This area is the most dangerous for earthquakes to occur.
The region is bounded by geopolitical fault lines, as well as geological.
Politics can hinder efforts to provide desperately needed assistance to those in need. The aid effort may be hampered by the bitter legacy of civil wars, sectarian strife, and ethnic tension.
Residents trapped by earthquake and freezing are unable to reach them.
We have seen a lot of horror pictures from Turkey that were destroyed by the earthquake. But it is north-west Syria, where the greatest challenge lies.
Rebel groups were beaten in Idlib as the Syrian civil War turned against them.
Even in the best times, the Assad regime has restricted aid to Idlib’s large refugee camps from the south, its forces stealing supplies, and cutting them off capriciously.
Only one crossing point is visible from the north, which was badly damaged by the earthquake.
In southern Turkey, there are millions of Syrian refugees living in camps around Gaziantep. This is the epicenter of the earthquake.
Although there has been a lot of destruction and loss of lives, it is possible for tensions to flare up if refugees are treated more favorably than their hosts.
There are also ethnic tensions in Turkey. There is a large Kurdish population in the region.
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The Kurds have been disproportionately affected by poor, badly built housing in previous earthquakes and blamed corruption and the Turkish government for this.
This has fueled rioting and friction with authorities.
Like others in the past this earthquake could exacerbate friction above ground. This will not help in efforts to provide aid and relief for those who are in dire need.