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Men stand in a damaged building in the Duma neighbourhood of Damascus March 14, 2014.BASSAM KHABIEH/Reuters

Three years into the crisis in Syria, millions of civilians urgently need care and food, yet remain out of reach for aid groups and caught in a conflict with no end in sight.

The Geneva-based International Committee of the Red Cross says Syria lacks sufficient medical supplies, doctors or hospitals and nine million people need urgent care in a "humanitarian disaster of appalling dimensions." The threat of violence, bombings and kidnapping looms large. Communities are besieged, most prisons are closed off to international inspectors (as they have been for decades) and checkpoints from various factions line roads. Conditions are dire and overwhelming for aid groups.

An estimated 2.4 million people have fled in the past two years. ICRC director general Yves Daccord says wealthier Syrians have mostly left along with anyone else who could manage to flee to neighbouring countries, leaving largely the poor, elderly, ill and other vulnerable groups trapped amid the fighting. Another 6.5 million, according to the United Nations, are internally displaced.

"What's amazing about the three years is there's no one in Syria that is not directly concerned by the conflict," Mr. Daccord told The Globe and Mail in an interview in Ottawa this week. "No one. Every single person in Syria is absolutely affected by the conflict … You've just had three years of a conflict dragging on, and even more problematic is it will last."

Vigils were planned worldwide Saturday to honour Syrians killed, trapped, driven from their homes or otherwise affected by the civil war.

Lakhdar Brahimi, the special Arab League and UN envoy to Syria, painted a grim picture on Friday of the worsening "humanitarian catastrophe" in Syria, which he called "mind-boggling." The number of refugees, he said, is expected to reach four million by the end of the year if the conflict continues and the number of deaths 350,000, if not more, by 2015.

"These numbers sound frighteningly high," Mr. Brahimi said, according to a transcript of remarks he made to a closed-door session of the Security Council. "But when one hears that half a million people left Aleppo during the past few weeks, we see that those levels will alas be attained."

Calling the economic situation in Syria "catastrophic," he warned that Syria is "on the cusp of colossal destruction that could see it become a failed state by 2015."

In February, the Security Council called unanimously for greater aid access in Syria, including a demand for cross-border access, which Damascus has resisted because it has lost control of some border regions. But access has not been provided, or has been provided only for brief times. That means food and needed health care are not reaching Syrians. Before the conflict, doctors inside Syria would see fewer than one case a month of a child with life-threatening malnutrition. Now they tell Unicef they encounter 10 or more a week, said Juliette Touma, a Middle East regional spokesperson for the UN children's agency.

The ICRC, which works with all sides in conflict zones to help victims of war, has 200 people working in Syria, Mr. Daccord said. Others work for the local Syrian Arab Red Crescent. Ideally, ICRC would have 10 times that number of people in the country, he added, but its work continues to be blocked by the ongoing conflict. Three ICRC staff were taken hostage in October and remain in captivity.

"In Syria, it's more difficult because there are places that are off-limits to us," Mr. Daccord said when he met with Canadian Red Cross and federal government officials to discuss the situation in Syria and other issues. "It's changing and evolving because the war is extremely fluid and the opposition has changed dramatically over the last 2 1/2 years."

He was in Ottawa to meet with Canadian Red Cross and federal government officials to discuss the situation in Syria and other issues.

The agency warns the humanitarian association continues to "deteriorate rapidly." Three years in, Mr. Daccord said he doesn't believe world interest has faded – just that the will to resolve the situation has amid Western nations wary of getting involved in another foreign conflict.

"Attention is not the problem. I think it's a moment in history – and that's a bit of a concern – where there's no international convergence to deal with conflict. I think conflict can be contained, not only in Syria, we see it in other places, but not dealt with," he said, saying he sees no sign a global solution can be reached soon. "We're nowhere there, and that's extremely damaging because this war will last," he said.

Canada has committed $640-million in humanitarian aid, Foreign Affairs Minister John Baird's office said Friday. He added that "Canada maintains that only a political solution will lead to the peace, security and freedom the Syrian people have demanded."

Mr. Daccord, after meeting with the top bureaucrat in Mr. Baird's department, told The Globe that Canada should continue to fund humanitarian projects in Syria while also pursuing diplomatic solutions to end the fighting.

"The message is keep on [going]. Just don't abandon Syria. Make you sure you continue to support humanitarian. It might be frustrating. It's possible the area where the frustration is the biggest between what we can do and the needs. But please, keep on, because I think this conflict will last," Mr. Daccord said.

A long-term solution in the country will require at least a Security Council resolution, and likely more than that, he said – a daunting prospect. He urged Canada, and therefore Mr. Baird, to be "creative" in pursuing diplomatic solutions. "I know it looks impossible today, but maybe tomorrow there will be solutions and we need an international solution for Syria."

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