How do you send a package to someone you don’t know, who has no address in an area with no government infrastructure and no means of modern communication? What if that address is in the center of an intractable conflict? How do you start to solve this problem? That’s the challenge Direct Relief faces every day, working to get medical aid to those displaced by conflict and need it the most.

The hardest to reach people are often the most in need. Armed conflict, ­and the complex political, socioeconomic and geographical factors that characterize conflict zones, not only produce human suffering but also militate against humanitarian aid. What’s more, as people flee the fighting and populations disperse, humanitarian crises can escalate quickly across vast geographies – both within the country, where families survive as internally displaced people (IDPs), and across borders, where they seek safety and security as refugees.

The resulting challenge for aid agencies is to negotiate the various barriers to delivering aid to those in need. These can include inaccessible ports, roads and bridges, checkpoints, and no-go areas. Such physical obstacles often are coupled with administrative hurdles and a limited capacity to store and transport supplies securely. Direct threats to personnel, drivers and those receiving aid also factor into the difficulty of getting assistance to areas of need.

The ongoing civil conflicts in Afghanistan, Yemen and Syria have created the biggest flow of refugees and one of the greatest humanitarian crises since World War II. The scale of the crisis is hard to fathom and is occurring simultaneously across multiple countries with common and discrete local characteristics.

Afghanistan: The United Nations estimates that nearly one-third of Afghanistan’s population will need aid in 2017. Recognizing the ongoing need, Direct Relief has sent nine shipments of medical aid to Afshar Hospital in southwest Kabul since July 2016, allowing the hospital to carry on their life-saving work in underserved communities. The latest shipment, which arrived Dec. 15, 2016, journeyed almost 8,000 miles through some of the world’s most treacherous territory.

The shipment, which was sent from Direct Relief’s Goleta warehouse, wound its way through the rugged Khyber Pass before crossing the Torkham border from Pakistan into Afghanistan. The shipment took over three months to get to Kabul, primarily because the country’s board of pharmacy was disbanded, and newly appointed officers instituted different importation rules.

The delays added on to the shipment time, but Direct Relief met the criteria, and the shipment of surgical supplies, antibiotics, syringe needles, gauze, bandages and other items arrived at Afshar Hospital.

Syria: With civilians under constant siege, area hospitals in and around Aleppo have also been under attack. Several of these hospitals were destroyed while awaiting shipments from Direct Relief. With doctors and nurses administering care wherever they can, a follow-up shipment from Direct Relief will provide emergency medicine and supplies to treat patients, as well as three medical tents to serve as makeshift hospitals.  Five solar suitcases, which will provide power for the tents, are also en route from Turkey.

Direct Relief also works wherever it can around the edges of the conflict. One example is the Jordanian government, which is supporting more than 1 million Syrian refugees. Donations of medical supplies and medicines from Direct Relief are also enabling medical groups in Turkey and Greece to care for refugees.

Yemen: A similar shipment is on its way to Yemen, which has been in humanitarian crisis since 2015, with children particularly impacted. Direct Relief has shipped medical tents, an emergency health kit and solar suitcases to the country by way of neighboring Djibouti. Yemen’s airport remains closed, leaving sea transport as one of the only options to get aid into the country.

In each place, Direct Relief pursues the same goal of delivering medical aid to refugees who have been forced to flee their country and to those displaced within their country’s borders. To make this possible, creativity and the continual search for excellent partner groups on the ground is key.

Getting aid to those in need in conflict zones is perhaps the hardest challenge faced by Direct Relief. As conflict erupts, access to food, shelter, water and health care is threatened. As people are displaced by fighting, the needs expand even more. It’s not always possible, but often – and always in partnership with local groups – medicine makes it to the people who need it.