The UN Security Council is set to begin debating the renewal of a key mechanism for delivering aid to Syria on Monday. With a deadline looming, Russia holding veto power, and the Ukraine war complicating diplomacy and worsening the plight of Syrian civilians, humanitarians are understandably nervous.

Since 2014, the UN has only been able to bring assistance from Turkey into rebel-held northwest Syria (which includes Idlib province and its surroundings) without the permission of President Bashar al-Assad because of UN Security Council Resolution 2585.

For years, al-Assad ally Russia has warned that it wants to get rid of the resolution, which would effectively strip UN agencies of access to the one border crossing it can use to enter the northwest. The mechanism – set to expire on July 10 – has already been haggled over, extended and changed over time.

Although media attention has drifted off to other emergencies and fighting in Syria has slowed, Syria’s humanitarian crisis is in many ways more severe than at any point since the start of the war in 2011. Food prices are up (in part due to the conflict in Ukraine) and money is worth less.

Many people sheltering in Idlib have been forced to flee from homes elsewhere in the country and are now living in desperate circumstances.

The UN insists that an end to the crossborder operation, which it says provides “food, vaccines and other vital aid” to 2.4 million people each month, would be catastrophic. UN Secretary-General António Guterres has called renewal a “moral and humanitarian imperative”, and the heads of seven UN agencies recently warned of “dire humanitarian consequences” if access is cut off.

The end of direct access from Turkey, the agencies say, would “immediately disrupt the UN’s lifesaving aid operation, plunging people in northwest Syria into deeper misery and threatening their access to the food, medical care, clean water, shelter and protection from gender-based violence currently offered by UN-backed operations”.

But what happens in the Security Council is not up to the humanitarians. Internal Russian politics, Moscow’s relationship with al-Assad and Turkey, and the ongoing war in Ukraine will all play a role in the complex negotiations to come.

The humanitarian situation in Syria, and the northwest in particular, is dire: Since late 2019, the Syrian economy has been crumbling, for reasons that include a banking crisis in Lebanon, Covid-19, and US sanctions. Millions of Syrians can no longer afford enough food or other necessities.

The UN’s World Food Programme reports that food prices in Syria rose by 800 percent between 2020 and 2022.

Russia’s February 24 invasion of Ukraine has added to the problem, sending wheat prices to record levels even as Western governments divert aid money toward refugees in Europe.

The cost of a WFP food basket jumped 37 per cent between February and April 2022, and in May the agency said it was forced to reduce the size of food rations in northwestern Syria due to insufficient funding.

If the cross-border operation ends, UN agencies like the WFP will need permission from al-Assad’s government to access rebel-held territory. The regime has routinely rejected or delayed requests like these in the past.

Established aid operations on Turkish soil would have to instead leave from Damascus, forcing convoys to travel longer distances across active front lines. Some of these convoys are already happening, but only at low levels: Since August 2021, no more than five aid convoys have reached northwestern Syria from Damascus, totalling 70 truckloads of aid. In contrast, more than 800 aid trucks entered Syria from Turkey in 2021. UN officials say similar volumes will be delivered this year.

A large proportion of aid to Idlib comes from non-UN organisations, like the Turkish Red Crescent and Western-funded NGOs. If the UN is forced to stop its operations in the northwest, they would likely keep working in the region, in defiance of Damascus. But some may not be willing to risk it, and other NGOs say that without the UN they would see a drop in their capacity and the number of people they can reach.

That’s because although the UN is not the only aid actor in northern Syria, it is the largest one, and it plays a central role in supporting the operations of other NGOs. UN agencies plan, fund and coordinate NGO activities; they arrange bulk procurement and logistics; and they handle high-stakes diplomatic, legal and political issues that are beyond the scope of individual NGOs.

The UN’s cross-border operation also provides a certain degree of political and legal cover, so an end to its work would mean that operating through Damascus would become politically impossible for some NGOs now based in Turkey, and unsafe for many local Syrian aid workers in the northwest.

After years of Russian threats to end the UN’s permission to deliver aid across Syria’s borders, aid groups have had time to investigate alternative strategies. Little has been made public about any contingency planning, but it appears to include scaled-up NGO operations, pre-positioning resources inside Syria, and discussing ways to “offshore” UN involvement so that UN officials will be able to offer remote support for an NGO-run cross-border operation without actually entering Syria.

“The reality is that it would simply create more operational impediments to reaching a population that has already endured more than 11 years of crisis.”

But no matter what workarounds may be found, aid officials say that the loss of a direct UN role would be devastating for millions of Syrian civilians.

“Due to the scale of the UN cross-border operation it will be impossible for it to be replaced by either an NGO-led response or by cross-line operations alone without there being a massive humanitarian impact,” Tanya Evans, the International Rescue Committee’s Syria country director, says.

“The reality is that it would simply create more operational impediments to reaching a population that has already endured more than 11 years of crisis,” said Amany Qaddour, the regional director for Syria Relief and Development, warning that the situation in Syria “is already rife with hopelessness and despair”.

• The New Humanitarian report