For those Damascus-based humanitarian agencies delivering food, medicine and essentials to Syrians living in besieged and hard-to-reach areas, the buzzword is “access”.

Access has gotten considerably better since 2015, when only one besieged area, the Yarmouk suburb of the capital, received aid. All other besieged areas were out of bounds, resulting in well-publicised starvation deaths among children in the insurgent-held town of Madaya, near the Lebanese border.

This year access has been secured to 16 of 18 besieged areas and aid agencies have entered hard-to-reach locations.

"The beginning of 2016 is different compared with 2015," Kieran Dwyer, communications officer of the UN children's agency Unicef, told The Irish Times. "We have reached 430,000 this year, many people more than once.

Procedures for gaining access have been cut from eight to two steps. But still, this is not good enough. We call upon the government and [armed] groups for unhindered and continual access everywhere.”

Asked if Unicef and other humanitarian agencies can ensure that food and medical supplies reach needy civilians rather than armed elements, he said they have only a few hours on the ground when making deliveries, but have systems of allocation to ensure that aid goes to the most vulnerable.

“The more we go back to a community, the more they trust us,” Dwyer said. “Distributions are more orderly, more relaxed. People are less desperate. Communities organise and give us lists of things they need.”

Unapproved supplies

Though agencies have a better understanding of people’s needs, medical supplies and equipment are not approved by the Syrian authorities and surgical kits and antibiotics are removed from deliveries. It was also difficult to organise medical evacuations.

Unicef and other groups have recently reached about 200,000 people trapped by Islamic State in Deir al-Zor, in the east near Syria's border with Iraq. Supplies have finally been dropped from the air after weeks of preparation by the World Health Organisation.

Unicef is currently preparing for World Vaccination Week, when it plans to vaccinate Syria’s 2.8-2.9 million children under age five. Before the war, “90 per cent” were protected against major communicable diseases, said Dwyer. Now, the figure was 50-60 per cent, leaving the rest not only uncovered but also possible carriers of diseases that could infect others.

So far there has been no opposition to the vaccination campaign, although there could be problems with armed groups because Damascus’s ministry of health is involved.

Unicef also provides chlorine to treat the water consumed by 12 million Syrians, including those living in Raqqa, the de facto capital of Islamic State, also known as Isis. The UN agency’s efforts to improve sanitation have also been successful.

"Unicef is proud that there is no cholera in Syria, " said Dwyer.*

This year's access success story belongs to the UN agency dealing with Palestinian refugees. Unwra has had eight weeks of largely continuous and unrestricted access to the Damascus suburbs of Yalda, Babila and Beit Saham.

Food parcels, hygiene kits, blankets and other items have been delivered and medical teams and dentists have treated Palestinians and other patients from Yarmouk.

Before the war, Yarmouk had a population of one million, including 160,000 Palestinians who fled their homeland when Israel was established in 1948.

Yarmouk's population is now 3,500 families, while 2,000 families live in a neighbouring area. Access has been granted in spite of the presence of fighters from Jabhat al-Nusra, which is linked to al-Qaeda, and other groups.

Fighting for supplies

An Unwra source who accompanies deliveries said the situation is now “enormously better”. Last year, recipients were angry and fighting for supplies when deliveries took place.

“Since they have received several deliveries, people are relaxed, they wait calmly,” the source said. “There is more food available. The security situation is better due to the cessation of hostilities,” referring to a fragile ceasefire that came into effect on February 27th.

Since the war began, he said, “this is the first time people are starting to see how to get out of the hole”. Some Palestinians were beginning to come back from places of refuge inside Syria and neighbouring countries.

*This article was amended on April 15th 2016