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There's a photograph that has become emblematic of the misery in Syria as the civil war there enters its fourth year. It shows thousands of desperate people waiting to receive food aid. The photo has been shared millions of times on the Internet. It's been published in hundreds of newspapers worldwide. And today, it's appearing twice on a big screen in New York's Times Square. NPR's Deborah Amos reports that aid agencies are using the photo to call for better access to people trapped in the war.

DEBORAH AMOS, BYLINE: The image is epic. Thousands fill a gray canyon of rubble framed by shattered buildings. Yarmouk is a neighborhood of Palestinian refugees who fled to Syria decades ago. For more than a year, Syrian government forces have held 20,000 people there under siege. This photograph documents a food distribution in January by the Agency for Palestinian Refugees. Chris Gunness, the agency spokesman, explains why he believes the image has such power.

CHRIS GUNNESS: I mean, it's cinematic in its scope and grandeur, and yet, it's deeply personal. Etched on each small face is a very personal private story. And I think it's the combination of the epic and the miniature, which partly explains it.

AMOS: It's about timing, too, he says. He released the photograph as the U.N. Security Council debated a resolution last month urging Syria's government to open besieged areas for aid. The social media reaction was unexpected.

GUNNESS: It's been extraordinary. Within minutes of that iconic photograph being sent out, it went viral.

AMOS: When charges surfaced that the photograph was a fake, Gunness released a video from Yarmouk recorded at the same time.

(SOUNDBITE OF VIDEO)

UNIDENTIFIED GROUP: (Foreign language spoken)

AMOS: The food distribution came after a fragile ceasefire between government forces and rebels inside Yarmouk. The video shows the magnitude of the humanitarian crisis for civilians.

UNIDENTIFIED WOMAN: A lot of the people I'd seen had very, very black hands because of inability to be able to wash with soap on a regular basis.

AMOS: She's an aid worker and wants her name withheld. She's not authorized to speak to the media. In Yarmouk, she says, a woman in the food line, hungry like the rest, said we are not beggars.

UNIDENTIFIED WOMAN: It's very, very powerful. She's like, I have never stood in a bread line in my life. They were people that were middle class or people that had their businesses. They were teachers. They were accountants. They had their kids in university.

AMOS: And they are trapped, says Amr Azm, an academic with ties to the Syrian opposition. Syrian government officials say Yarmouk is held hostage by terrorists and besieged the camp to flush them out. Western governments charge the Syrian regime deliberately blocked food and medicine to starving people. Azm says the U.N. system has failed Syrians, a system dependent on approvals from a host government to deliver aid.

AMR AL AZM: The whole aid program has been a total catastrophe. It's been used - allowed to be used by the regime to advance its own agenda or for its own purposes. And they've done nothing about it. The international community has done very little to try and prevent this from happening.

AMOS: International aid workers say it's a struggle to work in Syria. Gareth Price-Jones directed Oxfam's program there, a country he rarely visited, he says, because the Syrian government restricts visas to aid workers.

GARETH PRICE-JONES: I think we're all deeply troubled. There's many, many of the compromises that we're very unhappy about having to make.

AMOS: There has been some success. Oxfam has delivered generators that now pump clean water for a half a million people, he says. But the conflict tests a basic principle: neutrality. Humanitarians are dedicated to helping all sides in a conflict.

PRICE-JONES: The political will to make this happen is just not there. The whole of the international system was set up after World War II to address these current challenges, and it's clearly failing dismally.

AMOS: And that brings us to the photograph from Yarmouk camp, which sparked a social media campaign, generated international sympathy, but has done little to open the besieged neighborhoods in Syria. Deborah Amos, NPR News, Beirut.

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