As the Syrian conflict enters its fourth year, the U.N. estimates that 9.3 million Syrians are in need of urgent humanitarian aid, nearly half of them children. More than 3 million live in besieged areas that are all but impossible for aid agencies to reach. But despite outcry from international organizations like the U.N. and Oxfam, humanitarian appeals for Syria and the region remain severely underfunded.

Aid groups working in Syria and in Turkey, Lebanon and Jordan, the neighboring countries hosting the bulk of Syria’s refugees, say they have received only 28 percent of the $6.5 billion needed for 2014, and still require $4.7 billion.

The dearth of funds from international donors has led the U.N. to revise its two largest plans for 2014 – the Syria Humanitarian Assistance Response Plan (SHARP), serving IDPs, and the Syria Regional Response Plan (RRP), serving those outside – several times.

The RRP for 2014 is one of the largest appeals ever presented for a refugee emergency. The organization says it has only received 30 percent of the $4.2 billion it has requested in order to meet the basic needs of what some say will be 4.1 million Syrian refugees by the end of the year.

Here, Cassandra Nelson, a director at Mercy Corps; Andy Baker, regional program manager, Syria Crisis at Oxfam; and Juliette Touma, regional spokeswoman at Unicef discuss the difficulties in prioritizing aid allocation while battling donor fatigue.

Syria Deeply: How short is your funding for Syria aid?

Cassandra Nelson: The civilian needs inside Syria are staggering and far outstrip the funding available. Mercy Corps and our colleague NGOs working inside Syria have the capacity to quickly scale up to address unmet needs, if provided additional funding.

Furthermore, large need remains in funding the emergency refugee response. An estimated 2.8 million Syrian refugees have fled to neighboring countries to escape the conflict. We are halfway through the year and the joint U.N. and NGO funding appeal – RRP – is only 30 percent funded. This appeal funds both short-term and long-term responses for refugees, and both are woefully underfunded.

Juliette Touma: We are very, very short of money throughout the region in terms of our response to the needs of Syrian children. We have a 70 percent gap in funding. That means we still need $582 million to [deliver] lifesaving supplies in the areas of water sanitation and hygiene, improve health and nutrition (including vaccines against polio and mumps and rubella), increase the number of children enrolled in schools and provide psychological support. In total for the whole region, we’re still 70 percent underfunded.

Currently the least funded [of our Syrian aid operations] is the area of water sanitation and hygiene. By June 30, we need to receive $58 million [from international donors], which would help provide clean water inside Syria.

Andy Baker: We are seeing donor fatigue. Governments are facing their own budget cuts, a lack of appetite for humanitarian response and difficulty having a continued sense of generosity, in particular when it comes to protracted situations like Syria.

We have set a three-year program with a three-year budget for Jordan, Lebanon and Syria. Our budget is $132 million and we’ve secured funding for $73 million so far, a shortfall of $58 million. Across the board we have the capacity to absorb more money and expand operations, if we could find the aid.

Syria Deeply: What are the most immediate needs?

Touma: We focus on the number of children in need: that is currently more than 5.6 million children. Inside Syria it’s 4.3 million, and that means these are the kids internally displaced and also those living under siege and in the line of fire where heavy violence is taking place.

Inside Syria, we focus first on reaching children in the most need – children who haven’t been reached [by aid] for a while. Our focus now is what we call “reaching the under-reached” children who are living in areas under siege. More than 1 million children live in areas under siege or where there’s heavy violence.

In addition to that we have 1.4 million refugee children in neighboring countries, mainly in Lebanon, then Turkey, Jordan, Iraq and Egypt. So our assistance delivery is at the regional level, but with a primary focus inside Syria, which is where the children with [the most] needs are.

For the past few months, our priority has been to reach children with polio vaccines. Polio’s re-emergence after 14 years has created an emergency within an emergency. Now that it has returned to Syria, we have to respond rapidly and widely.

Nelson: Top priorities for us are food, shelter and water and sanitation. Given funding constraints, even within those key sectors, Mercy Corps targets the most vulnerable among the internally displaced, refugees, host communities and others impacted by the conflict. Mercy Corps is particularly focused on strategies to ensure that adolescents are not falling between the cracks.

Baker: There is a difference between what we need to prioritize as Oxfam and what program donors are willing to support. In terms of short-term aid, our key goal is to provide basic aid to displaced people. The priorities there are around public health: water and sanitation, food and livelihood and provision of medical care so people can survive.

We are heading into summer and a drought is forecast for Jordan, Syria and Lebanon, so we will face challenges for host communities and displaced people to access clean water and safe hygiene practices. Oxfam is working together with Unicef to develop a pipe water system for Zaatari camp.

The other area we focus on is refugee protection: how we empower refugees to live safely and uphold their rights when they’ve been displaced for long periods of time. The third area is livelihood: how we can give refugees the money they need to feed themselves and pay their rent, medical bills and any priorities their families might have. The long-term aid goals are much harder to predict. We’ve seen extraordinary devastation inside Syria to buildings, infrastructure and cities. It is very hard to quantify the degree of destruction and needs in order to rebuild Syria when peace comes.

Syria Deeply: When dealing with such a large-scale shortage of donor funds, how do you balance and prioritize long-term versus short-term needs?

Nelson: Short-term programs alone cannot adequately address the needs of the Syrian crisis. Short-term programs do not allow for comprehensive responses to complex needs. Lurching from one short-term plan to the next significantly undermines efficiency.

Funding for programs with a longer term vision is particularly important in the refugee response. Donors and programs need to shift away from “siloed” approaches in which short-term humanitarian responses and three- to five-year development programs are kept separate.

Instead, we must implement a holistic strategy that bridges relief and development needs, and shores up the ability of front-line host communities to withstand and respond to the challenges of a protracted crisis; and enables donors and implementers like Mercy Corps to efficiently marshal limited resources in response to growing, long-term needs, particularly in refugee hosting countries. This holistic strategy should also be closely aligned with the national plans put forward by refugee hosting countries – including Jordan’s National Resilience Plan and Lebanon’s Stabilization and Recovery Program.

Baker: People are trying to look beyond the humanitarian response to more long-term and sustainable approaches and projects, which is completely reasonable. But there are still refugees crossing borders, so we need to find a way to keep the message going about the ongoing urgency of the humanitarian crisis.

From a donor perspective, it has been most challenging to raise money for cash-transfer programs. When speaking to beneficiary communities outside the camps, people are asking for cash programs where NGOs give grants for money to help refugees pay rent and decide their own priorities. Cash transfer programs are expensive and can absorb large sums of money very quickly and donors and host countries are reluctant to provide funds for this type of aid.

There is also no sign of this conflict coming to an end, so we have to recognize the generosity of the host nations who probably don’t feel they are sufficiently supported by the international community in terms of other countries offering resettlement and aid to refugees. The number of other countries opening up their doors and offering donor support is very low.

Syria Deeply: What’s the way forward?

Nelson: Donors need to prioritize programs that build the resilience of refugees and host communities, with special focus on adolescents and conflict mitigation. More than 1.5 million adolescents have been affected by the conflict: boys and girls on the brink of adulthood who are facing uncertain futures because of the shocks and stresses of war, educational disadvantages, exposure to violence and discrimination.

Donors need to increase funding for programs targeting adolescent refugees and their peers from host communities to address their unique psychosocial and developmental needs, including through programs that promote tolerance, build employability – along with economic opportunities – and conflict management skills, and strengthen young people’s community engagement through involvement in quick-impact community projects.

To help these adolescents and meet other long-term needs, it is imperative that the donor community shift gears and develop an integrated strategy that moves beyond the basic provision of humanitarian assistance.