The influx of hundreds of thousands of Syrian refugees is seriously straining the limited resources of countries generously taking them in and tension between host and refugee communities is rising. Urban refugees, in particular, are saturating housing markets, leading to steep rent increases for both refugees and locals. Commodity prices are up and wages are down. Health, water, sanitation and education systems are struggling to cope. Countries in the region have been spending their own money to respond to the exodus and are now overtly asking for help. Iraq is also grappling with the return of 60,000 Iraqi refugees from Syria. "These countries feel neglected by the international community and saddled with an immense burden that has no end in sight," the report says.A Protracted Humanitarian Emergency The IRC report asserts that the Syria crisis will be a protracted humanitarian emergency: "An end to the civil war will not necessarily end sectarian violence; indeed the violence could well increase. Recovery, reconciliation and political transition will be fraught with challenges and could take years. Every country in the region is unsettled by the prospect of hostilities spilling over their borders. They fear continuing refugee influxes could create internal instability or exacerbate simmering or historical tensions. Even if the conflict comes to a swift end, Syria will emerge in ruins—its social and civic fabric in shreds, its economic foundation and infrastructure devastated and its population scattered throughout the region—potentially unable for months if not years to return to shattered communities." "Donors need to step up, recognize the severity of the humanitarian crisis in and around Syria and face the virtual inevitability that this is going to get much worse and last much longer than initially anticipated," says Sir John Holmes, commission member, Co-Chair of the IRC-UK Board of Trustees and director of the Ditchley Foundation. The IRC's Commission on Syrian refugees makes the following recommendations: Increase humanitarian aid: Donor governments must urgently meet the UN funding appeal for $1.5 billion to aid uprooted Syrians and significantly ramp up bilateral assistance to countries absorbing refugees to help offset the strain on their infrastructure and mitigate growing tension. Maintain open borders: Host countries must keep their borders open to endangered Syrian civilians and continue offering them safe haven. "Buffer zones," which have a poor record of effectiveness, are difficult to protect and create a false sense of security for civilians living in them, should be discouraged. Expand international assistance inside Syria: The international community must expand partnerships with Syrian organizations that provide lifesaving assistance throughout Syria. Channeling aid to such groups is essential now and must be maintained in a post-conflict phase. Access must also be granted or improved for international aid groups that can provide emergency and recovery aid for Syrians and other vulnerable groups inside Syria, including Palestinian and Iraqi refugees. Prepare for a protracted humanitarian emergency: The international community must put financial diplomatic and logistical plans in place for a regional humanitarian crisis that could last years, given the scale of displacement and destruction and the risk of regional instability and increased sectarian violence. Preparations must be made for a mass exodus of refugees, should there be a sudden escalation of the crisis. UNHCR and donors should also discuss resettlement options for extremely vulnerable refugees. Scale up programs for "urban refugees": While camp-based Syrian refugees require improved and ongoing support, it is vital that international donors vastly increase resources for programs that aid refugees living outside camps and bolster the infrastructure of over-extended host communities. Major investment is needed to help hospitals and clinics treat thousands of extra patients daily and to expand cash assistance programs so that urban refugees can afford food, rent and other essentials for their survival. UNHCR should continue to expand registration sites to ensure that all refugees who want to register can, and that those who are afraid to register can still access available assistance. Address violence against Syrian women and girls: Funding must be increased for programs that prevent and respond to violence against women and girls, inside and outside of camps. This includes clinical care and emotional support for survivors, improving safety in camps, minimizing survival sex, forced marriage, and domestic violence and providing economic aid so that women do not revert to exploitative jobs. Invest in children's safety and healing: Programs must focus on identifying and providing tailored support for harmed or at risk children, including psychosocial support, aid for separated children and prevention of abuse, child labor and recruitment into armed groups. Local educators and health workers need special training in caring for violence-affected children. It is critical that Syrian refugee children are able to return to school and programs meet the minimum standards for education in emergencies.