ATMEH, Syria — The more than $1.5 billion in aid, pledged this week by international donors, no doubt comes as a welcome development to the limping Syrian relief effort.

King Abdullah of Jordan said his resources were drying up, and UN Secretary-General Ban Ki-moon warned that “more Syrians will die” if funds were not forthcoming at this week's donor conference in Kuwait City.

The funds were forthcoming. The United States became the single largest giver, pledging $155 million on top of a previous donation of $410 million. Meanwhile, key Arab states also came forward — Saudi Arabia, the United Arab Emirates and Kuwait each promised $300 million.

But the amounts promised aren't the whole story. Often nations don't wind up giving as much as they said they would. And even if targets can be reached, there is no accounting for the equality of distribution.

According to a statement released Wednesday by Doctors Without Borders, one of the only international aid groups to be working inside opposition-held areas, almost all international aid to Syria is being spent only in government-controlled regions. Doctors without Borders said one in 3 Syrians — or 7 million people — live in areas beyond government control.

“The current aid system is unable to address the worsening living conditions facing people inside Syria,” said Dr. Marie-Pierre Allié, president of Doctors without Borders. “The participants in the Kuwait City conference must acknowledge the legitimacy of cross-border humanitarian operations intended for Syria and grant them the financial, administrative and logistical support they require.”

The only aid making it to the towns of Seyjar and Jabal al-Zawiya in nothern Syria, has come from private donors, according to rebel commanders in the regon. On a recent visit to Seyjar, several families — many fleeing heavy fighting elsewhere — were crammed into every home. Electricity works only for an hour or two a day at best.

During heavy shelling last week, a crowd of women and children gathered in the basement of one home, shuddering. Many were in tears, aware that with no medical facilities in the surrounding area and little fuel for transport, the chances of surviving a serious injury were bleak.

Across Syria's northern province of Idlib, a chronic shortage of fuel has left families living through rain and snow with no heat and few blankets to go around. Food shortages combined with soaring inflation have forced many to flee to border camps just to feed their families.

“I am the one who must provide for my mother and sister,” said Muhamed Raslan, as his family shivered in a one-room stone cottage in Jabal al-Zawiya. “I am doing everything I can to keep them from the camps. Life is so miserable there.”

As he spoke, Raslan’s mother broke apart precious branches from the family's few scattered olive trees to light a stove in the center of the room.

“We have no power, no fuel. This is our only way to cook,” she said. “We are all black from the soot. My hands are always covered with burns.”

The United Nations says 3 million Syrians are internally displaced and at least 2.3 million are in need of basic assistance.

In a statement issued Tuesday, Doctors without Border said that to date most aid operations have been implemented from Damascus by the Red Cross and UN agencies. These programs extend through government-held territory, but have no impact on impoverished areas controlled by the opposition, the group said.

Samantha Robison, director of AptART, a children’s charity for victims of trauma, described the difficulty getting aid through to rebel-held areas.

“In general, donors give money only to registered organizations,” she said during a recent visit to a refugee camp in Atmeh to coordinate a privately-funded project.

“Within a conflict like Syria, how many registered groups are the rebels going to have? Compare that to an already established aid system that has been running for decades under the Syrian regime? And registration is not the only factor. You need a history, account records or donors simply will not back you. All this takes time and infrastructure to establish,” she said.

As conditions worsen within Syria, the number of refugees fleeing to neighboring countries has surpassed 700,000 and is growing by the day. Two-thirds of the money pledged at the Kuwait conference is earmarked for helping these refugees.

Thursday morning, children wandered through the mud at the camps in Atmeh village, near the Turkish border in Idlib. A young boy sat shivering below a tattered blanket on the dirt floor of one tent, his hand wrapped in a soiled bandage.

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The winter chill has made life in the camps even more miserable. Many of those who fled in the summer came with only the clothes they wore. None of these families have adequate means to cope with the winter cold.

Last month, as a family burned olive branches to try and keep warm in the cold night, their tent caught fire. Five children and their mother died.

Overlooking the hillside camp in Atmeh was 19-year-old Abdullah Omar, a university student who now works alongside his family to provide basic necessities for the more than 20,000 refugees in Atmeh, his home village.

“We need help from the outside. We can’t handle this alone anymore,” he said. “We don’t want money; we need materials: food, tents, medicine. We are always wondering what we will feed them the next day. Sometimes we finish all the bread even for the whole village. We need more donors!”

Omar described one night last week when 400 new arrivals came at 4 a.m.

“All we had to give them were 18 tents and 18 blankets for all these families,” he said.