Due to the drastic decline in production by professional oil refineries in Syria, many civilians have begun to refine oil by themselves. The conditions in these makeshift refineries are causing enormous health and environmental pollution problems in the region. The PAX report Scorched Earth and Charred Lives shows a sharp increase in the number of makeshift refineries in Syria’s oil rich Deir ez-Zor governorate, in the past four years, with the most recent analysis based on satellite images from June 2016. There are likely tens of thousands of makeshift refineries in the region, in which adults and an alarming number of children work. The consequences for public health and the environment are huge. This research provided by PAX for Peace highlights wider concerns about the unpredictable consequences of conflict on public and environmental health. It urges international agencies, relevant member states and their armed forces as well as relevant humanitarian actors to prepare intervention strategies for dealing with the serious health impacts of civilian-operated oil refineries, as well as socioeconomic development plans to support alternative ways of generating income. The research builds on PAX’s previous desktop study “Amidst the debris” published in October 2015.