DUBAI — International aid has poured into Turkey and parts of Syria following last week's earthquakes, which have killed more than 43,000 people. The quakes destroyed thousands of buildings, tearing apart families and communities across 19,300 square miles of land.

Aid agencies are working to help millions of people with food, tents, warm winter clothing, blankets, mattresses, medical supplies and mental health support. There's concern, though, that needs arising from other crises, like the war in Ukraine and Syria's own protracted civil war, could affect that assistance over time.

Donor fatigue for the conflict in Syria had set in well before this month's earthquakes. Not even half the $328 million goal set by the U.N. Children's Fund's annual appeal for Syria had been met by then.

Carla Haddad Mardini, director of UNICEF's private fundraising and partnerships, tells NPR Syria had lost the attention of the world, as have many other underfunded crises. She was speaking at the World Government Summit in Dubai, an annual forum of political and thought leaders.

Donor support is critical for UNICEF to continue its work of reuniting unaccompanied children with relatives, Mardini says, and distributing sanitation services and safe drinking water to people to avert the spread of diseases in quake-stricken areas.

"We know the needs are immense across the board, but it's essential for their support to reach us as quickly as possible so that we can bring the aid where it's needed most," she says.

Aid groups are trying to marshal the current outpouring of support into greater pledges of aid for Syrians while attention is still on the earthquakes, but the road to recovery will be long and uncertain.

The hard part is still to come

The U.N. is appealing for nearly $1.4 billion to help survivors in Turkey and Syria — $1 billion to help more than 5 million people in Turkey and $397 million for northwestern Syria, a territory devastated by civil war and divided between opposition and government control.

Mike Ryan, director of the World Health Organization's emergencies program, says more will be needed.

"We have to deal with the aftermath of this crisis, which is going to be months and months of work. To help those who've been injured, people with amputations, people with psychological stress, ruined hospitals, collapsed schools," he says. "This is the hard part."

He too spoke with NPR at the World Government Summit in Dubai. He'd just returned to the United Arab Emirates from Syria, where the WHO is delivering tons of medical supplies such as amputation equipment, intravenous fluids and medicine.

The World Health Organization estimates that 200,000 people are now homeless in government-controlled Aleppo, where the distribution of international aid is controlled by the regime of Bashar Assad.

Assistance to some 4.6 million Syrians living in the rebel-held northwest has been slower than in government-controlled areas. It took nearly five days for the first U.N. aid to arrive, due to restricted access.

"Unspeakable heartache" for those devastated by the quakes

More than 9 million were affected by the earthquakes in Turkey, home to the largest number of refugees in the world. The U.N. says 1.74 million refugees, many of whom are Syrian, lived in the 11 Turkish provinces hit by the earthquakes.

"Many families have been separated, with hundreds of children now orphaned or unable to be reunited with their parents," the U.N. has said.

The U.N.'s humanitarian relief coordinator, Martin Griffiths, visited areas affected by the earthquakes and described situations of "unspeakable heartache."

A Syrian resident of Turkey, with millions of followers on social media, shared his tear-filled video in Arabic detailing psychological trauma among Syrian survivors.

Omar Abu Lebda described visiting Antakya and meeting a 13-year-old boy who'd survived three days under the rubble. He'd suffered a leg injury and was now living in a car with his younger sister and father. Another sister and his mother had died in the earthquakes.

Abu Lebda also described seeing a Syrian man abruptly getting off a bus after insisting he'd heard his two children calling for him from under the rubble of his home.

The U.S. has loosened some sanctions to help aid flow, but its overall Syria policy remains unchanged

So dire is the situation that the U.S. has softened its sanctions against Syria for three months to ensure that earthquake relief efforts are not hampered by those restrictions. Despite preexisting exemptions on humanitarian assistance, fear of running afoul of sanctions might have affected the delivery of much-needed aid.

Amid mounting international pressure, Syria's government, which is backed by Russia, announced a three-month opening of humanitarian aid crossings into the rebel-held northwest, allowing for additional aid routes into the devastated enclave. Millions of displaced Syrians there were dependent on U.N. aid even before the earthquakes.

The Washington Institute for Near East Policy's Andrew Tabler, who was once director for Syria on the National Security Council, said in a brief that the U.S., Britain, the European Union and Canada provide just over 90% of the annual $2.38 billion of humanitarian aid for Syria.

He said the U.S. should formulate a new approach, "placing greater priority on Syria policy" in the aftermath of the earthquakes.

Meanwhile, the U.N. refugee agency says it closed last year with only 56% of its funding needs met, leaving a $4.7 billion budget shortfall. The agency, which assists millions of Syrian refugees, says to date it has received just 15% of its global funding requirements for 2023 — a budget that's yet to factor in the impact of the earthquakes.

Copyright 2023 NPR. To see more, visit https://www.npr.org.

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