GENEVA — The humanitarian situation is dire for millions of Syrian civilians – especially children – and is likely to deteriorate further unless the warring sides in the three-year conflict allow aid organizations unhindered access to besieged and difficult-to-reach areas, the United Nations children’s agency warned Tuesday.

It was the fourth report this month to provide a grim assessment of efforts to help what the U.N. estimates are 9.3 million Syrians in urgent need of humanitarian aid. One-third of those, 3.3 million people, are in hard-to-reach areas because of fighting, including more than 200,000 trapped in areas besieged by government or armed rebel groups.

Senior humanitarian officials told McClatchy that the assessments show that a U.N. Security Council resolution adopted Feb. 22, which called for all sides in the conflict to allow unhindered access for humanitarian assistance, had largely failed.

“After three years of conflict and turmoil, Syria is now one of the most dangerous places on Earth to be a child,” concludes the report by UNICEF.

“Syria’s social fabric is being systematically torn apart,” the report said, adding that 3 million buildings have been destroyed along with much of the country’s critical infrastructure.

The UNICEF report highlights that child casualty rates “are the highest recorded in any recent conflict in the region.” It notes that the U.N. “conservatively estimates that at least 10,000 children have been killed. The real number is likely to be even higher.”

Overall, the conflict is estimated to have claimed the lives of more than 130,000 people. Of those, two-thirds are combatants, according to the Syrian Observatory for Human Rights.

“Since March 2013, the number of children affected by the crisis has more than doubled from 2.3 million to more than 5.5 million,” the UNICEF report said.

The number of children forced from their homes who remain inside the nation has more than tripled, to almost 3 million from 920,000 a year ago, the report said, and the number of children who have fled the country has more than quadrupled, to 1.2 million from 260,000.

In other reports, blame for the situation has fallen on both sides in the conflict.

A report by the Independent Commission of Inquiry on Syria, published March 3, accused the government and its militia supporters of “instrumentalizing basic human needs for water, food, shelter and medical care, as part of its military strategy,” by cutting off access to towns.

Similarly, rebel groups have encircled other towns, the commission said.

“The absolute impunity that pervades the conflict, now entering its fourth year, is utterly unacceptable,” said the chairman of the commission, Paulo Sergio Pinheiro.

A report released Monday by Amnesty International said that nearly 200 people have died in Yarmouk since the siege was tightened there in July 2013. Of those, 128 starved to death.

On a brighter note, the World Food Program reported Monday that in the past few weeks it had succeeded in delivering food for 40,000 people.

Amir Abdulla, the program’s deputy executive director, said the one-time deliveries can provide only temporary relief, and that the organization needs to be able to deliver food regularly to improve the situation.

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