Dubai — When hundreds of thousands of people across the Arab world poured into the streets in 2011 to demand freedom from dictatorship, they set in motion a series of events which not only created humanitarian needs in countries that were otherwise relatively stable, but also exacerbated existing humanitarian and developmental challenges.
"Despite the fact that the Arab Spring may have brought hopes for freedom, democracy and better living conditions, it has not been without cost," said Abdul Haq Amiri, head of the UN Office for Coordination of Humanitarian Affairs in the Middle East.
Here are the top 10 humanitarian consequences of a momentous year in the region, focusing on Egypt, Libya, Syria and Yemen.
2011 began with an 18-day uprising against former Egyptian President Hosni Mubarak which left more than 800 people dead and over 6,000 injured. By year end, sporadic clashes between protesters, security forces and "thugs" had killed at least another 81 people and injured hundreds more.
In Syria, a crackdown against demonstrators demanding President Bashar el-Assad step down led to more than 5,000 dead - though the number is constantly changing.
In Yemen, at least 2,700 protesters, tribal supporters, defected soldiers and government-aligned army members and policemen have been killed in what began as peaceful protests against President Ali Abdullah Saleh but increasingly involved an armed opposition. Some 24,000 others were injured since the protest movement broke out in the first week of February, according to the NGO Dar al-Salam.
Former rebels in Libya estimate the war there killed 50,000 people.
Thousands fled Syria for Turkey, Lebanon and Jordan due to fighting between government forces and protesters, supported by army defectors. The economic situation of many host families in Lebanon was strained, and Syrians were attacked along and across the border, leaving them vulnerable not only in their home country but also when seeking refuge.
So-called sectarian clashes in Egypt, as well as a series of attacks on Coptic Christian churches, led as many as 100,000 Christians to flee the country in the months that followed the revolution, according to a local NGO.
In Libya, many people were unable to return to their homes because of the heavy damage and sensitive politics.
Iraq prepared for an influx of returnees from places affected by instability.
The Arab Spring both affected the millions of migrants already in the Middle East and North Africa when uprisings erupted across the region; and also created new migration flows.
In Libya, sub-Saharan African migrants were accused of fighting alongside former leader Muammar Gaddafi and targeted by rebel forces. Hundreds of thousands of migrants left Libya during the war, in many cases returning to communities that did not have the capacity to support them.
In Egypt, migrants returning from Libya came home to a difficult reality and heightened nationalism led to violence and discrimination against foreigners, including migrants and refugees.
Despite a host of problems in Yemen, Somali and Ethiopian refugees and migrants continued streaming into the country in unprecedented numbers, often accused of being a party to the conflict between Saleh and the protesters trying to oust him.
Meanwhile, tens of thousands of Yemenis illegally entered neighbouring Saudi Arabia in search of work. Saudi authorities say they detained 239,000 illegal immigrants in 2011, up 37 percent on the year before.
Access to health care
The often-violent crackdown on protests in Egypt's Tahrir Square led to a shortage of vital medicines in pharmacies and a sharp drop in blood donors. Amid the security vacuum that followed Mubarak's departure, hospitals became dangerous places.
In certain parts of Yemen, vaccination rates decreased by 20-40 percent as a result of the country's political and economic challenges. Hospitals struggled to cope with increased demand among protesters. Health care facilities were barely functioning and access remained limited due to a lack of security, leading some health workers to flee their hospitals and clinics. Military presence in and around hospitals in Yemen led some wounded to seek treatment in private clinics.
Similarly in Syria, activists said they were afraid to take wounded protesters to hospitals, for fear they would be arrested by security forces there.
In Libya, the severely wounded had a hard time reaching hospitals and the government struggled to secure medical treatment for the war-wounded abroad.
Access to education
The unrest in the region set back the likelihood that many countries would achieve the Millennium Development Goals for education by 2015.
In Egypt, nationwide demonstrations and repeated confrontations between demonstrators and military policemen forced several schools and educational institutions to close, while parents complained that their children were attacked by thugs on their way to school. Some rights groups said criminals used arms to take money from schoolchildren.
In Yemen, hundreds of thousands of children stayed at home because their schools were either housing displaced people or being used as army barracks.
In the Syrian city of Homs a school came under attack.
On the positive side, the children of displaced Syrians in Lebanon were able to enrol in public schools in northern Lebanon.
Access to basic services
Yemen faced acute water and power outages. By year end, the price of water-trucking had risen to US$8 per cubic metre in some places, 2-3 times more than in March 2011. The power went out for more than 20 hours a day in most of the country's main cities, including the capital Sana'a, due to repeated attacks on the national grid.
Some areas of Libya went without water and electricity for months due to severe damage to infrastructure; and activists in Syria said water and electricity were cut from certain cities for days at a time before and during military operations.
Across the region, the Arab Spring led to higher food and fuel prices, less availability of certain products on the market, people losing their jobs, enterprises going out of business, and investors being wary. The economies of Egypt, Syria and Yemen were particularly hard hit. Libya's oil production dropped significantly and it had trouble accessing funds frozen under sanctions against Gaddafi.
The devastated economies forced families to make difficult choices. In Yemen, where one third of people did not have enough to eat before the crisis, aid workers warned of shocking malnutrition figures.
The price of basic food commodities in Yemen increased by 43 percent on average over the course of 2011, in a country where families spend 30-35 percent of their daily income on bread.
The Studies and Economic Media Center, a local think tank, warned that the number of food-insecure people increased from seven million to nine million in 2011 because of the unrest.
In Syria, the government made cash payments to thousands of vulnerable families to stem food insecurity.
The Egyptian government was incapable of maintaining the bread subsidy that many poor Egyptians rely on, and there were signs of increasing malnutrition in Upper Egypt.
Proliferation of weapons
Weapons proliferation increased in the region, especially in Libya, where an estimated 120,000 fighters needed to be demobilized; and surprisingly, in places like Egypt, where citizens purchased small arms to defend their families. An increasing number of army defectors led to a more violent Arab Spring in Yemen and in Syria, where the UN resident coordinator in September warned of the risk of civil war.
In Yemen, less government control has led tribesmen to break into military camps, looting small, medium and heavy arms.
Insecurity and the spread of conflict in several areas of Yemen hindered access of humanitarian actors and made aid delivery even more complex.
Syria has been virtually off-limits for aid workers and certain areas of Libya remained inaccessible for months due to fighting during the war.
According to one UN official, the unrest in the region caused some Gulf countries to cut some of their foreign spending and refocus funds internally, to appease the local population and avoid uprisings in their own countries. The Palestinian Authority, for example, complained of decreased donor funding.
[ This report does not necessarily reflect the views of the United Nations ]