It is hard to believe that Syria could get any worse. Already, some 20 percent of Syrians have fled the country, and about 80 percent of the remaining citizens are poverty-stricken, displaced, and in need of urgent and continuing aid.

Yet Syria gets worse daily. Much of Western Syria has now been taken over by ISIL, not well known for its “generous and sensitive” rule and management of populations, particularly non-Muslim ones. Assad, finally, is clearly hurting. How long he lasts has now become an actual discussion point, one that some say could perhaps lead to long-awaited serious action by the outside good guys. But don’t count on it.

The United States and its Western allies still continue to stand resolutely idly by, except for the occasional American bombings of ISIL-held territory. President Obama mostly controls his rhetoric, speaking infrequently, and then only in noncommittal terms, about Syria. For his part, Turkish President Recep Erdoğan says little about ISIL, though he fulminates frequently against his once-buddy Assad, promising to hold the American coat in the event that President Obama decides to go after Assad. But the truth is, President Obama has decided not to go after Assad, and that is not expected to change.

Getting food and other commodities to the vastly growing number of destitute Syrians is an increasingly difficult job for even the most dedicated and determined NGOs. Although it’s unwilling to solve the conflict, the United States is very willing to shell out sizeable humanitarian aid to show its always-concerned nature, but it has only taken in a scattering of Syrian refugees. Washington cautiously has promised to take in perhaps a few thousand of the two million Syrian refugees, who now reside mostly In Turkey. As for Mr. Erdoğan, he has been slow to match his aggressive rhetoric with equally aggressive deeds but at least has been a genuine humanitarian in regard to the fleeing Syrians. He’s gotten much domestic flak from that posture, but still gets an A for this policy on a report card that is otherwise riddled with Ds and a few Fs (except for his other A in desecularization).

Meanwhile, the conflict is growing. There is a serious Syrian opposition to Assad, although it sometimes seems hard to find. The United States has talked a good game about building up the non-Islamist opposition, but it seems to be a leisurely operation. Saudi Arabia, Qatar, and Turkey profess eagerness to help, but as happens often in this region, between the thought and the realization falls the shadow. However, any increased initiative on their part raises the important question of who exactly is receiving this aid. But, that’s the pessimistic view.  On the other hand, we have been at it for quite a while, and maybe we and the Syrian opposition will soon get better at mounting a serious campaign.

And, in theory, it should not be too hard to weaken Assad further, but the practical problem is how to do so without handing control over Syria to ISIL or Iran, either of which may happen in any event. That is a growing concern, in turn raising questions about whether we may push Assad too hard. It is no small dilemma, and it has been made more difficult by anti-Assad rhetoric as well as the time required for and the difficulties of producing a larger, reputable anti-Assad force.  The large number of Syrians escaping the country compounds the problem.

Patience is no great answer in this case. In a relatively short term, we will have to both significantly enhance the armed opposition to the Assad regime and work out an arrangement with Iran on Assad’s departure—but it is unclear whether either is feasible. More likely we can count on more fighting, a tragic loss of more lives, and displacement on a large scale.