Amid the scenes of devastation and the sounds of pummeling artillery fire, the familiar sight of a small red cross or a red crescent painted on the roof or side of an approaching vehicle has long been a sign of help and hope in war zones across the globe.

The emblems signal the arrival of the International Committee of the Red Cross (ICRC) or its partner organization the International Federation of Red Cross and Red Crescent Societies (IFRC), which have been a lifeline for victims of countless armed conflicts and natural disasters.

The groups provide humanitarian assistance in the form of basic necessities like food and water, health care and other essential supplies and services, but it's not always apparent just how many steps are involved in getting that aid to those who need it.

The first step in any Red Cross aid mission is ensuring the safety of the organization's own workers.

"There is a certain incomprehensible risk that we do take when working in such contexts," said Hicham Hassan, ICRC public relations officer for the Middle East region.

"There has to be a minimum level of security conditions that have to be available for us to work."

Access can be a problem

After the risk of entering into a war-torn area is assessed, the next step is identifying where the most urgent humanitarian needs are, said Hassan, who has been working in the field of humanitarian aid for 17 years.

In a hot zone like Baba Amr, the neighbourhood in the Syrian city of Homs that has endured weeks of relentless shelling by government forces trying to rout rebel fighters from the area, the agency can face difficulty in even gaining entry to the area.

A convoy of ICRC vehicles carrying supplies and staff drives toward the Libyan town of Sirte on Oct. 3, 2011. The Libyan civil war is one of the recent conflicts in which the Red Cross has provided aid. (Anis Mili/Reuters)

"We want to go inside for many reasons," Hassan said of Baba Amr. "The first is to have a clear understanding of the humanitarian situation, and the second is always to bring in emergency assistance, including food, ambulances in order to evacuate people who need to be evacuated, who are wounded and sick."

The Geneva-based Red Cross organization was created in 1863, when Swiss businessman, and later Nobel Peace Prize winner, Henry Dunant lobbied political leaders to take more action to protect war victims. Since then, the movement has provided aid throughout two world wars and a host of other conflicts.

But this work hasn't come without risks. In 2001, six ICRC aid workers were killed while on an aid mission to the Democratic Republic of the Congo. Red Cross workers have also died in Senegal, Haiti, Sarajevo and other conflict zones.

Local volunteers key to successful aid missions

The ICRC's effort is bolstered by national Red Cross or, in the Middle East and North Africa, Red Crescent societies — in the Syrian case, the Syrian Arab Red Crescent.

The ICRC works with the Syrian Arab Red Crescent on a daily basis. The organization has 19 branches all over Syria staffed by thousands of local volunteers and employees.

"They know the cities, the people," Hassan said. "They are able to identify needs and hot spots. They know where people could be hiding, where people who fled from Baba Amr are staying."

Members of the Syrian Arab Red Crescent carry caskets containing the bodies of U.S.-born British journalist Marie Colvin and French photographer Remi Ochlik, who were killed last month during the shelling of the Baba Amr district of the city of Homs. The workers were transporting the caskets from a hospital in Damascus on March 3 so they could be taken out of Syria. (Khaled al-Hariri /Reuters)

Just how the wheels that get humanitarian aid flowing into an area get turning depends on the specific situation and location. In Syria's case, an ICRC office has operated in the country for 40 years. In peacetime, it provides non-essential aid and services to the local population.

"Since we were [already] there, and we saw the violence escalating, we knew that we had to help more," Hassan said.

Once the need for action is agreed upon within the organization, the next step for the ICRC is to approach the local authorities and other relevant parties in a given conflict — in Syria's case, this means both government and rebel forces.

"We have to be in touch with the authorities and the opposition, so we can know that we can go into all places affected by the violence in order to help as many people as possible," Hassan said. "Then, we can say to the authorities, 'We are here, we can help, and we want to help,' because we know their needs."

Help for those who want it

The parties involved have the right to refuse the aid offered by the ICRC, either directly or, as happens in some cases, in a roundabout way. For example, last week, the Syrian government cited safety issues as the reason it denied a Red Cross aid convoy access to Baba Amr.

Not having access to the area means that the ICRC must work out of surrounding regions.

'At some point we know we have to move, we have to help.'— Hicham Hassan, ICRC spokesperson for Middle East

"Just because we are not entering Baba Amr today, it doesn’t mean we would neglect the fact that there are families who have fled Baba Amr that are staying in other towns," Hassan told CBCNews.ca on Monday. "This is why we often not only have one team going somewhere but also two or three other teams going to several places at the same time."

Hassan said the Red Cross doesn't impose its help on anyone and lets citizens of the places it enters make an informed choice about whether or not to accept the organization's aid.

"They know who we are, why we are there, why we want to help, and what we could offer," he said.

"The choice remains for people to take this help or refuse it. Obviously, in most situations, people take the help, because they need it."

Dangerous work

The head of the Syrian Arab Red Crescent in Homs said authorities told the group it could enter all of Baba Amr on Tuesday, and it plans to send three trucks full of aid to the area.

Authorities have gone back and forth on whether to allow the Red Cross into the neighbourhood — first telling the group it would be granted access and then turning back its trucks.

It had, however, managed to enter the area earlier in the conflict during lulls in the fighting.

"There wasn't a ceasefire," Hassan said. "It was simply security conditions that were just enough for them to go in and evacuate people."

It's obvious that whether they are with the Red Cross or other organizations, aid workers take plenty of risks when doing their job. During the Syrian conflict, a Syrian Arab Red Crescent volunteer was killed when an ambulance transporting an injured person to hospital came under attack.

In January 2011, Abd-al-Razzaq Jbeiro, the secretary general of the Syrian Arab Red Crescent, was killed.

"We are very careful, but at some point, we know we have to move; we have to help," Hassan said. "This is why we have to strike a balance between being extremely careful, because, obviously, if we have a security incident, then this will affect the whole humanitarian operation."