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Even before Monday's devastating earthquake, getting aid to all parts of war-battered Syria was fraught with daunting political and logistical challenges.
Those hurdles have only multiplied in the wake of the disaster that has killed thousands in Turkey and Syria and brought down thousands of buildings.
Damage to roads and other infrastructure in southern Turkey has stalled aid from reaching northern Syria, an area already devastated by 12 years of conflict.
Meanwhile, the government of Bashar Assad in Damascus is still a pariah in much of the international community, sanctioned by the U.S. and European countries, which are reluctant to route aid directly through the government. American and EU officials have made clear the quake won't change that.
Emergency workers say delays could cost lives, as local rescue crews struggle to pull families and children from the rubble and find housing for survivors amid brutal winter weather.
A key issue complicating the dispersal of aid is "the war and the way the aid response is split between rebel areas and Damascus," said Aron Lund, a fellow with New York-based think tank Century International who researches Syria.
While the majority of Syria is under the control of the government in Damascus, most of the north is controlled by different -- and sometimes conflicting -- groups. The northwest is divided between land de facto controlled by Turkey and by Hayat Tahrir al-Sham, a rebel group with ties to al-Qaida. Syria's northeast is mostly held by U.S.-backed Kurdish-led groups.
Foreign aid for years has been brought into northwestern Idlib province by way of Turkey, because of the difficulty of going by way of Damascus. But the area of southern Turkey traditionally used as a staging area has itself been heavily damaged by the earthquake.
Aid delivery into northwestern Syria was "temporarily disrupted" Tuesday, a United Nations spokesperson told The Associated Press, due to infrastructure damage and difficulty with road access.
In particular, damage to the Hatay airport and the road to the border crossing used for aid, Bab al-Hawa, was delaying shipments, said Emma Beals, a nonresident fellow at the Washington-based Middle East Institute.
"There is also the fact that there are enormous needs in Turkey itself," she said.
One cause for hold-ups is that the U.N. mandate for delivering aid to the territory only allows it to enter through Bab al-Hawa crossing, Beals said. Also, international search teams may be reluctant to enter earthquake-affected areas controlled by HTS, which is designated as a terrorist organization by the U.S.
The group's "presence limits the kinds of aid many donors are prepared to supply to the area," she said.
The government in Damascus and its allies in Russia have seized the moment to renew their push for aid to the north to be routed through Damascus. Countries opposed to Assad do not trust the Syrian authorities to effectively deliver aid to opposition areas and worry it would be diverted to benefit people and institutions linked to the government.
Natasha Hall, a senior fellow at the Washington-based Center for Strategic and International Studies, said sending aid via Damascus to the north is not viable in practice, especially at a time of urgent need.
"It is extremely logistically and administratively difficult to get the approvals (from Damascus)," she said. Coordination of aid is also hampered "because the government of Syria doesn't recognize the non-governmental organizations working in northwest Syria."
At a press conference Tuesday in Damascus, Syrian Arab Red Crescent head Khaled Hboubati said his group is "ready to deliver relief aid to all regions of Syria, including areas not under government control." He called for the European Union to lift its sanctions on Syria in light of the massive destruction caused by the earthquake.
Aid convoys and rescuers from several countries, notably key ally Russia, as well as the United Arab Emirates, Iraq, Iran, and Algeria, have landed in airports in government-held Syria.
Still, the sanctions exacerbate the "difficult humanitarian situation," Hboubati said.
"There is no fuel even to send (aid and rescue) convoys, and this is because of the blockade and sanctions," he said.
So far, the U.S. and its allies have resisted attempts at creating a political opening by way of the disaster response. U.S. State Department spokesman Ned Price told reporters Monday that it would be "ironic, if not even counterproductive, for us to reach out to a government that has brutalized its people over the course of a dozen years now."
Price said the U.S. would continue to provide aid through "humanitarian partners on the ground."
Similarly, a spokesperson for the United Kingdom's Foreign, Commonwealth & Development Office said the "sanctions regime was put in place in response to human rights violations and other abuses by the regime and their cronies."
A U.S. State Department spokesperson said humanitarian assistance in government-held areas go through partner organizations instead of the government.
"Our partners in regime-controlled areas directly deliver assistance to beneficiaries without control or direction from the Assad regime," they told AP. "This is to ensure that our assistance is not diverted by malign actors or the Assad regime and reaches the intended beneficiaries."
One of the main groups supported by the United States and Britain is a civil defense organization in opposition-held areas known as the White Helmets; USAID Administrator Samantha Power spoke with the group's head Tuesday and "discussed how USAID can provide the most urgently needed assistance in response to the earthquake," her office said in a statement.
The European Union has provided aid in all parts of Syria through U.N. and NGO partners and is trying to increase funding for humanitarian support, said European Commission spokesperson Balazs Ujvari. He said the Syrian government has not yet formally requested Europe send rescue and medical workers.
In theory, aid operations in government areas should not be blocked by sanctions, since both the U.S. and EU have exemptions for humanitarian aid.
But the reality on the ground is sometimes different. For example, Lund said, banks might block transfers to pay suppliers or local workers for aid organizations for fear of running afoul of sanctions, despite the exemptions.
Also, U.S. sanctions and to some extent EU ones try to prevent rebuilding of damaged infrastructure and property in government-held areas in the absence of a political solution, which could hamper post-earthquake recovery, Lund said.
Meanwhile, in both parts of Syria, local emergency workers say only limited aid is reaching them.
"There are promises that aid will get to us but nothing has gotten here yet," said the White Helmets' head Raed Saleh.
