A decade after Syria’s conflict flared up, families struggle more than ever to buy food while ambulances lack fuel to bring injured people and COVID-19 patients to hospital, Red Cross and Red Crescent officials reported on Thursday.

“Syria is in a deadly spiral of warfare, economic downturn, pandemic and sanctions,” International Committee of the Red Cross (ICRC) President Peter Maurer told a news conference. “Nearly three-quarters of the population now need humanitarian assistance, a surge of 20% compared to 12 months ago.”

UN figures reveal that 13.4 million rely on aid in Syria out of the country’s current population of around 18 million.

Syria has seen a sharp rise in coronavirus cases since mid-February but lockdown options remain limited due to the country’s dire economic situation, a member of the country’s COVID-19 advisory committee said in Damascus on Thursday.

Western sanctions on the government of Syrian President Bashar al-Assad also impeded imports of medical equipment and medicines, said Khaled Hboubati, President of the Syrian Arab Red Crescent.

“The lack of fuel means that there are no ambulances to bring patients to hospital,” said Francesco Rocca, President of the International Federation of Red Cross and Red Crescent Societies. “Without power it is impossible to safely store blood or, one day, the vaccines.”

Maurer said ICRC officials continue to visit people held in Syria’s central prisons but had no access to unofficial detention centers on all sides.

Prisoner exchanges, clarifying the fate of tens of thousands of missing and identification of dead bodies were vital preconditions for meaningful talks to end the war, he said and needed to be done urgently.