The U.N. Security Council unanimously approved a resolution Saturday demanding a 30-day cease-fire across Syria "without delay" to deliver humanitarian aid to millions and evacuate the critically ill and wounded.
U.N. humanitarian chief Mark Lowcock welcomed the vote saying: "Words must now quickly become action - any cessation of hostilities must be real. Attacks must stop."
The vote was postponed for several days of lengthy and intense negotiations to try to get support from Russia, a key Syrian ally that said repeatedly an immediate cease-fire was unrealistic.
Sponsors Kuwait and Sweden amended the resolution late Friday in a last-minute attempt to satisfy Russia, dropping a demand that the cease-fire take effect in 72 hours.
The effort worked, though U.S. Ambassador Nikki Haley was sharply critical of Russia for delaying the vote.
"How many mothers lost their kids to the bombing and the shellings?" due to the delay, she asked. "How many more images did we need to see of fathers holding their dead children?"
Sweden, Kuwait and many other countries had been pressing for an immediate cease-fire as deaths mount in a Syrian bombing campaign in the rebel-held suburbs of Damascus known as eastern Ghouta where the death toll in a week of bombardment has risen to 500.
Earlier this week U.N. Secretary-General Antonio Guterres urged an immediate suspension of "all war activities" in eastern Ghouta, where he said 400,000 people are living "in hell on earth."
Guterres welcomed the resolution's adoption and stressed his expectation that it will be "immediately implemented and sustained" so aid gets to the needy and sick, U.N. spokesman Stephane Dujarric said. "The U.N. stands ready to do its part."
While the spotlight is on eastern Ghouta, the resolution expresses "grave distress" at the humanitarian situation there as well as throughout the country including Idlib governorate, Northern Hama governorate, Rukhban and Raqqa.
It states that urgent humanitarian assistance is now required by 13.1 million people in Syria, including 5.6 million people in 1,244 communities in "acute need." That includes 2.9 million in hard-to-reach and besieged locations such as eastern Ghouta.
The resolution calls on all parties to immediately lift the sieges of populated areas including eastern Ghouta, Yarmouk, Foua and Kefraya.
On the key issue of a cease-fire, the resolution "demands that all parties cease hostilities without delay for at least 30 consecutive days throughout Syria for a durable humanitarian pause, to enable the immediate delivery of humanitarian aid and services and medical evacuations of the critically sick and wounded ... and demands that all parties engage to this end."
The resolution also demands that a cease-fire be followed immediately by access for humanitarian aid.
Sweden's U.N. Ambassador Olof Skoog told the council just before the vote that "the U.N. convoys and evacuation teams are ready to go."
Kuwait's U.N. Ambassador Mansour Al-Otaiba, the current council president, said after the resolution's adoption that "it cannot end the human suffering in Syria immediately."
"However, it is a positive sign sent by the Security Council — a sign that the council is united and showed solidarity to stop the humanitarian suffering and stop hostilities immediately," he said. "Now we must implement this resolution to save the lives of Syrian people and to deliver humanitarian aid."
Since the Syrian conflict began nearly seven years ago, the Security Council has been deeply divided, with Russia backing President Bashar Assad's government and the U.S., Britain and France supporting the opposition. The result has almost always been paralysis and inaction.
Those divisions were evident Saturday in the tough language from the U.S. ambassador and the reply from her Russian counterpart after the vote.
"Every minute the council waited on Russia the human suffering grew," Haley said. "Getting to a vote became a moral responsibility for everyone, but not for Russia, not for Syria, not for Iran. I have to ask why? At least 19 health facilities have been bombed since Sunday" in eastern Ghouta.
She expressed hope that Russia's belated decision to support a cease-fire "after trying every possible way to avoid it ... will be a turning point, where Russia will join us in pushing for the political settlement to this conflict."
Russia's U.N. Ambassador Vassily Nebenzia responded saying it took so much time to reach an agreement because an immediate cessation of hostilities, which was originally called for by the sponsors, was "not feasible, ... not possible."
"What is necessary is for the demands of the Security Council to be underpinned by concrete, on-the-ground agreements," he said. "It would be naive to think that difficult issues can be addressed overnight, momentarily. We trust that all parties with influence to bear will help to bring this about."
Another major issue in the negotiations was an exemption the Russians sought to keep up attacks against extremist groups.
The resolution allows attacks directed at extremists from the Islamic State group and all al-Qaida affiliates including the Nusra Front to continue. The Syrian government and its Russian allies say they are pursuing Islamic extremists they call "terrorists" — and U.S.-backed forces are also going after IS and al-Qaida militants.
Nebenzia accused the U.S. of using the fight against terrorists for "geopolitical agendas with dubious legitimacy." Instead of "scaling-up rhetoric against Russia," he called for the U.S.-backed coalition to promptly end its "occupation" which would improve the humanitarian situation in Syria's north and east.
Later, he told reporters that Russia also negotiated for so long to make sure the resolution "is not used as a pretext for any military action. He pointed to "worrying comments on that in recent days, and including today some very bellicose language."