Syria’s Yarmouk refugee camp, on the outskirts of Damascus, once housed 160,000 people. Now, tens of thousands of Palestinian refugees are trapped in the camp, which has been besieged for months by the Syrian army. Starvation, malnutrition and disease are growing threats.

Earlier this year, as the U.N. Security Council debated a resolution urging Syria’s government to open besieged areas for humanitarian aid, United Nations Relief and Works Agency (UNRWA) spokesman Chris Gunness released an image that quickly went viral. It showed residents lined up in desperation, waiting to receive food aid.

Here, Gunness weighs in on the deteriorating conditions on the ground.

Syria Deeply: How many people currently live in Yarmouk?

Chris Gunness: UNRWA has been working in Yarmouk since it was established in 1957. Yarmouk camp was immune from the fighting for the first year of war, and the Palestinian people made a direct decision not to be involved and tried to keep a low profile.

In December 2012, armed opposition groups moved into the camp, because there was a lot of tension between one of the Palestinian groups that is very much aligned with the government and the local people. In response, the government then heavily attacked the camp.

Yarmouk’s population of 160,000 Palestinians and several hundreds of thousands of ordinary civilians depleted over time, from a population of nearly half a million to 18,000 Palestinians and a couple thousand ordinary civilians.

SD: What are some of the challenges to delivering aid here?

Gunness: With the besiege of the camp that came into full force in July 2013, UNRWA has found it increasingly difficult to get aid in.

When convoys leave our main warehouse in Damascus, we are in government-held territory. We go through to the northern entrance into Yarmouk, a no mans’ land, and we cross over into areas in proximity to opposition-held areas. It is a no man’s land defined by sniper position, to be perfectly frank. We have assurances of security from both sides, but there have been clashes in the last few days that have prohibited us from delivering aid. There has been severe fighting in seven out of 12 of the refugee camps where we operate.

SD: What is the current situation on the ground in Yarmouk?

Gunness: On January 18, there was a cease-fire between 14 Palestinian factions, under which we were called in to deliver aid.

Since then, we’ve delivered about 11,000 food parcels to about 20,000 people, which really is not enough. Food parcels feed a family of five to eight for 10 days. We need to get in 700 food parcels a day. At the moment, we are averaging less than 100 a day.

The food situation is so bad that children, the elderly and women are reduced to dissolving stale spices in unsafe water and drinking it. People are eating stale vegetables and fruit; people are eating animal feed and grass. We are seeing classic signs of malnutrition, especially prolonged shortages of protein, which is having a severe impact on children.

In one appalling case, a 14-month-old baby named Khaled came to UNRWA suffering from a severe form of malnutrition known as kwashiorkor. Khaled had survived on water and almost no solid food for two months. He looked like an 8-month-old baby, but with just a few weeks’ treatment he looked like a 14-month-old.

Khaled embodies Syria’s tragic conflict, but also the opportunities that we must grasp. It’s a sign that with treatment we can make a huge impact on children.

We have been able to deliver education and medical service, despite the fact that there is a civil war going on. We are doing e-learning, because people, where they are lucky, have computers and electricity. Some of our schools have been taken over by IDPs. The 60,000 children who attend our schools in Syria have managed to receive an education, and those that flee to neighboring countries like Lebanon have also continued their educations once we’ve adapted the curriculum to reflect that of Lebanon.

However, we aren’t getting nearly enough aid into Yarmouk. It will get worse every day we don’t get food in, which is why we say we need sustained, substantial and secure humanitarian access. The Humanitarian Security Council in Resolution 2139 made it very clear that there has to be full humanitarian access, but that is something, unfortunately, that we do not have today.

SD: Your photograph has become an iconic image of the Syrian conflict. Why do you think it resonated with so many people?

Gunness: When I saw the picture, the hairs on the back of my neck stood up. It’s both cinematic, epic and almost biblical in its grandeur and sweep, yet etched on the faces are miniature studies of human pain and suffering.

People in the Middle East say it reminds them of the Epic of Gilgamesh, others say it looks like something out of the Exodus. People have applied their own national ideologies from the image. People have also interpreted it on a thematic level, depending on where they work. For example, people in food security say it’s a picture of food security. Human Rights groups say it’s about human rights, or crimes against humanity.

One also has to remember that Yarmouk is an open-air ghetto with steel around it, much like the Palestinian experience in Gaza and the West Bank and some of the Palestinians refugee camps in Lebanon, where people are living in insecurity, vulnerability and fear. When Palestinians look at the picture, they see the common experience of incarceration, highlighting the fact that over 5 million people are living in a continuing state of exile and statelessness, and there has not yet been a durable solution to their plight. Some of them have been displaced several times, highlighting multiple layers of insecurity and vulnerability.

SD: How are you meeting immediate and long-term goals in a humanitarian crisis of such grand proportions?

Gunness: In terms of UNRWA, we are doing a lot of short cash assistance, food assistance and emergency education, but we are also doing capacity and resilience building. We inoculate children against polio, give them an education so that the future generation who will deliver peace will have an education, and we also have a very active microfinance program. We are trying to build capacity, so that when the days come that Syria needs to be reconstructed, people will be empowered for long-term human development. But there are many many Khaleds in Yarmouk.