agreed to a demilitarised zone in Idlib from which some opposition groups under Turkish influence were supposed to withdraw.

In the spring of last year, however, the Damascus regime ran out of patience and restarted its military advance with Russian air support culminating in an al- out offensive in December, which is now in full flow with dire consequences.

According to the think tank International Crisis Group (ICG) that monitors global conflict, “the regime’s assault has exacted a terrible human toll”.

It points to extensive Russian air power, which compensates for the regime’s weakness on the ground, as being particularly destructive, with hospitals, bakeries, schools and other vital infrastructure destroyed on purpose, as a means to demoralise and uproot Idlib’s civilian population, and undermine its civilian administration.

But just as the killing has intensified so the world appears to be looking the other way, drawing parallels with the previously besieged city of Aleppo, where the award-winning documentary film, For Sama, was made by Syrian filmmaker Waad al-Kateab.

“Millions watched my reports but no-one did anything,” al-Kateab recently observed of her dispatches at the time.

While the film won an Oscar last week for best documentary and was briefly the centre of global attention, the same horrendous bloodbath unfolding right now in Idlib has barely drawn any notice from the outside world.

Perhaps most galling of all for those humanitarian organisations trying to cope with the enormous human suffering there is that this was a disaster about which they have warned for so long now. It’s a crisis born out of cynical geopolitical manoeuvrings and decision-making over years, emanating from Ankara, Damascus, Moscow and beyond.

While Turkey talks of a “safe zone” in northwestern Syria that would accommodate the displaced population of Idlib, thus preventing them from landing on Turkish soil, what would most likely come about is something quite different.

“So then you have a Syrian version of the Gaza Strip, the bulk of the population in an area not much bigger than Rhode Island,” was how Soner Cagaptay, director of the Turkish Research Programme at the Washington Institute for Near East Policy, described it to The New York Times.

The Gaza analogy was echoed by others including David Miliband, the former Labour Party politician who is now head of the International Rescue Committee (IRC) aid group. Miliband said that Russian-backed Assad’s offensive on Idlib was creating a “Gaza in Syria” with millions crammed into a tiny space beset with violence.

He added that Idlib had become “the poster child for the age of impunity” and warned Europe must do more if it wants to avoid a fresh refugee crisis on its doorstep.

For their part, both Russia and Turkey are currently at odds over Idlib – but they are at one in wanting to exploit European Union (EU) sensitivity over refugee inflows to support their aims in Syria.

Turkish president Recep Tayyip Erdogan thinks nothing of using the unfolding mass displacement in Idlib to help revive the “migrant” hysteria that seized Europe in 2015/16 and helped power populist xenophobia.

Only last year, Erdogan threatened to “open the gates” for Syrian refugees to Europe if international support for a safe zone in northern Syria failed to materialise.

Erdogan will now do all he can to hold the EU’s feet to the fire on the refugee issue to gain leverage over the EU in tying to garner its support for creation of a buffer zone in Kurdish areas across northern Syria, to prevent them linking up with Kurdish insurgents inside its borders.

Those three-quarters of a million Syrians huddling up across the sealed Turkish border in an effort to escape the wrath of the Damascus regime, meanwhile, are shamelessly being used as nothing more then human pawns and bartering collateral to that end.

Listening to some commentators within the Turkish media one could be forgiven for thinking that Ankara’s ambitions stop at creating a buffer zone.

The belligerent mood there has been exacerbated by the loss of Turkish troops following shelling by Syrian forces around Idlib.

While Erdogan has warned that Turkey will strike Syrian government forces “anywhere” if more Turkish soldiers are harmed, the most bellicose of the pro-Erdogan press in Turkey have virtually declared war against the Syrian government.

It was left to Ibrahim Karagul, the editor-in-chief of the pro-government daily Yeni Safak, for example, to declare Syria a war zone from “Aleppo to Qamishli” or, in other words, across the whole of northern Syria.

“The operation era is now over. The war era has started,” Karagul, a staunch Erdoganist, wrote last week even before Erdogan’s latest speech.

On the ground, too, Turkey appears to mean business, massing 30,000 troops and armour at the Syrian border, and sending 5,000 reinforcements to bolster troops deployed in Idlib province.

Turkish forces have now also established new positions on the approaches to Idlib City, home to some 700,000 people, setting up posts at an airfield at Taftanaz, east of the city, and in Al-Mastumah, to the south.

The crucial question now is which side Turkey or Syria with its Russian and Iranian backers will blink first, if at all. For Turkey, the stakes are high. It has around 12,000 troops deployed in 12 outposts in Idlib province and nearby, some of them surrounded by Syrian-backed forces.

As the ICG warned in a recent article on its website: “Erdogan’s words are no idle chatter.”

Equally it’s hard to imagine that the Syrian government forces, after gaining ground that amounts to some 370 square miles in Idlib province, will withdraw from the de-escalation zone until the end of February, a deadline set by Erdogan.

“Damascus’s uncompromising rhetoric vis-a-vis the rebels – stating it will not talk to “terrorists” – and its bloody dispatch of past opponents make it hard to conceive of a peaceful middle ground in settling the fate of the province and its inhabitants,” concluded ICG.

As long as Russia does not turn away from its ally in Damascus, and it has not done so yet during the conflict, Turkey might have to rethink its threats and deadlines.

But what will ultimately unfold is anyone’s guess.

Many analysts have not ruled out the worst-case scenario of a direct war between Turkey and Syria – and perhaps by default Russia.

Whatever way events play out, one thing is certain: three-quarters of a million Syrian civilians are already suffering terribly and more left behind will suffer too.

By the hour, exhausted and terrified families are arriving in towns further north of Idlib near the Turkish border with no shelter available to them just as winter temperatures begin to bite.

Already there are reports of babies, children and the elderly dying of exposure.

With the Turkish border closed, and the province surrounded by government forces, there is nowhere left for them to go.

Hard as it is to imagine the humanitarian situation in Syria ever being worse than it has been to date, that is the actual prospect in store at the moment..

If the situation continues to deteriorate in Idlib and there’s no reason to doubt it will, the world, which has tried of late to blank from sight the suffering in Syria, will have no choice but to look again.

Like that Syrian doctor and the dilemma he faced in treating his two patients, painful and difficult choices will have to be made.

Someone has to speak up for those civilians who will bear the brunt, because for them there is nowhere left to flee and their choices have all but run out.