Aid agencies have expressed alarm about dire conditions in a besieged town west of Damascus where people have been eating cats and grass to stay alive and as many as 23 people are reported to have died of hunger.
No food has arrived in the rural town of Madaya since October, and desperate residents have posted photographs on the internet showing frail, skeletal corpses and emaciated people, including children.
The medical charity Doctors Without Borders said 23 people have died of starvation since 1 December at a clinic the group supports in Madaya, six of them infants less than 1 year old.
The town has become “an open-air prison,” Brice de le Vingne, director of operations for Doctors Without Borders, said in a statement. Desperate people who try to flee have been injured or killed by bullets or by land mines planted around the town, he added.
According to Hassan Abu Shadi, a rescue worker in Madaya, one or two people have been dying daily of hunger over the past week, since snow fell on the mountain town and blanketed the last remaining vegetation.
"We were eating leaves and grass, but these days there are no more leaves because of the snow," he said, speaking by telephone. "There is nothing left but salt and water."
The United Nations said in a statement that it has received "credible" reports of people dying of starvation and being killed while trying to leave the town. It welcomed what it said was a commitment from the Syrian government to allow aid to be delivered soon.
Madaya is an opposition stronghold that has been besieged by pro-government forces since July. The United Nations put the number of people trapped in the town at 42,000, but Doctors Without Borders said there were 20,000.
In pictures: Syria conflict
In pictures: Syria conflict
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Syrians carry children amid debris following a air strike by government forces in the northern city of Aleppo
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A Syrian man carries a girl on a street covered with dust following a air strike by government forces in the northern city of Aleppo
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Syrians react as they stand amid debris following a air strike by government forces in the northern city of Aleppo
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A Syrian man carries a girl amid debris following a air strike by government forces in the northern city of Aleppo
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An injured Syrian man walks out from the rubble of a destroyed building following a air strike by government forces in the northern city of Aleppo
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A Syrian woman makes her way through debris following a air strike by government forces in the northern city of Aleppo
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People stand on the rubble of collapsed buildings at a site hit by what activists said was a barrel bomb dropped by forces loyal to Syria's President Bashar al-Assad, in the Al-Fardous neighbourhood of Aleppo
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Syrian residents stand amid the rubble of destroyed buildings
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A Syrian resident grasps a mattress amid rubble in the al-Firdous neighborhood of the northern city of Aleppo
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A bullet-riddled parking sign stands amid debris in a deserted street leading into the old city of Homs
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A general view shows abandoned buildings on a deserted square in the old city of Homs after Syrian government forces regained control of rebel-controlled areas
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A mosque is pictured through shattered glass in the old city of Homs, as rebel fighters withdrew from the city centre in line with a negotiated withdrawal deal with the government after having held out under tight siege for nearly two years
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Buses carrying Free Syrian Army fighters leaving Homs. Exhausted and worn out from a year-long siege, hundreds of Syrian rebels left their last remaining bastions in the heart of the central city of Homs under a cease-fire deal with government forces. The exit of some 1,200 fighters and civilians will mark a de facto end of the rebellion in the battered city, which was one of the first places to rise up against President Bashar Assad's rule, earning it the nickname of "capital of the revolution"
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Syrian government forces hold up a portrait of President Bashar al-Assad (L) while others raise the national flag on top of a pole in the old city of Homs
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Forces loyal to Syria's President Bashar al-Assad run through Aleppo's Bustan al-Qasr crossing after their release by rebels. They were freed as part of a larger deal which saw the last remaining Syrian rebels in central Homs city evacuate their positions and free captives in several locations in northern Syria
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A Syrian woman and two children walk past heavily damaged buildings in the northern city of Aleppo
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A man carries a wounded girl following a reported bombardment with explosive-packed "barrel bombs" by Syrian government forces in the al-Mowasalat neighborhood of the northern Syrian city of Aleppo
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A wounded man sits as he is treated at a makeshift hospital following a reported bombardment with explosive-packed "barrel bombs" by Syrian government forces in the al-Sakhour district of the northern city of Aleppo
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Debris rises in what Free Syrian Army fighters and Islamic rebels said was an operation to strike Al-Sahaba checkpoint, which is considered a gateway to Al-Dayf valley, and remove forces loyal to Syria's President Bashar Al-Assad in Maarat Al-Nouman, Idlib province
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Men try to put out fire at a site hit by what activists said was an air strike by forces loyal to Syria's President Bashar al-Assad in the town of Azaz, north of Aleppo, near the border with Turkey
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Civil Defence members try to put out fire
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Survivors react at a site hit by what activists said was an air strike by forces loyal to Syria's President Bashar al-Assad in the town of Azaz, north of Aleppo, near the border with Turkey
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Residents queue as they wait to receive food aid distributed by the UNRWA at the Palestinian refugee camp of Yarmouk, south of Damascus
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Belongings of Syrian rebels inside a chapel at Crac des Chevaliers, the world's best preserved medieval Crusader castle in Syria. The village was destroyed in fighting between the government and rebel forces while the castle, listed as a UNESCO world heritage site, also has been damaged over the past two years
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Hosen Sabah, a 16-year-old student is comforted by his mother at a hospital in Damascus. Nosen was wounded by a mortar outside his school, while 14 other students were killed and over 80 wounded
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A Free Syrian Army fighter works on a locally made launcher before firing it towards forces loyal to Syria's President Bashar Al-Assad in Mork town
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Syrian policemen and citizens inspecting the site of a car bomb at the entrance of Moadhamiyet al-Sham neighborhood in rural Damascus. According to Syria's Arab News Agency (SANA), a car bomb explosion has gone off in the countryside of Damascus and initial information say there are casualties, where a car rigged with explosions was remotely detonated at the entrance of Moadhamiyet al-Sham neighborhood in rural Damascus during engineering units it was trying to dismantled it
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Opposition fighters carrying a rocket launcher during clashes against government forces in the Sheikh Lutfi area, west of the airport in the northern Syrian city of Aleppo
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A Syrian man helps a woman to make her way through debris following reported air strikes by government forces in the Halak neighbourhood in northeastern Aleppo
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A Syrian man reacts as he carries the body of injured boy following reported air strikes by government forces in the Halak neighbourhood in northeastern Aleppo. According to the Syrian Observatory for Human Rights, at least 33 civilians were killed in the attack
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Syrian rescue workers carry the body of a woman following reported air strikes by government forces in the Halak neighbourhood in northeastern Aleppo
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Syrians gather at the site of reported air strikes by government forces in the Halak neighbourhood in northeastern Aleppo
Fighting over Madaya, which fell into rebel hands in 2012, was supposed to have ended last summer under a cease-fire deal that also encompassed two rebel-surrounded towns in northern Syria. According to the terms of the cease-fire, rebel fighters from Madaya and nearby Zabadani were escorted by the United Nations to Turkey, and government loyalists from the towns of Foua and Kefraya were permitted to leave for government-held areas of Syria.
The deal stipulated that food aid and other supplies be allowed to reach civilians inside the towns. But only one delivery was made to Madaya, on 18 October, and residents since then have almost entirely run out of food.
The United Nations pointed out that it requires Syrian government permission to send food aid to the estimated 400,000 needy people living in various areas around Syria that are besieged by government forces. But in the past year, only 10 per cent of requests have been granted, the United Nations said.
People are going hungry in many of those locations, but Madaya appears to be the worst-afflicted by far.
The Syrian government has long used siege tactics to compel the surrender of towns that fell under rebel control during the uprising against President Bashar al-Assad. At the entrance to Madaya, Abu Shadi said, pro-Assad fighters have hung a sign proclaiming "Kneel or starve," a slogan intended to capture the stark choice confronting rebels in the besieged communities.
He said most of the fighters surrounding the town belong to the Lebanese Shiite movement Hezbollah, which supports Assad and has been leading the battle to recapture Syrian towns in the vicinity of the nearby Lebanese border.
Hezbollah denied the allegations, saying that rebels were preventing residents from leaving. "Terrorist groups are exclusively responsible for starving out the civilians in the town," said a report carried on the website of Hezbollah’s al-Manar television station. The towns of Foua and Kefraya also have not received aid, the report said.
Although the reports of starvation deaths cannot be independently confirmed, videos and photographs posted on social media showing emaciated people suggest that conditions are dire. In one, a mother is shown feeding her gaunt 16-month-old daughter sips of jam diluted with water, because, she says, there is no milk. A photo circulated on Tuesday showed the skeletal frame of a man who had died of hunger that day.
The United Nations said the Syrian government promised to allow aid to be delivered "in the coming days" to Madaya as well as the two northern towns surrounded by rebels.
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