World Vision has warned that many thousands of Syrian refugees are more vulnerable than ever as they face terrible weather conditions and other dangers.
More than 2.5 million people have fled Syria to escape ongoing violence in the region since the outbreak of civil war in March 2011.
Around 6.5 million are internally displaced, with many thousands living in tented settlements and camps that offer little protection against the elements.
Syrian political scientist Salam Kawakibi has written a report entitled 'The Syrian crisis and its repercussions' that details the ongoing effects on families across Syria.
"There are naturally consequences in terms of health and education, which particularly affect children," he writes, referring to unsanitary living conditions that many are forced to cope with.
"The main consequence of violent displacement is the disintegration of family structures. Part of this relates to the increase in violence within families resulting from proximity, tensions, anxieties and the violence endured by adults."
He underlines that children are often the ones who are most vulnerable in times of crisis, given their additional medical, nutritional, schooling and physiological needs.
"The experiences of displaced people and the management of humanitarian aid have created dynamics that will have unpredictable consequences for the country," the report notes, listing such issues as the "deep disruption in the education system at all levels" and "the psychological traumas that affect the majority of Syrians, and especially the most vulnerable: Syrian children".
Health workers in the region support this theory, having reported a significant increase in respiratory diseases among children as temperatures plummet. World Vision is among several international agencies working to help as many people as possible across the region during this crisis.
Heating fuel, blankets, rubber boots and winter clothing are being distributed in large numbers, but the scale of the crisis means that there is still a huge need as families face below freezing temperatures.
One Syrian father in Jordan explained that his family escaped Syria after their house was destroyed in the conflict, but now they are afraid of the dangerous weather conditions. "Perhaps it's better to be killed by someone than to watch your children die of the cold," he says. Their temporary home has no heating and no hot water.
World Vision's response director for the Syria Crisis, Joe Harbison, says teams are working hard to protect as many people as possible, but that they are running out of time. "For months we have been concerned about the dire consequences of the approaching winter on these vulnerable families.
"Now there's little time more for preparations or warnings. For Syrian refugees, time has run out, and winter is here."
In Za'atari Camp in Jordan and in many of the makeshift settlements in Lebanon, flooding is already a significant problem, adding to the freezing temperatures.
"Speaking with families, we know the fear that winter brings. I've seen far too many children with little more than sandals and short sleeves, even as winter approaches," said Conny Lenneberg, World Vision's head of programmes for the Middle East.
"We are working hard to ensure that we reach as many of the most vulnerable as we possibly can, so they get the protection they need, no matter the weather."
The problems being created by the civil war are expected to be long lasting; Kawakibi predicts that "by the end of this crisis, the economic situation will have reached catastrophic levels with problems at the level of human security."
"The reconstruction of the social fabric, which has been methodically ripped, will need meticulous work within an emerging civil society," he says.
Tanya Penny, Regional response and crisis communications manager for World Vision, is currently working in Jordon with Syrian refugees and host communities. She spoke with Christian Today about the ongoing challenges her team and the Syrian people are facing, and shared stories of suffering families.
"I met with one Syrian family, with one child only 14 months old, two young girls in primary school and several older children, who are living in a 2 room concrete box with no heating, no hot water and they only have the summer clothes they bought with them," she recounts.
"Their roof was leaking, and they only have a single gas heater which their Jordanian neighbour had very kindly given them, and some blankets," she says. "It is really overwhelming."
Tanya reports that many distributions or provisions for these families have been postponed as a result of the harsh weather. "One of the most difficult things for us is that we are having one of the worst winters in 60 years. We're used to storms, but this early and this severity is quite unprecedented. Things are very challenging," she says.
The need is showing no sign of slowing down either, in fact, conditions are getting worse and the sheer number of people who need help is overwhelming, Tanya notes.
"We're entering into the fourth year of the conflict, and we're seeing the need increase. Everyone is working really hard, and host communities are being incredibly generous and supporting the refugees, but they themselves are still struggling with harsh winters and poverty.
"Some of the numbers are quite staggering, and they're changing day by day."
Teams on the ground in the region are looking at how to best deal with the situation not only with regards to the immediate need, but also in the long term.
"The immediate need right now is we need to have families prepared for winter. But there is also a long term need – education is really important. It's a sign of hope and a sign of a future," Tanya says.
She reports that schools in host communities are struggling to cope with the number of children coming in, and are becoming overburdened. An estimated 2 million Syrian children are spread across Jordan, Turkey and Lebanon, and the system doesn't have the capacity to support them – around 35% of those 2 million are not attending school.
Remedial classes are being offered, and plans are being put in place to ensure that education doesn't suffer and to protect children from potential exploitation from entering the workforce too early.
The main thing needed, according to Tanya however, is prayer for peace.
"Everyone's prayer is for a peaceful resolution to the conflict. Of all the children I speak to, their number one wish is to go home," she says.