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DAMASCUS, Syria — Some 5 million Syrians are now refugees in their own country, many living hand-to-mouth in vacant buildings, schools, mosques, parks and the cramped homes of relatives. Others are trapped in neighborhoods isolated by military blockades, beyond the reach of aid groups. Already desperately short of food and medicine as winter closes in, they could begin to succumb in greater numbers to hunger and exposure, aid workers say.

The long civil war has forced 2 million Syrians outside the country’s borders, but more than twice that number face mounting privations at home.

The deepening humanitarian crisis threatens to set the country’s development back decades and dwarfs any aid effort that could conceivably be carried out while the conflict continues, aid workers and analysts say.

The cost of replacing damaged homes and infrastructure alone is estimated at more than $30 billion, and the ruin mounts daily. More than half of the country’s hospitals are destroyed or closed, and according to Save the Children a fifth of Syrian families go without food one week a month.

Even in relatively safe areas, the displaced are spilling from every corner. Thousands live in the gyms and hallways of a sports complex turned state-run shelter in Latakia. In the Damascus, newcomers crowd ramshackle hotels, half-finished buildings, offices and storefronts. Long lines form outside the shrinking number of government bakeries still operating. In some suburbs, people have confessed to eating dogs and cats, and imams have even issued decrees saying it is religiously permissible.

A $1.5 billion international aid effort, carried out under dangerous and politically charged conditions by the United Nations, the Syrian Arab Red Crescent and smaller local organizations, provides stopgap food, schooling and medicine to millions of people. But it is underfinanced, covers just a fraction of the needs, fails to reach people in blockaded areas and does not begin to address the collapse of Syria’s health, education and economic infrastructure and its devastating implications, aid officials in Syria and across the region say.

“If we continue to deal with this crisis as a short-term disaster instead of a long-term effort, the region will face even more severe consequences,” Neal Keny-Guyer, chief executive officer of Mercy Corps, wrote recently, calling for increased U.S. financing and a new focus on longer-term development projects, like repairing water infrastructure.