The ongoing conflict in Syria has created a serious humanitarian challenge. Syrians, as well as Palestinian and Iraqi refugees residing in Syria, have become increasingly vulnerable due to high levels of violence and insecurity, causing many to experience multiple displacements. As of May 2016, the UN reported that more than 4.8 million Syrians had fled the country and registered as refugees, 6.5 million people were internally displaced, and 13.5 million people inside Syria were in need of humanitarian assistance. In addition, millions of people inside Syria remain trapped in besieged and other hard-to-reach areas of the country where delivery of humanitarian assistance, including food, is rare or nonexistent. According to the UN, the number of people in need of humanitarian assistance inside Syria has risen steadily since 2012, as shown in figure 1. U.S. funding obligated in support of humanitarian assistance for people affected by the conflict in Syria began in fiscal year 2012 and totaled just over $5 billion, as of February 2016, as shown in figure 2. Approximately half of obligated funding for humanitarian assistance for people affected by the Syrian conflict from fiscal year 2012 through fiscal year 2015 was provided to people inside Syria, while the other half was provided to support the more than 4.8 million people who have fled as refugees to neighboring countries. The U.S. agencies and offices providing humanitarian assistance to people affected by the Syrian conflict include USAID’s Office of U.S. Foreign Disaster Assistance (OFDA) and Office of Food for Peace (FFP), and State’s Bureau of Population, Refugees, and Migration (PRM). From fiscal year 2012 through fiscal year 2015, USAID has obligated a majority of funding toward the response inside Syria—$1.7 billion for assistance inside Syria, and $694 million for assistance in the region. State has focused more on assistance to Syrian refugees in the region, providing $1.6 billion for refugees in the region and $547 million for assistance to people inside Syria, as reflected in figure 3. The United States and the international community provide funding for a range of humanitarian assistance inside Syria. In general, food, shelter, nonfood items, health and nutrition, and water, sanitation and hygiene are among the main types of humanitarian assistance provided inside the country, reflecting the most acute needs. According to USAID, as of February 2016, U.S. government assistance was reaching 4 million people inside Syria per month. Figure 4 illustrates the relative amounts of the main types of assistance provided. Inside Syria, USAID provides funds to UN organizations and also works through nongovernmental organizations (NGO), while State works through three main partners—two UN organizations and one public international organization. Humanitarian assistance provided by the United States in response to the conflict in Syria is part of a broader international response. Since 2013, the United States has consistently led global funding efforts. For instance, the United States provided more than a quarter of the total international funding for the 2015 Syria humanitarian response. Figure 5 shows the top ten international donors to this effort in 2015. In February 2012, the U.S. embassy in Syria suspended operations because of concerns over staff safety due to escalating violence. Since then, the U.S. government has coordinated Syria-related activities— including nonlethal assistance, political transition assistance, and provision of humanitarian assistance—remotely from locations in Jordan and Turkey through two interagency teams. The Southern Syria Assistance Platform, based in the U.S. embassy in Jordan, and the Syria Transition Assistance Response Team, based in the U.S. embassy and 3 other locations in Turkey, coordinate between themselves and with other State and USAID representatives, U.S. embassies, the Department of Defense, the governments of Jordan and Turkey, and other regional and international entities. Along with the Southern Syria Assistance Platform and the Syria Transition Assistance Response Team, State officials and USAID Disaster Assistance Response Teams manage humanitarian programs for Syria in partnership with UN agencies, international NGOs, and national organizations. Humanitarian assistance operations on the ground inside Syria are heavily influenced by the ongoing conflict, which began in March 2011 when demonstrations turned into protests against the government of Bashar al-Assad. Over the past 5 years, the conflict has grown more complex as the number of participating armed actors has proliferated; they now include the Syrian government, non-state opposition groups, the Islamic State of Iraq and Syria (ISIS), and the al-Nusrah Front. In addition, a number of other countries, including Russia, Saudi Arabia, and Iran, have strategic interests in Syria and have been directly or indirectly involved in the conflict. In February 2016, the United States and Russia brokered a cessation of hostilities, excluding ISIS and the al-Nusrah Front. According to the UN, the reduction in violence following the cessation of hostilities agreement allowed for increased humanitarian assistance deliveries to hard-to-reach and besieged locations in Syria during the months of March and April 2016. However, according to State and USAID, persistent armed conflict and aerial attacks, including attacks on medical facilities, continue to negatively affect millions of Syrians, and the UN reports that the resumption of active conflict in several governorates has hindered the effective delivery of humanitarian assistance as well as people’s access to essential services. State’s and USAID’s implementing partners contend with the multitude of actors as well as shifting conflict lines. In general, implementing partners operating out of neighboring countries, mainly Jordan and Turkey, cross the border into Syria to deliver assistance into opposition controlled areas. UN and international organizations operating from Damascus largely remain within Syrian government controlled areas, but may also utilize cross-line deliveries—traveling from the Syrian government controlled area through checkpoints into opposition controlled areas. According to USAID, its NGO implementing partners rarely utilize cross- line deliveries. Figure 6 shows this complex operating environment. Financial oversight in humanitarian assistance programs includes managing program funds to ensure they are spent in accordance with funding instruments by, among other things, assessing financial risks and implementing controls to mitigate those risks, including controls to prevent fraud and losses due to theft and diversion. Standards for Internal Control in the Federal Government provides the overall framework for establishing and maintaining internal control in the federal programs. In addition, the Committee of Sponsoring Organizations of the Treadway Commission (COSO) has issued an internal control framework that, according to COSO, has gained broad acceptance and is widely used around the world. Both frameworks include the five components of internal control: control environment, risk assessment, control activities, information and communication, and monitoring. Internal control generally serves as a first line of defense in safeguarding assets, such as food and nonfood items. In implementing internal control standards, management is responsible for developing the detailed policies, procedures, and practices to fit the entity’s operations and to ensure they are built into and are an integral part of operations. Effective delivery of U.S. humanitarian assistance to people inside Syria is complicated by three related factors—a dangerous operating environment, access issues, and remote management of programs. These factors can hinder the delivery of humanitarian assistance and, because U.S. agency officials must manage programs from outside of Syria, create challenges for financial oversight, such as increasing the opportunity for fraud and diversion. The increasingly violent and widespread Syrian conflict has hindered effective delivery of humanitarian assistance. Based on our analysis of monthly UN Secretary General (UNSG) reports on the situation inside Syria, as well as interviews with officials providing assistance to Syria based both inside and outside of the country, humanitarian assistance is routinely prevented or delayed from reaching its intended target due to shifting conflict lines, attacks on aid facilities and workers, an inability to access besieged areas, and other factors related to active conflict. The years of conflict have led to shifting areas of control as armed groups claim and lose territory. In late May 2015, for example, after ISIS took over the city of Palmyra, it reportedly seized the Syrian Arab Red Crescent warehouse, which contained food assistance for 35,000 people and hygiene kits for 15,000. According to USAID officials, this represented the largest loss USAID has experienced delivering aid inside Syria. In addition, the proliferation of armed actors has made the conflict extremely complex. According to one NGO based in Amman and operating in Syria, conflict lines in southern Syria that had been stable for a number of years began shifting rapidly in February 2016 due to Russian air strikes. All UNSG reports from 2014 and 2015 include descriptions of indiscriminate aerial bombardment by government forces and indiscriminate shelling by armed opposition groups. Implementing partner officials based in Damascus, Syria, told us that they are constantly reaching out to contacts to determine the safety of planned delivery routes. Humanitarian workers inside Syria must work within the insecure operating environment, affecting their ability to carry out their mission and placing their lives at risk. In addition, aid facilities are often indirectly impacted or directly targeted, leading to widespread damage. According to the UN reports, there are frequent instances of gunfire, car bombs, barrel bombs, rocket strikes, and mortar attacks near aid facilities; direct attacks on medical facilities and personnel; missing or detained humanitarian workers; and injury or death of humanitarian workers. In one instance, an air strike hit the Syrian Arab Red Crescent offices in Idlib, destroying ambulances and vehicles. The UN reported that, as a result, the capacity of the Red Crescent to provide first aid services in the city was curtailed. Medical facilities have also been attacked (see figure 7). Physicians for Human Rights reported that as of November 2015, there had been 336 attacks on 240 separate medical facilities and 697 medical personnel killed inside Syria. In addition, as of the April 2016 UNSG Report, a total of 87 humanitarian workers have been killed in Syria in the conflict.