Humanitarian access is a key issue as the United Nations tries to get Syrian parties to peace talks tentatively set for Monday. And it's the focus of a pledging conference on February 4 in London, with the leaders of countries including Germany and Iran expected to attend.
Almost five years after Syria's civil war began, the UN says more than 393,000 people are besieged. Food aid reached less than 1 per cent of them last year. About 181,000 are besieged by Syria's Government.
Aid airdrops in Syria are possible to do, the United States Air Force secretary noted last week.
"If we're asked to do it, we have the assets, we have the people, we know how to do airdrops," Deborah Lee James told an audience at the Centre for Strategic and International Studies.
The UN also has the capacity; the World Food Programme has made airdrops to hard-to-reach areas in other countries. And UN Security Council resolutions since 2014 allow for deliveries without the permission of Syria's Government, though their effect on airdrops is not clear.
But while diplomats, aid workers and UN officials say they are exploring all options to reach besieged communities, they say airdrops face deep complications, both political and logistical.
Without permission from Syria's Government for airdrops - something the UN says it does not have - there is the risk of Syria responding with force.
"If we fly aircraft over Syria without the permission of the Syrian Government, then there is a real danger that they will take action against them. And that is not going to help anybody," one Security Council diplomat said.
Valerie Szybala, executive director of the Syria Institute and the author of a report last year on besieged communities, was more blunt: "Anyone who enters Damascus airspace without the consent of the Syrian military and Russia runs a very real risk of being shot down."
For Syrians who see the US-led coalition and Russia carry out airstrikes in Syria and the US drop weapons to Kurdish fighters battling Isis, there is frustration that food and aid isn't being dropped as well.
"When they bombed Isis, did they ask the Government's permission?" said Fadi Hallisso. Hallisso is the head of an aid organisation, Basmeh and Zeitooneh, run by Syrian refugees like himself. "When they want something, they find a way to do it."
While the UN says all sides in the conflict have blocked the delivery of aid, it has repeatedly criticised Syria's Government. The UN secretary-general's latest report on the crisis, dated Thursday and obtained by the Associated Press, says that since the beginning of 2015, just 13 inter-agency convoys have been approved by the Government and completed, out of 113 requested.
Despite the need, the World Food Programme has ruled out doing airdrops in Syria.
"Airdrops require approvals for use of airspace, staff on the ground to organise and distribute and a drop zone that is clear of obstacles. Those conditions are not met in besieged areas of Syria," WFP spokesman Gerald Bourke said in an email.
Some aid groups call airdrops the last resort. "You need people on the ground to ensure everything is getting to the right place," said Noah Gottschalk, Oxfam's senior policy adviser for humanitarian response.
After Russia dropped supplies into Deir el-Zour, activists said Government security forces collected them to sell at the market.
Airdropping "lets governments have an easy quick win", said Frances Charles, advocacy director for World Vision's Syria efforts. It doesn't mean sustained access, and it draws away energy that should be spent on getting sieges lifted, she says.
But in a sign of how dire access remains in Syria, some aid workers are looking into the logistics of airdrops, just in case.
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