Last week, the president of the International Committee of the Red Cross (ICRC), Peter Maurer, made a trip to Syria to assess the humanitarian situation and negotiate broader field access.

“The scale of the Syria Crisis, with millions of civilians affected, is staggering and the humanitarian response insufficient,” said Mauer.

The trip comes at a time when localized efforts to reach truces and cease-fire agreements inside the country are the subject of international attention, and during a time in which the ICRC has crossed front lines to deliver aid in opposition-held territory several times in recent months.

Simon Schorno, the group’s spokesman in Syria, spoke to Syria Deeply about the ICRC’s operations, its kidnapped staff, and how it has to work with combatants on all sides.

Syria Deeply: The head of the ICRC made a special trip to Damascus last week. What was the mission?

Schorno: We have a large operation in Syria. We work very closely with the Syrian Arab Red Crescent throughout the country, across front lines, with offices in Aleppo, Damascus and Tartous. It’s a substantive assistance operation that includes water and food assistance, emergency assistance and crossing front lines to both opposition- and government-held territory.

We have limitations of course: access is still very challenging. There is a lack of authorization by the government and there are lack of security guarantees by the armed opposition, which make cross-line operations difficult.

Since the beginning of the year, we have increased levels of food and non-food assistance to the point that we have been able to give food to a million people every month – it’s quite an increase since the beginning of the year. We’ve been able to cross front lines repeatedly in the past few months, including delivering health assistance. It has always been very difficult to pass through checkpoints and front lines in the past, so it’s quite a breakthrough.

The ICRC has a multifaceted humanitarian mandate – there is an assistance component, but there is also a protection component. We enable the re-establishment of family links for people who have been separated by conflict. We visit detainees and offer our services as neutral intermediaries between parties. There is a whole range of services that the ICRC wants to provide in Syria but hasn’t been able to up to now.

The main purpose of the president coming is to bring those issues to the table at a time when there is a greater willingness on the part of the authorities to engage on those issues, and at a time when there have been talks about reconciliation. There have also been a series of local truces in which we haven’t played an active role, but have been able to access areas we haven’t been able to before as a result.

The idea is that as these breakthroughs are taking place, there might be a space for the ICRC to broaden its humanitarian presence and engagement in the country.

Syria Deeply: What are you seeing today, in terms of the humanitarian conditions inside Syria?

Schorno: We are talking about progress in terms of access, but it needs to be put in perspective – our efforts and those of the humanitarian community at large are but a drop in an ocean of needs. The needs remain overwhelming in terms of displacement, violence against civilians, targeting of medical and healthcare personnel and facilities, which take place on a daily basis.

The humanitarian situation is worsening – people continue to fear for their lives and safety, people are still being arrested, and families continue to be separated. Access to basic necessities like water across the country are extremely limited and hard, and the economic situation keeps deteriorating. Even in Damascus, there are lines for the past two weeks of people trying to get access to bottles of gas.

Syria Deeply: How limited is access to healthcare, food and water in Syria? How does this access vary per region, particularly in besieged areas?

Schorno: The most urgent needs are in besieged areas where the issue of humanitarian access and access by the population to basic necessities, emergency aid and in particular safe access to healthcare is extremely limited. We don’t have numbers, but the estimation is that there are over a million people living in besieged areas. Other areas that aren’t besieged per se but encircled like Aleppo, areas in Homs face very dire circumstances. Overall, people fear for their security, which then causes displacement.

In some areas, the issue of chronic diseases is becoming a real problem because people don’t have access to or can’t afford medicine. Even simple things that used to be treated in Syria for many people are becoming inaccessible.

We are in a constant emergency phase even though the conflict has been going on for three years now. People are scarred for life, but the psychological impact on the population is not something we have tackled yet. Even though the psychological impact is huge, we haven’t had time to work on that level.

Syria Deeply: Has their been broad compliance with Humanitarian Law and Resolution 2139, allowing aid access to opposition areas without government approval? Has it enabled more of your work?

Schorno: The ICRC works independently of U.N. resolutions. It has a bilateral dialogue with the government and armed opposition groups, independent of U.N. efforts and resolutions. We have our own humanitarian mandate given by the community of states and the Geneva Convention. We keep our distance from those initiatives, not because we don’t see their value, but in order to work across front lines and to have the credibility we need to have with both the local population and the parties in the conflict. Our success is mostly the result of our day-to-day engagement with the government and armed opposition, and the fact that we’ve been in the field, so parties and local people see the added value of working with us. The government in particular is seeing some of the value in independent, apolitical, humanitarian action in Syria.

Syria Deeply: Are you able to deliver humanitarian aid across front lines?

Schorno: It’s a very fragmented conflict so it’s a very challenging operational environment. We are based in Damascus and respect Syrian sovereignty, so we don’t do cross-border operations. We operate within the Syrian territory, so that of course means we need to negotiate with the government, to get the green lights to do cross-lines operations, which of course sometimes takes more time than we would like to.

We do the same thing with a number of armed groups operating in any given area. We foster acceptance by talking to people, we explain to people what we do, people see us at work, they observe us working without a political agenda. We negotiate access and when those things come together, we load trucks and cross front lines.

We’ve been able to that repeatedly in the past couple months, including to deliver medical aid, which is the most challenging type of assistance to bring, notably to besieged areas.

Syria Deeply: Has the rise of ISIS and the threat of other extremist groups made the delivery of aid more challenging?

Schorno: Security is paramount for our staff. We’ve had three of our staff members kidnapped, and they are still being held – a very clear signal of how dangerous it is to operation in Syria. This doesn’t mean we don’t apply the same modus operandi with all groups in Syria. We work with them in just the same way we work with others, which means engaging on a strictly humanitarian basis without a political agenda. We engage with them directly in order to assist the population that lives in areas under their control. In Raqqa, we’ve been able to develop a water assistance program, which was done after weeks of dialogue with the groups that control those areas. Even in places like Raqqa and Deir Ezzor, we are able to do some work.

Syria Deeply: What are your most immediate needs and biggest concerns?

Schorno: The issue of food and water is critical. The water infrastructure is in bad shape; many governorates don’t have the chemicals they need to purify the water, to make it drinkable. The products they need are becoming more rare, and the infrastructure is crumbling.

Safe access to healthcare is also a major concern at the moment. The health system has crumbled – doctors have fled, been systematically targeted and arrested by all sides. The price of medicine has gone up. The most immediate concerns are providing clean water to millions of people and protecting civilians.