International media attention has once again turned to Syria in recent weeks as Islamic State (IS) drove yet another minority community from their homes – this time it was the Assyrians in the north east of the country. But this is just one part of a brutal conflict which will enter its fifth year this weekend. As aid agencies seek to battle the staggering consequences, the fear is that the world will forget the war in Syria.

The conflict, which began with civil unrest protesting against President Assad's government on 15 March 2011, has killed more than 200,000 people, wounded a million, and caused a refugee crisis described by the UN as the "worst humanitarian crisis of our time". Nearly 4 million people have fled to neighbouring countries, including Turkey, Lebanon, Jordan and Iraq and another 7.8 million have been internally displaced, often more than once since the start of the war.

In total, more than half the population have had to leave their homes. This inevitably has a huge knock-on effect on health and children's education, adding to the trauma people have already experienced.

Inside Syria

Syrian civilians have spent the past four years caught in the crossfire between government forces and a number of rebel groups. The loyalties of these groups, and the territory they control, has changed over time, but IS now controls about a third of Syria (much of the north), with Kurdish forces also in the north. Other rebel groups and the Syrian armed forces control territory in much of the south and west.

Mark Ohanian, director of programs at the International Orthodox Christian Charities (IOCC), one of the few humanitarian organisations working on the ground in Syria, said that whether it is Islamic State, Al-Nusra Front, an Al-Qaeda affiliate also involved in the conflict, or other rebel groups, the brutality meted out on the civilian population is the same.

"ISIS is very good at the media aspect of it," he said, referring to the beheading videos on YouTube. "But what you don't see is the other horrors that are happening every day that may not end up in viral videos."

Aid agencies are concerned by ongoing attacks on civilians by government forces. "The government is still using its air force to bomb civilian populations who happen to be in non-government-held areas, so they are to some extent trapped with bombs coming down on them," said Frances Guy, head of Middle East at Christian Aid.

As well as bombing civilians, the government has prevented humanitarian organisations from delivering aid to certain communities. Yarmouk, a district in Damascus home to a large Palestinian community, has had limited access to food and water, and dozens have died from starvation. And there are other communities that have been similarly targeted.

"What we've seen over the last year is an increasing trend of trying to starve out the civilian population where they are in non-government-held areas," said Guy. "But they may not be there for a political choice, they are there because that's where they live... I think it's hard to imagine the horror of that."

Those displaced within Syria often seek shelter in churches and schools. Ohanian said the Church in Syria, and in the Middle East more generally, is known for its history of providing social services and humanitarian support to people regardless of faith. This was seen again during the recent IS attacks on Assyrian villages along the Khabur River. When the villages were under siege, people ran to the churches for shelter.

About 2,500 people fled on 23 February when IS began their campaign. The attacks began before dawn and many people fled only wearing their pyjamas. The IOCC, through the humanitarian arm of the Orthodox Church, has provided people with bedding, clothing, food and shelter, but this operation, like many other humanitarian efforts, is stretched by the demand.

Fleeing to Lebanon

The neighbouring countries that have accepted refugees are, like the aid agencies, dwarfed by the scale of the crisis. In Lebanon, a country that had a pre-war population of about 4 million, there are now around 1.2 million Syrian refugees.

Ohanian said many of the Christian refugees want to go to Lebanon as they see it as a place that has a strong Christian presence, and where Christians have relatively strong political representation. Although this assurance may not be borne out in reality, Ohanian says it offers them "some peace of mind".

For political reasons, there are no formal refugee camps in Lebanon, although there are people living in tents in informal camps, where it is even more difficult to ensure that people get the aid they need.

Such a large influx of people inevitably puts a strain on the resources of the host nation, particularly on social services. There are thought to be more than 400,000 refugees of school age in Lebanon, of whom perhaps only a quarter are able to get some form of education. Added to this is large proportion of children within Syria whose education has been disrupted by the war.

"Agencies can't cope," said Guy.

"Obviously initially food and shelter is the first priority, but if we're now talking about five years of conflict, five years of 80 per cent of kids not receiving an education. These kids are the future of Syria. What future will there be?"

And as the conflict continues, the only way that refugees can become self-supporting and no longer rely on foreign aid is for them to get jobs, and integrate into the local economy. But this is incredibly problematic – particularly in Lebanon and Jordan where the refugee community now represents about 30 per cent of the population.

The International response

Clearly the burden cannot only rest only on Syria's neighbours. "We have a big responsibility as the international community to do our part," Ohanian said. "I don't think we're doing enough. Many countries are funding the humanitarian effort, but more needs to be done at the political level. We cannot stop the war, it's the politicians and the leaders that need to be doing their part, otherwise we are going to have more and more people registering for assistance and we just can't keep up."

As the fourth anniversary of the conflict approaches, 130 NGOs have launched a new petition with the #WithSyria campaign which, among other things, calls on political leaders to prioritise a political solution that makes human rights a central concern.

The campaign highlights the fact that 83 per cent of the lights in Syria have gone out over the past four years, just one of the many effects of the war on the civilian population.

"Four years since this crisis began, Syria's people have been plunged into the dark: destitute, fearful, and grieving for the friends they have lost and the country they once knew," said David Miliband, president and CEO of the International Rescue Committee, part of the NGO coalition.

"Syrians deserve much better from the international community – it is past time to show that we have not given up and will work with them to turn the lights back on."

To Ohanian, there is also a sense in which the international community needs to make up for lost time, having failed to prevent the spread of organisations such as IS in Syria. "We shouldn't forget that ISIS started in Syria, before it was in our media every day," Ohanian said. "The question is, how did we let it get to his point?... The international community bears a big responsibility for its handling of the situation."

There are as many as 18 groups and foreign governments that have some kind of stake in the Syrian conflict – including those who are involved in US-led military strikes against Islamic State in both Iraq and Syria. Most, if not all, would agree that a political solution is the only way to end the war. But so far that solution has not been forthcoming. The next attempt to get the different parties around the table is due to be held in Moscow in April, although the last talks, also hosted by Russia, ended in stale-mate at the end of January.

Ohanian argues that there is little hope in looking to Syrian opposition forces for a moderate voice. "At the beginning of the crisis there was a moderate opposition," he said, "but within months it was taken over by the extremists. There is no such thing as a moderate opposition any more. By continuing to elevate [the idea of] moderate opposition we are giving ourselves false hope.

"That's not what's going to change the dynamic," he added. "What will, is if all these factions, and their supporters [foreign governments] sit together and talk."

Even President Assad acknowledges that a political solution is the only option. In a recent interview with Foreign Affairs magazine, he said: "All wars anywhere in the world have ended with a political solution, because war itself is not the solution; war is one of the instruments of politics."

An instrument it may be, but one which has had devastating effects on the Syrian population, and much further afield.