It is choice no child should have to make - put themselves in the line of fire or slide further into hunger.
But it is the reality for the millions of civilians displaced inside Syria as they prepare to face another winter without a safe place to live or enough to eat.
At least 10.5 million people may be in need of food aid in Syria, as do the millions of refugees who have fled to neighbouring countries such as Lebanon, Jordan and Turkey, Save the Children estimates in a new report.
‘‘We were trapped there for weeks. It was too dangerous for aid agencies: anyone moving in the street would be shot, there were snipers all over,’’ said Isra, a mother who made it to the relative safety of the Syrian border, in the report.
‘‘We used up all our supplies of food - I could only give my children one or two mouthfuls of rice to keep them going.’’
Even a trip to the local supermarket is an exercise in fear, another woman, Amjad, said.
‘‘The shelling happened every day ... it was not always day or night, you never knew when it would happen. The clashes between the armed groups would happen all the time, too; shooting everywhere. It was impossible to go and find food.’’
As world leaders gather in New York for the United Nations General Assembly meeting, Syria will be high on the agenda.
But to the frustration of aid agencies, it is not the issue of hunger that will dominate, but chemical weapons.
‘‘The whole discussion around chemical weapons has become a distraction for what we see as a catastrophe that is occurring every single day, where you have got half the population in some need of assistance,’’ says Roger Hearn, the regional director for Middle East and Eurasia with Save the Children International.
‘‘One-third of the country are basically homeless, yet all the international community can seem to mobilise around is chemical weapons.’’
Dr Hearn, an Australian who was based in Syria until September 2011 when conditions became too dangerous, says there are no reliable figures on the real need inside Syria, and UN estimates that 4 million people are ‘‘food insecure’’ are inevitably lower than the true level of hunger.
‘‘Winter is coming and the situation will get much worse - we have seen people living in the most dire of conditions, people living in caves, living in conditions not fit for animals, people who have been displaced two or three times now.’’
Syria’s children are in great danger, said Dr Hearn from his new base in Jordan, and risk death from lack of nutrients and starvation.
Those with chronic malnutrition will face lifelong health problems, and without immediate preventive action, Syria will slide into a malnutrition crisis, the report warns.
The conflict has caused nearly $US2 billion worth of agricultural damage, including loss of crops, livestock and infrastructure, forcing many of the eight million Syrians who depended on farming for a living into poverty.
And because of the ongoing fighting in a war that has now stretched for two-and-a-half-years, there are ‘‘major gaps’’ in the delivery of humanitarian aid, he says.
Once humanitarian convoys do have permission to travel the 310km from Damascus to Aleppo - Syria’s largest city - they must navigate at least 50 checkpoints.
Between January and July 2013, only 21 UN convoys were able to make the treacherous journey, the report found.
How to help:
Medecins Sans Frontieres, 1300 136 061, www.msf.org.au
UNHCR, 1300 361 288, www.unrefugees.org.au
Save the Children, 1800 76 00 11, www.savethechildren.org.au
World Vision, 13 32 40, www.worldvision.com.au