The United Nations estimates that 10 million Syrians currently need assistance - but international aid workers are not even able to get across the border. That is the case for Dutch national Ton van Zutphen, who coordinates aid for Syria and Turkey for the German organization Welthungerhilfe.
Van Zutphen works from Gaziantep, Turkey, supporting the more than 1 million Syrian refugees in Turkey and trying to transport desperately needed aid into Syria. About a fifth of Syrian refugees in Turkey live in government tent cities, thanks to the 2 million euros (2.7 million dollars) Turkey has contributed to support refugees - the rest eke out a marginal existence through difficult and poorly paid work. Innumerable undocumented Syrian refugees are also in Turkey - bereft of all worldly possessions.
The refugees' hope for a quick return to their home country is fading; van Zutphen thinks aid will be required for another five to 10 years. But even getting the aid into Syria is a challenge, due to armed militias controlling many regions.
Honor system for distribution
"If I were to turn up in an ISIS region, it's very likely I would not return," said van Zutphen in reference to the Islamic State of Iraq and Syria, which controls swaths in both Iraq and Syria. Van Zutphen and other aid workers thus have to rely on a network of Syrians who manage transport and try to get the help to where it is needed.
Aid organizations call the system "remote management," and it's based above all on trust. Van Zutphen conceded that they cannot be sure that everyone in the network has good intentions, but added that it's more important to try and help people than to worry about some resources going missing.
But many regions are not accessible, even for Syrians. A growing number of armed rebel and Islamist groups are making delivery of humanitarian aid ever more difficult. In addition to control by ISIS, Bashar Assad's army and the Free Syrian Army also dominate large areas in Syria.
Negotiating with militant groups
Every delivery of humanitarian aid must be discussed with such groups in advance. There are eight Welthungerhilfe delivery trucks that haven't moved an inch over the past two weeks, van Zutphen explained. "It's like a dance: you take one step forward and two steps back."
Some warlords want to prevent areas they control from receiving any sort of food aid. Others refuse to accept that women carry out distribution as well. But "we have our guidelines, and will stick to them," van Zutphen said.
Using predetermined criteria, local councils assist in establishing recipient lists. Affected families get ration boxes that are supposed to last them two months: cooking oil, sugar, tea and flour are among the items provided.
Aleppo is a key area being targeted for aid, van Zutphen said. Welthungerhilfe's work has only become more difficult since Assad's troops became established there - van Zutphen said that only about a third of the city's 300,000 residents receive aid. He fears access to the city will soon be cut off altogether.
Better than nothing
Together with its Czech partner People in Need, Welthungerhilfe has even been assisting with waste collection since the collapse of state infrastructure. The groups are also distributing medication, and baby formula to mothers with newborns and pregnant women.
"Syria didn't use to be a poor country," van Zutphen said. "It had good infrastructure, with water and electricity, and all children attended school. Over the next four, five years, fewer and fewer children will," he said.
Although his organization can't fix the situation, it can help a bit - and that little bit could make the difference. "Otherwise, people would have nothing," van Zutphen said.