The situation for Red Cross and Red Crescent personnel in Syria is becoming increasingly difficult. "The attacks have been mounting lately," complains Rima Kamal, of the International Red Cross' Damascus office. "There are sniper attacks and kidnappings."

Kamal is concerned the situation could get worse. "The fighting is escalating,” she says. “We're worried about a growing risk to our operations."

Spiral of violence

According to a recent report by the UN Human Rights Council, doctors, medical personnel, and ambulances in Syria are coming under fire - intentionally. Hospitals are also being bombed and paramedics terrorized, the report said.

In some areas around Damascus and Homs, for instance, between 70 and 80 percent of hospitals and other health care facilities are either heavily damaged or totally destroyed. And doctors and nurses have been killed or forced to flee.

Altogether, some 22 Red Crescent workers have been killed since the fighting in Syria began. The Red Crescent is a part of the International Red Cross and enjoys the same status under international law. That means its employees remain neutral in conflicts and, in turn, are allowed to move freely and help those in need, regardless of what side they are on. "That's the theory," says Kamal. "But the reality in Syria is different."

Attacks on life and limb

Not only do the medical aid helpers have to deal with direct attacks on their lives, the Red Cross and Red Crescent are also being increasingly hindered by the warring parties. "We have been trying to enter the embattled city of Homs for the past two months," says Kamal. The city, she adds, is controlled by the rebels and surrounded by government troops.

"We are negotiating with the local authorities, with Syrian government officials and with numerous opposition groups," Kamal says. "But we have not been able to get safety guarantees for our employees so that they can help the people in Homs."

The situation is similar in embattled areas around Damascus. Not one humanitarian aid organization has been allowed to enter these areas for six months. "Even after the poison gas attacks in August, we weren't allowed into the affected area," she says. "Not even the Syrian Red Crescent was permitted to go in and give afflicted people food and medical assistance."

Kamal is determined not to blame either side. It is important, she says, for the Red Cross and the Red Crescent to remain neutral, even in this dirty war. "I won't point a finger at anyone," she says. "What we always emphasize is every individual's right to medical assistance, be it an injured fighter, a civilian, children or women."

Symbol of impartial assistance

Neutrality is the most important basis for the Red Cross' work, according to Hans-Joachim Heintze of the Institute for International Law of Peace and Armed Conflict at the Ruhr University Bochum. For the Red Cross, it should never be a question of who is guilty or who is good or bad, but rather a question of who needs help, Heintze notes. The red cross on a white background has been a symbol of impartial assistance throughout history. "And in most cases in the past, this symbol has been respected," he says.

But the situation is changing in Syria. "We are now dealing with some parties that we can't identify and that do not feel bound by law because they don't see any reason to be," he says.

Or, as Christof Johnen, who coordinates the German Red Cross' foreign missions, rephrases it: "The warring parties don't like to see assistance given to people they view as enemies."

Shooting the wounded

That view is supported by recent reports from Syria about gunfire aimed at well-marked aid convoys, and snipers hanging around hospitals and even shooting the wounded.

Johnen says that in countries like Syria, the Red Cross faces not only a humanitarian challenge, but an educational one. "This conflict involves numerous groups that are not aware of the Red Cross and Red Crescent mandate," he says. "That's why both groups are trying to inform fighters of the ground rules they're supposed to obey."

But that can take time. Kamal is worried that the attacks on doctors and paramedics will only increase in the months ahead. "In the long term, such attacks will put off more people from helping others," she says. "When people risk their lives, fewer will be willing to help." The Syrian health system, she worries, could soon collapse.