Food aid has reached nearly half the civilians trapped in besieged areas of Syria, but much more remains to be done to help the 13.5 million in need across the war-torn nation, according to a United Nations report issued Wednesday.

The monthly report to the Security Council, found that despite a teetering cessation of hostilities, there was an overall increase in fighting and a significant rise in civilian casualties as well as the destruction of hospitals, markets and schools during the month of April.

According to the report, food assistance has reached over 200,000 people, or 41.9 per cent, of those living in besieged areas, nearly double the 21 per cent reached in March.

“While that is positive, overall progress is small and fragile. We remain far short of consistently meeting the needs of the 13.5 million civilians in need in the Syrian Arab Republic,” the report said.

Meanwhile, the killing of civilians and violations of human rights rose sharply in April after a period of relative calm, the report said.

“The resumption of active conflict in several governorates hindered the effective delivery of humanitarian assistance, as well as people’s access to essential services,” the report added.

The report said that of the 35 relief convoys planned for May and intended to reach 904,750 people in hard-to-reach areas, the Syrian government had only granted full approval for 14, as of May 4, and had conditionally approved eight more. Planned deliveries to 375,000 people in 13 other locations had not been approved.