Thousands of people have died in Syria since the February 6 earthquake hit the Turkish border, but aid has been slow to reach the hardest-hit areas.

Relief efforts have been hampered by a civil war that has torn the country apart and divided regional and global powers.

Here is a summary of the challenges aid is facing in Syria.

Consequences of the civil war in Syria

After nearly 12 years of conflict, Syria is in decline.

President Bashar al-Assad, backed by Russia and Iran, has regained control of much of the country, but hardline opposition groups and Turkish-backed militants control the northwest, where the United Nations says 4 million people need help before the quake. .

The rebel-held northwest of Syria was hardest hit by the 7.8 magnitude earthquake, although nearby government-controlled areas also suffered significant loss and damage.

A large area in the northeast is controlled by US-backed and Kurdish-led forces. This area was the least affected by the earthquake.

How can aid get to Syria?

The Assad government says foreign countries must respect Syria’s sovereignty and that aid to any part of the country must flow through government-controlled territory.

In practice, aid to rebels in the northwest has been flown for years from the border with neighboring Turkey, but the process requires UN Security Council approval every six months.

Russia, which has veto power in a council backed by the Damascus government, approved the opening of the only passage from Turkey to the northwest, saying United Nations aid must pass through Damascus and then to the front lines.

UN aid chief Martin Griffiths, who visited Syria on Monday, is pushing for the United Nations to open additional passages from Turkey for earthquake relief.

Can aid cross the front line inside Syria?

Some of the efforts to bring humanitarian aid to the Syrian front lines have shown how difficult and arduous the process is.

A motorcade from the Kurdish-controlled northeast heading for an area in the northwest controlled by Turkish-backed rebel groups – enemies that have been involved in several conflicts during the civil war – turned back on Thursday.

Sources from both sides criticized each other for why the aid was not delivered, accusing each other of trying to politicize the aid.

On Sunday, a UN spokesman said aid to the Syrian government-controlled area, mostly controlled by a radical Islamist group, had been suspended due to “permission issues.”

A source from the Hayat Tahrir al-Sham group said it does not allow shipments from government-controlled areas.

Who is sending help?

Western countries have sought to shield Assad from unleashing a conflict there, accusing him of brutally cracking down on mass protests in 2011.

They have imposed economic sanctions on Damascus and provided limited direct aid, though they say the sanctions are not intended to provide aid and they remain a major donor to the United Nations and other aid operations operating out of Damascus.

After the earthquake, Syrian state media reported that more than 50 planes carried aid from Arab and Asian countries to airports in government-controlled areas.

Italian medical aid arrived in Damascus on Sunday, the first European earthquake aid delivered to government areas.

Direct Western support for the northwest was also affected by the rise to power of radical groups, and an earthquake interrupted cross-border supplies for three days.

Deliveries began again on Thursday and have been increasing since then, but only include food, medical equipment and tents, not excavators and other equipment that rescuers in the northwest say they desperately need.

Source: Reuters.