DAMASCUS, Syria â Some five million Syrians are now refugees in their own country, many living hand-to-mouth in vacant buildings, schools, mosques, parks and the cramped homes of relatives. Others are trapped in neighborhoods isolated by military blockades, beyond the reach of aid groups. Already desperately short of food and medicine as winter closes in, they could begin to succumb in greater numbers to hunger and exposure, aid workers say.  The long civil war has forced two million Syrians outside the countryâs borders, but more than twice that number face mounting privations at home, and the toll keeps rising. The deepening humanitarian crisis threatens to set the countryâs development back decades and dwarfs any aid effort that could conceivably be carried out while the conflict continues, aid workers and analysts say.  The cost of replacing damaged homes and infrastructure alone is estimated at more than $30 billion, and the ruin mounts daily. More than half of the countryâs hospitals are destroyed or closed, and according to Save the Children a fifth of Syrian families go without food one week a month. Syriaâs economy has shrunk by half.  Even in relatively safe areas, a closer look at bustling streets reveals the displaced spilling from every corner. Thousands of people live in the gyms and hallways of a sports complex turned state-run shelter in the coastal city of Latakia. In the capital, Damascus, newcomers crowd ramshackle hotels, half-finished buildings, offices and storefronts. Long lines form outside the shrinking number of government bakeries still operating. In some of the suburbs, people have confessed to eating dogs and cats, and imams have even issued decrees saying it is religiously permissible.  Outside the Umayyad Mosque in the heart of old Damascus, Nasreen, 25, cradled her baby in her lap one recent evening. She and her siblings, husband and parents, who declined to give their family name for fear of reprisals, were cramped into a single room nearby, having fled the suburb of Daraya after their home was damaged.  With rising rent depleting their savings, and the shop they relied on for income now sealed off behind a government blockade, they accept occasional handouts from neighborhood organizations. But what weighs on them most are thoughts of the future: They said they could not imagine when or how they might return to a hometown where entire blocks have been bombed to rubble.  âWe have only God,â she said.  Even those still in their homes are increasingly suffering as inflation soars and food shortages grow, especially in areas blockaded by the government or rebels. Many are angry and mystified that more help has not reached them from the outside world.  âIt is as if we are living on Jupiter or Mars,â said Qusai Zakarya, a spokesman for an opposition council in Moadhamiya, south of Damascus, where the government has not allowed aid convoys to enter for nine months. âEveryone is looking at us from the window and we are in a separate world. Everyone left us alone, every single person on this planet.â  In a news conference in Kuwait on Thursday, the Turkish foreign minister, Ahmet Davutoglu, said that Turkey, which has absorbed 600,000 Syrian refugees, would keep its border with Syria open, but he also expressed his âdeep disappointment and frustration because of the absence of a proper reaction by the international communityâ to the humanitarian crisis.  A $1.5 billion international aid effort, carried out under dangerous and politically charged conditions by the United Nations, the Syrian Arab Red Crescent and smaller local organizations, provides stopgap food, schooling and medicine to millions of people. But it is underfinanced, covers just a fraction of the needs, fails to reach people in blockaded areas and does not begin to address the collapse of Syriaâs health, education and economic infrastructure and its devastating implications for the countryâs future, aid officials in Syria and across the region say.  âIf we continue to deal with this crisis as a short-term disaster instead of a long-term effort, the region will face even more severe consequences,â Neal Keny-Guyer, the chief executive of Mercy Corps, wrote recently, calling for increased American financing and a new focus on longer-term development projects, like repairing water infrastructure.  Some go further, saying that the only meaningful humanitarian action now is to end the fighting.
With millions displaced inside the country and an estimated $30 billion in infrastructure damage, the humanitarian crisis dwarfs any conceivable aid effort and could set Syriaâs development back decades.