At age 19, Fatima al-Omar is at her wits’ end. In the last year alone, she lost her home to fighting in Syria’s last rebel-held enclave and her mother was diagnosed with cancer. She became the sole breadwinner for her mother, three siblings and grandmother as they moved around between shelters.

Then the coronavirus struck, aggravating conditions in northwest Syria just as new fighting had uprooted 1 million people — the biggest wave of displacement in the country’s 10-year war. By late 2020, al-Omar contracted COVID-19, costing her the last job she had picking olives. She hasn’t been able to find work since and is now at risk of another eviction.

“It was all difficult, but it just keeps getting harder,” al-Omar said, speaking by phone from the latest home she moved to in Binnish, a small town in rebel-held Idlib province.

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Despite the worsening humanitarian situation across war-ravaged Syria, it’s been getting tougher every year to raise money from global donors to help people like al-Omar. The aid community is bracing for significant shortfalls ahead of a donor conference that starts Monday in Brussels and is being co-hosted by the United Nations and the European Union.

Pledges were already dropping off before the coronavirus pandemic mainly due to donor fatigue. Officials fear that with the global economic downturn spurred by the pandemic, international assistance for Syria is about to take a new hit just when it is needed most. Earlier this month, a U.N. appeal for aid to Yemen, the world’s worst humanitarian crisis, was less than 50% funded, in what U.N. Secretary General Antonio Guterres called a disappointment.

Across Syria, the pandemic has compounded the worst economic crisis since the conflict began in 2011. The local currency has crashed and food prices have soared — increasing by 222% from last year. Nine out of 10 people live below the poverty line and in northwest Syria, close to three-quarters of the 4.3 million residents are food insecure.

According to the U.N., 13.4 million people in Syria, more than half the country’s pre-war population, need assistance. That’s a 20% increase from last year.

“We don’t have nearly enough money to provide all the services that are needed,” said Mark Cutts, the U.N. deputy regional humanitarian coordinator for Syria.

“It is still just a struggle for survival for all these people and it is often the women, the children and the elderly and people with disabilities who are suffering most.”

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The U.N. and other aid groups are seeking more than $4 billion for aid within Syria at this year’s conference, their biggest appeal yet. Another $5.8 billion are requested for nearly 6 million Syrian refugees who fled their homeland.

Over the years, pledges have typically fallen short. The humanitarian appeal for 2020 was 45% below its $3.82 billion target — nearly a 14% drop from the year before.

“We fully realize that in donor countries there is also a COVID effect, that budgets are strained,” said Fillipo Grandi, the U.N. high commissioner for refugees. “But clearly because of that same pandemic that has an effect on budgets, this is not the time to let go.”

In the rebel-held area, coronavirus pandemic restrictions have further slowed economic activity, closing schools and reducing trade and movement with Turkey — the enclave’s gateway to the world.

Women and children are being forced to find low-paying and risky jobs, including minors collecting trash, begging or being recruited by armed groups. Aid groups say reports of suicide attempts among young men and adolescents are on the rise.

One in three children are out of school, down from about 70% enrollment a year earlier, said Amjad Yamin, of Save the Children.

The World Food Program reduced its monthly food basket throughout Syria to stretch available funding and prevent a reduction in the number of people reached. That meant dropping calories from 2,100 per person to 1,264 — a 40% decrease. Some families said the rice ration in the basket has gone down by half.

Meanwhile, water needs have increased by 40% because of the pandemic, but funding has not kept up. In a letter shared with The Associated Press, local non-governmental organizations told donors that cuts could potentially force as many as 55 water stations across northwestern Syria to shut down, denying nearly 740,000 people access to water.

“The gaps are enormous,” said CARE International’s Tue Jakobsen.

Reports of anticipated aid cuts — as high as 67% by some of the largest donors — were leaked in emails or relayed in private meetings. Aid workers have tried to adjust budgets and plan for the reductions.

The cuts could also put thousands of people out of work and force a couple of displacement camps to close, the letter shared with the AP said.

It has already been a struggle for al-Omar and her family to get help.

Since her family lost their home, they have not received any food assistance, she said. Savings have been used to pay for part of for her mother’s cancer treatment. Charity and local donations financed the rest, including lengthy medical trips to Turkey. Cash assistance that has helped her pay rent is not guaranteed.

Al-Omar’s pantry, where she kept food reserves such as pickles and jams, is empty. “We have nothing. We have no water. No food,” said al-Omar, whose father abandoned the family 11 years ago. “We are below zero.”

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Al-Omar’s best job was working from home, sewing masks and earning about $7 for every 1,500 masks completed. It meant staying safe and looking after her siblings. But she lost it when she moved to Binnish where rent is cheaper.

A year into displacement, she dreams of a room in one of the camps for displaced people. “It would be better than all this moving,” she said. “This is exhausting.”